bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Low‐Dose Baclofen Administration on Plasma Insulin‐like Growth Factor‐I in Persons With Spinal Cord Injury
Authors: Bauman William A. , Kirshblum Steven C. , Morrison Nancy G. , Cirnigliaro Christopher M. , Zhang Run‐Lin , Spungen Ann M.
Published: March 2006

Patients with chronic spinal cord injury (SCI), a condition associated with reduced physical function, have been reported to have lower plasma insulin‐like growth factor‐I (IGF‐I) levels than able‐bodied persons. We evaluated the potential for daily low‐dose baclofen administered over several weeks to increase plasma IGF‐I levels. Ten healthy male outpatients with chronic SCI were studied prospectively. Patients received escalating doses of baclofen for 4 weeks at each dose level (5, 10, and 20 mg/d). At each dose of baclofen, an increase in the plasma IGF‐I was noted; significant increases in plasma IGF‐I occurred at 2 weeks after administration of drug at doses of 10 and 20 mg/d, with a subsequent rise to peak levels on baclofen 20 mg/d [baseline, 205 ± 74; peak, 218 ± 76 (not significant), 239 ± 83 (P < .05), 263 ± 87 μg/L (P < .05), at baclofen 5, 10, and 20 mg/d, respectively]. In conclusion, low‐dose baclofen administration for 4 weeks stimulated the growth hormone‐IGF‐I axis in persons with SCI, with the potential for beneficial effects on body composition.
Constancy in Integrated Cisplatin Plasma Concentrations Among Pediatric Patients
Authors: Goodisman Jerry , Souid Abdul‐Kader
Published: March 2006

The authors report on the variability in the integrated quantity of free (unbound) plasma cisplatin (area under curve of plasma concentration versus time, AUC). The AUC was measured in 19 patients receiving cisplatin doses proportional to body surface areas (BSA), 30 mg/m2 over 1 hour. The relative standard deviation (RSD, population standard deviation divided by mean value) for the maximum free plasma cisplatin concentration (Cmax, μM) was 0.338; for the half‐life (t1/2, minute), 0.210; and for the AUC (μM minute), 0.320. Thus, BSA‐based dosing gave significant variability in the AUC. We attempted to use (weight)a (height)b, seeking values of a and b that gave the smallest RSD in AUC, but only minimal improvement could be obtained by deviating from the BSA formula (a = b = 0.5). However, dosing proportional to (weight)d(Cmax)f (with d ≅ 3/4 and f ≅ −1) reduced the RSD in AUC from ∼1/3 to ∼1/10. Dosing proportional to (weight)m (Cmax)n (t1/2)p (with m ≅ 0.7, n ≅ −1, and p ≅ − 1/2) reduced it further, to ∼1/32. In contrast, using (weight)d (Cmax)f (age)g gave no improvement over (weight)d (Cmax)f. The authors conclude that the inconsistency in AUC can be reduced 10‐fold with dosing proportional to the weight and the drug pharmacokinetic parameters [(weight0.7) ≅ (Cmax × t1/20.5)].
Determination of the Bioavailability of [14C]‐Hexaminolevulinate Using Accelerator Mass Spectrometry After Intravesical Administration to Human Volunteers
Authors: Klem B. , Lappin G. , Nicholson S. , van de Wetering J. , de Vries D. E. , Oosterhuis B. , Garner R. C.
Published: March 2006

Hexaminolevulinate (HAL) is a diagnostic agent that allows the visualization of tumor tissue in the bladder by fluorescence cystoscopy. It is administered intravesically via a catheter for 1 hour, followed by blue light bladder inspection to induce selective red tumor fluorescence. Hexaminolevulinate should ideally be confined to the bladder only, but it is likely that some absorption occurs during administration, and therefore the systemic bioavailability is of interest. The bioavailability of HAL was determined by intravesical and intravenous administration of [14C]‐HAL hydrochloride to 8 human volunteers. To reduce the radiation dose as low as possible, the ultrasensitive analytical technique of accelerator mass spectrometry was used to measure [14C]‐HAL. The bioavailability of [14C]‐HAL after intravesical and intravenous administration was determined from the respective area under the curve based on total radioactivity and was determined to be 7% (range, 5%–10%; 90% confidence interval). The systemic absorption of [14C]‐HAL after intravesical administration is low and supports previous clinical experience with HAL showing no systemic side effects.
Clinical Pharmacology of the Appeals and Exception Process: The Interface of the Patient, Physician, and Insurance Company to Assure Appropriate Care Under Medicare Part D
Authors: Blum Richard S.
Published: March 2006

