bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing doctor‐ and nurse‐led care in a sexual health clinic: patient satisfaction questionnaire
Authors: Miles Kevin , Penny Nikki , Power Robert , Mercey Danielle
Published: December 2004

Background. A new model of comprehensive care nurse‐led clinics has enabled experienced genitourinary medicine nurses to co‐ordinate the first‐line, comprehensive care of female patients presenting with sexually transmitted infections and other sexual health conditions and issues.

Aim. This paper describes the development of a patient satisfaction questionnaire to compare the satisfaction of women attending nurse‐led or doctor‐led clinics at a central London genitourinary medicine clinic.

Methods. A previously validated questionnaire was adapted using the findings of qualitative interviews exploring patient expectations of the service. The draft questionnaire was tested for internal consistency, sub‐scale homogeneity, construct validity and stability. The final version consisted of a 34 item, five‐point Likert scale, which was found to be both reliable (Cronbach's α 0·91) and stable (test–retest 0·95). There was some evidence of construct validity. The questionnaire was then distributed to a convenience sample of 132 women attending a nurse‐led clinic and 150 seen at a doctor‐led clinic.

Results. There was a 90% response rate. The median total satisfaction scores, out of a total of five, were 4·47 and 4·30 for the nurse‐led and doctor‐led groups, respectively (P  = 0·05). Significantly higher scores on the sub‐scales measuring quality and competence of technical care (P  < 0·001), provision of information (P  = 0·01) and overall satisfaction (P  = 0·01) were seen for the nurse‐led group. No significant differences were found in the sub‐scales measuring service attributes and specific attributes of interpersonal relationships.

Conclusion. The rigorous development, piloting and testing phases of this satisfaction questionnaire led to reliable and valid results. This study demonstrated that nurse‐led clinics within this service are an acceptable alternative to the existing doctor‐led clinics.
The Internet and access to evidence: how are nurses positioned?
Authors: Estabrooks Carole A. , O'Leary Katherine A. , Ricker Kathryn L. , Humphrey Charles K.
Published: December 2004

Background. Published literature that describes the use of the Internet by nurses is scant, but it does reveal that there has been a delay in the acceptance of the Internet as a workplace tool by the medical community and, in particular by nurses.

Aims. The purpose of this article is to report on a study of how often and from what location nurses accessed the Internet, as well as the types of information they were seeking. In addition, our goal was to compare nurses' Internet use with that of physicians and the public at large, and to highlight structural and institutional challenges to nurses' use.

Methods. Surveys (1996 and 1998) of Alberta Registered Nurses were used to examine their use of technology at work and at home. Additional data sources were used to compare nurses to physicians and to the general public.

Results. While nurses' Internet and e‐mail use at home increased over the 2‐year period and was comparable with other groups, Internet use at work was low compared with other groups despite adequate workplace access.

Conclusions. Nurses are more likely to value interpersonal contact, and prefer to use personal experience and communication with colleagues and patients rather than on‐line and traditional sources of practice knowledge. In order for an information source to be seen as valuable in the clinical setting, contextually relevant information needs to be accessed quickly and efficiently. Energies should be focused on constructing information systems that address the particular needs of nurses.
Nursing theory views on how to support the process of ageing
Authors: Wadensten Barbro , Carlsson Marianne
Published: December 2004

Background.  An important purpose of theories is to challenge practice, create new approaches to practice and remodel the structures of rules and principles. Therefore, it is of interest to study whether it is possible to make use of nursing theories in care of older people, when the aim is to support them in the process of ageing.

Aim.  To review 17 well‐known nursing theories/models in order to delineate the views on ageing presented and discover whether there are descriptions of how nursing care of older people could be organized.

Methods.  Seventeen nursing theories/models originating over a 30‐year period from the early 1960s to the early 1990s were chosen. A search of CINAHL was done and lists of reference from books were used to find original sources. For the review, a list of research questions were formulated and addressed to each theory.

Results.  Results showed that most nursing theorists see human ageing from a developmental perspective, but do not discuss what ageing implies. In only a few theories are some important aspects of nursing care of older people discussed, but no concrete instructions are given on how to apply these to nursing care.

Conclusion.  There is a need to develop a nursing care model that – more than other contemporary theories – takes into consideration human ageing.
Confronting life with rheumatoid arthritis
Authors: Melanson Patricia M. , Downe‐Wamboldt Barbara
Published: December 2004

Background. Older people with rheumatoid arthritis are confronted with a variety of chronic stressors on a daily basis. Living with rheumatoid arthritis means learning to cope with physical limitations, fatigue, losing mobility and independence, pain, uncertainty and role changes related to periods of exacerbation and remission. There is a paucity of literature that addresses the stress and coping processes over time for older people who have had rheumatoid arthritis since midlife.

