bluuebunny/crossref_metadata_2025 huggingface dataset:
Low-Dose Aspirin Affects the Clinicopathological Features of Gastric Cancer
Authors: Hwang Hye Jin , Youn Young Hoon , Kim Jie-Hyun , Chung Jae Bock , Lee Yong Chan
Published: March 2006

Background/Aims: There have been investigations on the chemopreventive effect of nonsteroidal anti-inflammatory drugs (NSAIDs) in gastric cancer and also on the association between cyclo-oxygenase 2 expression and the clinicopathological features of gastric cancer. However, it is not yet clear whether the cardioprotective properties of low-dose aspirin could affect the biological behavior of gastric cancer. This study was aimed at investigating the association between the use of low-dose aspirin and clinicopathological features of gastric cancer in human. Method: A case-control study was performed retrospectively by comparing the clinicopathological parameters between two groups of gastric cancers, 47 (30.5%) low-dose aspirin users and 107 (69.5%) non-aspirin users who were diagnosed and underwent operation for gastric cancers. Results: The gastric cancers of aspirin user group showed favorable clinicopathological features, such as earlier tumor stage (overall stage, T and N stage: p < 0.001, <0.001, and 0.002, respectively), smaller size (p = 0.03), and intestinal type rather than diffuse type (p = 0.004). But these differences were significant only in non-cardiac cancer while cardiac cancer patients showed no significant association with low-dose aspirin usage (overall stage, T stage, N stage, tumor size, and histological type: p <0.001, <0.001, 0.003, 0.035, and 0.004, respectively, by Cochran-Mantel-Haenszel statistics). Conclusion: The use of low-dose aspirin might affect the clinicopathological features in gastric cancers, and possibly have a favorable protective effect on the progression of gastric cancer in a subset of non-cardiac gastric cancer patients.
Early Lymph Vessel Development From Embryonic Stem Cells
Authors: Kreuger Johan , Nilsson Ingrid , Kerjaschki Dontscho , Petrova Tatiana , Alitalo Kari , Claesson-Welsh Lena
Published: March 2006

Objective—

The purpose of this study was to establish a model system for lymph vessel development based on directed differentiation of murine embryonic stem cells.

Methods and Results—

Stem cells were aggregated to form embryoid bodies, and subsequently cultured in 3-dimensional collagen matrix for up to 18 days. Treatment with vascular endothelial growth factor (VEGF)-C and VEGF-A individually enhanced formation of lymphatic vessel structures, although combined treatment with VEGF-C and VEGF-A was most potent and gave rise to a network of LYVE-1, podoplanin, Prox1, and VEGF receptor-3 positive lymphatic vessel structures running parallel to and apparently emanating from, capillaries. In contrast, fibroblast growth factor-2, hepatocyte growth factor, or hypoxia had little or no effect on the development of the early lymphatics. Further, cells of hematopoietic origin were shown to express lymphatic markers. In summary, different subpopulations of lymphatic endothelial cells were identified on the basis of differential expression of several lymphatic and blood vessel markers, indicating vascular heterogeneity.

Conclusions—

We conclude that the present model closely mimics the early steps of lymph vessel development in mouse embryos.
Race and Ethnicity in the Era of Emerging Pharmacogenomics
Authors: Harty Lea , Johnson Keith , Power Aidan
Published: March 2006

Race and ethnicity are terms that are commonly used to categorize subjects in medical research. Advances in genetics and the emerging discipline of pharmacogenomics have brought these terms under scrutiny, with arguments either for the continued use or for the abandonment of these terms generating strong views. As pharmacogenomics research develops, we may find that more accurate and specific descriptions of relevant variation in genes will reduce the value that these imprecise descriptors have in predicting how people will respond to drug therapies.
Safety, Tolerability, and Exposure of Ciclesonide Nasal Spray in Healthy and Asymptomatic Subjects With Seasonal Allergic Rhinitis
Authors: Nave Ruediger , Wingertzahn Mark A. , Brookman Sheldon , Kaida Shigenori , Matsunaga Takashi
Published: March 2006

