bluuebunny/crossref_metadata_2025 huggingface dataset:
What role do nurses play in Type 2 diabetes care in the community: a Delphi study
Authors: Peters Jean , Hutchinson Allen , MacKinnon Mary , McIntosh Aileen , Cooke Jo , Jones Roy
Published: March 2003

What role do nurses play in Type 2 diabetes care in the community: a Delphi study

Objectives. To identify the views of nurses on their current and future roles in care in the community for people with Type 2 diabetes.

Method. A two‐round Delphi study was used to elicit, and assess consensus on opinions from random samples of practice nurses, with a substantial role in the management of diabetes patients and diabetes specialist nurses. Both groups had defined levels of expertise in diabetes care and worked in Great Britain. The study instrument in round one comprised a questionnaire with 10 statement headings inviting opinions on the nursing role in the management and care of people with Type 2 diabetes. In the second round levels of agreement were elicited from responders on collated opinions from round one. The initial questionnaire also included closed questions to obtain a profile of current care delivered.

Results. Responders were 97 practice nurses and 69 diabetes specialist nurses with second round response rates of 93% and 86%, respectively. The 47 themes raised could be grouped under headings of clinical practice, responsibility, communication, knowledge, education/experience, rewards, and patients' roles. Many were common to several statements and both nurse groups. The level of agreement on the themes fed back was high, 85% of the 165 items achieved greater than 80% agreement. Agreement occurred for factors relating to clinical effectiveness, audit, knowledge, education and experience. Dissent occurred both within and between individual nurse groups on issues of responsibility, prescribing, service delivery, resources, and patient factors.

Conclusions. This Delphi study has identified key areas of consensus on the management of care for people with Type 2 diabetes in the community but also areas in which further work needs to be carried out to understand the differences found. Many of the discordant items relate to the separate roles and associated issues of the two nurse groups.
Refinement of the concept of uncertainty
Authors: Penrod Janice
Published: March 2003

Refinement of the concept of uncertainty

Aims. To analyse the conceptual maturity of uncertainty; to develop an expanded theoretical definition of uncertainty; to advance the concept using methods of concept refinement; and to analyse congruency with the conceptualization of uncertainty presented in the theory of hope, enduring, and suffering.

Background. Uncertainty is of concern in nursing as people experience complex life events surrounding health. In an earlier nursing study that linked the concepts of hope, enduring, and suffering into a single theoretical scheme, a state best described as `uncertainty' arose. This study was undertaken to explore how this conceptualization fit with the scientific literature on uncertainty and to refine the concept.

Design/Methods. Initially, a concept analysis using advanced methods described by Morse, Hupcey, Mitcham and colleagues was completed. The concept was determined to be partially mature. A theoretical definition was derived and techniques of concept refinement using the literature as data were applied.

Findings. The refined concept was found to be congruent with the concept of uncertainty that had emerged in the model of hope, enduring and suffering.

Conclusions. Further investigation is needed to explore the extent of probabilistic reasoning and the effects of confidence and control on feelings of uncertainty and certainty.
The implications of contact with the mentor for preregistration nursing and midwifery students
Authors: Lloyd Jones Myfanwy , Walters Stephen , Akehurst Ron
Published: March 2003

The implications of contact with the mentor for preregistration nursing and midwifery students

Aim of the paper. To examine the extent to which preregistration nursing and midwifery students have contact with their named mentor, and the implications of this.

Background/rationale. Mentorship has an important part to play in enabling preregistration nursing and midwifery students to gain the maximum benefit from clinical placements. Previous research has indicated that the benefits of mentorship to learners are related to the number of occasions on which the student and mentor work together.

Design/methods. A research project commissioned by the Sheffield and North Trent College of Nursing and Midwifery (now the University of Sheffield School of Nursing and Midwifery) provided an opportunity to examine the extent to which their named mentors were available to Project 2000 students, and the implications of this. Students and their named mentors were asked to keep an activity diary for 1 week. The main objective was to collect activity data to inform an analysis of the costs and benefits of clinical placements to service providers. This cost‐benefit study has been published elsewhere. However, the data also cast light on the extent to which mentors were available to students, and the implications of this, and it is these findings which are presented here.

Results/findings. Students frequently worked shifts without their named mentors even though unrostered students often worked weekends, evening and night shifts in order to maximize time spent with their mentors. In the mentor’s absence, other members of staff covered for some of their activities (in particular, direct and indirect supervision of students). However, students whose named mentors were absent spent significantly less time than other students working with a qualified member of staff as a partner in giving care.