Aim. The purpose of this study was to identify and describe, at three points in time and over two 6‐month intervals, the illness‐related stressors perceived by older people diagnosed with rheumatoid arthritis since midlife; their stress‐related emotions and the coping strategies they used to manage the illness‐related stressors.

Methods. A longitudinal, descriptive design was used to assess older people's perceptions of illness‐related stress, their stress emotions and the coping strategies used to manage the illness‐related stressors.

Findings. The majority of participants most frequently identified physical limitations as their illness‐related stressors, harm as the stress emotion they experienced, and use of confrontive coping strategies to manage the stress associated with rheumatoid arthritis.

Conclusions. The findings provide nurses with a better understanding of the experiences, emotions and coping strategies used by older people to manage the adversity of rheumatoid arthritis in daily living.
Living with a woman with fibromyalgia from the perspective of the husband
Authors: Söderberg Siv , Strand Marie , Haapala Maria , Lundman Berit
Published: December 2004

Background. Fibromyalgia (FM) is a chronic pain syndrome, which affects mostly middle‐aged women. The syndrome is poorly understood and treatment is mainly palliative. The diagnosis is established from diagnostic criteria. Living with FM means living a life greatly influenced by the illness in various ways for people affected.

Aim of the study. The aim of this study was to describe the experiences of living with a woman with FM from the husbands' perspective.

Methods. Five men married to women with FM were interviewed using a narrative approach. The interviews were analysed using qualitative thematic content analysis.

Findings.The analysis resulted in the following seven themes: increasing responsibility and work in the home; being an advocate for and supporting the wife; learning to see the woman's changing needs; changing relationship between spouses; changing relationship with friends and relatives; deepening relationship with the children and lacking information and knowledge about FM. The findings show that the women's illness had a great impact on husbands' lives, and that husbands lacked information about the woman's illness.

Conclusion. This study shows that it is not only the women with FM who experience a changed life; the whole family life is influenced and limited by FM. The husband's role in the family changes, first and foremost concerning responsibility and workload within the family. This must be taken into consideration in care planning. This study also highlighted the need of information and knowledge about FM expressed by the participants, information that health care personnel have a great responsibility to give.
A systematic review of stress and stress management interventions for mental health nurses
Authors: Edwards D. , Burnard P.
Published: December 2004

Background.  Health care professionals in the United Kingdom (UK) appear to have higher absence and sickness rates than staff in other sectors, and stress may be a reason for nurses leaving their jobs. These problems need to be addressed, particularly in the mental health field, if current service provision is to be maintained.

Aim.  The aim was to identify stressors, moderators and stress outcomes (i.e. measures included those related to stress, burnout and job satisfaction) for mental health nurses, as these have clear implications for stress management strategies.

Method.  A systematic review of research published in English between 1966 and 2000 and undertaken in the UK that specifically identified participants as mental health nurses was carried out to determine the effectiveness of stress management interventions for those working in mental health nursing. Studies from non‐UK countries were examined as potential models of good practice. The study was limited to primary research papers that specifically involved mental health nurses, where the health outcomes measured were stressors, moderators and stress outcomes and where sufficient data was provided.

Results.  The initial search identified 176 papers, of these 70 met the inclusion criteria. Seven studies have been reported since the completion of the review and have been included in this article. Sixty‐nine focused on the stressors, moderators and stress outcomes and eight papers identified stress management techniques. Relaxation techniques, training in behavioural techniques, stress management workshops and training in therapeutic skills were effective stress management techniques for mental health nurses. Methodological flaws however, were detracted from the rigour of many of the studies.

Conclusions.  The review demonstrated that a great deal is known about the sources of stress at work, about how to measure it and about the impact on a range of outcome indicators. What was found to be lacking was a translation of these results into practice, into research that assessed the impact of interventions that attempt to moderate, minimize or eliminate some of these stressors.
Space and place in the construction and performance of gendered nursing identities
Authors: Halford Susan , Leonard Pauline
Published: December 2004

Background and aims.  This paper draws on recent research conducted in two contrasting NHS hospitals: one a large District General, the other a small Community hospital; to look at hospitals as organizational spaces. This includes both the physical environment as well as how these spaces are inhabited and used. This paper aims to explore the ways in which hospital spaces impact on the working lives of nurses.

