bluuebunny/crossref_metadata_2025 huggingface dataset:
Writing poetry: a way of knowing nursing
Authors: Holmes Vicki , Gregory David
Published: March 2003

Writing poetry: a way of knowing nursing¶ Carper’s patterns of knowing expose the relevance and importance of different knowledge to the enterprise of nursing. She noted that the aesthetic pattern enables nurses to know unique perceptive experiences. Poetry captures particular perceptive experiences and reconstructs them into universal wholes. The opportunity for nurses to write poetry can illuminate and legitimate their perceptive experiences which often become worn or hidden in the everyday work world and in other ways of knowing. Expressing nursing experiences through writing poetry generally involves three phases: (a) creating an image of experience, (b) fully articulating the image, and (c) sharing a clear, new meaning of the image. A poem, written to express one author’s unique nursing experience, is used to explore the knowledge gained through the process of writing poetry. Writing poetry can help nurses connect with and maintain their personal and professional history. Moreover, writing poetry increases our awareness of the sensibilities of nursing practice and the meanings that these sensibilities add to the depth and design of the discipline.
Health visiting as therapy: a phenomenological perspective
Authors: Cody Ann
Published: March 2003

Health visiting as therapy: a phenomenological perspective¶ In the course of their work British health visitors encounter many individuals and families with problems. Support is usually offered, but if that support is for psychological health needs, it is less likely to be accepted as legitimate health visiting practice. Where a referral is either not accepted, or placed on a waiting list, the health visitor will support the client through a holding relationship until the other appropriate professionals can accept the referral. From a literature review, helping styles and holding relationships provide a ‘listening to’ opportunity, a ‘being there for’ and an exploration of the presenting problems. This paper aims to explore the practice of health visiting as therapy and urges health visitors to expand their psychological support of clients in preference to other role developments.
Talking on the telephone with people who have experienced pain in hospital: clinical audit or research?
Authors: Carr Eloise C. J.
Published: March 2003

Talking on the telephone with people who have experienced pain in hospital: clinical audit or research?¶ The adequacy of postoperative pain management in British hospitals appears insufficient to improve patient care, and much of the research and clinical audit in postoperative pain has failed to seek the patient’s perspective. This paper reports on the findings from a semi‐structured telephone interview survey which formed part of a hospital‐wide audit on postoperative pain at a district general hospital in the south of England. Of a total of 360 completed audit questionnaires, 114 patients left their telephone number and 29 were interviewed. Content analysis revealed five main themes: inadequate information, pain at home, staff attitudes, expectations of pain, and ward atmosphere. Several patients identified insightful strategies that potentially could improve pain management. The telephone interview generated a richness of data that had not been reported before in this important area. Some authors view clinical audit and research as having different characteristics but this work raises important questions for both approaches when using the semi‐structured telephone interview. The ethical issues pertaining to collection of audit data using the telephone interview are discussed.
A journey to becoming: the student nurse in transition
Authors: Holland Karen
Published: March 2003

A journey to becoming: the student nurse in transition¶ The study reported in this paper explored the nature of the transition experienced by student nurses in their journey to becoming qualified nurses. In keeping with the developing relationship between the disciplines of anthropology and nursing, the methodology of choice was ethnography. Data were collected by open‐ended questionnaires and interviews with key informants from one English College of Nursing undertaking Diploma level Project 2000 Adult Branch Studies. Thematic analysis of the data revealed an ill‐defined transition for the student nurse and this lack of clarity was being perpetuated for many by their dual role as both student nurse and worker. This was also creating a potential role conflict and a blurring of the boundaries between professional nursing and skilled health care work. The data also revealed two ‘in limbo’ states, a ritualized transition phase, and that the rationale for ‘learning to become a nurse’ retains the idealized and vocational imagery of nursing as helping and caring for sick people.
Facing the issue of dependence: some implications from the literature for the hospice and hospice nurses
Authors: Flanagan Jean , Holmes Susan
Published: March 2003

Facing the issue of dependence: some implications from the literature for the hospice and hospice nurses¶ Research and clinical practice suggest that dependence upon others causes distress to those with a life‐threatening illness and that the hospice may serve to reinforce feelings of loss of autonomy. Hospice nurses can contribute to good care and act therapeutically to maximize an individual's potential for independent activity where this is possible and desirable. However, literature from other contexts demonstrates variability in the extent to which this is achieved. This paper outlines the problem of dependence in those with a life threatening illness. Therapeutic nursing is explored in relation to issues which may arise in a hospice context, potential relationships between therapeutic nursing and partnership are noted, particularly with regard to the possible meanings of dependence which for some individuals comes to be apprehensively associated with impending death.
The professional socialization of diploma of higher education in nursing students (Project 2000): a longitudinal qualitative study
Authors: Gray Morag , Smith Lorraine N
Published: March 2003

