bluuebunny/crossref_metadata_2025 huggingface dataset:
Planning and managing research into day‐surgery for cataract
Authors: Rose Karen , Waterman Heather , McLeod David , Tullo Andrew
Published: March 2003

Planning and managing research into day surgery for cataract

Between 1995 and 1997, a randomized controlled study, funded by the Department of Health, was carried out into the management of patients with cataract attending a peripheral ophthalmic clinic and who had been assessed as suitable for day‐surgery. The research took place in a clinical setting and it was accepted from the outset that, while such studies have the power to give information about the real clinical world, this also means that the research is potentially at the mercy of events within that world. The purpose of this paper is to report how the study was set up and integrated into the clinic. First, a literature review was undertaken in order to focus the aims of the study more clearly. Second, drawing on principles of action research, clinical and research staff worked together to implement the study. This strategy allowed a flexible approach to the research which enabled problems to be handled as they arose.
The clinical role of the nurse teacher: a conceptual framework
Authors: Clifford Collette
Published: March 2003

The clinical role of the nurse teacher: a conceptual framework

A small scale qualitative study explored the clinical role of the nurse teacher and concluded by proposing a conceptual framework that seeks to illustrate how nurse teachers manage the clinical aspect of their work. Three conceptual categories (role clarity, fitting in and role justification) are proposed as a means of describing how the respondents approached their clinical role.
Health characteristics of elderly personal care home residents
Authors: Quinn Mary Ellen , Johnson Mary Ann , Andress Elizabeth L. , McGinnis Patricia , Ramesh Meera
Published: March 2003

Health characteristics of elderly personal care home care residents

The purpose of this descriptive study was to explore the health characteristics of elderly personal care home residents. Personal care homes are community‐based facilities that provide living arrangements, assistance with basic needs and protective oversight. Personal care home providers were interviewed regarding the health status of 80 elderly residents. The most frequent ADL needs were bathing, personal hygiene and dressing. Thirty‐seven per cent of the residents had some bladder incontinence. Eighty‐two per cent of residents needed some help with medication management. Over half of the residents had some cognitive impairment. These findings support the proposition of increased prevalence of cognitive impairment in personal care home residents as compared to the first studies a decade ago. The combination of functional deficits and cognitive impairment indicates that these elderly residents may have unmet health needs. The role of the registered nurse in this environment is discussed.
The effect of foot massage on patients’ perception of care following laparoscopic sterilization as day case patients
Authors: Hulme  , Waterman  , Hillier
Published: March 2003

The effect of foot massage on patients’ perception of care following laparoscopic sterilization as day case patients

This randomized‐controlled study examined the effects of foot massage on patients’ perception of care received following surgery. The sample of 59 women who underwent laparoscopic sterilization as day case patients were randomly allocated into two groups. The experimental group received a foot massage and analgesia post‐operatively, whilst the control group received only analgesia post‐operatively. Each participant was asked to complete a questionnaire on the day following surgery. This examined satisfaction, memory and analgesia taken. The 76% response rate was comparable with other patient satisfaction studies following day‐case surgery. Statistical analysis showed no overall significant difference in the pain experienced by the two groups; however, the mean pain scores recorded following surgery showed a significantly different pattern over time, such that the experimental group consistently reported less pain following a foot massage than the control group. This study has attempted to explore the use of foot massage in a systematic way and is therefore a basis for further study.
Depot neuroleptics, schizophrenia and the role of the nurse: is practice evidence based? A review of the literature
Authors: Marland Glenn R. , Sharkey Val
Published: March 2003

Depot neuroleptics, schizophrenia and the role of the nurse: is practice evidence based? A review of the literature

Nurses are expected to justify their practice with research based evidence. Community psychiatric nurses (CPNs) are under pressure to concentrate more on the ‘seriously mentally ill’, particularly those with a diagnosis of schizophrenia. Neuroleptic medicines are a recommended therapy in schizophrenia. The administration and monitoring of these drugs is a central part of the CPN’s role. The CPN also often assumes an important position as patient advocate in relation to prescribing practices. Neuroleptics are commonly given in depot form to promote compliance, prevent relapse and be of benefit to the patient. This literature review considers the research evidence that these aims are achieved through current practice and reflects on the implications for nursing. In the absence of definitive research work, it may be that important decisions are based on received wisdom rather than research evidence. Whilst the data supporting the use of depots are inconclusive, there is an increasing body of knowledge demonstrating the efficacy of nursing approaches to drug therapy which seek to empower the patient.
Transitions in the lives of elderly women who have sustained hip fractures
Authors: Robinson Sherry Beth
Published: March 2003