Personalized medicine considers factors unique and specific to each patient to make clinical decisions, including selecting pharmacotherapy. Drug formularies, including those available to enrollees in Medicare Part D, are based on group characteristics and financial considerations. Consequently, an appeal of a formulary's preferred drug selection may be necessary to ensure the best care of the patient. Consideration of basic principles of clinical pharmacology can be used to decide whether an exemption should be considered and to document specific reasons for the request.
New Insights into Glucose Regulation
Authors: Kruger Davida F. , Martin Catherine L. , Sadler Christopher E.
Published: March 2006

This review article describes the regulation of glucose homeostasis in subjects with and without diabetes based on the emergence of new information and discusses modes of action, attributes, and limitations of current diabetes therapies. In normal physiology, glucose homeostasis is tightly controlled by the interaction of pancreatic and gut hormones. Since the 1920s, diabetes has been viewed as a disease caused by deficient secretion of insulin, resulting in reduced glucose uptake and subsequent hyperglycemia. The discovery in the 1950s of the pancreatic hormone glucagon, which opposes insulin by increasing glucose appearance in the circulation, resulted in a bihormonal model of glucose homeostasis. More recently, with the discovery of the incretin hormones glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) in the 1970s and the pancreatic hormone amylin in the 1980s, it is now understood that several organs and hormones play roles in maintaining glucose homeostasis. Therapies for diabetes have focused on compensation for deficient insulin action through stimulation of insulin secretion, administration of insulin itself, reduction of peripheral insulin resistance, or decreased glucose absorption from the intestine. The discoveries of amylin and GLP-1 have furthered our understanding of the abnormalities involved in diabetes, enabling the development of additional therapeutic options.
Sustaining a Diabetes in Pregnancy Program
Authors: Pagano Michelle , Luerssen Marie , Esposito Eileen
Published: March 2006

Education regarding diabetes management is of utmost importance, especially during pregnancy when there are 2 patients being managed at the same time, a mother and a fetus. The level of education the mother receives affects both patients. The constant reevaluation and change in treatment plans based on those evaluations positively affects the outcomes for each of them. There are a number of complications associated with having uncontrolled diabetes during pregnancy. A diabetes in pregnancy management program can offer education, provide continuous evaluation of management options, decrease hospitalizations for glucose control, and decrease complications associated with uncontrolled diabetes. All programs must have a goal, a benchmark by which to measure themselves. Plans must be formulated using current and acceptable standards of care. Once implemented, there must be ongoing evaluation of outcomes to determine whether goals are being met. With implementation of the appropriate quality tools, programs can learn to formulate their plans, implement them, measure the results, improve outcomes, and sustain themselves.
What is the Future of Diabetic Wound Care?
Authors: Sweitzer Sarah M. , Fann Stephen A. , Borg Thomas K. , Baynes John W. , Yost Michael J.
Published: March 2006

With diabetes affecting 5% to 10%of the US population, development of a more effective treatment for chronic diabetic wounds is imperative. Clinically, the current treatment in topical wound management includes debridement, topical antibiotics, and a state-of-the-art topical dressing. State-of-the-art dressings are a multilayer system that can include a collagen cellulose substrate, neonatal foreskin fibroblasts, growth factor containing cream, and a silicone sheet covering for moisture control. Wound healing time can be up to 20 weeks. The future of diabetic wound healing lies in the development of more effective artificial “smart” matrix skin substitutes. This review article will highlight the need for novel smart matrix therapies. These smart matrices will release a multitude of growth factors, cytokines, and bioactive peptide fragments in a temporally and spatially specific, event-driven manner. This timed and focal release of cytokines, enzymes, and pharmacological agents should promote optimal tissue regeneration and repair of full-thickness wounds. Development of these kinds of therapies will require multidisciplinary translational research teams. This review article outlines how current advances in proteomics and genomics can be incorporated into a multidisciplinary translational research approach for developing novel smart matrix dressings for ulcer treatment. With the recognition that the research approach will require both time and money, the best treatment approach is the prevention of diabetic ulcers through better foot care, education, and glycemic control.
Outpatient Therapeutic Recommendations by Diabetes Educators in a Rural Vermont Hospital
Authors: Gorson David M. , Haytko Paula , Carpenter Patricia , Marr Tim , Borders Lara K. , Probola Dianne
Published: March 2006

Because of the rapid increase in the incidence of Type 2 diabetes that is occurring in southwestern Vermont (which correlates with the national increase), a “therapeutic guidelines” worksheet was developed to assist primary care providers with the management of Type 2 diabetes patients. Hospital-based diabetes nurse educators access cholesterol and AIC information from the hospital laboratory, assess the patient, and then make recommendations to the primary care provider. The worksheet is designed to be easily used by both the educator and the primary care provider. Feedback has been positive, as the worksheet serves to enhance providers’ ability to treat patients and to achieve recommended treatment goals.
From 'getting to know you' to 'soloing': The preceptor-student relationship
Authors: Crawford Marta J. , Dresen Sheila E. , Tschikota Sharon E.
Published: March 2006