The professional socialization of diploma of higher education in nursing students (Project 2000): a longitudinal qualitative study¶This paper presents a new theory of professional socialization in relation to diploma of higher education in nursing students (Project 2000). It was derived from a 3‐year, grounded theory, longitudinal study exploring the effects of supernumerary status and mentorship on students undertaking practice placements. A purposive sample of 17 students was used. Ten students volunteered to be interviewed on five separate occasions throughout their course and to keep a diary to record their experiences of mentorship during their practice placements. Their diary acted as an aide memoir during their tape‐recorded interviews. The other seven students participated by diary only and kept written accounts of their experiences of being supernumerary and having a mentor whilst on practice placements. Data were analysed with the aid of NUD.IST and subjected to the constant comparative method of analysis. Findings indicate that the mentor is the linchpin of the students' experience and that some students develop intuition much earlier than previous work has stated.
A concept analysis of autonomy
Authors: Keenan Jan
Published: March 2003

A concept analysis of autonomy¶Clinical and policy developments in health care have recently created demand for a professional response in terms of the development of advanced roles for nurses, notably `nurse practitioner' roles. Such roles demand the exercise of autonomy, a term which eludes succinct definition despite the fact that the preparation of practitioners for these roles relies on a clear understanding of its nature. Utilizing an approach described by Wilson, this paper undertakes a concept analysis of autonomy, each step illustrated with examples taken from clinical practice, with the ultimate aim of offering an operational definition of autonomy.
Satisfaction in childbirth and perceptions of personal control in pain relief during labour
Authors: McCrea B. Hally , Wright Marion E.
Published: March 2003

Satisfaction in childbirth and perceptions of personal control in pain relief during labour¶Satisfaction in childbirth is influenced by individual and environmental factors. Of specific interest in this study is the extent to which women feel that they have been able to control what happened to them during labour. The main purpose of this study was to examine the influence of personal control on women's satisfaction with pain relief during labour. A questionnaire‐based retrospective study of women's pain experiences within 48 hours of delivery was carried out on the postnatal ward of one teaching hospital in Northern Ireland. One hundred women who had had a vaginal delivery consented to take part in the study. Two main measures were used in the study; personal control in and satisfaction with pain relief during labour. The key finding of this study indicates that feelings of personal control influenced positively the women's satisfaction with pain relief during labour. Demographic and other psycho‐social variables had little impact on the women's satisfaction scores. These findings have implications for clinical practice and for the management of maternity services and are discussed.
Care, cure and interpersonal understanding
Authors: Widdershoven Guy A.M.
Published: March 2003

Care, cure and interpersonal understanding

This article distinguishes two approaches within care theory, relating them to different views on the physician–patient relationship within philosophy of medicine. The first regards care as a skillful comportment by the care‐giver, based upon intuitive insight into the needs of the care‐receiver. The second regards care as a mutual endeavour, based upon openness and dialogue. The first approach resembles the interpretative model of the doctor–patient relationship; the second is parallel to the deliberative model. The two approaches within care theory and the two positions within philosophy of medicine are both expressions of a fundamental distinction between two different views of interpersonal understanding. This distinction is elaborated upon by discussing Gadamer's analysis of interpersonal understanding.
Lost in the crucible of supportive clinical supervision: supervision is not therapy
Authors: Yegdich Tania
Published: March 2003

Lost in the crucible of supportive clinical supervision: supervision is not therapy

Clinical supervision as a mechanism that supports both professional and personal development is a concept that has captured the imagination of nurses. Though nurses generally agree that `supervision is not therapy', a clear distinction cannot be enunciated between these two processes when both aim at personal growth. In combining personal and professional growth, the rationale for clinical supervision is unnecessarily confused, with the unfortunate result that supervision may, unwittingly, become a form of therapy for nurses. This paper examines a model of supportive clinical supervision qua Chambers and Long's example of a facilitative therapeutic supervisory style, that reflects nurses' conceptualization of clinical supervision as enhancing personal and professional growth. However, it could be argued that this stance is in crucial respects incorrect, and needs to be rethought if clinical supervision is to be established as credible in nursing. Subsequently, it is important to remember that the utilization of certain techniques rather than their stated goals, will dictate the form that supervision, or therapy, will take. The purpose of this paper is to demonstrate the logical unacceptability in combining two processes as one, while developing a conceptual framework that differentiates supervision from therapy.
Emotional contagion, empathic concern and communicative responsiveness as variables affecting nurses’ stress and occupational commitment
Authors: Omdahl Becky L. , O'Donnell Carol
Published: March 2003