Transitions in the lives of elderly women who have sustained hip fractures

Hip fractures represent a major health problem within the older population, especially for elderly, white women. As the older woman transitions through the recovery process following hip fracture, her ability to meet basic needs, fulfil usual roles, and maintain well‐being is threatened. Despite the rehabilitation provided to these women, studies suggest that hip fractures frequently result in permanent decline in functional status. Little is known about what characterizes those few elderly women who do recover to their previous level of functioning. In this context, a study was designed to identify factors which promote function and enable a successful transition following hip fracture. A total of 15 women ranging in age from 72 to 82, who had returned home alone following care in a Midwestern subacute unit, participated in three focus groups. The data were analysed using the grounded theory method. The findings revealed that the women were confronted with an array of problems, which were labelled function‐inhibiting factors. To overcome these problems, the women mobilized their adaptive approaches to life. In addition, they identified various interdisciplinary interventions, labelled function‐promoting factors, which helped to provide a successful transition. From these findings, a programme of interdisciplinary interventions was identified which could be implemented in subacute units and tested to establish its effectiveness in promoting a successful transition following hip fracture.
Best hope or last hope: access to phase III clinical trials of HER‐2/neu for advanced stage breast cancer patients
Authors: Strauss Beth
Published: March 2003

Best hope or last hope: access to phase III clinical trials of HER‐2/neu for advanced stage breast cancer patients

Breast cancer is a major public health problem, with a 12% incidence among women. The over‐expression of the proto‐oncogene HER‐2/neu is associated with 30% of breast and ovarian cancers that are very aggressive and do not respond to standard therapeutic regimens. Entrance into clinical trials can represent the best hope and even the last hope for these patients. Entrance, however, is based on satisfying eligibility criteria. In examining advanced stage breast cancer patients’ access to phase III clinical trials for HER‐2/neu, two specific arguments regarding eligibility will be addressed. First, if research is to provide the utilitarian goal of the ‘greatest good to the greatest number’, delineation of the population receiving the ‘good’, rather than a homogeneous sub‐set of this population, must be addressed, along with patients’ values and goals, very relevant to determining a ‘good life’, how to achieve it, and whether a treatment is a part of that process. Second, the ‘good’ being generated should involve realistic, practical values of quality ways of living with advanced breast cancer and not just increased survival, or cure. Arguments for relaxing criteria are based on an accurate versus over‐simplified interpretation of utilitarian principles and concepts of human flourishing. Only through addressing these issues can the true ‘good’ of clinical trials and research be given to the greatest number of people.
A response to Dawson’s critical analysis of ‘spirituality as “integrative energy”’
Authors: Goddard Nancy C.
Published: March 2003

A response to Dawson’s critical analysis of ‘spirituality as “integrative energy”’

Dawson’s reply to ‘spirituality as integrative energy’, particularly his objection to the appropriation of energy as a conceptual descriptor, demonstrates a woefully inaccurate and grossly misleading interpretation of my work. The purpose of this response is to challenge Dawson’s assertion that such reformulation effectively strips spirituality of its historical meaning and to provide evidence of its appropriateness. I briefly consider the precepts underlying holism as a moral imperative for professional nursing, the traditional role of spirituality in health and illness, the rise of medical science and its eventual disjunction from metaphysics, and the his torical evolution of nursing. I also comment on the privileged nature of the nurse–client relationship and the social and moral obligation of nurses to engage in holistic practice. Finally, I suggest that the reconceptualization of spirituality as ‘integrative energy’ represents its dynamic, unifying nature and reassert my contention that ‘integrative energy’ is an entirely appropriate and eminently suitable definition of spirituality.
Neurological rehabilitation nursing: a review of the research
Authors: Thorn Sylvie
Published: March 2003

Neurological rehabilitation nursing: a review of the literature

Neurological rehabilitation is increasingly seen as a specialist form of rehabilitation requiring specialist nursing knowledge. However, as in many areas of nursing, nurses in this field recognize that there is a need to increase their knowledge base to ensure that they provide the best and most up‐to‐date quality care for their patients and their families. To achieve high levels of competence, neurological rehabilitation nurses need to be aware of the existing body of research in this field so that they can make sound decisions regarding their practice and future research endeavours. This review aims to validate the existing knowledge base in this area by identifying and critically analysing research conducted in the area of neurological rehabilitation nursing during the decade 1988–1998 and by identifying any gaps and weaknesses that may be addressed by future research. Studies were included in the review if they examined an aspect of rehabilitation nursing, were concerned predominately with the neurological patient and were conducted in an in‐patient setting. Research with a medical focus was not included and only research published in English was reviewed. Relevant research located examined the following areas: (1) the role of the rehabilitation nurse; (2) specific problems concerning the neurological rehabilitation patient; (3) specific nursing interventions; (4) rehabilitation nursing practice; (5) the delivery of rehabilitation programmes and team working; and (6) the family of the rehabilitation patient. The review concludes that research in this speciality remains limited both in quantity and quality. Most of the studies lack rigour and, because they were conducted at a single site, their generalizability to other clinical sites may be limited.
Understanding the nature of errors in nursing: using a model to analyse critical incident reports of errors which had resulted in an adverse or potentially adverse event
Authors: Meurier
Published: March 2003

