bluuebunny/crossref_metadata_2025 huggingface dataset:
Moving into the information era: does the current nursing paradigm still hold?
Authors: Spitzer Ada
Published: March 2003

Moving into the information era: does the current nursing paradigm still hold? The transition into the information era is characterized by society's passage through three crossroads representing a change from: (a) technology to post‐technology; (b) rigid jobs and hierarchies to dejobbing and vanishing hierarchies; and (c) limited competition to competition dominating all markets. These transitions have caused dramatic changes in the health care system at large and escalating problems that cannot be solved within the current paradigm of nursing. Among the nursing problems that were identified are those including difficulties in: (a) defining the relative contribution of nursing vis a vis other health professions; (b) the scope and dimensions of nursing authority; (c) implementing all aspects of the nursing intervention; (d) actualizing caring in nursing intervention; and (f) implementing the nursing process as a major thinking process in the profession. The analysis of the state of nursing suggests that the current clinical paradigm fails to consolidate the economic and quality issues into the core of nursing. It is not capable of solving central professional problems and emerging dilemmas. Considering that under the current paradigm, nursing has difficulties in highlighting to clients and the system alike where nursing can make a difference, it is questionable whether such a paradigm can ensure the existence of nursing in the future.
Emphasizing terminal care as district nursing work: a helpful strategy in a purchasing environment?
Authors: Goodman Claire , Knight Denise , Machen Ina , Hunt Barry
Published: March 2003

This paper describes how within a study on the experiences of district nurses since the introduction of general practitioner purchasing, participants were encouraged to describe and define the district nursing service. The identification of terminal care by district nurses and others as a significant and defining example of district nursing work is explored and the possible reasons for its emphasis over other aspects of patient care. The extent to which terminal care was used within contract and purchasing discussions to aid general practitioner understanding of district nursing work and achieve extra funding is described. The paper concludes by questioning the extent to which terminal care is a helpful and accurate representation of what district nursing work entails, and the implications there may be in emphasizing one aspect of care within a purchasing environment.
Fear of patients related to coronary arteriography
Authors: Heikkilä Johanna , Paunonen Marita , Virtanen Vesa , Laippala Pekka
Published: March 2003

The purpose of this paper is to describe and evaluate the ability of instruments to produce information about the presence and intensity of fear before, during and after coronary arteriography. Information about patient fear was measured from cognitive, physiological and behavioural dimensions. The sample of the study was 243 patients who were due to have a scheduled coronary arteriography in a university hospital in Finland. Fear was measured by the Visual Analogy Scale (VAS), Hospital Anxiety and Depression (HAD) Scale and State‐Trait Anxiety Inventory (STAI). Physiological measurements (blood pressure and heart rate) were obtained. The VAS was given to 46 nurses and seven nurse assistants to measure nurses’ perception of patient fear. Over 80% of the patients reported fears. Nurses perceived that the patients had more fears than they reported. Changes in physiological measurements were small but significant. One‐third of the patients felt increased fear after the coronary arteriography. VAS, STAI and HAD produced reliable information about the patient fear. The correlations between the instruments suggest that each is a valid and appropriate measure of fear. Nurses need to develop their communication and observation skills in order to develop their recognition of the patients’ fear.
Validating a measure of patient satisfaction with community nursing services
Authors: Gilleard Chris , Reed Rachel
Published: March 2003

This study describes an attempt to develop and validate a measure of patient satisfaction with a district nursing service in a south‐west London inner city borough. The patients were 126 house‐bound elderly people living alone and dependent upon district nursing services. The patient satisfaction measure was derived from an earlier North American questionnaire assessing satisfaction with hospital nursing services. The results indicated that the measure chosen reflected multiple dimensions of patient satisfaction that were differentially sensitive to factors such as the degree of personalization of care and the impact of disruptions to the service. Scores on the questionnaire were also related in a systematic way with the number and type of spontaneous comments made about the service. Overall the results suggest that self‐report questionnaire measures of satisfaction can be devised that are sensitive to variations in the style and level of community nursing offered to older house‐bound people.
The theory‐practice gap in nursing: from research‐based practice to practitioner‐based research
Authors: Rolfe Gary
Published: March 2003

