bluuebunny/crossref_metadata_2025 huggingface dataset:
Can concept mapping be used to promote meaningful learning in nurse education?
Authors: Irvine Lindesay M C
Published: March 2003

Recent changes in nurse education have led to a desire in nurse educators to promote meaningful learning rather than rote learning of facts A major metacognitive learning strategy that appears to promote this is concept mapping However, many nurse educators appear to be unaware of this strategy's existence, or of the research evidence available that supports the claim of promoting meaningful learning This paper sets out to address these issues It explores the nature of a concept map, the research on concept mapping and meaningful learning and possible reasons why its use has not been noticeable in nurse education By addressing these issues it is hoped that more nurse educators will attempt to use concept mapping in the promotion of meaningful learning
Measurement systems in principle and in practice: the example of nursing workload
Authors: DPhil RA Carr‐Hill , Jenkins‐Clarke S
Published: March 2003

There has been a rapid development of measurement systems in the health services in the United Kingdom (UK) over recent years, not always matched by a thorough understanding of the phenomenon being measured and rarely based on any assessment of reliability or validity A particularly flagrant example of this process is the development of nursing workload measurement systems (NWMS) The estimates from four NWMS were examined They were substantially different from each other for no obvious reason, and the difference between any of the estimates and the actual nursing hours worked could not be explained in terms of any other aspect of the nursing process There is no evidence that the NWMS deployed in the UK are anything more than an expensive numbers game, without this kind of investigation of how they actually work in practice, it would be prudent to be wary about any of the measurement systems which have been proposed Yet many of the measurement systems used in other sectors of the health service are equally untested
Alternative therapies as control behaviours used by cancer patients
Authors: Montbriand Muriel J.
Published: March 2003

Alternative health care practices are a way in which cancer patients can be in control of their illness situation. This assumption is investigated through control theory. While the socio‐cultural schemas of North American patients endorse control of illness, the stress of the cancer experience dismisses the advantage of control behaviours. Analysis also suggests that patients find ways to escape from the freedom of being in control of their health situation. This post‐analysis of a recent study uncovers major ambiguities concerning the control behaviours of cancer patients.
Assessing pain in elderly patients who cannot respond verbally
Authors: Simons Wendy , Malabar Roland
Published: March 2003

Many patients cannot respond verbally and there is noted to be an increase in disonentation and confusional states in advanced age The problem of pain assessment for this group is therefore not only a large problem but potentially a growing one A pilot study was carried out to validate a chart for the assessment and control of pain using observed pain behaviours The researchers studied elderly patients with a variety of medical problems on three wards The study was done by observing pain behaviours, carrying out pain intervention and re‐observing later to verify the effectiveness or otherwise of the intervention If this had been successful in moderating the behaviours it could reasonably be inferred that a method of monitoring and comforting verbally unresponsive patients had been found
A descriptive and exploratory pilot study into school re‐entrance for adolescents who have received treatment for cancer*
Authors: Glasson Joanna E
Published: March 2003

The purpose of this exploratory and descriptive pilot study was to explore the process of school re‐entrance for adolescents receiving outpatient treatment for cancers, using grounded theory All adolescents who had received a minimum of 3 weeks’ hospital‐based schooling, but had since returned to their own schools, and were booked for an outpatient appointment on a paediatric oncology unit during a specified 2‐week period, took part in an audio‐tape‐recorded, semi‐structured interview The sample consisted of five such adolescents Data were analysed using the constant comparison method of grounded theory Certain recognizable trends were noted leading to the development of a core variable to which other categories and their properties related Central categories identified were ‘disruption’, ‘adaptation’ and ‘normality’, with this latter concept considered to be the core variable Findings highlighted problem areas which are discussed and issues requiring further detailed investigation This led to an undertaking of theoretical sampling into hospital‐based schooling, as well as suggesting theoretical sampling for future studies
Evaluation of a nurse‐led acute pain service. Can clinical nurse specialists make a difference?
Authors: Mackintosh Carolyn , Bowles Sandra
Published: March 2003

This paper attempts to identify the impact of a nurses‐led in patient acute pain service (APS) on three areas of concern; pre‐operative information, patients self reported levels of pain, and analgesics prescribed. It considers the results of a baseline survey carried out in 1992 And its replication in 1995, in an attempt to assess the impact this service may have had. Results appear to indicate some changes in all areas of concern, with significant reductions in reported levels of pain and patterns of analgesic prescribing between the two surveys. It there fore appears within the constraints of this type of study, that the work of the nurse‐led APS has had a significant impact on changing outcomes and improving quality of patient care.
The problems of researching mixed sex wards
Authors: Batcup Dawn
Published: March 2003