Ciclesonide is an intranasal corticosteroid in development for the treatment of allergic rhinitis. To assess the safety, tolerability, and pharmacokinetics of ciclesonide, adult healthy volunteers and asymptomatic subjects with seasonal allergic rhinitis were randomized to receive intranasal ciclesonide or placebo for 14 days. Serum concentrations of ciclesonide and its active metabolite, desisobutyryl‐ciclesonide, were measured using high‐performance liquid chromatography assay with tandem mass spectrometric detection, with lower limits of quantification of 25 and 10 pg/mL, respectively. Adrenal function was monitored by diurnal serum free and 24‐hour urine cortisol concentrations. Despite the use of a sensitive assay and a high ciclesonide dose (800 μg/d), serum levels of ciclesonide and desisobutyryl‐ciclesonide were below the lower limits of quantification for the majority of samples assayed. Ciclesonide was well tolerated and did not appear to affect serum or urine free cortisol levels. The low systemic exposure and favorable safety profile support the continued clinical development of ciclesonide nasal spray.
Multiple‐Dose Plasma Pharmacokinetic and Safety Study of LY450108 and LY451395 (AMPA Receptor Potentiators) and Their Concentration in Cerebrospinal Fluid in Healthy Human Subjects
Authors: Jhee S. S. , Chappell A. S. , Zarotsky V. , Moran S. V. , Rosenthal M. , Kim E. , Chalon S. , Toublanc N. , Brandt J. , Coutant D. E. , Ereshefsky L.
Published: March 2006

The objective of this study was to measure the steady‐state cerebrospinal fluid (CSF) concentration of LY450108 and LY451395 (positive modulators of AMPA receptors) in healthy subjects after the administration of 1 mg and 5 mg. Secondary objectives included the evaluation of safety, pharmacokinetics, and steady‐state ratio of plasma:CSF concentrations of LY450108 and LY451395 after multiple dosing. This study was an open‐label, multiple oral dose study evaluating 1 mg and 5 mg LY450108 and 1 mg and 5 mg LY451395 in 12 (3 subjects per dosing group) healthy subjects, aged 18 to 49 years. Twelve healthy male subjects completed the study. LY450108 and LY451395 were quantifiable in CSF after 1‐mg and 5‐mg multiple‐dose administrations with plasma:CSF ratio of 82:1 and 44:1, respectively. LY450108 and LY451395 1 mg and 5 mg were measured in the CSF. Single and multiple oral doses of LY450108 and LY451395 were determined to be safe and well tolerated in healthy subjects.
Role perceptions of auxiliary nurses: An exploratory study
Authors: Pearcey Pat
Published: March 2006

Auxiliary nurses may form a necessary part of current nursing teams, but how clear are they about their roles, capabilities and limitations? The project described in this paper was divided into two phases: Phase 1 involved interviews with auxiliary nurses and corresponding G grade nurses; Phase two involved distribution of questionnaires to over 350 auxiliary nurses in nine hospitals across the Yorkshire region. This paper focuses on Phase 2 only. The questionnaire was developed from both the literature and Phase I results. The final section of the questionnaire was an adaptation of a series of questions developed from a tool devised by Rhodes (1985) to identify areas of decision-making in qualified nurses. Through use of an assessment scale for qualified staff, clarification of decision-making, both actual and potential, would be highlighted.

The results from the adapted scale seem strongly to suggest that not only are auxiliary nurses making decisions that were previously made by qualified nurses, but that an even larger number feel they ought to be making more. The results further suggest that 50% of auxiliary nurses attaining NVQ Level 2 standard still gained most of their knowledge through observing others.
The case for a more epidemiologically informed nursing profession
Authors: Mulhall Anne
Published: March 2006

This paper argues that a more epidemiologically informed nursing profession could confidently challenge conventional medical epidemiology, and yet retain those concepts useful to a more holistic interpretation of the discipline and its practice. Situated within biomedicine and based on natural science, epidemiology has often been ignored by nursing, which has developed a more holistic model of health and illness and a wide range of research methodologies. However, epidemiology is evolving as mainstream approaches to research using quantitative methodologies are challenged by qualitative techniques and the emergence of 'popular epidemiology'. An epidemiology which examined questions of sickness and health from different epistemological and methodological perspectives would have more in common with prevailing ideologies in nursing.

Complications arise as disciplines such as nursing and epidemiology, with different epistemologies and theoretical approaches, attempt to tackle similar problems. The difficulties are not only with paradigm incompatibility: each profession will be jealously guarding its particular territory and area of expertise. There has been little exploration of mutual or overlapping concepts and the new insights which these might bring to both disciplines. This paper attempts to redress this gap and argues that nursing has the potential to consolidate an increasingly divergent epidemiology, while gaining valuable skills to add to its own 'tool-box'.
Violent incidents in a forensic adolescent unit: A retrospective analysis
Authors: McDougall Tim
Published: March 2006