Conclusions. It is suggested that the extent to which named mentors are unavailable to Project 2000 students may be detrimental to the education and professional development of those students.
The effects of handholding on anxiety in cataract surgery patients under local anaesthesia
Authors: Moon Jung‐Soon , Cho Kyung‐Sook
Published: March 2003

The effects of handholding on anxiety in cataract surgery patients under local anaesthesia

Aim of the study. To assess the effectiveness of handholding on the anxiety of patients undergoing planned cataract surgery under local anaesthesia.

Background. Anxiety concerning anaesthesia, pain, physical injuries, isolation, prognosis, possibilities of deformity, or loss of self‐control may be stressful to patients undergoing surgery. Anxiety activates the sympathetic nervous system, characterized by an increase in catecholamine concentration, heart rate and blood pressure and increased glucocorticoid levels; it also affects immune responses. Therefore, there is a need for nursing interventions to reduce the anxiety of patients under local anaesthesia who are conscious.

Methods. An untreated control group design with pre and post‐test was used. Among 62 patients, 30 were randomly assigned to the handholding group and 32 to the control group. Handholding was provided to subjects of the handholding group during surgery. Visual analogue scales and interviews were used to measure anxiety, and pulse rate and systolic and diastolic blood pressure were used as physiological measures of stress. Blood was taken for analysis of levels of epinephrine, norepinephrine, cortisol, neutrophils, lymphocytes and natural killer cells.

Results. The number of subjects who reported decreased anxiety during operation was significantly higher in the handholding group compared with the control group and most of the subjects reported that handholding during operation was very helpful in reducing anxiety. Epinephrine levels in the handholding group were significantly lower than in the control group.

Conclusions. Results suggest that this noninvasive intervention has potential for reducing anxiety in patients having cataract surgery under local anaesthesia.
The wartime experience of Australian Army nurses in Vietnam, 1967–1971
Authors: Biedermann Narelle , Usher Kim , Williams Ann , Hayes Barbara
Published: March 2003

The wartime experience of Australian Army nurses in Vietnam, 1967–1971

Aims. To provide a synthesis of the experience of nursing in the Vietnam War.

Rationale. War and nursing are linked unequivocally. As battles have raged over the centuries, nurses have attended the ill and wounded soldiers, nursing them back to health or into death and the study of this phenomenon forms a significant part of Australia’s nursing history. However, a review of the Australian scholarly nursing and military history literature revealed that the experiences of Australian nurses in the Vietnam War has not been widely published. In an attempt to redress this gap in Australian nursing and military history, the aim of this study was to analyse the nature of the nursing work in the Vietnam War, and to increase awareness and understanding of the experience of nurses in the war within the nursing profession.

Methods. Using oral history interviews, this study investigated the nature of nursing work as experienced by 17 Australian Army nurses who served in the Australian Military Hospital in Vung Tau between 1967 and 1971.

Findings. The vast majority of the nursing sisters sent to Vietnam knew little about the type of work or the environment into which they were entering and were, therefore, clinically unprepared. It appeared that, by virtue of their being a nurse, it was an expectation that the nurses would adapt to the nature of their work in the war zone. However, this study also revealed that, although the nurses adapted professionally, their memories of their experiences have affected many personally.

Conclusions. This paper will increase current knowledge significantly regarding the phenomenon of nursing in the Vietnam War, enabling a greater understanding of the experience.
Illuminative evaluation: evaluating clinical supervision on its performance rather than the applause
Authors: Sloan Graham , Watson Hazel
Published: March 2003

Illuminative evaluation: evaluating clinical supervision on its performance rather than the applause

Aim(s) of the paper. This paper gives a description of illuminative evaluation and argues for its use in process‐focused research investigating the reciprocal interpersonal interactions between clinical supervisors and their supervisees. Experiences from conducting an initial pilot study, which is a part of larger qualitative project concerned with individual clinical supervision in mental health nursing, are highlighted.

Background. Research investigating fundamental process issues in clinical supervision and their influence on outcomes for nursing is uncommon. Previous work in this area has stopped short of exploring the supervisory relationship and illuminating the importance of this interpersonal process in the delivery of gains. At the heart of the present project are questions about which supervisor interventions facilitate and constrain the supervisee’s use of individual clinical supervision.

Method. Data were collected using individual in‐depth interviews, critical incident journals, session documents and audio recordings of supervision using illuminative evaluation and a case study approach.

Findings. Supervisor interventions included taking the lead, suggesting an option, exploring the supervisee’s work, reflecting back, conveying an understanding of client issues, being supportive and giving information. Using Heron’s framework, catalytic, prescriptive, informative and supportive interventions were identified. Interestingly, informative interventions related mainly to the sharing of team policy issues and were derived from the clinical supervisor’s agenda. Although undoubtedly relevant to the supervisee’s practice, such organizationally focused information giving may be at odds with progressing the therapeutic integrity and professional development of the supervisee. Degenerative interventions were also illuminated.