The aim of nursing research is generally agreed to be the generation of knowledge, and whilst this is a relevant aim in theory‐based disciplines such as sociology, the primary concern of nursing is with practice. Using examples drawn mainly from the field of mental health, it will be argued in this paper that the application of generalizable, research‐based knowledge to individual, unique, person‐centred practice, the so‐called ‘research‐based practice’ advocated by the Department of Health, is one of the main causes of the theory‐practice gap. It will be further suggested that nursing requires a paradigm of clinical research which focuses on the individual therapeutic encounter in order to complement the existing sociological paradigm of theoretical research which is best suited to the generation of generalizable knowledge and theory. The paper will conclude by suggesting that such a clinically based research paradigm must not only focus on the individual nurse‐patient relationship, but that it must be carried out by the nurse herself. Clinical research, if it is to make a difference to practice, must therefore be practitioner‐based research.
Hope as seen through the eyes of homeless children
Authors: Herth Kaye
Published: March 2003

Hope as seen through the eyes of homeless children¶Children now constitute the largest segment of the homeless population. Multiple studies have identified the adverse effects of homelessness on children’s health, development, academic success, and behaviour. Minimal literature exists that describes homeless children from the perspective of their strengths. The purpose of this study was to investigate the meaning of hope in homeless children and to identify strategies that children use in fostering and maintaining their hope. Using the technique of methodological triangulation (semi‐structured interviews and drawings) the investigator collected data on a convenience sample of 60 homeless children (6 to 16 years old) currently residing in homeless shelters. Transcriptions of the audio‐taped interviews were analysed following Colaizzi’s method of analysis. Transcript statements were compared with the drawings. Five themes representing hope emerged from the data: connectedness, internal resources, cognitive strategies, energy, and hope objects. School age children drew story book tale characters, pre‐adolescents drew real life situations, and adolescents drew future plans to represent their hopes. An understanding of hope from the perspective of homeless children could provide a basis upon which to develop interventions that engender hope and to develop programmes that build on the hopes that children had already developed.
Female patients with congestive heart failure: how they conceive their life situation
Authors: Mårtensson Jan , Karlsson Jan‐Erik , Fridlund Bengt
Published: March 2003

Female patients with congestive heart failure: how they conceive their life situation¶Congestive heart failure (CHF) is a significant health problem for women, particularly elderly women. The risk factors for heart failure appear to be different in women than in men, with hypertension and diabetes playing a greater role in women and ischaemic heart disease a greater role in men. The aim of this study was to describe, from a nurse’s perspective, how female patients with CHF conceive their life situation. Interview questions were designed with a focus on five dimensions: biophysical, socio‐cultural, emotional, intellectual and spiritual‐existential. A qualitative method was used with a phenomenographic approach, as this approach examines aspects of the surroundings as they are conceived. Five categories emerged in the results: feeling content, feeling a sense of support, feeling a sense of limitation, feeling anxiety and feeling powerless. A sense of limitation regarding working capacity and being able to support those in their surroundings causes patients with CHF to experience anxiety due to feeling insecure about themselves and in relation to their surroundings. This may result in feelings of worthlessness in women with CHF, both concerning their own capacity and the fact that they feel they are a burden to those around them. Through nursing intervention, these patients can receive help to break this vicious circle of feeling limited and powerless. This can be done by encouraging them to verbalize their feelings and set realistic goals and expectations, and by increasing their knowledge and that of their families concerning CHF and its symptoms, with a focus on self‐care and existing possibilities. These measures will make it easier for women with CHF to maintain a hopeful perspective and a sense of control, competence, and self‐esteem.
A comparative study of the perceptions of British mental health nurses and psychiatrists of their work environment
Authors: Dallender Janie , Nolan Peter , Soares Joaquim , Thomsen Sarah , Arnetz Bengt
Published: March 2003

A comparative study of the perceptions of British mental health nurses and psychiatrists of their work environment¶ This comparative study of the perceptions of mental health nurses and psychiatrists about aspects of their work environment was undertaken in the West Midlands in England. The aim of the study was to ascertain the extent to which the environment in which mental health professionals’ work impacts on their own mental and physical well‐being. Seventy‐four psychiatrists and 301 mental health nurses responded to a postal questionnaire. Analysis of data indicated that significant differences exist between nurses and psychiatrists in their working conditions, their physical working environment, their sources of support with a work‐related problem, and the effects of their work on their own mental and physical health. The main recommendation derived from this study was to improve communication between mental health professionals and their managers by giving more structured feedback and guidance about one’s work performance. This may help to alleviate the mental strain many mental health professionals experience in their work.
Specialist nurse counsellor interventions at the time of diagnosis of breast cancer: comparing `advocacy' with a conventional approach
Authors: Ambler Nicholas , Rumsey Nichola , Harcourt Diana , Khan Fawzia , Cawthorn Simon , Barker Jane
Published: March 2003