Methods.  The research employed two main methods. Two phases of round the clock non‐participant observation were carried out within each hospital, one at the beginning of the research period and one at the end. This generated thick description of the diversity of spaces, as well as individuals' use of space. In addition, more than 50 in‐depth unstructured interviews were conducted with both nurses and doctors.

Findings.
 Three aspects of the relationship between nurse and hospital spaces are considered. First, the degree of
access that nurses have to the different hospital spaces is limited, and many are confined to the wards in which they work. The high proportion of female nurses working on wards means that there are marked gender differences in access to hospital spaces. There are also marked professional differences when nurses are compared to doctors who have much greater freedom to roam and there are differences in the amount of private space allocated to nurses and doctors. Second, styles of bodily movement in space are also highly differentiated by profession and gender. Third, different spaces have very different meanings attached to them, and this has a strong impact on styles of performance and identity. Attention to space thus offers original insights to nurses working conditions as well as to inter‐professional relations.
How Japanese nurses provide care: a practice based on continuously knowing the patient
Authors: Takemura Yukie , Kanda Katsuya
Published: December 2004

Aim. Criticisms of the nursing process as a problem‐solving approach have emerged recently. This study aimed to identify and describe a way of nursing based on the clinical practice of selected nurses in Japan.

Methods. Data were collected using semi‐structured interviews and observations at one 300‐bed Japanese hospital in 1999. The purposive sample consisted of 24 female nurses. Data analysis occurred simultaneously with data collection, and questioning and constant comparison were used for data analysis. Codes were clustered into categories and relationships among these were identified. In the final stage of the analysis, two group interviews with participants were carried out to enhance credibility.

Findings. This study identified a Japanese way of nursing intended to help patients explore and realize meanings and values of their experiences with illness. When nurses first contacted a patient, they quickly formed a patient image, but altered it each time they obtained new patient information. A patient image consisted of the patient's subjective world (the patient's perspective) and the holistic patient (nurses' perspectives of the patient). The nurses sometimes pursued strategies to know the patient's subjective world. The target, direction, conditions and ways of nursing care were decided based on continuously knowing the patient. The nurses related their knowledge and thoughts to the patient, and by talking with the patient promoted the patient's consideration and participation, and empowered the patient. Nurses continued attending to patients even when they could not provide specific nursing interventions.

Conclusions. Knowing the patient was found to be especially important in determining nursing care. The model described in this study does not contradict the nursing process as a systematic approach to problem‐solving. Rather, it has some alternatives that might be useful in providing individual care in Japan.
Family and community support to adolescent mothers in Swaziland
Authors: Mngadi Patricia Thuli , Zwane Isabel Thembi , Ahlberg Beth Maina , Ransjö‐Arvidson Anna‐Berit
Published: December 2004

Background.  Early pregnancy and unplanned childbirth have far‐reaching physical, psychological and social consequences to the adolescent girl and her offspring and is therefore a public health problem for concern. At Mbabane Government Hospital 25% of the deliveries are by women aged 10–19 years. Little has been documented about family and community support for adolescent mothers in Swaziland.

Aim.  The aim of this study was to generate more systematic data on support to adolescent mothers and their newborns during the early postpartum period by families, communities and health professionals.

Methods.  Thirty‐one adolescent mothers were recruited from Mbabane Obstetric Unit after childbirth and were visited in their homes 7 days after delivery and interviewed about the family, community and health professional support experienced for themselves and their newborns. A semi‐structured interview guide was used to obtain both quantitative and qualitative data.

Findings.  Support from families, community and health professionals were generally poor, and pregnancies among adolescents were unplanned. There was poor or no communication, and information from parents and the community on sexuality and reproductive health had been grossly lacking. Peers were the primary source of information about sexuality and reproduction. Communities did not offer services aimed at providing adolescents with information and skills regarding safe sexual behaviour.

Conclusions.  Adolescents need contraceptive counselling and services in order to prevent pregnancies at a young age. Communication among parents and their daughters needs to be encouraged in order to monitor postpartum care and also to ensure continuity of maternity care.
Cross‐cultural psychometric testing of the Care Dependency Scale with data
Authors: Dijkstra Ate , Coleman Mick , Tomas Concepcion , Välimäki Maritta , Dassen Theo
Published: December 2004

Background.  The importance of the present study lies in addressing whether it is justified to compare the care dependency status of older patients from different settings and cultures using the same instrument.

Aim.  The aim of this international study was to compare the psychometric properties of the Care Dependency Scale (CDS) by analysing data gathered in Finland, Spain and the United Kingdom (UK).