The following paper discusses the process of doing research on a sensitive and politically charged topic; ‘mixed sex’ psychiatric wards. It also highlights the conceptual and methodological difficulties of carrying out this enquiry. The particular deconstruction presented is suggested as knowledge or data alone, even though they are rarely found in finished research projects. It starts by setting the broader context of the research at The Bethlem and Maudsley Trust by looking at National policy, other studies in this subject area and media attention. It shows the triggers that caused a re‐evaluation and changes in the original research question and assumptions about ‘mixed sex’ wards. It accounts for the research as it happens, rather than presenting a sanitised process of discovery. This forms the basis for describing some of the dilemmas for carrying out the in‐depth research; showing how the reconfigured research subject became focused on the safety and effectiveness of ‘mixed sex’ wards for women. The grounded methodological approach to this study is outlined and the paradoxes it identified in psychiatric discourse are mentioned. Exerts of findings from the three separate research studies at The Bethelem and Maudsley Trust are given and discussed. The conclusion analyses the complexities of the subject and suggests that the ‘mixed sex’ ward problem may be the contemporary emergence of a much older and fundamental problematic inherent to psychiatry. Consequently, no simple answer is recommended.
Nursing care as a calling
Authors: Raatikainen Ritva
Published: March 2003

A calling is a deep desire to devote oneself to serving people according to the high values of the task or profession. The aim of this study is to clarify the relationship between a calling experience and professional knowledge, nursing action and motivation. The data were collected from all the registered nurses (n=179) at five hospitals. The response was 70%. The nurses who were committed to their profession and experienced their job as a calling, had a good knowledge about the ill feeling and maladjustment of their patients and were also good sources of support for their patients. They understood the importance of family ties and offered support to their patients' families. They were aware of the needs of dying patients and their concern with spiritual questions, and satisfied these needs well. It was characteristic for them to collaborate closely within a team, to experience the content of their work as enriching and to possess proficient professional abilities. They were therefore excellent in supporting both the individual patient and his or her family. They had a deep understanding of the whole process of patient care. According to these results the calling experience is not in conflict with professional principles.
Choosing the choices in the USA: examples in the maternity area
Authors: Mander Rosemary
Published: March 2003

The concept of choice has featured prominently in both the recent united Kingdom (UK) health care reforms and in the debate relating to the care of childbearing women. An invitation to the USA facilitated contemplation of the health care system on which the recent UK reforms have been modeled. The impact of the health system on mother's choices was a source of particular interest. The implications for midwives, their practice and their relationships with their clients and colleagues emerge clearly. It may be that the United States' model of health care does not answer the needs of the UK.
The problems of elderly people at home one week after discharge from an acute care setting
Authors: Mistiaen P. , Duijnhouwer E. , Wijkel D. , Bont M. de , Veeger A.
Published: March 2003

The problems of elderly people following discharge from hospital is a worldwide focus of nursing attention. Actual and local insight into the nature worldwide focus of nursing attention. Actual and local insight into the nature and extent of post‐discharge problems is needed as a base for improving and evaluating discharge planning. Problems following discharge were investigated as the first part of a larger study. Over a 3‐month period, 251 elderly people who had been discharged after a hospital stay of more than 3 days. Were asked to participate in the study. Half received a postal questionnaire and half were interviewed at home, one week after discharge. There were 145 respondent. The need for information was mentioned by 80% of the patients. Housekeeping tasks also caused most patients some difficulty. Almost 40% of those discharged reported some kind of unmet need.
Long‐term indwelling urinary catheter care: conceptualizing the research base
Authors: Wild Mary H.
Published: March 2003

The traditional public health concepts of agent, host, and environment can provide a useful interdisciplinary model for analyzing the current state of knowledge in long term indwelling urinary catheter care. A broad review of literature about urinary catheter care was carried out to identify major areas of research and gaps in knowledge. Most research in the past decade has focused on understanding how catheter encrustations develop and how such encrustations may contribute to leaking/blocking of the catheter and urinary tract infection. Two tables are presented which summarize research related to the development of sediment/encrustation of the catheter and to irrigation of the catheter. Nevertheless, many areas related to catheter care have not been studied extensively. The patient's perspective is one such area. Other areas that have not been studied in depth in depth include care of the drainage bag and the role of fluid intake. These under‐studied concerns relate to environmental factors with which the nurse is directly involved, namely, asepsis and hydrokinetic forces. Further conceptualization of the nursing role in long‐term urinary catheter care might aid in the development of nursing theories that could be tested to understand how best to help people manage these catheters.
Tube feeding dilemmas: can artificial nutrition and hydration be legally or ethically withheld or withdrawn?
Authors: Goodhall Lesley
Published: March 2003