Emotional contagion, empathic concern and communicative responsiveness as variables affecting nurses’ stress and occupational commitment

Based on data gathered from registered nurses at two hospitals, this research examined the extent to which empathy variables contributed to nursing stress and occupational commitment. The empathy variables examined were emotional contagion (i.e. sharing the emotions of patients), empathic concern (i.e. being concerned for patients) and communicative effectiveness (i.e. effectively communicating with patients and their families). Nursing stress was explored through the variables of depersonalization, reduced personal accomplishment and emotional exhaustion. Multiple regression analyses revealed that the combination of the three emotional communication variables explained significant proportions of the variance in all three of the stress variables, as well as occupational commitment. The analyses further revealed that a lack of empathic concern and poor communicative responsiveness accounted for significant proportions of the variance in depersonalization. Lack of empathic concern, poor communicative responsiveness and high emotional contagion significantly contributed to reduced personal accomplishment. Emotional contagion explained a significant proportion of the variance in emotional exhaustion. Emotional contagion also significantly reduced occupational commitment. The findings are discussed in terms of nursing education and administration.
Strategies used by burns nurses to cope with the infliction of pain on patients
Authors: Nagy Sue
Published: March 2003

Strategies used by burns nurses to cope with the infliction of pain on patients

The infliction of pain on patients is part of the daily routine for many nurses, particularly those who work in burns units, but there has been little help available for nurses to develop useful ways of coping with such circumstances. Few researchers have considered how the ways that nurses manage their feelings about pain may provide insights into the reasons why available pain control methods have not been fully practiced. The aim of this study was to identify the range of coping strategies used by nurses when conducting painful procedures. Nurses working in five burns units were interviewed about their feelings when it was necessary for them to inflict pain on patients in the course of giving patient care. Content analysis was used to identify the kinds of coping strategies used by nurses to manage their feelings about such situations. Fourteen kinds of strategy were identified and were then grouped into four categories: (i) distancing oneself from the patient’s pain; (ii) engaging with the patient’s pain; (iii) seeking social support and (iv) reconstructing the nurse’s core role. The use of each of these categories of coping have implications for both the management of patient’s pain and the nurse’s emotional well‐being. While distancing oneself from the patient’s pain was the most prevalent way for nurses to cope with their feelings about causing pain to patients, all types of coping strategies had their advantages. It is possible that combinations of various strategies may be the most effective way for nurses to deal with their patients’ pain.
Practice nurses and the care of patients receiving depot neuroleptic treatment: views on training, confidence and use of structured assessment
Authors: Millar Elaine , Garland Carol , Ross Fiona , Kendrick Tony , Burns Tom
Published: March 2003

Practice nurses and the care of patients receiving depot neuroleptic treatment: views on training, confidence and use of structured assessment

The movement of care into the community for the mentally ill with severe and enduring problems has important implications for primary care services. This paper reports the findings from an interview with practice nurses working in south‐west London, United Kingdom, who had participated in a randomised control trial to investigate the effectiveness of training and structured assessment on clinical and social outcomes of patients receiving maintenance medication of depot antipsychotics. The aim of the interview was to explore current practice, attitudes, confidence and priorities for training in relation to these patients. Thirty‐nine nurses were interviewed. The majority of practice nurses received scant referral information and worked without protocols. Even though these nurses had received the training, and as a result of the study had increased awareness of the problems of the severely mentally ill, there was a significant relationship between inadequate knowledge of schizophrenia to carry out the task of medication management and lack of confidence. Although the small size of the sample does not permit generalization, important questions are raised for further practice development and research, including the future training needs of practice nurses and partnership relationships with mental health professionals for supervision and support.
Evidence for nursing practice: a clarification of the issues
Authors: Closs  , Cheater
Published: March 2003

Evidence for nursing practice: a clarification of the issues

There has been considerable confusion and unease within the nursing profession about the emphatic push for all healthcare to be ‘evidence‐based’. In particular, there has been anxiety that the emphasis on evidence ignores practitioners’ skills and individual patient preferences. This paper attempts to clarify the main issues surrounding evidence‐based nursing. These include its epidemiological origins and purpose, the meaning and limits of ‘evidence’, the need for individual skills and expertise in the use of evidence, and the strengths and weaknesses of different kinds of evidence. It aims to debunk the misconception that randomized controlled trials are synonymous with evidence, and to increase critical awareness of the nature of evidence in nursing.
The theory–practice relationship in nursing: the practitioners’ perspective
Authors: Fealy Gerard M.
Published: March 2003