Method.  The Finnish, Spanish and UK research instruments were translations of the original Dutch CDS. Psychometric evaluations of this were carried out for each country separately as well as for the three countries combined, based on a convenience sample of 378 older patients.

Results.  High alpha coefficients between 0·94 and 0·97 were obtained. Subsequent test–retest and interrater reliability revealed moderate to almost perfect kappa values.

Conclusion.  One of the main outcomes of the international comparison was that the findings between the three countries showed more similarities than differences in psychometric assessment, indicating that the CDS can be used for care dependency assessment in different countries.
Organization of nursing care and stressful work characteristics
Authors: Mäkinen Arja , Kivimäki Mika , Elovainio Marko , Virtanen Marianna
Published: December 2004

Background.Occupational stress is assumed to arise from social arrangements that are partially determined by the modes of organization of work. However, there is little systematic research on the extent to which modes of organizing nursing work are related to stressful characteristics of work.

Objectives.This study explored the relationship between modes of organizing nursing and stress.

Methods.Survey responses on modes of organization of nursing were collected from 27 ward sisters and those on stressful work characteristics from 568 nurses working in 27 wards with different nursing modes.

Results.Four different nursing modes (primary, modular, team and functional nursing) were not consistently associated with stress. Statistically significant associations involved only certain features of these modes and specific components of stress. After the effects of demographic and ward characteristics were controlled for, hierarchical regression analyses showed that opportunity to write nursing notes decreased the likelihood of nurses’ stress because of problems in interpersonal relationships. Writing nursing notes is common in patient‐focused nursing modes (primary and modular nursing). Other features of nursing modes were not associated with stress.

Discussion.In general, nursing mode is not associated with stressful job characteristics. However, certain aspects of patient‐focused nursing reduce the likelihood of interpersonal problems among staff.
The description and evaluation of a longitudinal pilot study of a smoking relapse/reduction intervention for perinatal women
Authors: Chalmers Karen , Gupton Annette , Katz Alan , Hack Tom , Hildes‐Ripstein Elske , Brown Judy , McMillan Diana , Labossiere Diane , Mackay Maria , Pickerl Cathie , Savard‐Preston Yvette , Vincent Jo‐Anne St , Morris Heather M. , Cann Beverley
Published: December 2004

Background.  Up to 70% of women who quit smoking while pregnant will relapse during the first postnatal year. In this study, a community‐based, ecological approach guided the development and implementation of a smoking cessation intervention for perinatal women.

Aims.  The aims of this pilot project were to: (1) develop and implement a community‐based intervention to assist women to stop smoking or prevent smoking relapse during the pre‐ and postnatal periods, (2) provide feedback on participants’ perceptions of the helpfulness of the intervention, (3) compare perceptions of the helpfulness of the intervention between women who received the intervention during the prenatal vs. postnatal periods, and (4) identify additional components of the intervention which need to be included in future research.

Design/methods.  Using a participative process and a detailed review of the literature, researchers, health care professionals and women (pregnant or postnatal) developed a multifaceted intervention. The intervention included four core components, which all women received: home visit by the intervention nurse, follow‐up telephone call(s), resource package, and letter of congratulations. Additional optional components included: telephone help line, support groups, referrals and other services. Forty‐two women who were pregnant or had recently delivered participated. Descriptive and evaluation data were collected from participants using questionnaires and telephone interviews. The research was approved by the university Research Ethics Board.

Findings.  Participants found the core components of the intervention to be helpful in their smoking cessation goals, particularly the home visit and resource material. The support groups and smoking help line were not used. There were no differences in how helpful the components of the intervention were perceived to be between women who received it in the prenatal or postnatal periods.

Conclusions.  Future research is needed to evaluate the effectiveness of the intervention.
The effectiveness of public health nursing: the problems and solutions in carrying out a review of systematic reviews
Authors: Elliott Lawrie , Crombie Iain K. , Irvine Linda , Cantrell Jane , Taylor Julie
Published: December 2004

Background.  In 1999 the Scottish Office, United Kingdom, intimated that the Chief Nursing Officer would undertake a policy review of nurses’ contribution to improving the public's health. The importance of reviewing the scientific literature on the effectiveness of public health nursing was recognized as a crucial part of the policy review. A final report was expected within a 6‐month period. The reason for the short time period was to fit the policy‐making schedule. This paper discusses our literature review for this work.

Aims.  The aim was to conduct a review of the international scientific literature that gave the greatest coverage of the role and potential role of nurses in improving the public's health in relation to 14 major health topics. This paper describes the methods used, outlines the rationale underpinning the methods, discusses the problems encountered and offers solutions to some of these problems.