Conclusions. Following the pilot study, it was concluded that the research approach known as illuminative evaluation using multiple case studies is an appropriate design to explore the supervisory process and the particular clinical supervisor and supervisee interactions which influence this. Potential outcomes from the supervisory experience will be contextualized with how mental health nurses engage in the supervisory process and the particular supervisor interventions delivered during supervision sessions.
What is consumerism and has it had an impact on health visiting provision? A literature review
Authors: Almond Palo
Published: March 2003

What is consumerism and has it had an impact on health visiting provision? A literature review

Aims. This paper analyses the concept of consumerism drawing on methods of concept analysis. It attempts to identify who the actual consumers of health visiting are before examining whether consumerism and the consumer’s voice has had an impact on health visiting provision.

Background. Patients and clients are increasingly being referred to as consumers, but the term seems to be used simply as substitute for patient, client or service user. Consumerism is a complex concept and the extent of its usage in the context of health visiting has not been fully explored.

Method. An integrative review of a range of literature relating to consumerism is presented. A focused analysis of consumer views of child health clinics is used to illustrate the concept of consumerism. Elements of concept analysis methods such as formulating a model case and a definition are used to illustrate the concept further.

Results. The review suggests that consumerism is an outdated concept and has been replaced by other less emotive terms such as partnership and participation. The apparent lack of impact of consumerism research in health visiting is argued by examining empirical evidence relating to child health clinics.

Conclusions. Consumerism has had relatively little impact on improving child health clinics although high levels of consumer satisfaction with the overall service exist. More methodologically sound studies are needed to explore users’ views of health visiting services and to implement findings to maintain or improve services.
Israeli nurses’ knowledge of health care reforms
Authors: Spitzer Ada , Golander Hava
Published: March 2003

Israeli nurses’ knowledge of health care reforms

Objectives. This study examines health care reforms’ implementation processes from the perspective of nurses’ knowledge regarding the reforms. The research has been carried out in the Israeli context, where health care reforms were initiated in 1995. Three specific research questions were formulated: (a) What is the level of nurses’ knowledge regarding the recommendations of the Netanyahu committee? (b) What is the level of nurses’ knowledge concerning the basic principals of the National Insurance Law? and (c) Are there knowledge differences relating to employment setting (hospital, community, and educational settings), nurses’ roles (managerial vs. staff nurses), years of experience, and level and type of education?

Method. The stratified nonproportional random sample consisted of a total of 468 nurses. Of these nurses, 206 were employed in community settings (136 in curative care, and 70 in preventive care), 137 were employed in hospital settings, and 125 worked in schools and departments of nursing. Research tools, developed for the purpose of this study, included the nurses’ knowledge questionnaire comprised of five subscales, and the knowledge relevancy questionnaire.

Results. Overall, data demonstrated a low to moderate level of knowledge on all knowledge scales. Knowledge level on the criteria questions was particularly low. Contrary to the low level of knowledge, nurses regarded health care reforms’ knowledge as highly relevant to their work life. Curative setting, an extensive work experience, managerial position, and non‐nursing academic degree were all positively related to higher levels of reforms’ knowledge.

Conclusion. These findings should encourage both policy makers and managers in various health care organizations to develop programs for informing health care providers on central aspects of health care reforms considered most relevant to the practice setting.
Models of psychiatric nursing education in developing African countries: a comparative study of Botswana and Nigeria
Authors: Adejumo Oluyinka , Ehlers Valerie J.
Published: March 2003

Models of psychiatric nursing education in developing African countries: a comparative study of Botswana and Nigeria

Background. Against the perspectives of the mental health needs of the people of Africa, this study explored and compared the models of psychiatric‐mental health nursing education (PMHNE) in two sub‐Saharan African countries – Botswana and Nigeria.

Method. Examination of the existing PMHNE programmes and responses to a self‐reporting questionnaire administered to psychiatric nurse educators from Botswana and Nigeria provided the sources of data.

Findings. Findings from both countries revealed that participants used various terms to describe the same model for PMHNE programmes in the countries. Botswana adopted a more functional generalist basic diploma nursing education approach that encouraged an advanced postbasic diploma specialization and practice in community psychiatric‐mental health nursing. Nigeria’s model leaned towards a hospital‐based basic specialization with no defined role for the generalist nurse within the psychiatric‐mental health nursing care system. Although community theme occurred in both countries’ curricula, PMHNE in Botswana appeared to be more geared towards the community than in Nigeria. While PMHNE and nursing education generally is affiliated to the University with a clear pathway within the formal higher education system in Botswana, basic and postbasic nursing programmes are mostly run independent of the country’s formal higher education system in Nigeria.