The theory–practice relationship in nursing: the practitioners’ perspective

Within contemporary scholarly discourse, there are a number of distinctive approaches to understanding the theory–practice relationship. Carr identifies four principal approaches, each of which is sustained within explicit views about the nature of theory. Carr terms these approaches the ‘common‐sense’ approach, the ‘applied‐science’ approach, the ‘practical’ approach and the ‘critical’ approach. Each approach is recoverable from the explicit and implicit content of scholarly literature. The study reported here sought to uncover the ways in which practising nurses understand the relationship between theory and practice and to establish the extent to which their explicit and implicit understandings accord with Carr’s typology. The study involved in‐depth interviews with six practising nurses. The purpose of the interviews was to prompt each study participant to enter into a reflective mode in a way that would generate narrative information, which would illustrate the various ways in which each theorized with respect to the theory–practice relationship. In this reflective theorizing, the study participants indicated that they understood the theory–practice relationship in ways that accorded with elements of Carr’s typology. A brief discussion considers the limitations of the study and the implications for further research into the theory–practice relationship.
‘Levels’ of attainment in nursing practice: reality or illusion?
Authors: Ashworth Peter D. , Gerrish Kate , Hargreaves Janet , McManus Mike
Published: March 2003

‘Levels’ of attainment in nursing practice: reality or illusion?

In earlier research based on an analysis of course documentation, it had been found that there was little consensus among nurse educators concerning the parameters which distinguish levels of practice skills, particularly those which differentiate diploma and degree qualifications in the United Kingdom. This result was confirmed and strengthened in the current study. Lecturers in nursing, when presented with a sorting task using 40 statements derived from course documentation selected from the earlier study, were unable to distinguish statements describing diploma level from those describing degree level practice. Possible reasons for the difficulty are discussed. It is concluded that the attempt to represent practice skill in a hierarchy of assessment for degree or diploma qualifications is premature since the parameters of practice remain unreliably specified.
Power, self‐care and health in women living in urban squatter settlements in Karachi, Pakistan: a test of Orem’s theory
Authors: Lee Marilyn Bell
Published: March 2003

Power, self‐care and health in women living in urban squatter settlements in Karachi, Pakistan: a test of Orem’s theory

This was a study of health in women living in urban squatter settlements in Karachi, Pakistan. The study grew out of the author’s concern for the generally poor health status of Pakistani women. Orem’s nursing theory was selected to examine health in these women. The purpose of the study was to examine relationships among basic conditioning factors, self‐care agency (specifically, perception of power as a foundational capability of self‐care agency and the enabling capabilities of self‐care agency), self‐care, and selected health outcomes of Pakistani women. Four hypotheses were developed and tested. They were that in a group of Pakistani women: (1) perception of power as a foundational capability and enabling capabilities of self‐care agency and self‐care will be related to selected basic conditioning factors; (2) perception of power, as a foundational capability of self‐care agency, will be directly and positively related to enabling capabilities of self‐care agency; (3) perception of power as a foundational capability and enabling capabilities of self‐care agency will have a direct and positive relationship with self‐care; and (4) self‐care will be related to selected health outcomes. Hypotheses one, two and three were supported. Findings indicate that the basic conditioning factors, socioeconomic variables, ethnicity and roles, were predictive of perception of power, enabling capabilities of self‐care agency, self‐care and health. Hypothesis four was not supported; basic conditioning factors had more influence on health than self‐care.
Myocardial infarction, spouses’ reactions and their need of support
Authors: Kettunen Sinikka , Solovieva Svetlana , Laamanen Ritva , Santavirta Nina
Published: March 2003

Myocardial infarction, spouses’ reactions and their need of support

The purpose of this study was to investigate the impact of myocardial infarction (MI) on survivor’s spouses in terms of fears and symptoms during the patient’s recovery period. In addition the researchers sought to evaluate the influence of the support by the health care professionals on spouses’ adjustment. A total of 57 Finnish spouses participated in the study. Of the spouses 47 were female and 10 were male. Data were collected using a structured questionnaire distributed to the spouses at a rehabilitation session at 2 weeks–4 months after the MI. Topics covered included fears, emotional and physical symptoms and the spouses’ experience of the sufficiency of the support that they had received from health care professionals during the patient’s recovery. Data were analysed using quantitative methods including descriptive statistics and multivariate methods. Fears and symptoms were classified using factor analyses. For fears two factors emerged which were named: disease‐related fears and personal fears. In respect of symptoms experienced by the spouse three factors emerged: one which describes emotional distress, one which describes dysfunction and one describing spouses’ own vulnerability. The significantly most intensively experienced fears by the spouses were the disease‐related fears followed by the personal fears. The most frequently reported symptom was dysfunction followed by emotional distress and vulnerability. In regression analysis emotional distress was predicted by personal fears, support from the health care professionals, the shock reaction, spouse’s own health and time after MI. Dysfunction was predicted by spouse’s own health and personal fears whereas vulnerability was predicted by spouse’s own health and support from the health care professionals. Study findings show that in the planning of the care of patients with MI it is important to attend to the reactions and needs of spouses. Their resources are required for optimal rehabilitation of the patient.
Post‐positivistic critical multiplism: a beginning dialogue
Authors: Letourneau Nicole , Allen Marion
Published: March 2003