Methods.  The initial search for relevant scientific literature revealed 709 suitable primary papers. Reviewing this number was beyond the time limit set by the funding organization. Therefore, a decision was made to concentrate on the evidence contained in systematic reviews. Reviewing systematic reviews raises a number of methodological problems to which there are often no predetermined solutions, such as ensuring that important interventions are included, assessing the relevance and quality of the reviews, and grading the strength of the evidence.

Discussion.  Reviewing systematic reviews provides the scope to increase the number of topics that might be covered. However, it is possible that a number of interventions may be missed, particularly those that are not subject to review or those assessed using qualitative techniques. The definition of public health nursing used in the present study was also restrictive, and could be widened to include community interventions. Finally, assessing the quality of reviews and grading the evidence proved difficult and there is lack of consensus on how these tasks should be achieved. Nevertheless, the review presented policy makers with accessible information on a large number of relevant international studies.
Teamworking in nursing homes
Authors: Wicke Dorothy , Coppin Richard , Payne Sheila
Published: December 2004

Background.  Nursing homes have an important role in the care of frail older people, but concerns have been raised about the quality of care. High standards of care appear to be facilitated when nurses work in effective teams. Greater understanding of teamworking in nursing homes could have implications for training and policy‐making.

Aim.  The aim of the study was to explore the experiences and perceptions of teamworking with qualified nurses working in nursing homes.

Method.  This was a small, exploratory focus group study. The sample was 12 qualified nurses working in nursing homes in the south of England. Transcriptions of the focus groups were coded by the research team and agreement was achieved by discussion.

Findings.  Teams described were constructed in ‘vertical’, hierarchical terms rather than as ‘flat’, collaborative structures. The achievement of good teamworking was hindered by inadequate communication, particularly as many staff worked part‐time and on shifts. Management was perceived as remote, and lines of authority were ambiguous and unfocused.

Conclusions.  This group of nurses were aware of the difficulties of working in a hierarchical, profit‐making culture. Individually, they tried to provide good quality care for patients and aspired to teamworking, but seldom succeeded to their satisfaction. There may be considerable potential to improve the working lives of staff and quality of patient care by effective teamworking. However, significant barriers, particularly concerning organizational culture, need to be overcome.
Pain assessment in intellectually disabled people: non‐verbal indicators
Authors: Zwakhalen Sandra M.G. , Van Dongen Katinka A.J. , Hamers Jan P.H. , Abu‐Saad Huda Huijer
Published: December 2004

Background. Although important progress has been made during the past decade, research on pain in people with intellectual disabilities is still scarce. Pain assessment in people with intellectual disabilities is a frequent and difficult problem, especially for nurses working with people with intellectual disabilities on a daily basis. Gathering more information about pain in people with intellectual disabilities is of major importance and relevance for nursing, and adds to the developing body of knowledge.

Objective. To investigate the nature and relative importance of non‐verbal indicators used by nurses to assess pain in people with a severe or profound intellectual disability.

Methods. A questionnaire consisting of 158 indicators of pain was used. A total of 135 nurses from nine institutions specializing in the care of people with intellectual disability were asked to rate each indicator on a scale of 1–10 to show which non‐verbal expressions they considered important in diagnosing pain.

Results. A total of 109 nurses responded. All 158 indicators were mentioned as being important to indicate pain. All except four had a range of 9. Seven (moaning during manipulation, crying during manipulation, painful facial expression during manipulation, swelling, screaming during manipulation, not using (affected) body part, and moving the body in a specific way of behaving) were reported as ‘very important’ by more than 50% of nurses. The lowest score (median 5·5; minimum 1, maximum 10) was given to the indicator ‘waving arm movements’. The pain of people with severe intellectual disability appeared to be assessed differently from that of people with profound intellectual disability. Indicators belonging to the ‘physiological’ category scored relatively higher in the group of nurses specializing in profound disability. In contrast, indicators belonging to the ‘social‐emotional’ category were scored relatively higher by nurses specializing in severe disability.

Conclusion. Nurses used a wide range of indicators to assess pain in people with intellectual disability. Functional abilities and level of disability seem to influence the indicators used.
Use of physical restraints with cognitively impaired nursing home residents
Authors: Hamers Jan P.H. , Gulpers Math J.M. , Strik Willem
Published: December 2004

Aim.  The aim of the study was to examine the prevalence of physical restraint use in cognitively impaired nursing home residents, the manner in which restraints are used, reasons for using them, and relationships between residents’ characteristics and use of physical restraints.