Understanding the nature of errors in nursing: using a model to analyse critical incident reports of errors which had resulted in an adverse or potentially adverse event

Human errors are common in clinical practice, but they are under‐reported. As a result, very little is known of the types, antecedents and consequences of errors in nursing practice. This limits the potential to learn from errors and to make improvement in the quality and safety of nursing care. The aim of this study was to use an Organizational Accident Model to analyse critical incidents of errors in nursing. Twenty registered nurses were invited to produce a critical incident report of an error (which had led to an adverse event or potentially could have led to an adverse event) they had made in their professional practice and to write down their responses to the error using a structured format. Using Reason’s Organizational Accident Model, supplemental information was then collected from five of the participants by means of an individual in‐depth interview to explore further issues relating to the incidents they had reported. The detailed analysis of one of the incidents is discussed in this paper, demonstrating the effectiveness of this approach in providing insight into the chain of events which may lead to an adverse event. The case study approach using critical incidents of clinical errors was shown to provide relevant information regarding the interaction of organizational factors, local circumstances and active failures (errors) in producing an adverse or potentially adverse event. It is suggested that more use should be made of this approach to understand how errors are made in practice and to take appropriate preventative measures.
Still fumbling along? A comparative study of the newly qualified nurse’s perception of the transition from student to qualified nurse
Authors: Gerrish Kate
Published: March 2003

Still fumbling along? A comparative study of the newly qualified nurse’s perception of the transition from student to qualified nurse

An earlier study conducted in the United Kingdom, examining the newly qualified nurse’s perception of the transition from student to qualified nurse, highlighted the limitations of pre‐registration nurse education in respect of failing to provide adequate preparation for the qualified nurse’s role. In the intervening years, major reforms in pre‐registration nurse education and continuing professional education have occurred. Concomitant with these reforms have been major policy changes in health care delivery that have impacted upon the role of the nurse. Questions now arise as to whether the education reforms have served to equip newly qualified nurses more appropriately with the necessary knowledge, skills and confidence to function in contemporary health care settings. This paper presents the findings of a follow‐up study that entailed a secondary analysis of exiting data obtained from in‐depth interviews with 10 newly qualified nurses in 1985 and collecting additional data from 25 newly qualified nurses in 1998 in order to ascertain their perceptions of the transition from student to qualified nurse. Interview transcripts from both sources of data were coded and thematically analysed and comparisons made between the two sets of data. The paper focuses on one theme emanating from the original study. Entitled ‘fumbling along’, it described the haphazard manner whereby the nurses learned to perform their role in the light of what they perceived to be inadequate preparation and lack of support. Similarities and differences in the experiences and perceptions of the two cohorts of nurses are examined in respect of stressful aspects of the role, pre‐registration preparation and post‐registration development. Data from the follow‐up study suggest that although newly qualified nurses still feel inadequately prepared for their role, they have developed a more active style of learning and when supported through a preceptorship scheme appear to find the transition less stressful than nurses in 1985. However, further attention needs to be paid to the development of clinical, organizational and management skills in pre‐registration courses and the bridging period between the latter part of the course and the first 6 months post‐qualification, in order to enable the neophyte nurse to acclimatize gradually to becoming an accountable practitioner.
Using restraint with nursing home residents: a qualitative study of nursing staff perceptions and decision‐making
Authors: Hantikainen Virpi , Käppeli Silvia
Published: March 2003

Using restraint with nursing home residents: a qualitative study of nursing staff perceptions and decision‐making

The study reported in this paper applied a qualitative and interpretative approach to nursing staff perceptions of the use of restraint with elderly nursing home residents, and into nurses’ decision‐making on restraint use. The data were collected using unstructured interviews with a purposive sample of 20 trained and untrained nursing staff from two Swiss nursing homes. Data analysis was based on Colaizzi’s phenomenological method. Three main themes were extracted from the data: (1) understanding the term restraint, (2) situations in which the decision to apply restraint is considered justified and (3) situations in which nursing staff are uncertain about the use of restraint. The underlying bases with respect to decision‐making were: understanding restraint, the rights and responsibilities of both residents and staff, and the duties of staff. Staff members were ambiguous in their understanding of restraint and they showed positive as well as confused attitudes towards its use. Their behaviour was defensive and protective rather than challenging. Further research is required on what is meant by safety in care of the elderly nursing today. In nursing practice, as far as issues of restraint are concerned, greater attention should be devoted to the relationship between elderly residents’ self‐determination and responsibility for their actions.
The diagnosis and management of acute childhood illness: is there a role for health visitors?
Authors: Kendrick Denise , Young Anousha , Futers Debbie
Published: March 2003

The diagnosis and management of acute childhood illness: is there a role for health visitors?