Post‐positivistic critical multiplism: a beginning dialogue

Following the recognition that logical positivism was no longer tenable in modern science, post‐positivism and its research methodology, critical multiplism, emerged and offered a new way of thinking about science. Though not a panacea, critical multiplism, in which methodological pluralism is advocated, offers a way around the debate of which conception of science is appropriate for nursing and, as such, poses advantages for nursing scientific knowledge development.
Development and testing of the Family Caregiving Consequences Inventory for home nursing assessment in Taiwan
Authors: Shyu Yea‐Ing Lotus , Lee Hsiao‐Chin , Chen Mei‐Ling
Published: March 2003

Development and testing of the Family Caregiving Consequences Inventory for home nursing assessment in Taiwan

This paper describes the development and psychometric testing of the Family Caregiving Consequences Inventory (FCCI). Data were collected from a convenience sample of 97 families in Taiwan to examine the validity and reliability of the three FCCI scales: frail elder outcomes, caregiver outcomes and family outcomes. Acceptable test–retest and internal consistency reliabilities were found, though inter‐rater reliability was unsatisfactory. Criterion‐related validity was demonstrated by congruence with home nursing specialists’ assessment of family caregiving outcomes. Confirmatory factor analysis with a good overall model fit supported the construct validity of FCCI. However, a poor fit of the internal measurement structure was found for the frail elder outcomes scale and the family outcome scale. Studies with larger samples are needed to further verify the measurement models used here. Nevertheless, in its current form, the FCCI can be used to increase the sensitivity of home care nurses to family caregiving situations and provide an instrument for studies of family caregiving in Taiwan and other countries with similar home care needs.
Individual and organizational well‐being in psychiatric nursing: a cross‐cultural study
Authors: Thomsen Sarah , Arnetz Bengt , Nolan Peter , Soares Joaquim , Dallender Janie
Published: March 2003

Individual and organizational well‐being in psychiatric nursing: a cross‐cultural study

Although health care systems around the world are undergoing rapid changes, there is an absence of comparative studies of how these changes affect nurses’ well‐being and work life. The purpose of this study was (i) to identify and describe possible differences between the psycho‐social work environments of English and Swedish mental health nurses, and (ii) to attempt to explain these differences. 1016 psychiatric nurses from Stockholm (Sweden) and Birmingham (England) responded to a postal questionnaire on their psycho‐social work environment and feelings of professional fulfilment, mental energy and work‐related exhaustion. The study was given ethical clearance in Stockholm and Birmingham. Results indicated that while the English nurses rated their organizational well‐being more favourably, Swedish psychiatric nurses reported greater individual well‐being than their counterparts. Multiple regression analyses indicated that self‐esteem was important for explaining mental energy and work‐related exhaustion, but less so for explaining professional fulfilment, which was predicted primarily by organizational factors. When controlling for self‐esteem, which was higher amongst the Swedish nurses, the differences in professional fulfilment and mental health were no longer significant. Reasons for the differences in self‐esteem and experiences of the workplace are discussed. Low response rate may have contributed to a selection bias.
Blood gas analysis: a study of blood loss in intensive care
Authors: Andrews Tom , Waterman Heather , Hillier Valarie
Published: March 2003

Blood gas analysis: a study of blood loss in intensive care

This paper describes a quantitative study conducted on an intensive care unit in the north of England. It involved the collection of data from the existing records of 65 patients consecutively sampled from a predetermined date provided that they stayed more than 24 hours and had an arterial line in situ. As patient records were used, ethical approval was not necessary. The objectives of the study were to quantify the mean number of blood gas samples taken per patient and estimate the mean blood loss resulting from this, including discard volume. Limitations include reliance on records and lack of an economic evaluation. The results show that blood loss in this study was greater than that reported elsewhere. Patients who were ventilated for 24 hours or more had a statistically significant greater blood loss when compared to those who were not (P < 0·001). A subgroup of patients undergoing renal replacement therapy had the greatest blood loss (mean 55·18 ml per day). This loss was statistically significant when compared to patients not in acute renal failure (P=0·007). When patients undergoing multiple therapies normally associated with increased sampling were compared to patients not receiving such therapies, there was no statistically significant difference in blood loss. The need to change current nursing practice to reduce iatrogenic anaemia is emphasized.
Physical touch in nursing studies: a literature review
Authors: Routasalo Pirkko
Published: March 2003