The incidence of elderly patients receiving long‐term artificial nutrition and hydration via a percutaneous endoscopic gastrostomy (PEG) feeding tube is increasing. The wisdom of this practice is debatable when poor quality of life is often the outcome, and this has resulted in a dichotomy of opinions. The legal and ethical implications of withholding or withdrawing life‐sustaining nourishment, however, appear to be formidable. This paper examines the judicial trends and the ethical reasoning which influence health care professionals, and attempts to answer the question ‘can artificial hydration and nutrition be legally or ethically withheld or withdrawn?’ The value of advance directives and surrogate decision‐making for non autonomous patients is considered, and the quality of life concept is discussed. A bias towards the reductionist male ethos may exist and may be influencing the developing case law. It is recommended that the nursing profession helps to redress the imbalance by becoming more active in ethical decision‐making.
Nurses' reflections on problems associated with decision‐making in critical care settings
Authors: Bucknall Tracey , Thomas Shane
Published: March 2003

The present study investigated nurses' perceptions of the problems associated with their decision‐making in critical care settings. This paper reports a survey of 230 Australian practicing critical care nurses. In responses to a set of structured questions concerning various difficulties in making decisions, it was found that between 22 and 56% of nurses reported to be experiencing difficulties on a weekly or more frequent basis ‘due to knowledge base’, and ‘personal values conflicts with other staff’, Nearly one‐third (30.3%) of the respondents indicated that they disagreed with other staff who were responsible for making decisions in their units on at least a weekly basis. The nurses were also invited to comment in writing on their concerns in a variety of areas. Major sources of nurse dissatisfaction included: treatment decisions for patients with poor prognoses; disharmony with medical staff concerning decision autonomy issues, especially with junior doctors; time constraints on nursing care; the demands of new intensive care technology upon the nurses' knowledge bases; and the need for in‐service education to address this problem. The paper concludes with arguments for the use of in‐depth interviews to further study these issues.
Identification of nursing management diagnoses
Authors: Morrison Ruby Shaw
Published: March 2003

Theories from nursing and management provide frameworks for enhancing effectiveness of nursing management practice. The concept nursing management diagnosis has been developed by integrating nursing diagnosis and organizational diagnosis as a basis for nurse manager decision‐making. Method triangulation was used to identify problems of managing nursing units, to validate those problems for relevancy to practice, to generate nursing management diagnoses, and to validate the diagnoses. Diagnoses were validated according to a definition of nursing management diagnosis provided. Of the 72 nursing management diagnoses identified, 66 were validated at a 70% level of agreement by nurse managers participating in the study.
Patients' needs in hospital: nurses ‘and patients’ views
Authors: Lauri Sirkka , Lepistö Mervi , Käppeli Silvia
Published: March 2003

This study set out to identify the most important needs of hospital patients on surgical and medical wards and to assess the ability of nurses to identify these needs. The population consisted of 92 Finnish patients and 69 Finnish nurses. The study was carried out using a questionnaire designed on the basis of the need theory presented by Yura and Walsh. The results of the statistical analyses were presented in the form of frequencies, cross‐tabulation and chi‐square tests. The patients' most common needs were related to vital functions (44%), followed by those related to functional health status (38%) and environmental needs (36%). The last item on the list of expressed needs concerned reactions to functional health status (31%). Over 70% of the surgical patients suffered from problems related to sleep and rest. Less than 60% of them suffered from acute pain. Medical patients, in turn, had more frequent needs related to vital functions than did surgical patients. Three out of four medical patients suffered from acute pain. Sleep and rest disturbances, stress, bad mood and listlessness were also common problems. The nurses underestimated all patient needs, apart from environmental needs, which they regarded as the main concern of patients. There was a statistically significant difference between patients ‘and nurses’ assessments for 38% of all needs. Moreover, there were differences in assessments between the surgical and medical wards included in the study.
Nursing students ‘response to self‐directed learning: an evaluation of a learning process applying Jarvis’ framework
Authors: Pedley Gillian E. , Arber Anne
Published: March 2003