Much of the published literature on nurse practitioners relates to nurses with backgrounds, training and nursing experience other than health visiting. Health visitors however may be ideally placed to develop their role in the identification and management of acute childhood illness, and such a development may benefit patients, the health service and health visitors themselves. This study examines the current practice and attitudes of heath visitors in identifying and managing acute childhood illness using a postal questionnaire survey in one community National Health Service (NHS) Trust. The majority of responding health visitors reported that they were already identifying and advising on a range of acute childhood illnesses. Their confidence in undertaking these activities varied by condition. They were less confident in identifying and advising on conditions requiring the use of diagnostic equipment, viral illnesses which are becoming increasingly rare, and those with potentially serious outcomes. More knowledge and more training were seen as methods for increasing confidence. Most health visitors could see advantages in taking on this role; almost two thirds felt it would become part of the role of the health visitor in the future and a high level of interest was expressed in developing such a role.
Accounting for overlap? An application of Mezzich’s κ statistic to test interrater reliability of interview data on parental accident and emergency attendance
Authors: Eccleston Philippa , Werneke Ursula , Armon Kate , Stephenson Terence , MacFaul Roderick
Published: March 2003

Accounting for overlap? An application of Mezzich’s κ statistic to test interrater reliability of interview data on parental accident and emergency attendance

Study rationale. The number of interview studies with service users is rising because of growth in health services research. The level of agreement between multiple interview data coders requires statistical calculation to support results. Basic κ statistics are often used but this depends on having mutually exclusive data. Researchers should be aware that this is not valid when an interview word or paragraph can be coded into more than one category. The ‘proportional overlap’κ extension by Mezzich et al. (1981, Journal of Psychiatric Research16, 29–39) has been investigated as an original solution.

Objectives. To assess the level of agreement beyond chance between several raters of interview data by applying the ‘proportional overlap’κ statistic by Mezzich et al. to verbal interview data. The clinical area investigated was child attendance at an Accident and Emergency Department, where parental attendance experiences have been under‐explored.

Methods. Two researchers using a coding schedule coded a random sample of interview transcripts. These data were applied to Mezzich’s procedure; coder 1 notes that a paragraph refers to category A and B but coder 2 notes A, B and C. The total agreement overlap in this case was 0·66 because two actual agreements out of three possible agreements were made. This was repeated for each paragraph and divided by the number of coding pairs. All agreement values were summed then subsequently divided by the total number of paragraphs to get Po (total number of observed agreements) and by the total number of coding pairs to get Pe (total number of agreements by chance alone). Po and Pe were used in the basic κ formula to assess interview coding reliability.

Results. The overall mean Po was 0·61, the mean Pe was 0·32, with a κ score of 0·43; a moderate level of agreement which was statistically significant (t=4·8, P < 0·001, d.f.=23).

Conclusion. Mezzich’s procedure may be applied to interview data to calculate agreement levels between several coders.
Chronic pain and coping: a proposed role for nurses and nursing models
Authors: Richardson Cliff , Poole Helen
Published: March 2003

Chronic pain and coping: a proposed role for nurses and nursing models

Aims. Activity of living based nurse models such as that proposed by Roper, Logan and Tierney are utilized commonly to rationalize, structure and guide practice. This paper proposes that their use, in the context of chronic pain, should be extended to incorporate the assessment of coping and its effect on disability.

Background. As coping has been found to account for some of the variance in adaptation to chronic pain, generic models of coping and their utility in this context are considered. The need for reliable and valid means to assess coping are of paramount importance as this will facilitate and inform treatment and management of chronic pain. At the present time coping is most generally assessed using self report instruments which primarily focus on the number and type of strategies used to cope rather than their effectiveness in reducing disability and increasing function.

Findings. A classification system which categorizes chronic pain patients in terms of how they function in daily life as either adaptive copers, interpersonally distressed or dysfunctional is outlined. The similarities between this and a routine nursing assessment based on an activities of living model are highlighted.