Physical touch in nursing studies: a literature review

In nursing contexts a distinction is made between two types of touch: physical touch and therapeutic touch. Physical touch may be experienced as therapeutic, but that is not its explicit purpose in the same way as with therapeutic touch. Most of the touch studies reviewed in this article are from the United States of America, Canada and the United Kingdom and thus represent the culture of modern western society. The area covered by these studies is far from coherent, and even the results are to some extent contradictory. It follows that it is difficult to draw any firm conclusions from this review of the concepts, methods and main results of touch studies.
Psychiatric nursing in prison: the state of the art?
Authors: Polczyk‐Przybyla Mark , Gournay Kevin
Published: March 2003

Psychiatric nursing in prison: the state of the art?

Psychiatric nursing in prisons has received criticism from within and outside the profession in recent years. In England and Wales this amongst other issues has prompted a review of forensic health care by the United Kingdom Central Council for Nursing, Midwifery & Health Visiting (UKCC). The status of forensic psychiatric nursing as a specialty has also been disputed in the literature and the role of nurses working in this field is seen by some to be more about social control than caring. These arguments are set in the present situation of increasing numbers of mentally ill individuals in the prison system and a crisis in the availability of beds in secure units, a situation that is paralleled throughout the western world. The standard expected of health care services in prisons is equivalence with the service the public receives from the National Health Service (NHS). The number of prisoners needing transfer to hospital has increased during the last decade, resulting in competition for a limited number of suitable beds. The effect on health care centres (HCCs) in English prisons is that they now must provide long‐term care for seriously mentally ill prisoners. This paper outlines the development of British psychiatric services in prisons. It then describes the HCC in Her Majesty’s prison (HMP) Belmarsh and reports on recent radical changes in the management structure of this service. The aim of these changes is to produce a clinical environment in which psychiatric nurses can deliver high quality care in an area beset with difficulties for clinicians and managers and to further progress towards the goal of equivalence. These advances have been achieved through a shift of emphasis in management structure that increases the number of clinical posts and minimizes administrative and security‐based responsibilities held by clinical grades. We conclude that although external contracts are necessary, much can be achieved through internal review and changes in policy.
A national survey of practice nurse involvement in mental health interventions
Authors: Gray Richard , Parr Ann‐Marie , Plummer Susan , Sandford Tom , Ritter Susan , Mundt‐Leach Rosie , Goldberg David , Gournay Kevin
Published: March 2003

A national survey of practice nurse involvement in mental health interventions

Background: The move in the United Kingdom (UK) from institutional to community care has led to an inevitable increase in the involvement of practice nurses (PNs) in mental health care. Around 20 000 PNs are currently working in the United Kingdom (UK). However, the extent and nature of PN involvement in delivering mental health interventions has not been adequately explored. Aim: This study aimed to quantify practice nurses’ involvement in delivering mental health interventions in primary care settings. Method: A questionnaire was sent to a random sample of 1500 practice nurses registered with the Practice Nurse Forum at the Royal College of Nursing. Sixty per cent of questionnaires were returned; however, once non‐eligible respondents were removed an adjusted response rate of 54% was achieved. Results: Practice nurses play a significant role in the assessment and treatment of mental health problems, most frequently via the administration of depot antipsychotics and the screening for depression. However, antipsychotic side‐effects were infrequently monitored and PNs’ understanding of treatment issues in depression is poor. These findings may be associated with the reported lack of mental health training that PNs have received. Conclusions: The findings of this study have important implications for the training of practice nurses in mental health, specifically in the areas of medication management and the detection of mental disorders.
A discussion of the legal aspects of female genital mutilation
Authors: Hopkins Susan
Published: March 2003

A discussion of the legal aspects of female genital mutilation

The purpose of this paper is to examine the position of the nurse/midwife in the United Kingdom when involved with the care of a woman or female child who has suffered genital mutilation, which is an illegal practice in this country and most other areas of the world. The types of circumcision commonly practised are introduced, the prevalent reasons for the continuation of the practice among certain ethnic groups are presented, and the range of issues to be considered by the nurse is examined. These include international and national legal aspects which do not exist in isolation and are considered in context with cultural, medical, human rights and gender issues. Nursing legal issues include child protection, consent, advocacy and confidentiality, which invoke the Code Of Professional Conduct of the United Kingdom Central Council for Nursing Midwifery & Health Visiting. Midwives and nurses working in the field of gynaecology have raised questions regarding possible courses of action to take when presented with this issue. Increased knowledge can help to inform those decisions. Therefore, implications for future practice are addressed, together with recommendations to assist nurses with decision making when faced with this scenario in the future.
Making sense of problem‐based learning: the perceptions and experiences of undergraduate nursing students
Authors: Biley Francis C. , Smith Keri L.
Published: March 2003