Conclusion. A model that streamlined PMHNE within the general system of education in both countries was proposed. It was stressed that one key concept that must underlie the development of PMHNE in the two countries, and Africa in general, was the need to create a psychiatric‐mental health nursing education programme and role that would be appropriate for people’s mental health needs and the provision of quality nursing care.
Interaction relating to privacy, identity, autonomy and security. An observational study focusing on a woman with dementia and ‘behavioural disturbances’, and on her care providers
Authors: Graneheim Ulla H. , Norberg Astrid , Jansson Lilian
Published: March 2003

Interaction relating to privacy, identity, autonomy and security. An observational study focusing on a woman with dementia and ‘behavioural disturbances’, and on her care providers

Aim. The study aims to illuminate how one woman with severe dementia and so‐called behavioural disturbances acts in relation to her care providers and how the care providers act in relation to her.

Methods. Fourteen participant observations, including one woman with dementia and six care providers, were performed. A reflective dialogue focusing on the interaction between the woman and her care providers followed each observation. The tape‐recorded observational notes and reflective dialogues were fixed as a text, which was subjected to a thematic content analysis.

Findings. The main findings are that the interaction between a woman with severe dementia and ‘behavioural disturbances’ and her care providers relates to privacy, identity, autonomy and security. The phenomena are intertwined and also in conflict with each other. Interaction is a complex dialectic process in which those who are engaged meet problems that can be solved and are involved in dilemmas that cannot be solved, only related to.
Gatekeeping and legitimization: how informal carers’ relationship with health care workers is revealed in their everyday interactions
Authors: May Judith , Ellis‐Hill Caroline , Payne Sheila
Published: March 2003

Gatekeeping and legitimization: how informal carers’ relationship with health care workers is revealed in their everyday interactions

Aim(s) of the study. This study explores the relationship between informal carers of older people, and health care workers within the context of a hospital ward. Through an analysis of their language‐based encounters the purpose of the study was to identify the discursive processes involved in face‐to‐face informal carer‐health care worker interactions, during the course of carers’ visits to one elderly care rehabilitation hospital ward.

Design. An ethnomethodological research design, which encompassed the concerns of conversation analysis and the study of institutional interaction, was used. The study involved videotape recording informal carers naturally occurring spontaneous interactions with a range of health care workers on the ward. Data collection was carried out for between 1 and 3 hours, two to three times a week over a period of 3 months. The data comprised: 30 dyadic and group interactions involving 19 different carers and 25 different health care workers, including nurses (qualified and unqualified), physiotherapists, occupational therapists, dieticians, ambulance personnel, housekeepers and nursing auxiliaries. Detailed transcriptions of the data were produced and analysis was undertaken using a modified conversation analysis approach.

Findings. Analysis revealed that a central aspect of the way the relationship between informal carers and health care workers is framed is by the way information and access to information is obtained. This paper examines some of the aspects of informal carer‐health care worker discourse, which denote both parties as gatekeepers. In doing so it considers the roles that legitimatization of competence and knowledgeability have in facilitating informal carers interactions with health care workers.

Conclusions. We conclude that the accomplishment of legitimacy is largely a collaborative undertaking on behalf of health care workers and informal carers. The implications of these findings for carers, health care workers, policy and future research are discussed.
Disability, facilitated sex and the role of the nurse
Authors: Earle Sarah
Published: March 2003

Disability, facilitated sex and the role of the nurse

Aim. The aim of this paper is to explore the role that nurses can play in acknowledging and facilitating the sexual needs of disabled patients within an holistic framework of nursing care.

Background. Contemporary nursing claims to offer patient care within an holistic framework; this framework should encompass the biopsychosocial needs of patients, as defined by patients themselves. In spite of the importance of sexuality and sexual expression to the psychosocial welfare of patients, sexuality is often excluded from nursing practice.

Method. Literature is reviewed from nursing, disability studies, and a variety of social science disciplines.

Findings. The paper begins with a discussion of the concept of ‘holistic care’ and the ways in which this has been interpreted in the nursing literature. The biopsychosocial approach and the notion of ‘whole person’ holism seem particularly significant, although the lack of attention to patient sexuality is identified. Literature from the social sciences is used to explore the significance of sexuality to individual self‐identity and psychosocial welfare. This literature also highlights the way in which the denial of sexual identity is a significant feature of power relations. The disability studies literature catalogues the way in which disabled people are generally infantilized by society and perceived as asexual. This literature also highlights the professional neglect of disabled sexual identities. Using a variety of literature, the concept of facilitated sex is explored as a continuum of activities and the role of nursing, within a holistic framework, is examined.