Specialist nurse counsellor interventions at the time of diagnosis of breast cancer: comparing `advocacy' with a conventional approach¶ Over recent years, specialist breast care nurses have become increasingly recognized as core members of any breast care team within the UK. Part of the role is to support patients at the highly stressful stage of receiving a diagnosis. This paper describes an `advocacy' style of nurse counsellor intervention which aims to improve patients' preparation for, and involvement in, the diagnostic consultation and provides a framework for future counselling support. One hundred and three women undergoing surgery following diagnosis of breast cancer or a benign breast lump were supported using either this advocacy intervention or a more conventional model of care. The aim was to identify the most effective and appropriate method of intervening at this important stage. Assessment took place before surgery, with 2‐week and 6‐month follow‐ups, and included the Hospital Anxiety and Depression Scale, Rotterdam Symptom Check List and semi‐structured interviews addressing perceived quality of care, involvement in decision‐making and psycho‐social functioning. Whilst the results of many measures were similar for women in the two intervention groups, qualitative data support the implementation of the advocacy method by the breast care nurse.
Development of basic nursing education in China and Hong Kong
Authors: Chan Sally , Wong Frances
Published: March 2003

Development of basic nursing education in China and Hong Kong

Hong Kong returned to the sovereignty of the People’s Republic of China in July 1997. In the past, Hong Kong has been greatly influenced by the British system of nurses’ training, which was very different from that in mainland China. As Hong Kong is now a part of China again, there is an increased opportunity for the exchange of experience and ideas among nurse educators. The First China–Hong Kong Nursing Education Conference has provided opportunities for the authors to gain a deeper understanding of the development of nursing education in China and Hong Kong. The authors believe that it is also important for China and Hong Kong to increase networking with the international nursing community. This paper has been written largely based on the information gathered from papers presented in the Conference and the discussion with nurse educators who attended the Conference, together with a review of literature. This paper focuses on comparing the history and present development of basic nursing education in both places. The future direction for the development of nursing education in these two places will also be discussed.
Gender and perceived nurse caring in nurse–patient dyads
Authors: Ekstrom David N.
Published: March 2003

Gender and perceived nurse caring in nurse–patient dyads

The effect of nurse gender on nurse and patient perceptions of nurse caring was explored. Members of nurse–patient dyads (N = 145), equally distributed among the four possible gender combinations, completed matching forms of the Caring Questionnaire immediately following a shift. Perceptions of nurse caring that actually occurred during the preceding shift, as well as usual preferences about nurse caring, were measured. Results of two‐factorANOVASshowed no significant differences in actual caring according to nurse gender from either the nurse or the patient perspective. Expectations of certain nurse caring behaviours, however, were significantly lower for male nurses from both nurse and patient perspectives. The results suggest implications for nursing practice, education and further research.
Verbal communication: what do critical care nurses say to their unconscious or sedated patients?
Authors: Elliott Rosalind , Wright Lucie
Published: March 2003

Verbal communication: what do critical care nurses say to their unconscious or sedated patients?

The importance of using verbal communication in the care of critically ill patients has long been known. Both qualitative and quantitative studies have presented evidence of the benefits of effective communication. This non‐participant observational study aimed to explore how much and what types of verbal communication critical care nurses use when caring for unconscious or sedated patients. Sixteen critical care nurses were observed in 4‐hour episodes and their verbal communication was transcribed and timed at source. Seven categories of verbal communication and a ‘core concept’ emerged on analysis of the raw data. Medical investigations/interventions performed on the patients increased the amount of communication used. The participants in this study were found to use a greater variety and amount of verbal communication than participants in other studies. The findings of this study highlight the need for formal support systems and continued education for nurses about the benefits of verbal communication.
Learning to listen: serendipitous outcomes of a research training experience
Authors: Chambers‐Evans Jane , Stelling Joan , Godin Maryse
Published: March 2003

Learning to listen: serendipitous outcomes of a research training experience

Experience gained in a qualitative research‐training project led a group of clinical nurse specialists to discover the value of using research interview strategies in their clinical work. Clinical interviews, designed to garner data sufficient to decide on interventions, narrow the focus of the interviewer to information deemed relevant to that end. Research interview strategies involve a temporary suspension of the search for intervention, encourage a full description of the respondent’s story and experience, and emphasise really listening to that story. In this case it is the respondent who decides what the story is and what information is relevant. This leads the interviewer to a fuller understanding of the context and perceptions of the respondent. The understanding and knowledge thus obtained comprise a better foundation for devising interventions which are individualised and specific to the individual and family.
The quality of life of cancer patients participating in phase I clinical trials using SEIQoL‐DW
Authors: Campbell Sophia , Whyte Fiona
Published: March 2003