A correlational survey of violent incidents using a descriptive, retrospective design and quantitative data analysis showed that the large majority of violent incidents in an adolescent forensic unit were generated by young people with no prior offending history. The most violent young people were characteristically psychotic and conduct-disordered, and presented with high risk and challenging behaviour. By contrast, a small minority of violent incidents were generated by mentally disordered young offenders with a history of seriously violent behaviour including murder, attempted murder and manslaughter. A training needs analysis is presented which will inform a strategy for the management of aggression and violence in young people.
The Scope of Professional Practice: A literature review to determine the document's impact on nurses' role
Authors: Finlay Teresa
Published: March 2006

Following the UKCC's publication of The Scope of Professional Practice (Scope) in 1992, it commissioned a study to investigate the document's impact. As part of the study, a review of the literature relating to Scope and its application was undertaken. Given the association of expanded practice using Scope, with new nursing roles and titles, the British and American literature relating to clinical nurse specialists and advanced practice was included in the review. This was undertaken because of the considerable influence from America on developments in this area in Britain.
The analysis of focus group data: A challenge to the rigour of qualitative research
Authors: Twinn Sheila
Published: March 2006

Focus groups have become increasingly popular as a source of data in nursing research. Although the methodological issues involved in this method of data collection have been addressed in the literature, there has been little work on the process of data analysis. This paper reports a case study that was undertaken to examine Hong Kong Chinese women's experiences and perceptions of screening for cervical cancer and considers some of the issues involved in the analysis of data from focus group interviews. In the first stage of the study, 100 women were given structured interviews. Subsequently, 52 of the women were recruited, using convenience sampling, to participate in focus groups, which provided the data for the second stage of the study. The 12 focus group interviews, undertaken in Chinese, were audiotaped, transcribed and translated. The process of analysing the data was found to be time-consuming and difficult. Factors such as the unit of analysis, dynamics within the groups, between-group variations, consistency of the data, and the translation, all contributed to the complexity of data analysis. During the focus group interviews, many topics were discussed which, although not directly related to the research question, were of interest to the researchers. Women's health beliefs and attitudes to sexuality are two examples. The challenges to the rigour of the research findings created by these methodological issues are considered.
Community nursing achievements in tackling inequalities in health in Northern Ireland
Authors: Lazenbatt Anne , Orr Jean , Bradley Martin , McWhirter Liz
Published: March 2006

Targeting health and social need is an important theme in the Northern Ireland Regional Strategy, Health and Well-being into the Next Millennium: A regional strategy for health and social well-being, 1997-2002 (Department of Health and Social Services for Northern Ireland, 1996), which is concerned with addressing inequalities in health status and social well-being. This paper describes a project which assessed the contribution made by nurses, midwives and health visitors to targeting health and social need (THSN). While there is a considerable body of research and information on variations in health and social well-being, few evaluative research interventions improve the health of disadvantaged groups. The initial project was commissioned by the Department of Health and Social Services (DHSS) for one year, had a timetable that covered three phases and was jointly conducted by the schools of nursing at The Queen's University of Belfast and the University of Ulster.

In the first phase a survey questionnaire was distributed to a purposive sample of nurses working with both community and voluntary groups to assess their contribution to THSN (n=1000). The paper describes the results from the 392 questionnaires returned (a response rate of almost 40%) and the work carried out in phase 2 of the study, in which the responses were analysed to allow further investigation. By using selection criteria devised by the Project Advisory Board, the interventions were reduced to 22. In an overview of each of these, a number of characteristics kept recurring that could serve to define aspects of 'good practice'.

The results highlight nursing competencies gained through their work, the lessons learnt and the problems and difficulties encountered. Importantly, the 22 case studies demonstrate the efforts made by nurses and health professionals to change behaviour, practice, the community and the environment.

The paper concludes that the use of qualitative research opens the door to measures of social position that reflect the ways in which people define themselves and the relationships which sustain them. Although there is still some way to go in understanding the different approaches to evaluation, an environment which fosters the monitoring and assessment of practice might be created in the future within the nursing community.
Lesbians' experiences of healthcare
Authors: Platzer Hazel , James Trudi
Published: March 2006

This paper reports on the findings of part of an interview study of lesbian and gay men's experiences of nursing care which was conducted to develop nursing guidance for members of the Royal College of Nursing (RCN). The RCN recognises that discrimination and prejudice against lesbians and gay patients occurs in nursing and it is committed to developing and promoting good practice for this group of patients (RCN, 1994). One area where such discrimination and prejudice exists is in the ways that nurses approach lesbian patients when questioning them about their sexual or reproductive health. Nurses and other healthcare professionals often ask about sexual and reproductive health, and respond in a way that implies a lack of respect for individuals, heterosexism and homophobia. Guidance on the nursing and health needs of lesbian women is being produced (RCN, 2000). A more detailed discussion of the research findings used to develop the guidance is presented here.
Patient perceptions of crisis pain management in sickle cell disease: a cross-cultural study
Authors: Smith-Wynter Lilieth , van den Akker Olga
Published: March 2006