Conclusion. The paper concludes by arguing that an holistic approach to nursing care should include an appreciation of patient sexuality. In particular, it suggests that nurses can play an important role along the continuum of facilitated sex.
Self‐directed learning: views of teachers and students
Authors: Hewitt‐Taylor Jaquelina
Published: March 2003

Self‐directed learning: views of teachers and students

Aim. This paper reports the findings of an investigation into teachers’ and students’ understanding of the term self‐directed learning (SDL), and their views concerning its value in paediatric intensive care (PIC) nurse education.

Methods. Qualitative methods of data collection and analysis were used. The findings from interviews with teachers and students across eight PIC nursing courses are reported. Local Research Ethics Committee protocols were followed. Data were analysed using constant comparative analysis.

Findings. Teachers and students appeared to experience some difficulty in articulating a precise definition of SDL. Both groups saw it as one teaching and learning method to be used alongside others, and focused their definitions on the observable events thought to demonstrate self‐direction rather than the cognitive processes involved. Teachers and students considered SDL of some value, but only when used in conjunction with teacher‐led methods. Both teachers and students felt that students take more responsibility for learning in SDL than in traditional teaching. However, there was a difference of opinion as to the manner in which responsibility was devolved and accepted, and neither party was completely convinced that the other respected them.

Limitations. The study explored only PIC nurse education, and was not intended to be generalized beyond this field.

Conclusion. The evidence from this study suggests that SDL has elusive qualities which defy precise definition. It appears that attempting such a definition and reducing SDL to an observable form may detract from its perceived value. It can be inferred from this study that in order to implement SDL issues of control and autonomy within the learning environment merit further exploration, rather than simply focusing on observable teaching and learning tools or methods.
Premature menopause: multiple disruptions between the woman's biological body experience and her lived body
Authors: Boughton Maureen A.
Published: March 2003

Premature menopause: multiple disruptions between the woman's biological body experience and her lived body

Aim of the study. The aim of this phenomenological study was to find out what menopause was like as an experience for women who were not yet 40 years old.

Background. Women's bodies have naturally occurring rhythms and expected transitions related to their menstrual cycle. One transition that all women will experience, provided they live long enough, is menopause. Menopause involves hormonal changes that result, on average (for Australian women), in the cessation of menstruation around 51 years of age. When women experience menopause prior to the age of 40 years it is defined (medically) as premature. While there is abundant literature on menopause as a biological event, the experience of premature menopause has been paid little attention and dismissed as a `mystery'. This study intended to uncover some of the so‐called `mystery' of the experience from the perspective of the women.

Research methods. Hermeneutic phenomenology and feminist philosophy informed this study involving 35 women, all of whom volunteered to participate. They responded to newspaper articles, a radio announcement and through a midlife and menopause support centre. Thirty women engaged in separate face‐to‐face conversational style interviews. The remaining five women participated in a collaborative interview after some themes were identified through preliminary analysis of the transcripts of the one‐on‐one interviews. With the consent of participants, all interviews were audio‐taped and later transcribed.

Findings. This study revealed that the experience of menopause came as a shock for the women – it was perceived as a major epiphany in their lives and they were confronted with a multitude of issues related to the timing of the event and their embodied understanding of menopause. The experience of menopause resulted in multiple disruptions in the women's lives. The women discussed many aspects of their lives that now seemed to be `out of synchrony'.
Caring for maltreated children: a challenge for health care education
Authors: Paavilainen Eija , Åstedt‐Kurki Päivi , Paunonen‐Ilmonen Marita , Laippala Pekka
Published: March 2003

Caring for maltreated children: a challenge for health care education

Aim of the study. The aim of this study was to establish whether paediatric nurses and doctors in a university hospital need supplementary training in the identification of child physical abuse and whether there is a need to develop health care education on child abuse issues.

Background. Child physical abuse was defined as actions of a parent or a primary caregiver of a child under 18 years of age, which have caused physical injuries to the child.

Methods. The sample consisted of paediatric staff (n=513) in a university hospital. Data were collected with a questionnaire, and the response rate was 62%. The data were analysed using statistical methods and quantitative content analysis.

Findings. Sixty per cent of respondents needed supplementary training in the identification of child abuse. Those having experience in caring for abused children considered the identification most difficult (P < 0·001) and needed training more often (P < 0·005) than the others. The need for training was explained by stating that their basic education had not addressed child abuse issues, and by the complexity of the issue.