Methods.  A point prevalence study was conducted on the use of physical restraints among all residents cared for in two Dutch nursing homes and one nursing home unit (n = 265). Data about the nursing home residents and the use of restraints were collected by means of a questionnaire, which was filled in by the nurses. The response rate was 98%. The mean age of residents was 81 years (sd = 8·6), 74% of whom were female.

Results.  One or more restraints were used with 49% of the residents. The most frequently used physical restraints were bed rails, a waist belt, and a chair with a table. In almost all situations (90%), residents were continuously restrained and restraints were used for longer than 3 months. The most common reason (90%) for use of restraints was to prevent falls. Logistic regression analysis revealed that use of restraints was highly associated with poor mobility, care dependency and risk of falling in the opinion of nursing staff.

Conclusions.  The results of this study are comparable with those of other studies. However, since recent studies have reported that physical restraints are inadequate to prevent falls, recommendations are made to re‐evaluate critically the use of restraints and to conduct future research into a responsible and safe way of decreasing the use of physical restraints.
Nurses’ views of using computerized decision support software in NHS Direct
Authors: O'Cathain Alicia , Sampson Fiona C. , Munro James F. , Thomas Kate J. , Nicholl Jon P.
Published: December 2004

Background.  Nurses working in NHS Direct, the 24‐hour telephone advice line in England, use computerized decision support software to recommend to callers the most appropriate service to contact, or to advise on self‐care.

Aims.  To explore nurses’ views of their roles and the computerized decision support software in NHS Direct.

Methods.  Qualitative analysis of semi‐structured interviews with 24 NHS Direct nurses in 12 sites.

Findings.  Nurses described both the software and themselves as essential to the clinical decision‐making process. The software acted as safety net, provider of consistency, and provider of script, and was relied upon more when nurses did not have clinical knowledge relevant to the call. The nurse handled problems not covered by the software, probed patients for the appropriate information to enter into the software, and interpreted software recommendations in the light of contextual information which the software was unable to use. Nurses described a dual process of decision‐making, with the nurse as active decision maker looking for consensus with the software recommendation and ready to override recommendations made by the software if necessary. However, nurses’ accounts of the software as a guide, prompt or support did not fully acknowledge the power of the software, which they are required to use, and the recommendation of which they are required to follow under some management policies. Over time, the influence of nurse and software merges as nurses internalize the software script as their own knowledge, and navigate the software to produce recommendations that they feel are most appropriate.

Conclusions.  The nurse and the software have distinct roles in NHS Direct, although the effect of each on the clinical decision‐making process may be difficult to determine in practice.
Promoting cognitive and metacognitive reflective reasoning skills in nursing practice: self‐regulated learning theory
Authors: Kuiper Ruth Anne , Pesut Daniel J.
Published: December 2004

Background.  Effective clinical reasoning in nursing practice depends on the development of both cognitive and metacognitive skills. While a number of strategies have been implemented and tested to promote these skills, educators have not been able consistently to predict their development. Self‐regulated learning theory suggests that this development requires concurrent attention to both the cognitive and metacognitive dimensions of reasoning in nursing care contexts.

Aims.  This paper reports on a study to explore the impact of self‐regulated learning theory on reflective practice in nursing, and to advance the idea that both cognitive and metacognitive skills support the development of clinical reasoning skills.

Methods.  Integrative review of published literature in social science, educational psychology, nursing education, and professional education using the Cumulative Index to Nursing and Allied Health (CINAHL), Educational Resource Information Center (ERIC), and American Psychological Association (PsychInfo) Databases. The search included all English language articles with the key words clinical reasoning, cognition, critical thinking, metacognition, reflection, reflective practice, self‐regulation and thinking.

Findings.  Reflective clinical reasoning in nursing practice depends on the development of both cognitive and metacognitive skill acquisition. This skill acquisition is best accomplished through teaching–learning attention to self‐regulation learning theory. A critical analysis of the literature in the areas of critical thinking and reflective practice are described as a background for contemporary work with self‐regulated learning theory. It is apparent that single‐minded attention to critical thinking, without attention to the influence of metacognition or reflection, is but one perspective on clinical reasoning development. Likewise, single‐minded attention to metacognition or reflection, without attention to the influence of critical thinking, is another perspective on clinical reasoning development. While strategies to facilitate critical thinking and reflective practice have been used in isolation from each other, there is evidence to suggest that they are inextricably linked and come together with the use of self‐regulated learning prompts.