Sickle cell disease has a variety of signs and symptoms, the most common being painful vaso-occlusive crises. Due to the severity of the pain, narcotic analgesia is described in the literature as the drug of choice for pain relief. The UK, in line with many other countries, uses narcotic analgesia in crisis management. In Jamaica, however, mild analgesia is the usual drug of choice for the patient in crisis. This difference in management approaches between the two countries was seen as an area for exploration to determine the factors which may reflect the nursing strategies used. This paper describes a cross-cultural survey of patients' perceptions of the painful crises and their management within the home and healthcare settings in Jamaica (West Indies) and Birmingham (UK).

The results of the study show many areas of similarities, particularly in relation to the causes of the crises, home management and in-patient admissions. However, there were significant differences in crisis length and the in-patient management of crises. The study highlighted areas of crisis management which must be improved in the UK if patients are to receive optimum care from primary care and hospital nurses, as well as from general practitioners.
Is nurse-led thrombolysis clinically safe, beneficial and acceptable?
Authors: Holland Emma , Foxcroft David
Published: March 2006

This study examined the sensitivity and specificity of coronary care unit (CCU) nurses' ability to diagnose acute myocardial infarction (AMI) and to make an independent clinical decision about thrombolysis. The effectiveness of this simulated nurse-led thrombolysis was compared with the sensitivity and specificity of subsequent senior house officer diagnosis and actual treatment. A blinded, retrospective gold standard was provided by consultant cardiologists. Predictions were that: nurse-led thrombolysis would be no worse than current practice; it would lead to a significant time-saving in CCU door-to-needle times; CCU nurses would accept this potential development in their role. The first and second predictions were upheld. Regarding the third prediction, most nurses felt confident about diagnosing AMI and administering thrombolytics, but only half of those who completed an anonymous questionnaire said that nurse-led thrombolysis should be part of the nursing role. The comments against nurse-led thrombolysis related to extra responsibility, legal cover, professional and organisational support and backup, and financial reward. The results of this simulation study suggest that, providing these concerns are addressed, nurse-led thrombolysis may be clinically safe, beneficial and acceptable to nurses.
Talking pictures: Investigating personal knowledge through illuminative art-work
Authors: Spouse jenny
Published: March 2006

This paper discusses how participants' art-work was used in a naturalistic, phenomenological and longitudinal, study. It investigated nursing students developing their professional knowledge while working in clinical settings. Eight students participated in the study and at the end of each clinical placement they created a picture of what it felt like to be a nurse. In a follow-up interview, students described and discussed the symbolism they had portrayed in their picture. Using pictures in this manner gave participants an opportunity to tap into their pre-conscious knowledge and to give words to experiences that might otherwise have remained dormant. At the end of their course, the material was assembled and analysed using a constant comparative method. Several themes were elicited from the data that related to students' socialisation into the nursing profession. This understanding was complemented by visual representations students had created, and these provided a more meaningful understanding of their professional development. In discussing the process of creating illuminative art-work, two examples and their accompanying narratives are provided to illustrate the relevance of this supplementary approach to data collection; they provide a powerful tool for researchers concerned with everyday human experiences.
Women's education level as an influence on hormone replacement therapy being suggested at the menopause
Authors: Rubin Rona , Quine Lyn , Edwards Martin
Published: March 2006

This research investigates the extent to which a woman's education level both influences information-seeking about hormone replacement therapy (HRT) and whether or not HRT is suggested as a treatment when presenting to the GP with a range of menopausal symptoms. A random sample of 1200 women was generated from family health services authority records and a questionnaire distributed. The questionnaire inquired about the participant's information-seeking strategies about HRT, her recent menopausal symptoms, whether a GP had been consulted, and whether HRT had been suggested. Results indicate that participants who had more educational qualifications were more successful in finding information about HRT. Furthermore, although there were no significant differences in the number of reported symptoms, GPs were significantly more likely to suggest HRT to the less educated women. The implications for health centre practice are discussed.
Improved outcomes following a change in the cephalosporin policy in an acute hospital
Authors: McCowan Margaret , Curzio Joan , Jones Robin Knill , Redding Penelope j.
Published: March 2006