The quality of life of cancer patients participating in phase I clinical trials using SEIQoL‐DW

The nature of phase I clinical trials in cancer patients raises many ethical issues. An area of major importance is the quality of life (QoL) of these patients. However, there is limited information available concerning the impact of phase I clinical trials on the QoL of patients with cancer. The primary aim of this study was to examine the QoL of cancer patients participating in phase I clinical trials. A descriptive triangulation approach was employed. The secondary aim was to determine the acceptability of the Schedule for the Evaluation of Individual Quality of Life — Direct Weighting (SEIQoL‐DW) within this group of patients. SEIQoL‐DW is a relatively new tool which investigates the areas identified by individual patients as important to their QoL. Cancer patients (n=15) participating in phase I clinical trials were interviewed using the SEIQoL‐DW tool. During this interview patients nominated the areas of life important to them and rated their relative weighting and current status. Cues nominated were described and results analysed using non‐parametric statistical tests. The results showed that health and family were particularly important to patients in relation to their QoL. The importance of an individualized approach in the measurement of QoL was evident. SEIQoL‐DW was found to be acceptable and practical to use in cancer patients participating in phase I clinical trials. Recommendations for practice were drawn and suggestions made for further research.
Beliefs about health and illness essential for self‐care practice: a comparison of migrant Yugoslavian and Swedish diabetic females
Authors: Hjelm Katarina , Nyberg Per , Isacsson Åke , Apelqvist Jan
Published: March 2003

Beliefs about health and illness essential for self‐care practice: a comparison of migrant Yugoslavian and Swedish diabetic females

In a multicultural society the frequency of contact with migrant diabetic individuals will increase, as well as the need for knowledge about their beliefs about health and illness, which have rarely been studied. The aim of the present study was to explore beliefs about health and illness among migrant Yugoslavian and Swedish diabetic subjects that might affect their self‐reported self‐care practices and care‐seeking behaviours. The study design was explorative, and a purposive sampling procedure was used. Fifteen females born in Sweden and 13 in former Yugoslavia, aged 33–73 years, with previously known diabetes mellitus were recruited from primary health care centres in southern Sweden. Median time of residence in Sweden was 5 years (range 2–30 years). Eight of the Yugoslavians had their diabetes diagnosed in Sweden. Focus‐group interviews including scenarios of common problems related to diabetes mellitus were held. Yugoslavian females in general gave less tangible examples concerning beliefs about health and illness. Yugoslavians were orientated towards feelings related to their migratory experiences, enjoyed life by making deviations from dietary advice and retaining former traditions, and were less inclined towards self‐monitoring and preventive foot care. They also expressed a passive role, depending on health care personnel, and discussed the influence of supernatural forces. Swedes expressed themselves in terms of medicine and a healthy lifestyle, took active part in their self‐care and let self‐monitoring guide their actions. Self‐care was mainly practised to restore health when ill in both groups, and when help was needed it was sought in the professional sector (nurse or physician). Yugoslavians expressed higher confidence in physicians and used more natural cure medicine, side by side with biomedicine, while Swedes more frequently used alternative medicine. Demonstrated dissimilarities illustrate that beliefs about health and illness differ between migrant Yugoslavian and Swedish diabetic individuals, and are essential for self‐care practice and care‐seeking behaviour and must be considered when planning diabetes care.
Assessing educational effectiveness: the impact of a specialist course on the delivery of care
Authors: Jordan Sue , Coleman Mick , Hardy Billy , Hughes David
Published: March 2003

Assessing educational effectiveness: the impact of a specialist course on the delivery of care

An exploratory study was undertaken in South Wales to assess the changes in clinical practice brought about by a specialized pharmacology module designed for Community Mental Health Nurses (CMHNs), in our institution. The respondents were the seven CMHNs who completed the course in 1997 and returned to clinical practice, and seven CMHN comparators, matched on the basis of work experience and location. In order to assess the impact of the module, the practice, attitudes and knowledge of the respondents were investigated before and after the course and 6 months later, using semistructured interviews, nonparticipant observation and questionnaires. The three data sets were analysed using the constant‐comparative method, and relevant themes were identified and refined. While we obtained some objective measures of positive educational impact, these should be considered in relation to contextual and confounding variables. Both reported and observed behaviours indicated that the main benefit from the course was increased awareness and monitoring of the side‐effects of medication. Respondents had not implemented change uniformly; several factors determined how they modified working practices, including service pressures and the support of colleagues.
Altered body image: a fear‐avoidance model of psycho‐social difficulties following disfigurement
Authors: Newell Rob J.
Published: March 2003