Conclusions.  Students and practising nurses are able to improve their cognitive and metacognitive skills in clinical contexts by using self‐regulated learning strategies. The self‐regulated learning model in nursing is offered to support teaching and learning of reflective clinical reasoning in nursing practice contexts.
A typology of knowledge for district nursing assessment practice
Authors: Kennedy Catriona M.
Published: December 2004

Background. This paper reports on part of a larger study, the aim of which was to explore the nature of knowledge required by district nurses (DNs) to carry out first assessment visits, and the relationship of this to the decisions they make. Assessment of need is a key and complex component of the DN role. To date, there has been limited exploration of the knowledge underpinning needs assessment in district nursing practice.

Aim. The aim of this paper is to identify and categorize the knowledge in use by DNs undertaking first assessment visits, by presenting it in the form of the typology of knowledge which emerged from the study.

Methods. The study used a qualitative, ethnographic design. Eleven DNs were observed undertaking first assessment visits and interviewed twice: following the observed visit and 1 year later, after preliminary data analysis had been undertaken. Approaches to analysis were data driven, and constructing the typology involved uncovering and linking what the DN was seeing, asking and doing. Data were collected during 1997 and 1998.

Findings. The findings revealed a breadth and depth of community nursing knowledge that seemed to incorporate an amalgam of theoretical (knowing that) and practice‐based (knowing how) knowledge. The findings depict the range and scope of the knowledge in use by the DNs, and challenge the utility of theoretical models that remove knowledge from the context in which it is used and applied.

Conclusion. The findings presented here provide fresh insight into the ‘know‐how’ of district nursing assessment practice. Whilst the typology requires further testing and refinement in order to enhance understanding of practice, it conceptualizes aspects of district nursing assessment knowledge and addresses the current lack of underpinning principles in district nursing practice.
Complexity in caring for patients with advanced cancer
Authors: Tishelman Carol , Bernhardson Britt‐Marie , Blomberg Karin , Börjeson Sussanne , Franklin Liselotte , Johansson Eva , Leveälahti Helena , Sahlberg‐Blom Eva , Ternestedt Britt‐Marie
Published: December 2004

Background.  The gap between nursing research and practice is readily acknowledged in literature, with a variety of strategies suggested for reducing this gap. It is necessary not only to address problems of research implementation in practice, but also to find strategies that strengthen the influence of practitioners on research agendas through more collaborative relationships in order to have an impact on care of patients. A multi‐centre research project was therefore initiated by two universities and three health care facilities, aiming to improve quality of care for patients with advanced cancer through a knowledge‐exchange programme between nurse researchers, practitioners and students.

Aim.  The aim of this article is to explore how clinical staff reason about care provision for patients with advanced cancer, through analysis of 20 focus group discussions conducted with staff in three different health care facilities in two Swedish cities. An initial analysis based on grounded theory was complemented with consideration of the interactive process in the focus group discussions, and carried out by a team consisting of senior nurse researchers, clinical experts and nursing instructors.

Findings.  The findings of the focus group discussions emphasize the complexity of caregiving for patients with advanced cancer. The tension between caregiving ideals and limits imposed by the realities of caregiving in today's health system were striking. Practitioners discussed the organization of care, different constellations of relationships between patients, family members and professionals, and theoretical and experiential knowledge as equally important aspects in dealing with all concrete situations in daily practice. The importance of reflective practice, use of self and ethical reasoning also permeated the focus group discussions.

Conclusions.  These findings highlight an integrated need both to influence organizational structures and working relationships, along with increasing knowledge, if sustainable change is to be effected.
Improving the postnatal outcomes of new mothers
Authors: Morse Carol , Durkin Sarah , Buist Anne , Milgrom Jeanette
Published: December 2004

Background.  Postnatal depression persists worldwide as a troubling issue for many new mothers and their families. The practice of early discharge within 72 hours after birth from maternity hospitals in Australia requires community‐based care of new mothers, typically provided by community midwives initially, and then by maternal and child health nurses (MCHN). This latter workforce encounters the onset of distress/depression in vulnerable women and is expected to manage their care, but their training does not equip sufficiently them to do this.

Aims.  The aim of the study was to evaluate the effectiveness of brief training for MCHN in early detection and effective management of mildly distressed new mothers.

Methods.  A controlled comparative longitudinal study was carried out with a group of first‐time mothers recruited through antenatal clinics at four major hospitals in a large Australian city. Forty MCHN were allocated to the intervention group. Those in the intervention group received training in the identification and management of distressed mothers. Intervention group nurses also had access to a liaison psychiatric network for consultation and referrals. Other nurses were allocated to the control group, which provided standard management services to new mothers in their catchment areas. Mothers’ outcomes in psychological and psychosocial functioning were assessed; comparing those cared for by the nurses who had received the intervention with those cared for by standard practices. Mothers’ satisfaction with the maternal and child health nurse services was also assessed.