This paper evaluates the effectiveness of a student‐centred module of learning using Jarvis ‘experiential framework. One hundred and thirty‐five students undertook the module over a 9‐month period. A semi‐structured questionnaire was used to explore students’ learning, choice of topic, structure, and benefit of the module. The data were analysed using simple descriptive statistics and content analysis. A key theme emerged related to the beneficial learning experience. Presentation skills/shared learning, choice and autonomy, taking responsibility, and research skills were other themes that emerged. Whilst the literature suggests students dislike experiential forms of learning, the positive evaluation of this module demonstrates that it can be used effectively. Furthermore, Jarvis' model provides a useful framework for structuring this approach to learning. One of the research strategies within a nursing faculty should be to develop progressive student‐focused educational methods and evaluate their effect on professional preparation. This, it is argued, needs to be perceived as a valuable and essential activity within an academic nursing department.
Constructing career pathways in nursing: some issues for research and policy
Authors: Robinson Sarah , Murrells Trevor , Marsland Louise
Published: March 2003

Nurses currently construct careers in a climate of continuing occupational and organizational change. A longitudinal project is in progress which is documenting the post‐qualification histories of a cohort of registered general nurses, and studying the extent to which their careers represent occupational choice, a response to organizational constraints, or a combination of both. Three elements comprise the core of the research: questions which provide information on the cohort's career plans, charts which document their career histories and questions which explore the relationship between the two. The basis of the design is the first element, and this paper focuses on the problems encountered in designing the questions and routeing structures which enabled all cohort members to describe their plans for the future.

The importance of extensive pilot work is demonstrated in the development of options tailored for each potential career pathway and to allow expressions of uncertainty to emerge at points when appropriate to respondents. Of the 1164 members of the cohort, 1015 returned the questionnaire; a response rate of 87%. Findings are presented on the cohort's plans at qualification. The majority of respondents (86%) saw themselves as remaining in nursing and in clinical practice in the early post‐qualification period. Eighteen per cent said they intended to practise abroad at some point, 30% foresaw a likelihood of working in the private sector, 59% wanted to take one or more English National Board courses and 42% expressed interest in obtaining an undergraduate or postgraduate degree.
The human science basis of psychiatric nursing: theory and practice
Authors: Barker P. J. , Reynolds W. , Stevenson C.
Published: March 2003

Psychiatric nurses in the United Kingdom (UK) have begun to reattend to people with ‘serious and enduring mental illness’. At the same time research in the USA and UK has refocused much of its attention on neuroscientific theories and models of serious mental illness. Psychiatric nurses are being encouraged to consider the value of biomedical explanations of serious illness, such as schizophrenia, and to accomodate these theories and models in the practice of nursing. This paper will examine the challenge of the biomedical approach for the continued development of psychiatric nursing theory and practice. It is proposed that psychiatric nursing needs to develop further its own ‘proper focus’, if it is to survive as a key player in the health care field of the 21st century.
Disseminating research evidence. A controlled trial in continence care
Authors: Williams Kate S. , Crichton Nicola J. , Roe Brenda
Published: March 2003

The dissemination of research evidence from which clinical practice should be based poses many well‐documented problems for nurses. This study set out to overcome some of the common barriers to dissemination by providing a research‐based clinical handbook for continence care. The impact of the handbook on nurses’ knowledge of both urinary and faecal incontinence was tested using an experimental and control group. The experimental group received the handbook while the control group did not. Both groups completed an assessment questionnaire at week 1, prior to the intervention in the experimental group, followed by a second assessment at week 7 after the intervention in the experimental group. Data were collected using semistructured questionnaires. Statistically significant improvements in knowledge were found for those nurses who received a copy of the handbook, and nurses reported that they found the handbook useful and acceptable as a form of clinical updating. The dissemination of research findings is essential if evidence‐based nursing is to become a reality, and this study clearly demonstrates one method by which this can be successfully achieved.
The impact of prematurity and neonatal illness on the decision to breast‐feed
Authors: Jaeger Marie Christine , Lawson Margaret , Filteau Suzanne
Published: March 2003

This paper reports on a qualitative and quantitative cross‐sectional study of infant feeding practices made in three neonatal intensive care units. Findings from interviews with 44 mothers of diverse ethnic origin, social class, age and gestation at delivery are reported. All the mothers interviewed had at some time provided breast milk and rates of breast‐feeding on these units were higher than the national average. Eight mothers reported changing their mind about feeding methods after their baby was admitted, including three changes from formula to breast‐feeding. Mothers’perceptions with regard to milk expression and their expressing history gave indications of factors underlying decisions to provide breast milk and the quality of support to do so. While mothers considered overall support to have been good, notably 35% of mothers had themselves suggested that they express milk, nearly half did not start expressing for 2 or more days, 43% expressed fewer than four times a day and 48% of mothers had received conflicting advice. There were some difficulties with both the hospital facilities and with expressing milk at home. There is a need for more consistent advice and practical help to be given to mothers.
A study to ascertain gynaecological patients' perceived levels of embarrassment with physical and psychological care given by female and male nurses
Authors: Lodge Nicholas , Mallett Jane , Blake Peter , MSc Ian Fryatt
Published: March 2003