Altered body image: a fear avoidance model of psycho‐social difficulties following disfigurement

Altered body image is a potential and actual source of considerable distress, particularly following facial disfigurement, and social functioning is reported as a major area of difficulty by sufferers. However, the area of facial disfigurement has received comparatively little attention from researchers in health care. Two current models of disturbed body image are examined, and it is contended that both require development in order to be of use in responding to the difficulties experienced by disfigured people. A fear‐avoidance model of exaggerated pain perception, which has clear treatment implications, is described, and it is shown how this model may be modified to offer a framework for the understanding and treatment of the psycho‐social difficulties of disfigured people. In particular, it is suggested that the avoidance present following disfigurement is phobic in nature, and special attention is given to the roles of avoidance and confrontation in mediating these difficulties. Implications for intervention and the shortcomings of the model are described.
Modes of relating in a caring conversation: a research synthesis on presence, touch and listening
Authors: Fredriksson Lennart
Published: March 2003

Modes of relating in a caring conversation: a research synthesis on presence, touch and listening

The purpose of this qualitative research synthesis was to develop an ontological and theoretical understanding ofpresence,touchandlisteningin a caring conversation. The material consisted of 28 articles published between 1989 and 1997 in caring and nursing journals. The examination was based on a qualitative research synthesis approach applied to each concept separately. The synthesis was summed up in a model encompassing two modes of relating in a caring conversation: a connection with high intersubjectivity and a contact with limited intersubjectivity. In a connection the nurse is listening, using caring and connective touch and is present as ‘being with’ the patient. In a contact, the nurse is hearing, using task orientated touch and is present as ‘being there’ for the patient. A connection is grounded in a mutual receiving which allows a high degree of intersubjectivity. The nurse and the patient are not only present to each other as roles but also as unique persons. Contact is grounded in the attentive attitude of the nurse and in the fact that the nurse and the patient are relying on roles which allow a limited intersubjectivity. The model provides a point of departure for clinical discussions among nurses as well as areas for further research in the field of nurse–patient communication.
A comparison of three strategies for risk‐adjustment of outcomes for AIDS patients hospitalized for Pneumocystis carinii pneumonia
Authors: Bakken Suzanne , Dolter Kathryn J. , Holzemer William L.
Published: March 2003

A comparison of three strategies for risk‐adjustment of outcomes for AIDS patients hospitalized for Pneumocystis carinii pneumonia

Background: The need for risk‐adjustment of patient outcomes has been driven by the competitive health care market and the subsequent increase in comparative outcome reporting among health care institutions, among managed care plans, and among individual providers for some procedures (e.g. coronary artery bypass graft surgery). However, if the outcomes reported do not take into account patient characteristics that can be considered dimensions of risk for poor clinical outcomes or increased utilization of services, there is the possibility that inaccurate conclusions will be drawn about the quality of care provided. Objective: The specific purpose of this study was to examine the ability of four measures, APACHE III — acute physiology scale, Quality Audit Marker — ambulation score, Quality Audit Marker — self‐care ability score, and Nursing Severity Index, to predict mortality and hospital length of stay in a convenience sample of 140 males with Pneumocystis carinii pneumonia. Methods: The study utilized a descriptive, longitudinal design. Results: APACHE III — acute physiology scale (P = 0·006, odds ratio = 1·40), and Quality Audit Marker — ambulation (P = 0·037, odds ratio = 0·50), were significant predictors of hospital mortality and the APACHE III — acute physiology scale was also a predictor of mortality within 3 (P = 0·004, odds ratio = 1·13) and 6 months (P = 0·009, odds ratio = 1·10) following hospitalization. Only Quality Audit Marker — ambulation (P = 0·0001) was a significant predictor of length of stay. Conclusions: The findings of this study confirm the findings of other investigators that measures of acute clinical stability and functional status have utility as risk‐adjustment approaches for the outcomes of mortality and length of stay. Further research is needed that compares the utility of generic vs. disease‐specific measures for prediction of outcomes in HIV/AIDS.
Equipoise: an appropriate standard for ethical review of nursing research?
Authors: Olsen Douglas P.
Published: March 2003

Equipoise: an appropriate standard for ethical review of nursing research?