A preceptored practicum for senior students is seen by many to be an important transition to the graduate nurse role, although there is very little literature describing the development of the student during these clinical experiences. Furthermore, the exact role of preceptors in facilitating students' learning and socialisation into the nursing profession is not well defined. This descriptive exploratory study sought to elucidate the meaning of the experience of preceptorship to senior baccalaureate nursing students during their senior practicum. To that end, audiotaped interviews were conducted with 15 senior Canadian baccalaureate nursing students at the end of the first, second and third months of their practicum. Students were asked to describe a recent significant incident from their practice experience, the context of the situation, and why the incident was significant. The research team analysed the interview transcriptions, extracted significant statements, and identified themes and patterns relating to the students' perceptions of their experiences. The relationship with the preceptor was perceived by students as pivotal to their development as a nurse. Emerging themes that described this experience were: 'developing a productive relationship', 'creating a safe environment for learning', 'teaching strategies employed by preceptors', and 'soloing'. An understanding of the experiences of senior student nurses during their practicum will assist both faculty staff and preceptors to develop strategies to facilitate student growth and comfort during the experience.
Clinical supervision: What is going on in West Wales? Results of a telephone survey
Authors: Jenkins Ergys , Rafferty Mic , Parke Silan
Published: March 2006

This research was designed to identify successful models of clinical supervisory practice and the problems encountered by practitioners following the incorporation of clinical supervision into their practice. The survey population of 35 was a self-selected sample out of 118 practitioners who had completed the Welsh National Board validated diploma level module in clinical supervision. These practitioners had completed the module organised by the School of Health Science at Swansea at eight sites across Mid and West Wales between February 1995 and June 1997. Work on the study began in March 1997 and was completed in March 1998.

The study employed semi-structured telephone interviews which sought information on practitioners' experiences, and how their clinical supervision was organised in practice. The data were analysed by quantification, and by description of the responses by repeated independent analyses. Finally, the key themes were organised into 'narrative types'.

The findings are presented in three parts relating to the three functions of supervision: support, learning, accountability. Key findings include:

•The method was suitable and effective •Community practitioners are generally better placed than their counterparts in acute hospitals to undertake effective supervision •Time and organizational support are crucial factors •The need for, and value of, clinical supervision was universally acknowledged by those interviewed.

Recommendations relating to the findings are included.
Ethnomethodology-The problems of unique adequacy
Authors: Wakefield Ann
Published: March 2006

This paper has been developed from an ethnomethodological study examining the practicalities of organising surgical nursing work. The discussion explores the extent to which ethnomethodology can be employed to extrapolate data from the investigative domain. The concept of 'unique adequacy' has been examined in considerable detail, as this element of the methodology created significant problems when analysing the data. 'Unique adequacy' is defined here as the researcher's ability to analyse the encountered social world from practitioner research rather than from 'classical social theorising' (Cuff et al., 1992) perspectives. The debate focuses particular attention on highlighting the difficulties encountered when attempting to achieve 'ethnomethodological indifference' (Garfinkel, 1986), that is, the researcher's ability to remain non-judgemental when reporting on the findings.
Stress and coping in forensic community mental health nurses: Demographic information and qualitative findings
Authors: Coffey Michael
Published: March 2006

Occupational stress and burnout in nurses is now well documented. Community mental health nursing has been shown to be particularly stressful. The field of forensic psychiatry has in recent years seen the emergence of the role of the forensic community mental health nurse (FCMHN). There is little documented evidence about these nurses or their experience and perceptions of the work they do. This study forms part of a larger study investigating the levels and sources of stress and burnout among this group of nurses. Preliminary findings suggest that, as a group, FCMHNs are an experienced group of nurses with an average 15 years or more in psychiatric nursing. They tend to occupy higher grades and are almost equally made up of men (53.8%) and women (46.2%). The majority are happy with life in general, do not use maladaptive coping strategies, have good job security (67.1%), feel supported by their manager (87.2%) and carry an average caseload of 13.15 patients. Caseload issues and organisational issues were reported as the most stressful elements of work. Peer support and good supervision were the main coping strategies reported. Consideration for training and reducing the isolation of FCMHNs as they expand into new areas with increased risk of role ambiguity is indicated.
The use of narrative in the study of caring: A critique
Authors: Priest Helena M.
Published: March 2006

Within nursing and the allied professions there is an extensive and growing literature that aims to uncover the meaning of caring and its application in practice. Review of the literature reveals a wide range of data collection and analysis methods, including measurement and multivariate analysis, concept analysis, content analysis, Q-sort methodology, the repertory grid technique, case study, ethnographic and phenomenological approaches. It is argued that while all approaches make a valid contribution, appropriate methods for nurses of obtaining rich data about the meaning and practice of caring are those which permit the researcher to enter the world of the nurse and explore perceptions as expressed through stories.