Conclusions. The findings indicate that research‐based knowledge of the identification and treatment of child abuse should be incorporated into health care education. Supplementary education should address the management of complex and sensitive issues with customers, legislation, division of labour and multiprofessional collaboration in which nurses and doctors have an important, family wellbeing promoting role.
Research and organizational issues for the implementation of family work in community psychiatric services
Authors: Jones Adrian , Scannell Tony
Published: March 2003

Research and organizational issues for the implementation of family work in community psychiatric services

Background. The need for evidence‐based practice (EBP) to guide and develop mental health services remains fundamental for modern services.

Aim. To discuss issues that impact upon implementation of EBP and practice development using family work (FW) as an example.

Method. A selection of the FW literature was reviewed drawing on sources including the Cochrane Library, Cinahl and Medline. Keywords used were FW, community mental health team and research design.

Findings. Centralized policy initiatives and guidelines that are themselves guided by evidence of randomized controlled trials predominantly risk alienating practitioners and clients/carers. Family work has some demonstrable clinical benefits although models differ and the active therapeutic agent remains unclear. Its adoption into routine care is also hindered by a productivity management outlook that seeks to maximize stretched resources and whose values are likely to be internalized by practitioners. The dichotomous position of previous research and practice development make implementation of EBP difficult and highlights the need for strategic planning that embraces both factors.

Conclusion. The current drive to increase EBP requires a bi‐directional process of influence that allows individual practitioners and clients/carers to become producers of evidence and not simply recipients. The authors support wider adoption of case study research designs to reflect the unpredictable nature of mental health care. Adoption of assertive community treatment models within community services is most likely to promote the excellence management model and accommodate EBP such as FW.
Learning disability nurses' experiences of being with clients who may be in pain
Authors: Donovan Jim
Published: March 2003

Learning disability nurses' experiences of being with clients who may be in pain

Aims. This study aims to describe the experiences of Learning Disability Nurses (RNLDs) when they are with clients who may be in pain but who cannot communicate their feelings verbally.

Background. Research indicates that general nurses often find it difficult to perceive their patients' pain accurately, but no studies refer to the experiences of RNLDs. For people with severe learning disabilities this could lead not only to unnecessary suffering, but also to long‐term tissue damage and may even prove fatal.

Method. A phenomenological approach was adopted, as unrecognized pain is a subject about which little is known and the lived experiences of nurses and the meanings that they attach to them were being explored. Data were collected by unstructured interviews with a snowball sample of eight RNLDs. The participants were asked to describe a situation in which they thought a client was in pain. Analysis was based on Hycner's guidelines for the phenomenological analysis of interviews.

Findings. Five central themes emerged: the importance of a caring relationship with the client, recognizing changes in verbal and nonverbal behaviour, searching for a meaning in the client's behaviour, negotiating with other health professionals and sharing in the client's feelings.

Conclusions. Nurses valued highly their relationship with a client, which can, in itself, be therapeutic. Clients apparently used a wide range of both conventional and nonconventional forms of nonverbal communication, including aggressive and self‐harming behaviours, as the primary way of expressing pain. Functional speech cannot be taken as an indicator that the clients can self‐care with regard to pain. RNLDs play an important role in negotiating between their clients and other health professionals, but must be careful not to make assumptions about the causes of pain and pass these assumptions on to the General Practitioner as a professional opinion. The use of diagnostic tests should be supported. RNLDs appeared to be sympathetic, rather than empathetic, towards their client's painful experiences.
A controlled trial of music and pre‐operative anxiety in Chinese men undergoing transurethral resection of the prostate
Authors: Yung Paul Man Bun , Chui‐Kam Szeto , French Peter , Chan Tony Moon Fai
Published: March 2003

Aim of the study.

 To test the effects of music intervention on pre‐operative anxiety in Chinese males undergoing transurethral resection of the prostate
.

Rationale.  No studies have measured the effects of music intervention in reducing pre‐operative anxiety for patients with transurethral resection of the prostate (TURP). Previous studies have examined the effects of music on pre‐operative anxiety but have not examined the possible effects of the presence of a carer as an independent variable in pre‐operative anxiety levels of patients in addition to the music intervention. The cultural validity of applying a music intervention to the reduction of pre‐operative anxiety was also investigated.

Design.  A quasi‐experimental design with three groups: music intervention, nurse presence and control group.

Method.

 Thirty patients having TURP were randomly assigned (
n  = 10 each group) to one of the three groups. Pre‐ and post‐test measures of systolic and diastolic blood pressure, heart rate and state anxiety using the Chinese State‐Trait Anxiety Inventory (C‐STAI) were obtained for the three groups.

Results.  The findings showed that the music intervention significantly reduced all blood pressure levels for the patients. A reduction in state anxiety level was also found for the music intervention group. No significant reductions in blood pressure, heart rate and state anxiety level were found in the nurse presence and control groups.