Conclusions. It is proposed that the innovative use of nursing activity of living models could provide the framework for a pain clinic based assessment of coping that has greater utility for professionals and patients alike.
Going home from hospital: the carer/patient dyad
Authors: Procter Susan , Wilcockson Jane , Pearson Pauline , Allgar Vicky
Published: March 2003

Going home from hospital: the carer/patient dyad

Aims. This study aimed to provide an in‐depth understanding of the process of hospital discharge experienced by the carers of patients ‘at risk’ of unsuccessful discharge from medical wards in three hospitals in the North of England.

Background. The Community Care Act and the Carers Recognition and Services Act placed responsibility on service providers to ensure the smooth discharge of patients from hospital making sure that appropriate community services are in place to support the patient and their informal carer following discharge from hospital. The study, from which this paper is taken, identified patients at risk of unsuccessful discharge and tracked the experiences of the patient and their carer through the discharge process. For the purpose of the study unsuccessful discharge is defined as unplanned readmission within 6 weeks of discharge or extended length of stay.

Design. The study combined qualitative and quantitative methods to identify factors leading to unsuccessful discharge. Logistic regression was used retrospectively with the records of 1500 patients to identify factors predicting unsuccessful discharge. A sample of medical patients predicted to be at risk of unsuccessful discharge, their formal and informal carers, were followed through the discharge process using qualitative techniques to look at decision‐making and outcomes related to discharge.

Findings. This paper presents findings relating to patient/carer experiences of the discharge process. It explores the obligate moral climate in which the role of carer is negotiated between professionals, patients, family members, friends and neighbours and the differing assumptions about duty associated with caring roles in hospital and in family and community settings.

Conclusion. The discussion adopts a critical theory perspective to examine the contradictions confronting practitioners, patients and carers arising from hospital policies which promote cost‐effective and efficient use of expensive technical resources while simultaneously seeking to identify and meet the needs of patients and carers for care.
Methodologies analysing individual practice in health care: a systematic review
Authors: Watts Tessa , Jones Melanie , Wainwright Paul , Williams Anne
Published: March 2003

Methodologies analysing individual practice in health care: a systematic review

Aim of the review. The aim of the systematic review was to identify, explore and evaluate the current level of knowledge of methodologies used in comparative analyses of the individual practice of doctors, nurses and midwives.

Rationale. The question of how roles and responsibilities might be shared differently between professional groups in order to promote improved, cost‐effective health care requires a systematic analysis of existing roles and practice. To do this effectively, knowledge of the methodologies available for such an analysis is essential.

Methods. A systematic review of the literature published since 1989 comparing the practice of doctors, nurses and midwives was undertaken.

Findings. The findings are presented in tabular format and include the following categories of published methodologies: experimental/quasi‐experimental; descriptive/nonexperimental and qualitative studies. The discussion centres on a critique of quantitative methodologies used to analyse individual practice in relation to role substitution and diversification. The potential contribution of qualitative methodologies in the analysis of individual practice is discussed.

Conclusions. The authors conclude that the current level of knowledge is biased towards quantitative research. It is argued that the assessment of health care roles and responsibilities would be well served by a more balanced approach that recognizes the strengths of both quantitative and qualitative work.
Comparison of caloric intake and weight outcomes of an ad lib feeding regimen for preterm infants in two nurseries
Authors: Pridham Karen F. , Kosorok Michael R. , Greer Frank , Kayata Sahar , Bhattacharya Abhik , Grunwald Patricia
Published: March 2003

Comparison of caloric intake and weight outcomes of an

ad lib

feeding regimen for preterm infants in two nurseries

Background. Effects on caloric intake and weight gain of an ad libitum (ad lib) feeding regimen for preterm infants may be specific to a special care nursery.

Objective. To explore across two nurseries the similarity of effect on caloric intake and weight gain of an ad lib feeding regimen compared with a prescribed regimen and the similarity of effect of caloric intake on weight gain.

Methods. All infants participating in the multi‐site randomized clinical trial (RCT) of the ad lib feeding regimen were <35 weeks gestational age at birth and had birth weight appropriate for gestational age. Data on caloric intake and weight gain were collected at two nurseries (A, n=22; B, n=78) with the same feeding regimen protocols. Two strategies were used to explore similarity of regimen effect on caloric intake and weight gain. Repeated measures analysis of variance (ANOVA) was used to examine the effect on caloric intake and weight gain of time, feeding regimen, and time‐by‐regimen interaction for each nursery.

Results. In both nurseries, regimen effects were reasonably consistent for caloric intake and weight gain. Caloric intake was lower across nurseries for infants fed ad lib. After accounting for caloric intake, the ad lib regimen did not affect weight gain. The time‐by‐regimen interaction effect on caloric intake was significant in both nurseries. Caloric intake for infants fed ad lib increased significantly over 5 days.