Reference is made within this paper to the use of narrative in an ongoing research study which explores nurses' perceptions and experiences of psychological care-giving and the ways in which these develop throughout nurse education programmes. However, the main purpose of this paper is to present arguments for and against the use of the narrative method, concluding with a brief discussion of methodological choice applied to the study of caring.
An evaluation of the impact of developing nurse-led treatments for minor injuries in community hospital casualty units
Authors: Macduf Colin , West Bernice J.M. , Lawton Sally
Published: March 2006

This paper reports the evaluation of a nursing role development based on assessment/treatment protocols for minor injuries. The initiative evolved in an integrated way across nine community hospital casualty units, presenting an interesting opportunity to research its impact. A primarily descriptive, developmental evaluation approach was adopted which surveyed the perceptions of the main stakeholders and collated existing data. The development was found to have impacted very positively for the main professional groups involved, and patient waiting times appear to have been reduced. The educational course which underpinned the initiative was an important factor in its success. A number of other influential factors were identified during the research and these are discussed in relation to role development in nursing and evaluation methodology for nursing.
Violent incidents in a forensic adolescent unit: A functional analysis
Authors: McDougall Tim
Published: March 2006

This paper reports on a survey which identified categorised and measured the relative frequency of specific antecedents before, and the consequences following, violent incidents in an adolescent forensic unit during a two-year period. Retrospective analysis of 219 violent incidents involved the examination of incident forms, nursing-process records and accident reports. Antecedents and precipitating factors were also recorded.

The results demonstrated that the vast majority of incidents were precipitated by several observable antecedents or precipitating factors (186, 85%). Only a small proportion of the violent incidents were preceded by a single risk indicator (21, 9.5%) and a minority were reported to have occurred in the absence of observable antecedents (12, 5.5%). The severity of violent incidents was rated on a four-point scale but no significant correlation was found between category or frequency of antecedent and the violent act itself.

The consequences for the young person following acts of violence were also documented, and the results show that the large majority of incidents were followed by increased staff observation (197, 90.5%). Coercive interventions such as physical restraint (177, 80.8%) or idiosyncratic sanctions (88,40.2%) were commonly recorded. A significant proportion of violent incidents did not appear to be followed by staff intervention, sanction or punishment (80, 36.5%).

Finally, results are considered against research and best practice evidence, and suggestions for further studies are presented. Organisational interventions, strategies for the management of aggression and violence, and a staff training needs analysis are also indicated.
An analysis of the ability of nurses to identify the anxiety levels of patients in general medical and surgical wards
Authors: Teasdale Kevin , Mulraney Stephen , Blanchard Helen , Rolfe Jayne , Pallett Steven
Published: March 2006

The study investigated whether qualified nurses could distinguish between low and high anxiety in general medical and surgical wards. The sample comprised 94 patients and 62 nurses in two district general hospitals. The patients completed the Spielberger State-Trait Anxiety Inventory Version Y and were divided into high and low anxiety groups by reference to the published norms for the inventory. The nurses independently rated the patients into either high or low anxiety groups according to whether or not they believed individual patients needed more nursing time than was usual to help them to manage their anxiety. The joint ratings were signficant beyond the 0.01 level, supporting the hypothesis that the nurses could distinguish between high and low anxiety patients. However when data from the two hospitals were separated, the overall results were only significant in the hospital where patients had reported significantly lower average levels of anxiety. A tentative explanatory hypothesis is that assessment of patients may be easier where the general background level of patient anxiety in a ward is relatively low. In a subsidiary part of the study, feedback and group training failed to increase the correspondence between nurses' ratings and those obtained from the patients' questionnaires. The research method for comparing the views of patients with those of nurses proved practical for implementation in busy hospital wards and may therefore be useful for other investigations in similar settings.
Quality in nursing care: Context, complexity and the role of professions
Authors: Normand Charles , Doagllas Hannah-Rose , Castelnuovo Enmanuela
Published: March 2006

Requests for quality and affordability have driven healthcare reforms in the UK and elsewhere at all levels of the system. The introduction of some aspects of private markets in healthcare has paved the way to transfers of organisational know-how across the private and public sector. However, the concept of quality has a wider meaning in the public sector, incorporating social as well as individual goals. Furthermore, the incentives needed to achieve improvements in quality are different between the sectors.