When using control‐group methodologies, the provision of different forms of treatment, which may vary in efficacy, to similar groups of research subjects must be ethically justified. The conventional justification is the existence of a state of clinical equipoise, defined as a lack of consensus among the expert community on the relative efficacy of the treatments. Control groups are justified when the profession does not know which treatment confers more benefit; otherwise, the provision of treatment known to be less effective than other available treatment is unethical. The concept of equipoise was developed to justify clinical trials of medical interventions. Equipoise has proven a durable standard in studies of interventions that confer benefit regardless of the subject’s perception. However, equipoise does not apply when a substantive benefit is conferred by the subject’s perception. In psychosocial interventions, a subject’s experience of the intervention confers benefit and is used to evaluate benefit. Therefore the subject is in a valid position to prefer one treatment over the other and equipoise does not apply.
Examining the correspondence of breastfeeding and bottle‐feeding couples’ infant feeding attitudes
Authors: Shepherd Chew Kim , Power Kevin G. , Carter Harden
Published: March 2003

Examining the correspondence of breastfeeding and bottle‐feeding couples’ infant feeding attitudes

This report focuses on the comparison of infant feeding attitudes within breastfeeding (n = 126) and bottle‐feeding (n = 101) couples and their socio‐demographic details. The findings from this study reinforce the view that socio‐demographic factors are associated with the mothers’ choice of feeding method. However, this study highlights the influence of maternal and of paternal knowledge and attitudes which distinguish between breastfeeding and bottle‐feeding couples. Fathers of bottle‐feeding babies were found to have limited knowledge of health benefits of breastfeeding to both mothers and infants. However, bottle‐feeding mothers, when compared with their partners, were more supportive towards bottle feeding and less negative towards breastfeeding. Fathers of breastfeeding babies, compared with their partners were found to be less aware of the benefits of breastfeeding. Furthermore, breastfeeding mothers when compared with their partners were more supportive towards breastfeeding. Fathers of both bottle and breast feeding babies were also found to be more embarrassed than their partners about mothers in general breastfeeding in front of nonfamily members. It seems that bottle‐feeding mothers and all fathers could be better prepared in many aspects of breastfeeding by the nursing professions to allay the many misconceptions and the social embarrassment associated with breastfeeding, by providing appropriate information and support.
Clinical problem‐solving in nursing: insights from the literature
Authors: Taylor Catherine
Published: March 2003

Clinical problem‐solving in nursing: insights from the literature

This paper reviews the literature surrounding the research on how individuals solve problems. The purpose of the review is to heighten awareness amongst nurses in general, and nurse academics in particular about the theories developed, approaches taken and conclusions reached on how clinicians problem‐solve. The nursing process, which is heavily used and frequently described as a problem‐solving approach to nursing care, requires a deductive reasoning process which is not the problem‐solving process in use during care‐giving activities. More knowledge is required on what process is in place as we develop as a profession. The literature highlights the complexities involved in attempting to uncover thinking processes. The main research approaches to discovering problem‐solving strategies in the past three decades have been from a cognitive perspective, with two main theories, decision‐theory and information processing‐theory, underpinning the majority of studies conducted. None of the research approaches used to date has resulted in the identification of a general model of problem‐solving that is consistent across tasks or disciplines. However, early hypothesis activation with subsequent testing of the hypothesis seems to be consistent in clinicians across disciplines.
Situated learning in the practice placement
Authors: Cope Peter , Cuthbertson Philip , Stoddart Bernadette
Published: March 2003

Situated learning in the practice placement

Nurses who had just completed their training in Scotland were interviewed with regard to their experiences on placements. The nurses had either completed a traditional training course or came from the first cohort of the Project 2000 diploma level course. The interviews focused on the way in which the student nurses had learned in their practice placements. The results suggest that the placement is a complex social and cognitive experience in which there are elements of situated learning. Acceptance into the community of practice is important but this can be separated, conceptually at least, into a social acceptance which might be extended to any student and a professional acceptance which relies on the display of appropriate competence. The nurses described the way in which their mentors had interacted with them in terms which suggested that cognitive apprenticeship strategies had been used to further their learning in practice. It is concluded that, in view of the central importance of the placement for training nurses, explicit use of mentoring techniques derived from situated learning and cognitive apprenticeship might be beneficial.
Disposition towards critical thinking: a study of Chinese undergraduate nursing students
Authors: Ip Wan Yim , Lee Diana T.F. , Lee Iris F.K. , Chau Janita P.C. , Wootton Yvonne S.Y. , Chang Anne M.
Published: March 2003

Disposition towards critical thinking: a study of Chinese undergraduate nursing students