Ths sex Discrimination Act lifted the barriers which prevented men from training and practising as midwives. However, cultural attitudes perceive nursing to be a female profession, and whilst care from a male doctor is considered to be acceptable, care from a male nurse is said to be embarrassing. The purpose of the study was to identify if there was any relationship between the intimacy of a nursing interaction and the patient's level of embarrassment. Data collection was by questionnaires with rating scales. Demographic data was obtained from ursing and medical notes. Statistical analysis was performed by non‐parametric methods using Mini‐tab. Ninety‐one questionnaires were returned from a convenience sample of patients on a gynaecological oncology ward. Analysis of the data indicates that in a population of patients who have no prior experience of hospital admission, or of being cared for by a male nurse, there is a preference for care by a female nurse. However, this preference is not demonstrated in patients who have undergone previous hospital admission within the last five years or who have been cared for by a male nurse. These findings would indicate a cultural preference for care by a female nurse in patients with gynaecological cancer that is changed by experience during hospital admission.
Becoming a mother — an analysis of women's experience of early motherhood
Authors: Barclay Lesley , Everitt Louise , Rogan Frances , Schmied Virginia , Wyllie Aileen
Published: March 2003

This paper presents the results of a qualitative study conducted by midwife researchers into women's experience of new motherhood. Data were collected using focus groups involving 55 first‐time mothers and analysed using grounded theory method. The analysis produced six categories: ‘realizing’, ‘unready’, ‘drained’, ‘aloneness’, ‘loss’ and ‘working it out’. The core category, ‘becoming a mother’, integrates all other categories and encapsulates the process of change experienced by women. Also explained are factors mediating the often distressing experience of becoming a mother. The analysis provides a conceptualization of early motherhood enabling the development of strategies for midwives, nurses and others helping women negotiate this challenge.
Peppermint oil: a treatment for postoperative nausea
Authors: Tate Sylvina
Published: March 2003

This paper describes a research study to investigate the efficacy of peppermint oil as a treatment for postoperative nausea. It uses a three‐condition experimental design using statistical analysis to compare groups. The Kruskal–Wallis test was used to establish significance and the Mann–Whitney test to differentiate significance between the groups. The control, placebo and experimental groups of gynaecological patients were compared, using variables known to affect postoperative nausea. They were found to be homogeneous for the purposes of the study. A statistically significant difference was demonstrated on the day of operation, using the Kruskal‐Wallis test, P= 0·0487. Using the Mann‐Whitney test the difference was shown to be between the placebo and experimental group (U=3; P= 0·02). The experimental group also required less traditional antiemetics and received more opioid analgesia postoperatively. The total cost of the treatment was 48 pence per person.
Incomplete holism in pre‐registration nurse education: the position of the biological sciences
Authors: Wynne Nigel , Brand Stuart , Smith Roy
Published: March 2003

There is an ongoing debate in nurse education concerning the role and delivery of the biological sciences in the nursing curriculum. One of the fundamental questions raised by this debate asks how best can teachers impart biological knowledge in a manner that can be readily applied by students and qualified nurses to inform their clinical practice. This paper will include a discussion of some of the features of pre‐registration education that may have influenced the manner in which biological sciences are perceived, taught and used by nurses. It will be argued that nursing may have developed a form of incomplete holism and that this may be in part responsible for the challenges that remain to be met within this area of the nursing curriculum. As a response to incomplete holism an innovative approach within pre‐registration education will be introduced. This development involves the use of linked teaching sessions which aim to develop the analytical skills necessary to apply physiological knowledge to nursing practice.
Clinical nurse specialists and quality patient care
Authors: Chuk Peter Kai‐Cheung
Published: March 2003

Clinical nurse specialists (CNSs) deliver expert patient care that is based on advanced nursing models with two important characteristics, clinical judgement and leadership, as summarized by Spross & Baggerly. To utilize the clinical judgement for the benefit of patients, CNSs stay within the realm of direct patient care. The leadership of CNSs is demonstrated by their subroles. When CNSs directly and indirectly provide patient care, the quality of care is improved. This is a result of (i) the important changes of specialization in nursing, (ii) the pivotal role of CNSs in direct patient care, and (iii) the subroles of CNSs that experienced registered nurses (RNs) may not have.
Clinical leadership in nursing development units
Authors: Christian Sara L. , Norman Ian J.
Published: March 2003