The notion of quality incorporates contrasting, even paradoxical ideas: it can be seen as a notion of achieving standards and norms on the one hand, and on the other, as enhancing variability and adaptability to changing environments. While the public sector appears to be moving towards the former, the private sector is moving in the opposite direction. Improving the quality of nursing care means finding quality improvement technologies which can incorporate aspects of healthcare that are among the most difficult to define and measure. This may be a reason why nurses have been less successful than doctors at controlling the quality agenda for their profession. Initiatives in the private sector which focus on adaptability and flexibility may be worth exploring in order to identify innovative ways of capturing important aspects of nursing care which cannot be standardised.
Is quality assurance in nursing research-based?
Authors: Sale Diana
Published: March 2006

This paper attempts to answer the controversial question: 'Is quality assurance in nursing research-based?' The argument put forward is whether or not the off-the-shelf monitoring tools which originated, and were researched and piloted, in the US, offer research-based quality assurance following their migration to nursing in the UK. The paper includes a brief history of quality assurance and an overview of some of the most commonly-used quality assurance tools, including Monitor, Qualpacs and Phaneuf's Nursing Audit. The paper further explores the use of standards and integrated care pathways as systems for monitoring the quality of care, and whether or not standards set for evidence-based care and integrated care pathways based on sound research result in research-based quality assurance in nursing.
A critical review of the use of time sampling in observational research
Authors: Oldfield Sandra J.
Published: March 2006

Observational methods are under-utilised in nursing research, but have a number of benefits. This paper outlines two approaches to collecting observational data, namely continuous sampling and time sampling. Time sampling is critically reviewed, and methodological considerations when adopting this method are discussed. A major issue is the reliability in estimating frequency and duration of observed behaviours. Researchers have shown that the selection of the appropriate interval length is critical to this reliability, emphasising the need for pilot work to define and estimate average duration of behaviours to be observed. The paper outlines conditions when either of the two sampling methods, partial interval recording and momentary time sampling, may be reasonably selected. However, continuous sampling may be preferable for observing complex behaviours involving at least two participants.
Pre-operative visiting in Wales: A study of its prevalence and nature
Authors: Coleman Mick , White Jean
Published: March 2006

A telephone survey was completed involving senior nurses from all NHS theatre units in Wales that carry out routine scheduled surgery (n=19).The survey examined whether these units had pre-operative visiting regimes, constraints and barriers to pre-operative visits and the nature, content, timing and staffing of any visits that were undertaken. A purposive sample of respondents from the telephone survey (n=6) was interviewed further and a content analysis of the transcribed interviews completed.

The results indicate that only a small percentage of patients undergoing surgery actually receive a pre-operative visit. When visits are carried out their content does not reflect the evidence of effectiveness in the research literature. The reasons for this apparent non-utilisation of research evidence are explored in the paper and recommendations are made as to how this situation could be altered.
Health-related quality of life assessment in end-stage renal failure
Authors: Piillips Louise , Davies Simon J. , White Edward
Published: March 2006

End-stage renal failure (ESRF) is a life-threatening condition and survival can be maintained only with renal replacement therapy. Furthermore, the complications of ESRF, its treatment and co-existing diseases have been found to have a significant impact on the physical health of patients. It is well documented that the health status of the renal patient population is worse than that of the general healthy population; for this reason the assessment of quality of life of ESRF patients has received considerable attention.

During the 1990s, the focus of health assessment moved away from the disease itself towards health status and wellbeing. The widespread use of the 36-item short-form (SF-36) questionnaire has promoted this. In ESRF studies from data using the SF-36 questionnaire it has been shown that it is the physical functional component of health that is most affected by the patient's condition, with co-morbidity having a significant impact.

There is growing consensus that health-related quality of life is more than just an assessment of health status. Rather, it is the relative importance given by the individuals themselves to the impact of the disease on their life. While this approach is emerging, some of the tools which have been developed to measure individualised quality of life require further scientific validation for use with the ESRF population.
A multi-method examination of the views of community nurses on the core skills of community staff nurses
Authors: Forbes Angus , White Alison , Dyson Liz
Published: March 2006

Although staff nurses comprise a large and important group within the community nursing workforce, there is some confusion surrounding their role and the skills required by them. This study explored the views of a range of different community nurses (n=68) working in one inner-city community trust regarding the skills and learning needs of community staff nurses. The sample comprised community staff nurses (n=28); health visitors (n=15); district nurses (n=19), and nurse managers (n=6) within one trust. The study used three data collection methods: semi-structured interviews, focus groups and a postal questionnaire, with the data from each being triangulated. The findings suggested that the role of staff nurses working in the community differed from that in hospital and that the role requires a broad range of skills. The study therefore highlighted the need for flexibility and adaptability in the skills of community staff nurses.
Classifying nursing care to improve patient outcomes: The example of WISECARE
Authors: Kearney Nora
Published: March 2006