This paper evaluates the effect of a policy change on the use of cephalosporins in an acute hospital. The main outcome measures (timeliness and appropriateness of administration of antibiotics, infection rates, length of hospital stay and readmission rate) showed significant improvements. The change of policy from three doses a day to a once-a-day dose improved the prescribing, preparation and administration of all cephalosporins in the short term and resulted in a shorter length of hospital stay, lower readmission rates and a reduction in bacteriologically confirmed infections. This pilot study could be used as the basis for further research.
Concept mapping — An evaluation of its use in community nursing research
Authors: Quickfall Julia
Published: March 2006

A study was carried out in 1998 to examine the reliability and validity of concept mapping, a relatively new research method. Concept maps of vulnerability produced by two groups of health visitors were compared. The results showed that the similarities in the concept maps were composed of the medical and nursing knowledge of the two groups, whereas the differences reflected the social and economic working environments of each group. Concept mapping can be seen to be a highly valid and reliable method of data collection, and is a useful evaluation tool for community nursing research.
Does nursing, midwifery and health visiting need a research council?
Authors: Rafferty Anne Marie , Bond Senga , Traynor Michael
Published: March 2006

The need for access to a sustainable source of research funding in nursing has been a longstanding issue for debate and there has been intermittent support for the idea of a nursing research council. Although some have argued that a dedicated fund may lead to the marginalising of nursing research instead of a mainstreaming, recent UK government initiatives such as a focus on professional regulation and clinical governance reinforce the need for high-calibre research into nursing, midwifery and health visiting. A more secure funding base for nursing research could strengthen nursing's position in higher education, address issues of research capacity and problems over research careers as well as improve the focus of nursing research as a whole. Different options for research funding are considered and it is argued that a current policy convergence exists that makes arguments for a dedicated fund more compelling than hitherto.
Benchmarking evidence-based nursing
Authors: Cole Nick , Tucker Linda F. , Foxcroft David R.
Published: March 2006

The aim of this formative evaluation (action research) study was to develop and apply a set of criteria for benchmarking evidence-based nursing. There were three phases: the identification (through literature searches and contact with experts) of previous work on the development and assessment of evidence-based nursing; the development (through a consultation exercise) of criteria for measuring and benchmarking evidence-based nursing; and applying these criteria (through semi-structured interviews) in six discrete clinical areas.

Numerous papers were found that discussed evidence-based nursing and barriers to research utilisation, but no previous work on benchmarking or assessing evidence-based nursing was found. Fourteen 'benchmarking evidence-based nursing' criteria were developed, organised around four key themes for achieving effective practice: Selecting a particular aspect of practice to question or examine; finding out from the literature, professional networks and other sources what is current best practice, and critically appraising the available literature and sources of information; implementing and/or learning how to provide best-known clinical practice; and confirming that you are providing best practice.

All six clinical areas were generally poor on all 14 benchmarking criteria. However, there were some positive attributes: nurses with degree level post-registration education had better knowledge of searching for and critically appraising research; some senior clinical specialists were supportive of evidence-based changes; and one ward had stronger communication/dissemination links for relevant evidence with related clinical areas (paediatrics).

It was concluded that the benchmarking tool developed in the study was useful in identifying positive and negative aspects of evidence-based nursing practice. The tool may be helpful to other organizations considering how to take forward evidence-based nursing practice.
Nurses' knowledge of biological and related science
Authors: Campbell John , Leathard Helen
Published: March 2006

The aims of this small, local study were to determine the level of biological and related knowledge held by student and qualified nurses at a college of higher education; and to ascertain whether such knowledge is lacking, or held but poorly applied to the clinical situation. A group of student and qualified nurses (n = 141) were assessed using a four-part assessment tool. Overall, the scores achieved by the nurses in the sample were below the pass mark at grade C or above for GCSE examinations. No significant differences in knowledge levels were found between student and qualified nurses, or between nurses on degree as opposed to diploma programmes. There was some association between previous relevant qualifications and performance in the assessment and a probable association between nursing experience and levels of practical knowledge. The researcher concluded that there was a lack of scientific knowledge rather than just a lack of application. This finding may have a bearing on quality of patient care, professional accountability, nurses' personal well-being and the development of nursing as a profession, although larger studies are needed to investigate this.
Nurses' experiences in caring for patients from different cultural backgrounds
Authors: Boi Sandra
Published: March 2006