Conclusion.  The results support the cross‐cultural validity of using a music intervention in pre‐operative anxiety reduction, in this case for TURP patients waiting in the theatre holding area.
Edwards, Benner and Wrubel on caring
Authors: Horrocks Stephen
Published: March 2003

Aims.  To explain the difficult Heideggerian concept of the ontological difference and then use it as a context to explain the misperceptions of Benner and Wrubel's reply to Edwards' criticism of the differences between ontological and intentional care.

Background.  Edwards' paper attempts to clarify what Benner and Wrubel actually mean by the category of ontological care. The latter's reply totally bypasses Edwards' criticisms because they have a misunderstanding of Heidegger's philosophy, which they use to support their arguments.

Conclusion.  Benner and Wrubel's claims that they are using Heidegger to underpin their arguments is wrong. This has the consequence that their category of ontological caring comes tumbling down and their philosophy is not as radical as they think it is.
Gaining access to the life‐world of women suffering from stroke: methodological issues in empirical phenomenological studies
Authors: Kvigne Kari , Gjengedal Eva , Kirkevold Marit
Published: March 2003

Aim.  First to give a brief introduction to some dimensions of phenomenology as philosophy, and then to discuss some problems related to empirical research. The objectives of the discussion are: (1) to show what is involved in investigating changes in the life‐world caused by illness and (2) to show what must be taken into consideration to obtain adequate descriptions of the changes.

Rationale.  To discuss some of the methodological requirements and challenges that phenomenological studies are expected to meet, particularly focusing on the data collection phase.

Methods.  This is primarily a theoretical analysis supplemented by illustrations drawn from an ongoing study of women who have had suffered stroke.

Findings.  Openness is essential in the whole research process. It is a precondition for conversation with the informants. In interview‐based investigations two forms of openness are at issue – the informant's openness in describing his/her life‐world, and the sensitivity of the researcher as regards seeing and hearing what is conveyed in the situation. Both forms of openness can be influenced positively or negatively by many factors, including the physical and mental health of the informants, the researcher's theoretical insight, her ability to communicate, and not least the relationship between the informant and the researcher. A relationship of power, for example, might reinforce gender differences, differences in cultural background, education and social status.

Conclusion.  Openness on the part of the researcher is a prerequisite in order to gain access to the informant's life‐world.
Effects of prone and supine positions on sleep state and stress responses in mechanically ventilated preterm infants during the first postnatal week
Authors: Chang Ying‐Ju , Anderson Gene Cranston , Lin Chyi‐Her
Published: March 2003

Background/rationale. Preterm infants in mechanical ventilation are vulnerable and may manifest physiological instability and a disorganized behavioural state when responding to external stimuli. Adequate positioning strategies may play an important role in protecting infants from environmental stressor and assisting quality of sleep. However, no study has examined effects of prone and supine positions on behavioural state and stress signs including startle, tremor, and twitch responses for ventilated preterm infants during the critical first week postbirth.

Aim of the study. The purpose of this study was to compare effects of prone and supine positions on behavioural state and stress responses in mechanically ventilated preterm infants.

Design/methods. The infants were aged 25–36 weeks of gestation, ≤ 7 days of age, and without sedation or congenital abnormalities. Using a crossover design, 28 infants were randomly assigned to supine/prone or prone/supine position sequence. Infants were placed in each position for 2 hours. A stabilization period of 10 minutes before observation of each position was allowed. During the protocol, care procedures were kept minimal and ventilator settings remained unchanged. Behavioural state and frequencies of stress signs including startle, tremor, and twitch were systemically recorded and analysed with repeated measures analysis of variance.

Findings. Infants when prone compared with supine had (a) less crying, less active sleep, and more quiet sleep states, and (b) fewer stress responses of startle, tremor, and twitch.

Conclusion. Results indicate that prone positioning improves the quality of sleep and decreases stress for ventilated preterm infants during the first week postbirth. These may conserve energy and assist infants' extrauterine adaptation.
A conceptual model‐based programme of nursing research: retrospective and prospective applications
Authors: Radwin Laurel , Fawcett Jacqueline
Published: March 2003

Background. A conceptual model implicitly or explicitly guides research. Some researchers identify the conceptual model prior to conducting their studies. Other researchers may eventually come upon a conceptual model that provides a context for the research already completed and direction for future studies.

Aim. The purpose of this article is to explain how one researcher, working with a theoretician, found a conceptual model that has provided a frame of reference for her past, present, and future studies and has allowed her to view her heretofore somewhat disparate studies as a more coherent programme of research.