Currently, the vast majority of nursing practice is not assessed in any quantifiable manner, making it difficult to demonstrate explicitly the value of nursing to cancer care. This results from the lack of any meaningful or universal system or language that makes visible what nurses 'do'. As a consequence, nursing is often deemed invisible in terms of its importance in healthcare. A model for classifying nursing care may therefore address this situation, making nursing visible not just to policymakers but also to patients. This paper highlights the need for clarity in classifying nursing practice and presents a potential solution through the Workflow Information Systems for European Nursing Care (WISECARE) project. WISECARE was an EC-funded project which utilised state of the art information technology to develop an information tool which allowed a systematic approach to nursing practice through the classification of patient problems.
The importance of pilot work to ensure questions have meaning to participants: Developing questions about PREP
Authors: Tingle Alison , Marsland Louise
Published: March 2006

Small-scale qualitative work has long been recommended as a sound basis for developing structured questionnaires (Hoinville et al., 1978; Morton-Williams, 1985). The aim of this paper is to demonstrate the importance of qualitative interviewing to determine when questions become relevant to participants. During a longitudinal study of nurses' careers, pilot work was undertaken at each phase of data collection in order to test the efficiency and effectiveness of the data collection tool. Using questions about PREP, the paper describes how a three-stage process of unstructured interviews and postal pilots was used to develop questions which had meaning to nurses at three time points in their careers, thereby helping to ensure that the data produced were valid.
Partnerships for changing practice: Lessons from South Thames Evidence-based Practice project (STEP)
Authors: Ross Fiona , McLaren Susan , Relfeirn Sally , Warwick Cathy
Published: March 2006

Partnership working is central to the rubric of contemporary health policy. This paper discusses and analyses the STEP partnership model and the issues emerging for academic and service coalitions, which were formed for the purpose of implementing evidence-based practice in nine clinical centres. Using a framework for collaboration, key themes for successful partnerships are summarised in a model as contextual factors: articulating a clear purpose, identifying the capacity to collaborate, ensuring wide organisational ownership, nurturing fragile relationships and securing collaborative, mutually beneficial outcomes. The paper focuses on the experience of setting up, managing, supporting and evaluating the STEP partnership from the perspective of academic and clinical leads and the independent evaluation.
Working together: Crossing discipline boundaries to evaluate complex interventions
Authors: Corner Jessica , Normand Charles
Published: March 2006

Nurses, it is argued, should participate in interdisciplinary research, yet there is little written about working in an interdisciplinary environment in research. This paper sets out some reflections on the experience of a nurse and a health economist working together on a series of studies. A number of difficulties are identified as themes running through the experience of interdisciplinary research: evaluating complex interventions, disruption of normal academic and scientific life, competition between disciplines and teams, finding a common language and learning to work together, finding the common ground and mutual self-interest, and learning to respect other perspectives and disciplines. Rosenfield's (1992) taxonomy of cross-disciplinary research is presented as a model to explain the development of our own approach. A commitment to the goal of transdisciplinarity in research is suggested.
Using log-linear models to analyse categorical data
Authors: McEvoy Phil , Richards David
Published: March 2006

This paper provides a brief introduction to log-linear modelling that is designed to be accessible to readers with a cursory knowledge of elementary statistics. Log-linear models belong to the family of general linear models and they are generally regarded as the method of choice for analysing the associations between variables in large sets of categorical data. The primary objective of using log-linear modelling procedures is usually to identify the simplest model that fits the data adequately, although in some instances more than one model may be acceptable. The main drawback of using log-linear models is that the procedures require very large data sets. A case study illustrates that, even with a relatively large sample, problems may arise if the data are unevenly distributed.
Changes in student nurses' approaches to studying
Authors: Howard David , Hayes Maiy, , Solomonides Ian , Swannell Malcolm
Published: March 2006

This research identified the approaches to studying preferred by student nurses, determined whether these changed during the Diploma of Higher Education in Nursing (DipHE Nursing), and which approaches to studying were associated with greater academic achievement. Two cohorts of student nurses were sampled. Cohort 1 (n=40) completed the 44-item Revised Approaches to Studying Inventory RASI (Tait and Entwistle, 1996) at the end of the course and was interviewed. Cohort 2 (n=76) completed the RASI twice, once at the beginning of the course and again following the first year.