Conclusions. Despite differences between nurseries in infant characteristics and in protocol implementation, the feeding regimen effect was consistent for caloric intake and weight gain. Further support was found for the development of infant self‐regulatory capacity.
The nurse specialist role in Hong Kong: perceptions of nurse specialists, doctors and staff nurses
Authors: Chang Ka Pik Katherine , Wong Kwok Shing Thomas
Published: March 2003

The nurse specialist role in Hong Kong: perceptions of nurse specialists, doctors and staff nurses

Aim. The purpose of this study is to review and delineate the impact in terms of the perceived importance as well as the role components of nurse specialists in Hong Kong.

Rationale. The Nurse Specialist Scheme was launched in 1994 in Hong Kong. Studies in the West showed that there were impacts on the roles of other members among the health care team. However, minimal local published work has been carried out in reviewing the scheme.

Design. The design of the study was nonexperimental. Data were collected by self‐administered questionnaires. The questionnaire adopted was developed by O’Mullan (1995), and the five roles studied were administration, clinical practice, consultation, education and research. To ensure the contextual relevancy and consistency of the questionnaire, content validity and test–retest reliability tests were performed. The content validity index was 0·85 and the test–retest reliability (Spearman’s ρ coefficient) ranged from 0·57 to 0·97. Subjects were obtained by stratified convenience sampling technique. The ratios for subject selection among the doctors, ward managers, nursing officers and registered nurses were 3:1:3:10, respectively. Because of the small numbers for nurse specialists, they were all included in the study. The final sample consisted of 11 nurse specialists, 47 ward managers, 56 nursing officers, 110 registered nurses and 15 doctors (n=239).

Results. The results showed that there were significant differences in the perceptions of importance of the administration, clinical practice, education and research roles, and the frequency of occurrence of the clinical practice and research roles. This was further verified by the Fisher’s Least Significant Differences (LSD) test.

Conclusions. A regulatory system of the nurse specialist was recommended to monitor the development of the nurse specialist role and practice and to ensure the safety of the public with regard to the emerging role. Both the implications and limitations are discussed.
An archaeology of caring knowledge
Authors: Paley John
Published: March 2003

An archaeology of caring knowledge

Background. There have been repeated attempts, especially during the last 20 years, to say precisely what caring in nursing is. Authors who undertake this task usually begin with the observation that the concept of caring is complex and elusive, and suggest that their contribution will help to clarify this most confused of notions. However, they are always followed by other authors, who do exactly the same thing. We seem to be no closer, now, to a clarification of caring than we have ever been.

Aim. The paper offers a diagnosis of this situation, and explains why the project of retrieving caring from its elusiveness is an impossible one. I will suggest that this has nothing to do with the concept of caring, as such. Rather, the impossibility of the task follows from what these authors take to be knowledge of caring.

Method. I present an analysis of some presuppositions about what knowledge is. These presuppositions pervade the literature on caring, and can be summarized as follows: knowledge of caring is an aggregate of things said about it, derived from a potentially endless series of associations, grouped into attributes on the basis of resemblances, and conceived as a holistic description of the phenomenon. Further, I suggest that this analysis is akin to the one which Foucault offers of sixteenth century knowledge.

Conclusions. The analysis suggests that this way of knowing is approximately 350 years out of date, and explains why the task of arriving at knowledge (in this sense) is impossible. Moreover, Foucault’s claim that sixteenth century knowledge is ‘plethoric yet absolutely poverty‐stricken’ applies, with equal force, to nursing’s knowledge of caring.
Mental disturbances and perceived complexity of nursing care in medical inpatients: results from a European study
Authors: Jonge Peter De , Zomerdijk Marieke M. , Huyse Frits J. , Fink Per , Herzog Thomas , Lobo Antonio , Slaets Joris P.J. , Arolt Volker , Balogh Nandor , Cardoso Graca , Rigatelli Marco
Published: March 2003

Mental disturbances and perceived complexity of nursing care in medical inpatients: results from a European study

Aims and objectives. The relationship between mental disturbances – anxiety and depression, somatization and alcohol abuse – on admission to internal medicine units and perceived complexity of care as indicated by the nurse at discharge was studied. The goal was to study the utility of short screeners for mental disturbances to select patients for case‐management on admission.

Design. The study had a cohort design: patients were included on admission and followed through their hospital stay until discharge. The study was conducted within the framework of the European Biomed 1 Risk Factor study.