There is an expectation for Nursing Development Units (NDUs) to explore and develop the clinical leadership role. This paper describes how 28 Department of Health funded NDUs in England sought to meet this objective. We describe the personal and professional characteristics of NDU clinical leaders (CLs) and their perceived responsibilities. We identify 10 elements which appear to be central to the CL role and together form a core role set of the leader which is applicable, to some extent, across clinical specialties and settings. The position of the CL in the organizational hierarchy emerges as crucial to his/her ability to act on these responsibilities and fulfil a leadership role.
Changes in nursing students’ perceptions of nursing as they progress through their education
Authors: Manninen Elsa
Published: March 2003

Nursing education has shifted from the biomedical approach towards using a human scientific model. At the same time, the traditional role of nurses has changed towards professionalism owing to the development of nursing science. The purpose of this longitudinal study was to examine Finnish nursing students’ perceptions of nursing after 6, 18 and 30 months of education and at the end of the education programme. The sample consisted of 158 students selected by means of stratified sampling from six specialities in nursing. Data were collected with a questionnaire from 26 institutes. The summarized variables were based on factor analysis and analysed by one‐way analysis of variance. The students had assimilated nursing as activity which promotes human health and well‐being and is based on professionalism. The medical‐technical model was not predominant at any phase of the education. The students of six specialities differed only slightly from each other. The students’ development was congruent with the aims outlined in the curriculum.
The treatment of pressure sores: a comparison of novice and expert nurses’ knowledge, information use and decision accuracy
Authors: Lamond Dawn , Farnell Sarah
Published: March 2003

The knowledge experts have and the way it is organized is thought to affect their decision accuracy and the information they use to make decisions. This exploratory study examines the information used by experts, the way they organize their knowledge and their decision accuracy when considering treatments for pressure sores. A convenience sample of 14 subjects (seven experts and seven novices) were given a card sorting task and a decision task. The cards for the sort contained photographs of pressure sores and various dressings, which the subjects had to place into meaningful categories. In the decision task they were given a photograph of a pressure sore, together with various items of information which could be used to make a decision about the appropriate treatment for the pressure sore. The accuracy of the subjects’ decisions were compared to a ‘gold standard’ decision formulated by an expert panel. Results indicated that experts were more accurate in their choice of treatments in the decision task, and also focused on specific items of information to make their decisions. The accuracy of their decisions was not linked to the categorization strategy used in the card sorts. The findings from this study indicate that more research into the way in which such treatment decisions are undertaken needs to be carried out. Specifically, the way in which education into wound care treatments affects decision accuracy needs to be identified, and ways of aiding individuals to focus on relevant information explored.
Successive surveys of an expert panel: research in decision‐making with health visitors
Authors: Lemmer Bill
Published: March 2003

A United Kingdom expert panel was consulted to develop a self‐completion instrument for research on decision making in health visiting practice. The use of a Delphi‐type technique demonstrated how a stand‐alone postal survey was an insufficient measure for health visitors, requiring a supplementary follow‐up method to study types of casework. A review of literature raised questions about the significance of intuitive thinking and reasoning in health visitor practice, in relation to measuring professional service and individual performance.
A review of the outcome of stoma surgery on spinal cord injured patients
Authors: Craven Mary L. , Etchells J.
Published: March 2003

A study was conducted to determine the short‐term and long‐term outcome of stoma formation on spinal cord injured (SCI) patients. Twenty‐seven medical records of SCI patients with colostomy, ileostomy or urostomy were reviewed. Eighteen SCI patients were then interviewed or completed a comprehensive questionnaire to determine the physical and psychological effects of the surgery and to assess changes in lifestyle due to the formation of the stoma. It was found that bowel and bladder management was greatly improved in most cases, resulting in improved quality of life for these patients. Other positive psychological effects were noted and the question of a colostomy being offered earlier in the rehabilitation of the SCI patient was raised.
The debates emerging from the literature surrounding the concept of spirituality as applied to nursing
Authors: McSherry Wilfred , Draper Peter
Published: March 2003

This paper explores three debates surrounding the growing concept of spirituality as applied to nursing: ‘Spirituality: in pursuit of conceptual and theoretical unity’; ‘The demise of spirituality and the rise of secularism within nursing’; and ‘Spirituality: a unifying force at the foundation of holistic philosophy’. The debates reveal the complex and diverse nature of spirituality suggesting that there is no single authoritative definition. The debates challenge the nursing profession to develop a definition of spirituality which is broad enough to accommodate the uniqueness of all individuals.
Connection: an exploration of spirituality in nursing care
Authors: Golberg Bernice
Published: March 2003