Making sense of problem‐based learning: the perceptions and experiences of undergraduate nursing students

This paper reports the findings of one stage of an ongoing project to evaluate a problem‐based learning (PBL) curriculum. Focusing on the students themselves, the ethnographic study explored how undergraduate nursing students (n=17) managed and made sense of a PBL programme. Fieldwork and ethnographic interviews revealed the students’ perceptions of the purpose of PBL and further issues that were of concern were identified and labelled the uncertainty of functioning without a clearly delineated educational structure, perceptions of knowledge acquisition, understanding of group interactionprocesses, and the role of the facilitator. These findings and the implications that arise as a result are discussed.
Predictive validity of the BRASS index in screening patients with post‐discharge problems
Authors: Mistiaen Patriek , Duijnhouwer Ellen , Prins‐Hoekstra Anja , Ros Wynand , Blaylock Ann
Published: March 2003

Predictive validity of the BRASS index in screening patients with post‐discharge problems

Rationale: Discharge planning is a nursing intervention that aims to ensure continuity of care; it consists of several steps of which selecting patients in need of it is the first one. The Blaylock Risk Assessment Screening Score (BRASS) index is a risk screening instrument which can be used early after admission to identify those patients in need of discharge planning. Aim: To test the predictive validity of the BRASS index in screening patients with post‐discharge problems. Design: Prospective longitudinal design with prediction instrument measured at admission, and outcomes measured at discharge and 7 and 30 days after discharge. Outcomemeasures: length of stay, discharge destination, status after discharge. Instruments: BRASS index, Problems after discharge Questionnaire, Nottingham Health Profile, COOP/WONCA charts. Research method: 503 elderly patients were screened at admission with the BRASS index. Length of stay and discharge destination were measured at discharge in these same patients. Outcomes after discharge were gathered only in patients who were discharged home and with length of stay of more than 3 days (n=226); outcomes were measured by postal questionnaires at day 7 and day 30 after discharge. Results: patients identified by the BRASS index as high risk are frequently not discharged home and have a longer length of stay. The BRASS scores correlate significantly with the outcome scores after discharge: the higher the BRASS score, the higher the difficulty score after discharge on all domains. However, the sensitivity of the BRASS index is rather low. Conclusion: This study demonstrates that the BRASS index is a good predictor instrument for indicating patients who are not discharged home, that the BRASS scores correlate significantly with problems experienced after discharge and that it has high specificity to predict patients with problems after discharge. Clinical use, however, is limited due to the low sensitivity. The BRASS index is a promising case‐finding instrument for discharge planning, but needs further development.
Evidence and outcomes: agendas, presuppositions and power
Authors: Ray Lynne
Published: March 2003

Evidence and outcomes: agendas, presuppositions and power

This paper explores philosophical and methodological issues involved in determining ‘What counts as making a meaningful difference?’— the fundamental question in health outcomes research and evidence‐based practice. Eight diverse stakeholders are identified along with the competing agendas they bring to the debate. The power to define what counts as meaningful change in health status is typically rooted in disciplinary socialization, linguistic traditions and an orthodox consensus that circumscribes acceptable research foci and methods. The various implicit assumptions and sites of definitional authority have consequences both for health researchers and for the public being served. For researchers, their designs may be driven by available instrumentation, short political time lines, and statistical rather than clinical significance. Because methods to capture salient health outcomes are still being developed, failure to capture significant outcomes may be methodological in origin. The public may experience the consequences of subsequent programmatic funding decisions and the exclusionary potential of different categorization schemes. Despite this, the public seldom has a voice in deciding what constitutes a meaningful health outcome. Researchers are urged to involve their target population in designing studies to help rebalance relative stakeholder power, and to consider the consequences of their methodological decisions.
The essential elements of spirituality among rural Thai elders
Authors: Tongprateep Tassanee
Published: March 2003

The essential elements of spirituality among rural Thai elders

The purpose of the study reported here was to understand and describe the essential elements of spirituality among rural Thai elders. The research question that guided the study was: How do rural Thai elders experience and describe spirituality in their daily lives? This question was explored through in‐depth, audio‐taped, face‐to‐face interviews with 12 rural Thai elders living in the Nakhorn Prathom Province in the central part of Thailand during the period from January to March 1998. Prior to implementing the study, approval to conduct this study was granted from the Institutional Review Broad of the University of Alabama at Birmingham. Through the process of hermeneutic phenomenological data analysis, three categories and nine themes emerged. The findings of the study provide a knowledge base for Thai nurses to explore and explain spirituality to enhance nursing science and provide holistic nursing care. Further research should be conducted throughout the health and illness continuum with all age groups and with individuals of different cultures and belief systems.
The role of the haemoglobinopathy nurse counsellor: an exploratory study
Authors: Gould Dinah , Thomas Veronica , Darlison Matthew
Published: March 2003