The purpose of this study was to explore empirically whether undergraduate nursing students at a selected university in Hong Kong display a disposition towards critical thinking. The California Critical Thinking Dispositions Inventory (CCTDI) was used to measure the key theoretical aspects of the overall dispositional dimension of critical thinking. A cross‐sectional descriptive design was used to examine 122 Chinese students who were completing their 1st, 2nd and 3rd year of a university baccalaureate nursing programme. In the majority of sub‐scales of CCTDI, students showed a negative disposition towards critical thinking. A one‐way ANOVA indicated that year 3 students scored significantly lower than their junior counterparts (P < 0·001). Pearson product moment correlation coefficient yielded a significant positive relationship between critical thinking dispositions and term grade point average (P < 0·05). Consistent with the findings of western studies, the students scored lowest on the truth‐seeking sub‐scale and highest on the inquisitiveness. Discussion of the findings with regard to nursing education, curriculum and research is delineated.
Factors affecting the administration of analgesia to patients following repair of a fractured hip
Authors: Willson Heather
Published: March 2003

Factors affecting the administration of analgesia to patients following repair of a fractured hip

Fracture of the neck of femur, or hip, has become common in older females and the resulting pain is often a factor in inhibiting early mobilization following surgical repair. Since the administration of analgesia is dependant upon decision‐making of the nurse, this study concentrated on what influences nurses in the administration of analgesia to patients following surgical repair of a fractured hip. A review of the literature identifies the main influencing factors as nurses’ lack of knowledge and the drug prescription, and suggests that education is the key enabler. However, much of this research is limited to controlled situations outside the clinical setting with a focus on the internal processes of decision‐making. This ethnographic multiple‐case study aimed to analyse factors which influence nurses’ decision‐making in the clinical setting and define behaviours in context. Following periods of participant observation and observation of documentation, semi‐structured interviews were conducted to explore further the rationale behind nurses’ decisions. Factors found to influence decision‐making were: time, organization of care, influence of shift worked, impact of the multidisciplinary team (MDT), concerns over the use of opioid analgesia, and information giving and collection. These influences were found to be dependant on location (ward), and shift, with the factor of time providing a tension between all influences. The study findings suggest that education alone will not improve the administration of analgesia. It recommends that the voice of patients is heard more clearly, that the administration of analgesia is separated from the routine drug round, that attention is paid to how decision‐making by nurses is supported in clinical settings, and that education be organized on a multidisciplinary basis. In addition, further research should be carried out in the clinical setting.
Interactions between nurses during handovers in elderly care
Authors: Payne Sheila , Hardey Michael , Coleman Peter
Published: March 2003

Interactions between nurses during handovers in elderly care

This paper explores the role of nursing interaction within the context of handovers and seeks to identify the clinical discourses used by registered nurses, student nurses and care assistants in acute elderly care wards, to determine their influence on the delivery of patient care. The study design involved an ethnographic approach to data collection which involved: observations of formal nursing end of shift reports (23 handovers) and informal interactions between nurses (146 hours); interviews (n=34) with registered nurses, student nurses and care assistants; and analysis of written nursing records. A grounded theory analysis was undertaken. Data were collected from five acute elderly care wards at a district general hospital in the south of England. Results from this empirical study indicate that handovers were formulaic, partial, cryptic, given at high speed, used abbreviations and jargon, required socialized knowledge to interpret, prioritized biomedical accounts and emphasized physical aspects of care. Patients’ resuscitation status was highly salient to all grades of nurse. Doing ‘paperwork’ was accorded less status and priority than patient care, and was regarded as excessively time consuming. Despite this, there was evidence of repetition in nursing documents. Moreover, the delivery of clinical nursing appeared to be guided by personal records rather than formal records.
Practical considerations in case study research: the relationship between methodology and process
Authors: McDonnell Ann , Jones Myfanwy Lloyd , Read Susan
Published: March 2003

Practical considerations in case study research: the relationship between methodology and process