This paper describes an exploratory research study that investigated nurses' experiences in caring for culturally different patients. The aim was to highlight any problems encountered by nurses delivering care to these patients. Data were gathered through interviews with seven nurses in an informal setting. It was found that they shared similar experiences and problems that hindered safe and effective care. A recurrent issue raised was the problem of language barrier, exacerbated by a lack of knowledge of the patient's culture. Holistic care was not, therefore, possible, so participants felt they were unable to deliver a high standard of care. The study suggests that there is a need for post-registration courses to address the issues of different cultures, health beliefs and practices. It is hoped that these findings will increase healthcare professionals' awareness of how best to care for culturally different patients. It is not suggested that nurses ought to have expert knowledge about all ethno-cultural groups but, rather, that they have an awareness of cultural flexibility and accept and understand each patient as an individual.
A comparison of soap, alcohol and glove use during the nappy-changing procedure in a special care baby unit
Authors: Chuadleigh Jane , Buckingham Christopher D.
Published: March 2006

This study was conducted in a special care baby unit (SCBU) in a district general hospital and concentrated on hand decontamination and glove-wearing during the nappy-changing procedure. The aims were to determine whether or not nurses were adhering to existing infection control policies and guidelines, and to determine the most appropriate product to be used for hand decontamination.

Nurses were observed carrying out nappy changes to determine their existing hand-washing and glove-wearing practices. A microbiological analysis of nurses' hands during the nappy change was performed in order to compare the effectiveness of soap, alcohol, and glove use in eliminating bacteria from the hands.

The observation study demonstrated that not all nurses were adhering to existing infection control policies and guidelines. The microbiological analysis found that on the majority of occasions, alcohol was better than soap at removing bacteria from the hands but that gloves provided the best protection overall for both babies and nurses by preventing the acquisition of bacteria.

Together these findings suggest that nurses' hands may be providing a route for the transmission of hospital-acquired infection in the SCBU. Ideally, nurses should be wearing gloves during the nappy-changing process and using alcohol to decontaminate their hands.
Is the research necessary? Equipoise and other fundamental ethical considerations
Authors: Scullion Philip
Published: March 2006

This paper examines issues concerning the necessity of research as an essential ethical question fundamental to ethical scrutiny of research proposals. In particular, the concept of 'equipoise' as a pre-condition to conducting a clinical trial is examined.

Equipoise refers to the degree of uncertainty over what constitutes best practice: existing or experimental interventions or various approaches to care. It is applied to individual practitioners, the profession as a whole and communities of patients and their advocates. Nurses' positive response to current government views on the evidence basis of practice and decision-making within the new NHS gives prominence to research feeding into the clinical governance process. This paper contributes to the ethical debates over nursing research and takes account of the view that some research - clinical trials in particular - should not proceed in the absence of equipoise.
Quantitative research: Designs relevant to nursing and healthcare
Authors: Seers Kate , Critelton Nicola
Published: March 2006

This paper gives an overview of the main quantitative research designs relevant to nursing and healthcare. It outlines some strengths and weaknesses of the designs, provides examples to illustrate the different designs and examines some of the relevant statistical concepts. The paper concludes with a brief discussion about the place of quantitative research in nursing.
Action research: A design with potential
Authors: le May Andrée , Lathlean Fudith
Published: March 2006

This paper discusses the main challenges posed by action research. These include issues related to definition, researcher role, collaboration, ethics and resources. We argue that action research has the potential simultaneously to contribute to the development of knowledge as well as to facilitate and evaluate change. The central tenets of action research are described and we use our research on the development of communities of practice as a means of illustrating these elements. We conclude that while the lack of precise definition may have led to suspicion about the robustness and scientific merit of action research, different and imaginative ways of employing it as an approach are proving that it is both a legitimate and highly contemporary research design for the exploration of health and social care issues and the development of practice.
The use of the telephone interview for research
Authors: Carr Eloise C.J. , Worth Allison
Published: March 2006

The increasing popularity of the telephone interview as a research method may be a reflection of broader social change and technological advances, with increased use and acceptability of telecommunications to support healthcare and service industries in general. Despite its widespread use there are few definitions of the term. Studies which directly compare telephone and face-to-face interviewing tend to conclude that telephone interviewing produces data which are at least comparable in quality to those attained by the face-to-face method. While it has been used for large survey studies, in nursing research the telephone interview is used predominantly in smaller-scale qualitative studies, where contact has already been made with the participants. The telephone interview was used in a study by one of the authors (EC) which explored the experience of postoperative pain. Issues relating to ethical considerations, reliability, validity, limitations and analysis are explored. The use of the approach for pain research is reflected upon before considering the wider applications that are available for this method of data collection in healthcare practice.
Critical reflexivity: A politically and ethically engaged research method for nursing
Authors: Freshwater Dawn , Rolfe Gary
Published: March 2006

Traditional interpretations of research tend to bifurcate research knowledge and practice knowledge, with knowledge derived from practice and direct interaction with patients being perceived as knowledge that is not formally admissible by the traditional scientific model. This paper proposes a research method that legitimises practice as a source of knowledge. Building upon the concepts of situational understanding and contingent knowledge, we advocate an integral research methodology, one which draws on the notion of the researcher-practitioner.