The role of the haemoglobinopathy nurse counsellor: an exploratory study

The haemoglobin disorders are among the most common genetically inherited conditions within the United Kingdom. Individuals who are fully affected have severely impaired health while carriers may be faced with difficult reproductive decisions although generally they are well. Policy makers agree that counselling for families at risk should be undertaken in primary care settings and since the early 1980s this service has been undertaken mainly by specialist haemoglobinopathy nurse counsellors. Despite a number of government reports and recommendations for best practice, problems with service provision continue to be highlighted. However, there is little documented information about the work undertaken by the counsellors or how they perceive their role. A descriptive study was therefore conducted to fill this gap. It took the form of a questionnaire survey undertaken with 26 counsellors. The results were analysed by content and used to develop an interview schedule which was employed to obtain more detailed information from staff in four centres. The counsellors suggested that most of their time was spent in client‐centred activities and most clients were first seen antenatally. However, there were significant barriers which prevented optimal service provision. These included: problems of communication with other health professionals, obtaining laboratory results crucial to the early identification of couples at risk, late referral from general practitioners and poor facilities for administration, especially maintaining computer databases essential for record keeping. Developing and obtaining written information suitable for families was particularly time‐consuming.
Cognitive behaviour therapy: teaching a client the ABC model — the first step towards the process of change
Authors: Lam Danny , Gale Julie
Published: March 2003

Cognitive behaviour therapy: teaching a client the ABC model — the first steps towards the process of change

Research suggests that clients need to be made aware of the relationship between thinking and emotional and behavioural reactions at the start of the therapeutic work. This paper looks at the clinical processes of educating the client about this relationship in a seven‐step ABC model. Rationales for each of the seven steps are given. The model illustrates the process of generating alternative beliefs in relation to a negative event and shows consequences of holding helpful and unhelpful beliefs.
Aggression and violence in health care professions
Authors: Rippon Thomas J.
Published: March 2003

Aggression and violence in health care professions

Although violence is increasing in most workplaces, it has become a significant problem in health care professions. Not only has the number of incidents increased but also the severity of the impact has caused profound traumatic effects on the primary, secondary and tertiary victims. More health care professionals than ever are suffering from symptoms of post‐traumatic stress disorder.Addressing the problem of violence in the workplace has been exacerbated by a lack of a clear definition of what constitutes aggression and violence. As a result, some administrators have been slow to commit resources to prevent further incidents and mitigate the impact. This article describes the magnitude of the problem from both an academic research and an operational perspective. A definition is presented as an initial step towards standardizing the research, and establishing an appropriate baseline upon which intervention policies and procedures can be created. This benchmark will also help to encourage empirical research into aggression and violence in health care professions and other professions. Further research needs to be conducted to create a comprehensive instrument that can more accurately measure the range of incidents and the severity of the impact.
Psychiatric nursing and compulsory psychiatric care
Authors: Clark Nicola , Bowers Len
Published: March 2003

Psychiatric nursing and compulsory psychiatric care

Community psychiatric nurses (CPNs) have long been involved in the operations of the English Mental Health Acts. Research has shown that compulsory detention is not used uniformly or consistently. Rates of involuntary hospitalization are reported to vary widely across Europe, but there is some consensus on patient profiles. The ethnicity, social status and gender of the patient, the involvement of the police, the availability of care, problems caused to relatives, and the country and particular legislative system where these judgements take place, all influence who is compulsorily detained.

This article reviews recent evidence from Europe and argues that involuntary psychiatric care can no longer be seen as entirely dependent on the symptoms and behaviour of the patient and that CPNs should be aware of and reflect upon these factors before invoking the detention process.
Assessment of older people: politics and practice in primary care
Authors: Vernon Susan , Ross Fiona , Gould Mairi A.
Published: March 2003

Assessment of older people: politics and practice in primary care

This paper reviews some of the key policy changes in the United Kingdom in relation to older people that have influenced assessment practice across health and social care, and have implications for nursing within emerging primary care groups. The role of assessment in purchasing care packages raises tensions and paradoxes for health and social care professionals that the paper sets out to elucidate with particular reference to district nurses. The issues for nursing have not been well described previously and questions such as key accountability, rationing, multiagency and interprofessional working, and the consumer voice, are discussed.