In keeping with research reported elsewhere (Swannell, 1992; Richardson, 1995; Devlin, 1996; Solomonides, 1996), an association between age and preference for the deep approach to studying was observed. It was also found that student nurses changed their approaches to studying during the course to favour the deep approach. This occurred as the theory became relevant to their concepts of nursing. As those students who preferred the deep approach attained higher assessment grades than those who preferred the surface approach, the paper recommends strategies to encourage the deep approach to studying from the outset of the course.
Empowerment and disempowernent: Models of staff/patient interaction
Authors: Faulkner Mark
Published: March 2006

This study aimed to develop valid models of empowerment and disempowerment relevant to staff/patient interaction as a means of generating a greater understanding of how these concepts are expressed in healthcare. This involved submitting the concepts of empowerment and disempowerment to an act frequency approach (Buss and Craik, 1983). Using this approach, registered nurses (n=38) were asked to nominate empowering and disempowering acts relevant to staff/patient interactions, yielding a list of 98 acts. Following this, older hospitalised people (n=20) were asked hypothetically to judge these acts as to the extent they would be 'control giving' if personally experienced. The 20 highest scoring acts for each concept were then incorporated into an act frequency observation scale. Using this composite scale, older hospitalised people (n=102) were asked to judge how often they had encountered each act over a pre-determined period of time. Act frequencies for each concept were then submitted to a principal components factor analysis.

The principal components of empowerment were identified as 'promoting patient independence,' 'promoting information exchange' and 'being aware of patient needs'; and for disempowerment, 'impeding patient collaboration in care planning,' 'domination' and 'indifference to patient needs'. Models of these concepts illustrate the therapeutic and non-therapeutic aspects of interpersonal care.
Service co-ordination: A successful model for the delivery of multi-professional services to children with complex needs
Authors: Tait Tom , Beattie Anette , Dejnega Suzi
Published: March 2006

Multiple agencies and professions provide services to children with complex needs but there is a need for such services to be well coordinated. A multi-agency approach to achieving greater co-ordination of services was developed in the city of Leicester and the counties of Leicestershire and Rutland. The project introduced regular planning meetings with families and agreed that parents would hold the multi-agency family service plans and records, and that families themselves, if they wished, could act as co-ordinators for their child.

A study was devised to test whether the aims of the project had been achieved. It was based on individual and group inteviews with parents and professionals, and examined the experiences and perceptions of services co-ordination among paricipants.

The aims of the project proved to be similar to six crucial elements of key working devised by Mukherjee et al. (1999). Both agreed that parents and professionals should have equal status, value and influence, and parents were perceived as important partners. The comments from parents and professionals taking part in the project indicated their satisfaction with the way the new scheme worked, which confirmed for the researchers that the aims had been achieved. Recommendations are made for future models of service co-ordination.
A concept analysis of practice development
Authors: Garbett Rob , McCormack Brendan
Published: March 2006

The term 'practice development' is widely but inconsistently used in British nursing, addressing a broad range of educational, research, and audit activity, but there appears to be little consensus as to what practice development actually involves. Such lack of clarity means that the increasing number of nurses whose work involves addressing practice development issues can have difficulty in focusing their efforts.

To try to clarify the concept of practice development and to describe the focuses of practice development work and the approaches used, a concept analysis was conducted. Both primary and secondary data were gathered and analysed in the study. One hundred and seventy seven items of published literature were gathered and analysed. Focus group interviews were carried out involving 60 practice developers. In addition, 25 clinical nurses were interviewed about their experiences of being involved in practice development.

This paper describes the identified purposes, attributes and outcomes of practice development. Practice development activities are described as addressing the effectiveness of care through the transformation of care practices and cultures. Practice development is described as a systematic, rigorous activity underpinned by facilitation processes. The outcomes of practice development can be described in terms of changes in the behaviours, values and beliefs of staff involved. Parallels between practice development and current policy imperatives are outlined.
Nursing informatics and practice development
Authors: Clambers Mary
Published: March 2006

The nature of healthcare is changing, and as society becomes more technologically driven, it is important for nursing to take a leading role. This paper briefly considers the history of nursing informatics from its development in the 1960s. The role of technology in nursing practice is discussed, together with the contribution it can make to enhancing the knowledge and skills of nurses.

Studies that have looked at the attitudes of nurses towards this new technology are then discussed. A consideration of how nursing informatics can advance practice development follows, illustrated using the examples of three nursing informatics projects — the Assisting Carers using Telematics Interventions to meet Older persons' Needs (ACTION) project, HeartCare, an internet-based cardiac recovery support service for patients at home following cardiac surgery, and a study to consider the effectiveness of telemedicine as a support system to encourage breastfeeding.
An evaluation study to assess the consistency of criteria for an integrated care pathway for total hip replacement
Authors: Douglas Patricia
Published: March 2006

This paper seeks to highlight that integrated care pathways (ICPs), advocated as a tool to improve patient care and reduce variation in practice, fail to achieve the desired outcome. An evaluation tool was developed based on relevant literature, and 27 pathways from different trusts were reviewed using this tool. Each ICP was evaluated against four themed headings: Quality of care; Multiprofessional working; Patient involvement, and Variation in clinical practice. The evaluation demonstrated that ICPs are in themselves as varied as patient care, and not all they are purported to be.
Managing pain in children: An observational study
Authors: Twycross Alison
Published: March 2006