This paper explores the extent to which the design of a research study is influenced by pragmatic as well as theoretical considerations by describing the authors’ experience of conducting multiple case studies in the context of a policy‐orientated research project. The case studies in question formed part of a collaborative project exploring the development of innovative roles in nursing and the professions allied to medicine. The researchers adopted Yin’s approach to the conduct of multiple case studies to explore issues relating to the effectiveness of new roles, their resource implications and educational issues surrounding their development. They address the fact that methodological decisions have practical implications and also explore the effects of practical and ethical issues on research design. Three purposively selected acute National Health Service Trust hospitals in England formed the case study sites for the work recorded in this paper. In each Trust, three nursing roles were selected, making nine cases for study. A variety of data collection strategies were used including semi‐structured interviews with post‐holders and other stakeholders (n=51), non‐participant observation of meetings, collection of audit, financial and statistical data and review of relevant documentation. This paper describes some of the dilemmas which arose during the course of the study, the rationale for methodological decisions taken to resolve these dilemmas and the steps taken to enhance rigour. In particular, the authors discuss the problems associated with obtaining informed consent in the context of qualitative research and with member validation of transcripts in a context where confidentiality was crucial. The decision to present findings thematically rather than as individual cases is justified both in terms of the nature and purpose of the research and in relation to the particular importance of anonymity and confidentiality in this study. Finally, the degree of reciprocity between researcher and researched is discussed.
Setting the context for research: exploring the philosophy and environment of a cancer clinical trials unit
Authors: Cox Karen
Published: March 2003

Setting the context for research: exploring the philosophy and environment of a cancer clinical trials unit

This paper describes a process of context setting that was undertaken prior to designing a study to assess the psychosocial impact of participation in phase I and II anticancer drug trials from the patient’s perspective. The paper outlines how and why this context setting was undertaken and highlights important aspects of the culture and organization of cancer clinical trials that may influence patients’ experiences in trial recruitment and participation. In this way, the context setting proved to be an invaluable tool for providing an orientation to the environment where patients received their care and treatment as well as identifying issues that would need to be taken into consideration later in the research study design.
Fatigue in persons with renal failure who require maintenance haemodialysis
Authors: McCann Kathleen , Boore Jennifer R.P.
Published: March 2003

Fatigue in persons with renal failure who require maintenance haemodialysis

Fatigue is a highly prevalent symptom experienced by persons who live with chronic illness, including those with renal failure who require maintenance haemodialysis. Fatigue, however, is a non‐specific and invisible symptom and is a phenomenon that is poorly understood by health care professionals. This study examined the symptom of fatigue as experienced by a group of 39 adult haemodialysis patients. The theory of unpleasant symptoms formed the conceptual framework for the study. A descriptive correlational design was utilized to examine fatigue from an inductive approach, considering relevant physiological, psychological and situational variables based on a review of the literature. Data were collected using a structured self‐report questionnaire and biochemical data from retrospective monthly blood tests. The results of the study indicated that high levels of fatigue are experienced, with correspondingly low levels of vitality, in all the areas measured – general fatigue, physical fatigue, reduced motivation, reduced activity and mental fatigue, by adult haemodialysis patients. Individual variation was noted in the dimensions of fatigue predominantly expressed. Fatigue was significantly associated with the presence of symptoms such as sleep problems, poor physical health status and depression. No associations between fatigue and the biochemical and situational variables measured were noted. Further examination of the data revealed complex relationships between the physiological and psychological factors examined. Depression was significantly associated with physical health status, sleep problems, symptoms and anxiety. Correlations were also noted between symptoms and poor physical functioning, sleep problems and depression. Based on the results, a revised version of the theory of unpleasant symptoms relating to fatigue is presented.
The health‐related quality of life in a Swedish sample of HIV‐infected persons
Authors: Eriksson Lars E. , Nordström Gun , Berglund Torsten , Sandström Eric
Published: March 2003

The health‐related quality of life in a Swedish sample of HIV‐infected persons

The purposes of the present study are (1) to assess the health‐related quality of life (HRQOL) and the subjective health status in a sample of human immunodeficiency virus (HIV)‐infected persons (2) to relate the results to different population groups and (3) to investigate the relationship of medical and demographic variables with HRQOL. A total of 72 HIV‐infected men were included. They answered the Swedish health‐related quality of life questionnaire and the health index. Demographic and medical data were obtained from the medical records. The data collection took place before entering a therapeutic HIV vaccine trial. The results showed a more negative impact on the HRQOL and subjective health status in the HIV‐positive subjects, compared with male population groups. The dimensions of emotional well‐being were most affected. When comparisons were made according to the medical and demographic variables for different subgroups within the HIV sample, differences in the physical‐dimension scales were most prominent. Symptomatic HIV infection or acquired immunodeficiency syndrome (AIDS), anti‐retroviral treatment, sick leave or disability pension, low income and basic education were associated with worse HRQOL and health status. In conclusion, it is of utmost importance to take into account, aspects of the patients’ emotional well‐being in nursing, as well as in medical care and interventions. Moreover, individualized caring programs are needed because the disruptions in HRQOL fluctuated within the HIV sample.