This paper aims to explore the meaning of spirituality in relation to nursing care using concept synthesis. Walker and Avant give three ways in which concept synthesis can occur: discovering new dimensions to old concepts, searching for similarities and discrepancies among sets of related concepts, and observing previously undescribed phenomena. It is the first two of these methods which have been used here. The phenomena that emerged from a reading of the literature around spirituality were meaning, presencing, empathy/compassion, giving hope, love, religion/transcendence, touch and healing. These phenomena were studied in order to sort them into fewer categories. They all appeared to be products of a relationship, some physical (presencing, touch and healing), and others emotional (meaning, empathy/compassion, hope, love, and religion/transcendence). Some of the phenomena appeared to fit in both categories, especially healing, which could be of a physical or emotional/spiritual nature. Once the two main categories had been arranged, it was obvious that a split between psyche and soma was not appropriate for labelling the spiritual dimensions of nursing care, as the original definition of spirit was something which motivated the body. Spiritual care is inseparable from physical, social and psychological care because together they form the whole ( Bradshaw 1994 p. 282). The two categories were then collapsed into one and given the label ‘connection’.
An adjusted version of Kohlberg’s moral theory: discussion of its validity for research in nursing ethics
Authors: Dierckx de Casterlé Bernadette , Roelens Agnes , Gastmans Chris
Published: March 2003

Critics of Kohlberg’s moral theory today focus on the content of his theory and more specifically on its justice‐orientated moral concept. This has led to the well‐known ‘justice‐care debate’. The purpose of this article is to critically examine the validity of Kohlberg’s moral theory for research in nursing ethics from a caring perspective (referring to the content) as well as from a cognitive‐structural perspective (referring to the basic assumptions of the model). The analysis points to the usefulness and value of the cognitive‐structural model to empirically study nurses’ ethical behaviour; the content of Kohlberg’s model, however, needs to be adapted by adding a caring perspective as well as some personal and situational variables. An adjusted version of Kohlberg’s model is proposed and discussed.
Pain and powerlessness: the experience of living with peripheral vascular disease
Authors: Gibson Josephine M. E. , Kenrick Maria
Published: March 2003

Peripheral vascular disease (PVD) is a widespread condition, the most common manifestation being a gradual occlusion of the arteries of the legs due to atheroma, which results in symptoms of ischaemia such as intermittent claudication or rest pain, ulceration and gangrene. Treatment of the condition is palliative and reconstructive, and aims to salvage the limb, restore mobility and function, and relieve pain. It usually involves attempts to revascularize the affected limb, either by surgical procedures such as bypass grafting, or by percutaneous transluminal angioplasty or thrombolysis. In some cases, it may be necessary to amputate the limb or part of it. Despite the chronicity of PVD, little is known about the ways in which individuals with vascular disease cope with their condition and about the effect it has on their life. In this context the aims of this study were to explore the lived experience of peripheral vascular disease, in order to identify key themes and categories, using a phenomenological grounded theory approach. A sample of nine individuals was drawn from patients who had had vascular bypass surgery within the past 18 months. Data were collected using audiotaped one‐to‐one interviews and the researcher’s field notes, and were validated with a group of experienced vascular nurses. Transcripts were analysed using open and axial coding techniques, and major and minor categories were identified and related to other data collected. It appeared that vascular patients experienced powerlessness in relation to the direct effects of their condition and in relation to its treatment modalities. The findings suggested that the ‘acute’ style of management of PVD often led to unrealistic expectations on the patient’s part, which gave rise to the experience of powerlessness. The implications of these findings for the management of patients with PVD are discussed.
Learning about reflection
Authors: Smith Ann
Published: March 2003

Learning about reflection An understanding of the nature and function of reflection in recognizing and developing nursing knowledge is a key concern. This paper describes a longitudinal study investigating the ways in which undergraduate student nurses reflected about practice as they progressed through a 3‐year programme in adult nursing. The method was qualitative, with data gained from written critical incidents based on practice experiences and classroom discussions, and analysed using the constant comparative method. Findings revealed the range of issues students perceived as most important, and to some extent, changes in levels of thinking. A strong theme occurring throughout related to the complexity of learning what it means to be a professional and, in consequence, what they learn about themselves. Students’ preoccupation with emotional aspects of learning and nursing care was evident. They had difficulty in disentangling ‘personal’ and ‘professional’ involvement but later data indicates that they had begun to learn to differentiate between involvement as a general characteristic of nursing practice and a overwhelming personal attachment. They generally use their own and each others’ experiences to examine meaning, in preference to formal theoretical explanations although there is evidence students moved from acceptance of information to the questioning and critiquing of arguments and professional assumptions, particularly concerning their relevance and appropriateness for practice.
Intervening to reduce anxiety for women with mild dyskaryosis: do we know what works and why?
Authors: Somerset Maggie , Peters Tim J.
Published: March 2003