Results.  Levels of distress peaked in early pregnancy in both groups and reduced over the study period. Rates and group levels of psychological distress and psychosocial functioning did not differ over time between mothers receiving care from the enhanced trained nurses and those receiving standard care. Differential group findings were apparent in attrition, with the more distressed mothers withdrawing from the control group and the less distressed withdrawing from the intervention group. Satisfaction with maternal and child health nurse services was high in both groups. Limitations of the study included events occurring while the study was in progress, such as staffing upheaval and unrest following the introduction of compulsory competitive tendering requirements, heavy workloads and the concurrent introduction of computerized case records that required the rapid familiarization with computer usage.

Conclusions.  Findings indicate that the extra training of MCHN did not substantially assist in the detection and management of postnatal distress in these new mothers. Unexpected ecological conditions of workforce disruption and extra workloads may have mitigated against the success of the programme. Limitations of the study are examined and the implications for future research are discussed.
Successful adherence after multiple HIV treatment failures
Authors: Enriquez Maithe , Lackey Nancy R. , O'Connor Mary C. , McKinsey David S.
Published: December 2004

Background.  Non‐adherence to human immunodeficiency virus (HIV) medications often results in irreparable drug resistance and poor outcomes. Hence, care providers generally think that treatment of HIV disease should be delayed until a person is ‘ready’ to adhere. However, little research has focused on understanding the process that results in readiness for successful adherence.

Aim.  The aim of this phenomenological study was to describe and understand the experience and decision‐making processes of people who became adherent to their HIV medication regimens after previously failing treatment because of non‐adherence.

Method.  A Husserlian phenomenological approach was taken, and in‐depth interviews were analysed using Giorgi's method of phenomenological description and analysis.

Findings.  Thirteen HIV‐positive men and women who had previously failed two or more treatment regimens because of non‐adherence were purposefully selected from two infectious diseases clinics in the Midwest region of the United States. They had achieved and sustained adherence to their HIV medications for 1 year or longer without formal intervention. All participants experienced a ‘trigger’ event preceding the process that led to the ability to incorporate lifestyle and health behaviour changes necessary for successful adherence. Factors associated with the process leading to adherence were: changing attitudes towards HIV medication, finding the right health care provider, creating the right support system, getting control of life and having goals.

Conclusions.  This study demonstrated that HIV‐positive individuals who had been non‐adherent and had been viewed as ‘difficult to treat’ nonetheless successfully adhered to treatment once they became ‘ready’. Findings from this study implicate that readiness may be a necessary component for successful adherence, particularly in HIV‐positive individuals who have previously failed treatment. Understanding the relationship between the phenomenon of readiness and subsequent HIV treatment adherence has implications for clinical decision‐making and for development of interventions that enhance adherence and prevent HIV drug resistance.
Enhancing Delphi research: methods and results
Authors: Kennedy Holly Powell
Published: December 2004

Background. The Delphi method provides an opportunity for experts (panelists) to communicate their opinions and knowledge anonymously about a complex problem, to see how their evaluation of the issue aligns with others, and to change their opinions, if desired, after reconsideration of the findings of the group's work. Delphi studies have the potential to provide valuable information, yet few researchers have taken further steps to support or refine their findings. Without this step there is a potential threat to the applicability, or external validity, of the results.

Aims. The purpose of this article is to present an argument for further inquiry to enhance and support Delphi findings, and specific approaches to this will be considered.

Methods. Methods to enhance, expand, or refine Delphi study findings are described. Mixed method design within a Delphi study on midwifery practice is described, and a follow‐up narrative study to examine the findings is presented.

Findings. Selected results from the follow up narrative study are presented to convey how the narrative data clarified the Delphi findings. Together, the studies provide a more robust depiction of midwifery practice, process, and outcomes. Although there were similarities to the dimensions identified previously, there was a more dynamic focus and explanation of the interaction between the midwife, the woman who had received midwifery care, and the health care system.

Study limitations. Lack of diversity in the sample and the midwives’ familiarity with the author's past research represent a potential threat to the findings. Prolonged interviews and multiple narratives were gathered in an effort to control for this.

Conclusion. Delphi studies are research exercises conducted by a panel of experts. Designing studies to further enhance, clarify, or refine their findings from the context of practice holds promise for their ability to influence clinical care.