This paper describes an observational study which examined how nurses (n=13) managed pain in one surgical ward in the Midlands. The results indicate that, while the nurses were good at giving analgesic drugs, general nursing care related to pain management was poor; for example, pain assessment was not undertaken systematically and non-drug methods of pain relief were rarely used. This was despite the ward being particularly quiet during the period of observation. The majority of prescribed doses of analgesia were within therapeutic levels. The results of the study add weight to the supposition put forward by Francke et al. (1997) that many nurses hold a one-sided view of pain management and believe that the nurse's role in pain management is synonymous with the administration of analgesic drugs. Other nurses hold an integrated view and believe that, in addition to pharmacological interventions, psychosocial and other non-drug interventions may be valuable in pain management. It is also postulated that poor pain management may be due to the stress inherent within nurses' role and associated with caring for children in pain.
Dissemination and utilization of an intervention to manage breathlessness: Letting go or letting down?
Authors: Froggatt Katherine , Corner Jessica , Bredin Mary
Published: March 2006

The relationship between research and practice development has not always been a close one. Researchers focus upon the production of new knowledge to create the evidence base upon which the development of practice is taken forward, usually by other people within the clinical area. Work being undertaken at the Macmillan Practice Development Unit (MPDU) in London about the dissemination and utilisation of evidence concerning the management of breathlessness has raised a number of issues. These concern the confidence of practitioners to take on new approaches within the practice sphere, their desire for accredited education, and questions about responsibility for, and ownership of, the dissemination process. Different values about the nature of learning are explored here, which may explain the dissonance between practitioner and researcher expectations about the dissemination and utilisation process.
Scoping the nursing and midwifery research and development capacity in Scotland to inform the development of a future strategy
Authors: Fyffe Theresa , Hanley Janet
Published: March 2006

Scotland is currently developing a nursing and midwifery research strategy. This paper briefly describes the process and the groundwork carried out so far. Consultation on initial proposals took place during May 2002 and, as this issue of NT Researchgoes to press, the responses are being collated. Further consultation will take place over the summer of 2002 and the strategy is due to be launched in Autumn 2002.
An assessment of lead R&D nursing roles in acute trusts and an evaluation of their status within the NHS research agenda
Authors: Browne Natasha , Harris Ruth , Hunt Jane , Kelly Daniel , Kelley Kate , Pearce Susie , Plant Hilary , Richardson Alison , Sitzia John
Published: March 2006

For over a decade, the need to develop a robust evidence base for nursing, midwifery and health visiting through research has been part of the UK government's R&D strategy. Progress has been slow and little is known about the organisational reality of the most recent strategies. This study aimed to investigate the nature of posts with named responsibilities to lead and develop nursing and midwifery research activity, based in acute NHS hospital trusts.

Data were obtained through telephone interviews with directors of nursing services, and a postal survey of relevant staff. Fifty two people responsible for nursing and midwifery R&D were invited to complete the questionnaire, of whom 34 responded. The majority of trusts were able to name an individual responsible for leading nursing R&D, although the remit of the role varied considerably. The effectiveness of implementing any national research strategy is likely to be constrained by the lack of consistency regarding nursing research roles, a factor that may also be implicated in the lack of progress in securing a meaningful contribution to NHS research from nursing R&D.
The organisation of cancer nursing services in the UK: A review of current practices
Authors: Richardson Alison , Miller Morven , Potter Helen
Published: March 2006

The reorganization of cancer services in recent years has presented cancer nursing with a range of organisational and developmental challenges. It is therefore encouraging to note that the specialty has evolved to the extent that an efficient and effective cancer nursing workforce is now acknowledged as a prerequisite for the provision of high-quality cancer care (Department of Health, 1995; 2000a; 2000b). However, despite the advances there has been little evaluation of the critical issues faced by specialist cancer nurses.

This project was undertaken as part of a larger scoping exercise designed to assimilate an evidence base to support the development, delivery and evaluation of UK cancer nursing services. This element of the project aimed to provide information to support the development and organisation of cancer nursing services by focusing on specific aspects of care (DoH, 2000a).

The results indicate that lead cancer nurses are striving to ensure that patients are provided with the best quality care through nurses' participation in collaborative endeavours, for example with the primary care and the voluntary sectors. There is still much to be achieved, primarily in the areas of workforce planning, the skill development of non-specialist nurses, and research and development. The evidence demonstrates that cancer nursing will continue to accept the challenges of changing practice, working to ensure that patients receive a high-quality service.