Beginning with an analysis of knowledge and power we explore the contribution of reflexivity to the development of a politically and ethically engaged research process in nursing. In discussing critical reflexivity as a research method, we will outline the focus of reflexive research and the role of the reflexive researcher.

Arguing against the superiority of theoretical research over practitioner research, we present a challenge to technical rationality, suggesting not only a new approach to research but also a new approach to practice.
Revisiting qualitative inquiry: Interviewing in nursing and midwifery research
Authors: Hollowaay Immy , Fulbrook Paul
Published: March 2006

Qualitative research is now often favoured in nursing and midwifery because it emphasises a person-centred and holistic approach. In this paper it is proposed that this type of inquiry is not only a valid way of carrying out research but also a very useful means of eliciting the perspectives of patients and colleagues. It is acknowledged that qualitative approaches are not unproblematic. In particular, there are issues of validity and reliability which should be addressed by researchers, hence a discussion of these is included. Interviewing is the most common method of collecting data within this approach and is examined here, together with its advantages, common pitfalls and problems.
Benchmarking in healthcare
Authors: Pantall John
Published: March 2006

This paper examines the process of benchmarking and the ways in which it can be used to secure improvement and best practice. Classic definitions are presented and their appropriateness to present-day conditions is considered. The four types of benchmarking — internal, competitive, functional and generic — are examined and the advantages and disadvantages of their use in healthcare settings presented. The benefits of considering and comparing practice in a wide range of organisations are emphasised. The paper argues that performance measurement is not an end in itself but a means of comparing practice and the impact of changes in practice intended to secure improvement.

The three major stages in the benchmarking process are examined — defining what to benchmark, the collection and analysis of data and the action. The key role of the service-user for determining what to benchmark and what is best practice are highlighted. The importance of always using the benchmarking process to secure improvement is emphasised, and the need to integrate benchmarking with other approaches to quality at the strategic level is stressed. The dangers of fragmented initiatives are also considered. Finally, the importance of having an appropriate organisation culture and management leadership to facilitate improvement is described.
An evaluation of the recruitment of black and minority ethnic students to pre-registration nursing
Authors: Chevannes Mel
Published: March 2006

This paper reviews the literature on the recruitment of minority ethnic students to pre-registration nursing courses and goes on to examine the evidence of ethnic minority under-recruitment and possible explanations for it, exploring the relationship between stated institutional policy on equality of opportunity, student choice of institution, and new data on the way the selection process operates in nursing course admissions.

While the perception of the institutions' policy towards minority ethnic students may affect the numbers applying, recent research shows that 6.7% of applicants were from minority ethnic groups (who make up 6% of the general population), but that only 3% went on to become students, a fact that could not be explained fully on the grounds of entry qualification or choice of nursing specialty at the time of application.

New data on recruitment of minority ethnic students to pre-registration nursing courses at Leicestershire in 1998/99 indicate that black and other minority ethnic students apply in large numbers but that their numbers diminish as they reach the shortlisting stage and reduce still further when they are offered a place on the course, with minority ethnic students remaining under-represented. The challenge of the situation requires universities to implement equality of opportunity policy in the selection process, undertake ethnic monitoring, train all staff involved with students' admission, and set targets on diversity.
The quality of life - A concept for research and practice
Authors: Draper Peter , Thompson David R.
Published: March 2006

This paper gives an overview of the concept of the quality of life as it is related to research and practice in nursing. The paper begins with an account of the concept's history, tracing attempts to measure quality of life to the post-war social indicators movement. This section also discusses problems with the concept's definition. Quantitative approaches to health-related quality of life are then described, with particular attention being given to issues of reliability and validity. The third section addresses qualitative approaches to the quality of life. The emphasis here is to outline a way of thinking about the quality of life that has the potential to inform practice. The approach described is based on the philosophical notion of eudaemonia, or human flourishing. In summary, this paper gives an overview of quantitative (statistical) and qualitative (philosophical) approaches to the quality of life and applies these to research and practice in nursing and allied disciplines.
Is health-related quality of life a suitable outcome measure for evaluating health promotion programmes?
Authors: Ashley Andrew , Lloyd Andrew , Lamb Sarah , Bartlett Helen
Published: March 2006