Conclusion. Finding an explicit conceptual model provided a meaningful frame of reference for interpreting previous research. Finding an explicit model also had the benefit of uncovering of new possibilities for research. In particular, as the findings from previous research were brought together within the context of the conceptual model, unanticipated areas of future study were identified.
Health‐related quality of life and health service use following total hip replacement surgery
Authors: McMurray Anne , Grant Sheila , Griffiths Susan , Letford Ali
Published: March 2003

Aims of the study.  The study investigated health‐related quality of life in relation to demographic and clinical factors, and health service use and satisfaction by older total hip replacement (THR) patients following discharge from one Australian Hospital.

Rationale.  Understanding health‐related quality of life and patterns of service use during recovery informs caregiving and patient and family education needs for discharge planning and case management.

Background.  Post‐discharge, older THR patients have a high rate of health services use. Few valid measures of outcomes link nursing discharge or case management to patient‐identified health status or service needs.

Research methods.  Ward nurses conducted telephone interviews to study self‐perceived health‐related quality of life using Medical Outcomes Study Short‐Form (SF‐36) and responses to an accompanying questionnaire on demographics, service use and satisfaction at 1, 2, 4, 8, and 12 weeks postdischarge. SF‐36 scores were compared with Australian population norms according to age and gender to determine the relative extent of postdischarge recovery.

Results.
 Psychosocial recovery preceded physical recovery, which steadily improved. Physical component summary scores reached population norms and mental component summary scores exceeded norms by week 1. No differences in quality of life were found by age, but women took longer to recover physically. Those who lived alone did
not have lower scores than those with residential support. General practitioners were seen most often; nursing visits were frequent only in weeks 1 and 2, specialist visits occurred at weeks 8 and 12. Allied health, hospital and pathology services were used less often. Most patients were satisfied or very satisfied with all services used.

Discussion/conclusions.  An almost immediate impact on quality of life was evident, probably indicating successful pain alleviation. Service use indicated adequate discharge planning and successful recovery. Having ward nurses as researchers was instrumental to continuity of communication between patients, families and service providers, which suggests increased potential for continuity of care.
Can burdened caregivers be effective facilitators of elder care‐recipient health care?
Authors: Greenberger Haya , Litwin Howard
Published: March 2003

Background. Caregiving by informal family caregivers of dependent older people in the community may be affected by burden and by the personal and social resources available to the caregiver. Given the increase in the dependent older population, study of factors affecting informal caregiving is necessary.

Aim. To examine caregiver resources, burden and competence as predictors of health‐care facilitation on behalf of older patients.

Design. Cross‐sectional data were collected by an interview schedule from 240 randomly sampled spousal and filial caregivers in Jerusalem. Study variables included caregiver background variables, general self‐concept and feelings of caregiver competence, informal and formal social support, burden and levels of health‐care facilitation. Path analysis was performed to clarify the direct and indirect predictors of health‐care facilitation.

Results. Caregiver facilitation of health‐care was positively related both to the presence of personal and social resources and to burden levels. The results suggest that quality caregiving can coexist with burden, provided that ample caregiver resources are present. The most important resources were caregiver sense of competence and support from the professional health‐care provider.

Discussion. Caregiving burden is not readily reducible, given the chronic nature of older people's health problems. However, caregiver resources can be bolstered, particularly by health professionals. Nurses, who are orientated to holistic family centred care, are especially well‐suited for this important intervention.
Theory‐driven guidelines for practical care of older people, based on the theory of gerotranscendence
Authors: Wadensten Barbro , Carlsson Marianne
Published: March 2003

wadensten b. &
carlsson m. (2003) Journal of Advanced Nursing 41(5), 462–470

 Theory‐driven guidelines for practical care of older people, based on the theory of gerotranscendence

Introduction. The theory of gerotranscendence states that human development is a process extending into old age. When optimized, this process ends in a new perspective. The developmental process towards gerotranscendence can be obstructed or accelerated by life crises and grief, but elements in the culture can also facilitate or impede the process. Similarly, the caring climate can obstruct or accelerate the process toward gerotranscendence. The view introduced by the theory may have several consequences for staff treatment of and actions towards older people, as it offers a new understanding of living into old age.

Aim. The aim of the present study was to derive guidelines for practical use in the care of older people. The guidelines should be used to promote a development toward gerotranscendence and should also be of value for people who already have attained a state of gerotranscendence.

Methods. The method of deriving guidelines from the theory was focus group interviews. The theory of gerotranscendence was used as a foundation for stimulating the discussions in the focus groups as well as for organizing the proposals that emerged.

Findings. Concrete guidelines at three levels, focusing on the individual, activity and organization, were derived. The guidelines describe different ways to support older people in their process towards gerotranscendence.

Conclusion. These guidelines could support staff in their practical care of older people and could be used as a supplement to enrich the present care.