Research methods and instruments. In the first 3 days of admission the patients were interviewed by a trained health care professional, who scored the SCL‐8D, a somatization questionnaire based on the Whiteley‐7 and the CAGE. At discharge, nurses rated the complexity of the patient’s care.

Results. Patients with high scores on anxiety and depression (SCL‐8D) and on somatization received higher ratings on perceived nursing complexity than those with low scores, with and without control for age, severity of illness and chronicity. The actual nursing intensity and medical care utilization, as measured daily by means of a checklist, could not explain these relations. No differences were found between patients with high or low scores on alcohol abuse.

Conclusions. The study shows a potential use of screeners for mental disturbances to detect patients for whom nurses might need additional help. However, mental disturbance is not the sole criterion: functional status and other variables that predict medical and nursing care utilization should be included in a screening strategy for case‐management programmes.
Validity in action research: a discussion on theoretical and practice issues encountered whilst using observation to collect data
Authors: Turnock Christopher , Gibson Vanessa
Published: March 2003

Validity in action research: a discussion on theoretical and practice issues encountered whilst using observation to collect data

Aim. The paper contributes to an understanding of validity in action research methodology by examining issues arising from our attempts to describe the role of an observer in an action research study.

Background. Our experiences in observing patient care in intensive care settings are used to illuminate discussion on the nature of validity in action research.

Content. The paper examines the nature of validity in action research methodology before briefly describing a study that included observing intensive care staff providing patient care. Various perspectives on observation as a research method are critically examined. These include observer role, level of participation, use of cover, structure and timing of observation. Validity in action research underpins the discussion in the paper.

Conclusion. We conclude that it may not always be possible to categorize the role of the observer within existing definitions. It may be better to summarize the actual observer role as a way of illustrating validity so that the reader can judge the validity of the findings from an action research study.
An insight into the experiences of parents with inflammatory bowel disease
Authors: Mukherjee Suzanne , Sloper Patricia , Turnbull Alastair
Published: March 2003

An insight into the experiences of parents with inflammatory bowel disease

Aims and objectives. To identify parents' views, both positive and negative on: how inflammatory bowel disease (IBD) affects people in their parenting role; effects parents with IBD have noticed in their children; ways of dealing with any difficulties in parenting; and support needed by parents with IBD.

Design. This was a small‐scale exploratory study, adopting a qualitative research design. A purposive sample of 19 mothers and five fathers with IBD was recruited through two hospitals and a voluntary group in the north of England.

Research methods. Data were collected through a combination of focus groups and interviews, and analysed using the `framework approach'.

Findings. The main positive effect for parents was developing a closer relationship with their children. When parents were experiencing symptoms there were difficulties in caring for young children; problems taking children to and from school, and attending school events; restrictions in social life; irritability and reduced tolerance of children. When in hospital, it was sometimes difficult to arrange for care of young children. These difficulties caused worry and guilt for parents, and a few spoke of periods of depression. Parents noticed that their children seemed caring and understanding of illness, but were also anxious when the parent was ill or in hospital, and reacted with anger or frustration to restrictions in social activities. Strategies commonly used to deal with difficulties were turning to family for support and trying to control symptoms. Support from health professionals was variable. Parents wanted more practical assistance, information for families on the effects of IBD, and support in coping with the condition. Awareness‐raising about IBD was considered important within health, social services, education and housing departments.

Conclusions. As a group in regular contact with parents with IBD, health professionals have an important role to play in providing support. Staff should be particularly vigilant towards parents with severe symptoms, mothers of younger children, and those receiving limited help from their families.
Rituals and nursing: a critical commentary
Authors: Philpin Susan M.
Published: March 2003

Rituals and nursing: a critical commentary

Aim of the paper. This critical commentary explores the concept of ritual in the nursing and social science literature in terms of investigating different understandings of its meaning and purpose.

Rationale. The term `ritual' is often used in a pejorative sense in nursing literature to refer to unthinking, routinized action by nurses, which lacks any empirical foundation. The purpose of this paper is to explore alternative understandings of the meaning of ritual, suggesting that the negative usage described above misses out on the wider symbolic meaning of the word.

Method. The literature search used a combination of electronic databases (CINAHL, ASSIA, MEDLINE and RCN) from 1960 to 2000 and serendipitous references in texts.

Findings. The commentary is presented under the following two broad emerging themes: first, the complex issues surrounding the definition of ritual, including the relationship between rational and rational action and second, the purposes served by ritual.