This study describes results from a double blind randomised controlled trial which examined the efficacy of a primary care-based exercise promotion programme (the Health Walks Scheme). Quality of life data from the SF-36 questionnaire are presented from 260 previously sedentary participants randomly selected from a large GP practice (data are available for 72% at the 12-month follow-up). After 12 months, only 61% of participants in the health walks group were still classified as sedentary, compared with 73% in the control group who were simply given advice regarding exercise (p=0.05). There were no significant changes in the dimensions of the SF-36 questionnaire at 12 months. Those people who actually completed a health walk showed larger improvements in dimensions of the SF-36 (although these were also not significant). The appropriateness of quality of life outcome measures in health promotion trials is discussed in the light of the findings.
A qualitative survey of staff responses to an integrated care pathway pilot study in a mental healthcare setting
Authors: Hall Julie
Published: March 2006

This qualitative study set out to discover a multidisciplinary team's impressions of an integrated care pathway pilot. Specific aims were: to explore participants' beliefs about the effectiveness and limitations of the pilot and its impact on practice, and to use the findings to develop recommendations for the future of integrated care pathways within the clinical area. The research setting was an in-patient dementia assessment service, forming part of the mental health directorate of an NHS trust in the east of England. Data were generated through semi-structured interviews with a purposive sample of the multidisciplinary team, based on the premise that a qualitative approach develops an insider view of the team's experiences, beliefs and perceptions. Theoretical analysis was conducted, based on the analytical framework described, and facilitated through the use of QSR.NUD.IST IV content analysis software. Four categories emerged, which focused on: the clinical impact of the pathway; team performance; pathway effectiveness; and practice development.

The team's impressions corroborated experiences of integrated care pathways outlined in the literature. Benefits identified by the team were the pathway's influence on managing care, increased efficiency, better team working and perceived positive impact on the experience of patient and carer. Particular new insights focused on the pathway's impact on professional roles and responsibilities. The study indicated that the pathway concept was adaptable to this mental health setting and that benefits had been derived. The study's limitations are the inherent complexities associated with validity and reliability. Recommendations relate to local evaluation of the integrated care pathway pilot and wider research considerations.
Developing, delivering and evaluating cancer nursing services: Building the evidence base
Authors: Richardson Alison , Miller BA (Hons) Morven , Potter Helen
Published: March 2006

The rate of evolution of cancer nursing in the UK has been remarkable over the past 20 years. Legislative changes and reform have provided the impetus for a range of developments in practice, research and education, and the push to achieve evidence-based practice has also driven the profession. There is a collective aspiration that all patients with cancer should expect to be supported by a cancer nursing service that is skilled, caring and competent. Demonstrating the value of nursing in terms of its effects on patients has never been so important. This project, commissioned by the Department of Health, was designed as a scoping exercise to assess the current state of the evidence base to support the development, delivery and evaluation of cancer nursing services in the United Kingdom. Three distinct elements were implemented concurrently to achieve this. The first was a review of UK literature centred around aspects of developing, delivering and evaluating cancer nursing and cancer nurses. The second was the development of a research directory profiling recently completed, currently under way and planned UK research concerned with cancer nursing and cancer nurses. The final element was a review of the organisation of cancer nursing services in England. This paper will report on the first two elements. The results of the third element will be published separately.
Does nursing need an ethical code for research?
Authors: Williamson Graham R.
Published: March 2006

The Royal College of Nursing (RCN, 1998) guidelines on research ethics are a laudable attempt to establish ethical principles for nursing research, but more relevant for protecting patients, clients and colleagues is the concept of a personal morality for nurses undertaking research. This paper examines the pros and cons of establishing ethical codes in research, and argues that the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) already sets a framework to which researchers, as well as nurses, must adhere.
Transdisciplinary education: Tensions and contradictions?
Authors: Glen Sally
Published: March 2006

While moves towards transdisciplinary education programmes for health and social care professionals are undoubtedly in evidence, the explicit objectives are often unclear and, in numerous studies, unstated. There are numerous interpretations of what a successful outcome in respect of closer collaboration between health and social care professionals actually means, and there also appears to be a prevailing idea that it is common sense that if students learn together they will be better prepared to work together. Whether it is helpful to put so much emphasis upon common studies is another matter. The danger lies in detracting from the distinctive contribution that each profession makes to service delivery. It is a strongly held belief in interprofessional education that comparative studies add value, by which it is meant that opportunities to learn from, about, and with each other, pave the way for collaboration in practice. Evidence is needed of the benefits of interactive learning so as to withstand arguments from employers that common studies are sufficient to facilitate flexible deployment of the workforce and from educational institutions who wish to use them to economise on scarce resources. What are required are longitudinal studies which focus on the possible relationships between education input and enhancement of quality care provision and an over-arching strategic vision to sustain developments in the long term.