In the United Kingdom women are encouraged to attend their general practice for cervical smear testing. Those who subsequently receive a mildly dyskaryotic result are placed under surveillance for 6 months before a further test is carried out. Receipt of a mildly abnormal result has been found to create anxiety in some women although it is suggested that this may be relieved by a specifically designed educational intervention. The qualitative investigation reported here explored the interaction which occurred during 10 nurse‐patient consultations during which a practice nurse presented an educational intervention designed to relieve anxiety delivered as part of a randomized controlled trial. The investigation highlights factors relating to aspects of the intervention perceived by patients and nurses as successful and as unsuccessful. Implications for the management of women with mildly dyskaryotic results and for future nurse‐led educational interventions are proposed. The need for appropriate training for practice nurses is underlined. It is suggested that training should aim to assist the nurse to identify the patient’s needs in order that interventions can be individually tailored and delivered effectively without creating anxiety with regard to other aspects of health.
The impact of participation in a study abroad programme on students’ conceptual understanding of community health nursing in a developing country
Authors: Inglis Alistair , Rolls Colleen , Kristy Susanne
Published: March 2003

The impact of participation in a study abroad programme on students’ conceptual understanding of community health nursing in a developing country A pilot study was undertaken to ascertain the changes in conceptual understanding that resulted from participation in a study abroad programme in Chiang Mai in Thailand of a small group of Australian final year nursing students. Students’ conceptual understandings were measured by means of open‐ended interviews based on a case study scenario describing health conditions in a hypothetical Thai village. Students were asked to imagine that they had been appointed to work as a community health nurse in the village and describe how they would undertake the task. Shifts in understanding were detected by interviewing the participants before, during and after their participation in the programme and comparing their responses. The results of this limited study indicated that the impact of participation in the programme was less than expected. Furthermore, the factors of which students tended to show greatest awareness were those about which they had been briefed prior to departure. Nevertheless participants reported they had learnt much from their experiences. It is suggested that the discrepancy between the evidence provided by interview data and students’ self‐reports may be explained by participation having resulted primarily in the acquisition of the tacit rather than conceptual knowledge.
An exploration of anticipatory grief: the lived experience of people during their spouses’ terminal illness and in bereavement
Authors: Duke Susan
Published: March 2003

An exploration of anticipatory grief: the lived experience of people during their spouses’ terminal illness and in bereavement Anticipatory grief has been the subject of much debate since Lindemann first coined the term to describe premature mourning. Much of the research in this area takes a positivist approach focusing on the effect of anticipatory grief on bereavement. In contrast, this study, explores anticipatory grief through a Heideggerian phenomenological approach to elicit the experience of anticipatory grief. Unstructured interviews were conducted with four participants. The resulting data were interpreted using hermeneutics and evaluated using the criteria identified by Madison. The themes arising from this interpretation identify the change the participants experienced. Although these findings are limited to four participants, they are offered to raise awareness of the impact of multiple role loss and the impact of diagnosis on supporting partners. The findings also raise ways in which nurses might support people experiencing loss.
It hurts most around the heart: a phenomenological exploration of women’s anger
Authors: Thomas Sandra , Smucker Carol , Droppleman Patricia
Published: March 2003

Women’s anger experience has been poorly understood and insufficiently researched. Yet the emotion of anger is vitally important to women’s physical and mental health, and to the quality of their relationships. This phenomenological study was undertaken as an expansion and extension of the Women’s Anger Study, the first large survey of the genesis, manifestations and correlates of anger in American women. Although the earlier study contributed to understanding of anger, a deeper examination of the context and meanings of anger experience was sought. Twenty‐nine Caucasian women ranging in age from 21 to 66 years were interviewed. Illustrative occupations ranged from homemaker, student, waitress to business executive, professor, and human service professional. Analysis involved thematizing by the researchers independently and within a multidisciplinary phenomenological research group. The thematic structure of women’s anger involved a building over time of a confusing mixture of feelings (hurt, frustration, disillusionment) precipitated by a violation of the core values of the self. The precipitant of anger was unfair and/or disrespectful treatment or lack of reciprocity in relationships. When the anger was confined within self, the woman felt helpless and powerless. However, powerlessness was also evident when anger was externalized in an outburst. To the study participants, an angry outburst meant a loss of control rather than ability to achieve control. Women reported a sense of power when using anger to restore justice, respect, and relationship reciprocity. Clinicians can assist women to reflect on their core values and use the power of their anger effectively. Further studies are in progress to examine the relevance of these findings for women of other races and cultural contexts.