Conclusions. The paper concludes with the recommendation that the rituals nurses use in the performance of their care are worthy of research as a rich source of insight into the meaning and purpose of nursing actions.
Patient and carer needs following a cancer‐related hospital admission: the importance of referral to the district nursing service
Authors: Wilson Kate , Pateman Brian , Beaver Kinta , Luker Karen A.
Published: March 2003

Patient and carer needs following a cancer‐related hospital admission: the importance of referral to the district nursing service

Background. Despite 30 years of research attention, discharge planning and district nurse (DN) referral remain problematic and few cancer‐related publications exist. With shorter hospitalizations, discharged cancer patients and their carers may experience unmet needs for assessment, information and support. Although DN referral might enable patient/carer needs to be met, the DN role lacks clarity.

Aim. To investigate the needs of people with cancer, and their lay carers during discharge from hospital to home, and identify the role of DNs in meeting these needs.

Method. In this qualitative study, 71 pre‐ and postdischarge interviews were performed with cancer patients and (where possible) their carers. Predischarge interviews focused on expectations and postdischarge interviews on experiences of discharge and aftercare. Interview tapes were transcribed and analysed thematically.

Results. Interviewees anticipated few aftercare needs during predischarge interviews but described met and unmet needs during postdischarge interviews. Unmet needs of those referred and not referred to the district nursing service were similar. Patients and carers had unmet needs for psychological support related to nutrition. Carers, especially those not resident with and not related to patients, had informational needs. Even very elderly, ill and isolated patients felt that other people had greater needs than their own and many thought that DNs only performed physical tasks.

Conclusion. All cancer patients discharged from hospital might be referred to a DN for ongoing assessment of needs. However, to ensure optimal results, the DN role needs to be clarified and public perceptions altered. Further research on psychological aspects of nutrition and the needs of carers not resident with/not related to patients is necessary.
Nursing the spirit: the Framework of Systemic Organization
Authors: Friedemann Marie‐Luise , Mouch Judith , Racey Teri
Published: March 2003

Aims.  To elucidate the concept of spirituality as an essential and integrated dimension of the functioning of individuals and families through the Framework of Systemic Organization (Friedemann 1995) and to demonstrate with a case example, how a nurse can integrate spirituality in the care of a terminally ill patient.

Background.  Spirituality is the focus of discussion in nursing and other health professions in the United States of America, but whether or not it should be generally included in patient care is heavily debated. Also unanswered is the question about how spirituality should be addressed. The Framework of Systemic Organization (Friedemann 1995) is introduced here as an organizing structure to guide nurses in caring for the spiritual needs of patients.

Implementation of the theoretical framework.  Spirituality is defined as connecting to systems such as God, nature or other people, and thus finding meaning through relationships. Key to spiritual care is the establishment of a balance between control and spirituality that is tailored to an individual patient's history, values and needs. A case example is used to show how a nurse intervenes with a patient who faces death.

Findings.  The example shows that control remains important in a patient's life process until death arrives. Nevertheless, a dying patient benefits from an increasing focus on spirituality to gain self‐acceptance, reconciliation with the family and restoration of emotional health. Nurses are instrumental in finding the balance between control and spirituality that a patient desires.

Conclusion.  Nurses who have explored and reconciled their own spiritual beliefs can learn to address their patients' unique needs within the broad context of family and environment. Nursing the spirit by using the Framework of Systemic Organization is a client‐directed and intimate process that leads to growth of both patient and nurse.
Nurses' perceptions of discharge planning in acute health care: a case study in one British teaching hospital
Authors: Atwal Anita
Published: March 2003

Aim of the study.  To provide an in‐depth understanding of nurses' perceptions of the hospital discharge process in a London teaching hospital.

Background.  Discharging patients from hospital is a key component of the nurse's role in acute health care settings. It is remarkable that despite government legislationand research, which stretches back over 20 years in both Europe and North America, discharge planning remains problematic. Furthermore, it is an activity that requires collaboration between health and social care agencies. In the United Kingdom there is a new emphasis and incentive on managing acute hospital beds, which in turn results in shorter stays in hospital. In London, discharge planners face additional problems because of social, economic and environmental factors.

Method.  Using a case study design, 19 nurses were interviewed using the critical incident approach to obtain their perceptions of the discharge process. Direct observation was conducted to record interactions between nurses and health care professionals in multidisciplinary teams. In total 14 meetings were attended in elder care and orthopaedics and 7 in acute medicine.

Findings.  Aspects of the discharge process were often ignored or neglected and assessments were rarely co‐ordinated. The nursing ward handover was regarded as a process that hindered communication. Lack of time was reported to be the biggest barrier that affected interprofessional working and hence the co‐ordination of assessments.

Conclusion.  The findings have important implications for nurses, managers and educational establishments. It is essential that social and medical diagnoses run parallel and that accurate information is collated and communicated within the multidisciplinary team. Further research into the impact of time pressures on communication, interprofessional working and the discharge process is needed.