bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating educational preparation for a health education role in practice: the case of medication education
Authors: Latter Sue , Rycroft‐Malone Jo , Yerrell Paul , Shaw David
Published: March 2003

Evaluating educational preparation for a health education role in practice: the case of medication education

Current health care policy and practice contexts in the UK point to the importance of nurses’ ability to make an effective contribution to educating patients about medication, as part of their role in health education and health promotion. Nurses’ potential contribution to this important activity will inevitably be dependent on knowledge and skills acquired during preregistration and postregistration programmes of education. Against this backdrop, changes in pre and postregistration nurse education in the UK in the past decade highlight the importance and timeliness of evaluating the adequacy of educational preparation for a medication role. This paper reports on the findings from an evaluation of UK educational preparation for a medication education role in practice. A case study design was used to investigate current educational preparation at three education institutions. Multiple methods of data collection at each site involved focus group discussions with lecturers and practitioners, individual interviews with key personnel, nonparticipant observation of teaching sessions, postobservation interviews with students and curriculum analysis. Findings highlighted the importance of a number of dimensions of preparation for practice of such a role: the need for sufficient taught pharmacology; opportunities for application and integration of prerequisite knowledge and skills; the importance of practice‐based learning; the need for an evidence‐based curriculum, and the importance of clarifying outcomes and competencies required for a medication education role within pre and postregistration curricula. The paper concludes with a discussion and implications of the findings.
From practice to theory: tightening the link via three fieldwork strategies
Authors: Schwartz‐Barcott Donna , Patterson Barbara J. , Lusardi Paula , Farmer Bonnie Cashin
Published: March 2003

Background.  Theory that is directly linked with clinical experience has far greater relevance for nursing practice; however, problems continue to persist with the establishment of that linkage. The use of fieldwork as a strategy for developing and linking theory has enormous potential for enhancing the number of theories that truly fit the clinical practice realities of nursing. Traditionally, fieldwork has been conducted in contexts that are unfamiliar to the researcher. However, nurses have a wealth of clinical understanding in their areas of practice. Conduct of inquiry in a familiar practice area may facilitate identification of significant, clinically relevant concepts and expedite theory development that is closely linked to nursing practice.

Aim of paper.   A two‐step fieldwork approach and three specific strategies are presented that have been found useful for developing theory that is tightly aligned with nursing practice. The strategies of theoretical selectivity, theoretical integration, and theory creation are described and an example of each presented. The strategies are an extension of the Hybrid Model of Concept Development. These strategies identify alternative paths for concept clarification and theoretical congruence through fieldwork in clinical settings. The focus of theoretical selectivity is elaboration of concept definition with selection among theories. In contrast, the focus of theoretical integration is the linking of a central concept with an existing theory or perspective in the prefieldwork phase and then using the full fieldwork to evaluate its usefulness. Lastly, the theory creation strategy emphasizes describing a phenomenon of interest, identifying influencing factors, and beginning to create relational statements. It is closest to standard inductive theory development.
Problem‐based learning in a new Canadian curriculum
Authors: Morales‐Mann Erlinda T. , Kaitell Christabel A.
Published: March 2003

Problem‐based learning in a new Canadian curriculum

Problem‐based learning (PBL) is a method of group learning that uses true‐to‐life problems as a stimulus for students to learn problem‐solving skills and acquire knowledge about the basic and clinical sciences. This article documents the design and implementation of PBL in a second year course in the new curriculum of the University of Ottawa School of Nursing’s Generic Program. The learning and teaching experiences of students and facilitators in this PBL course are described. As a way to determine students’ perception of their learning using PBL, they were asked to respond to four questions. The most frequently described thinking processes were problem solving, nursing process and group process. When asked to describe the learning they derived from PBL, as differentiated from other instructional methods, students identified group process and problem solving most often. The most frequently identified factors that influenced performance and learning in PBL were positive attitude and group effort. The factors that affected the facilitators’ performance of their role were large group size, insufficient practice of facilitator skills and PBL preparation. To enhance group process, facilitators modelled and shared roles. They fostered student motivation and development through formative evaluation. PBL produced clear benefits for students, such as increased autonomous learning, critical thinking, problem solving and communication. For facilitators, PBL was a liberation from the traditional role of ‘content expert and super consultant’.
Mothers’ coping in chronic childhood illness: the effect of presymptomatic diagnosis of vesicoureteric reflux
Authors: Swallow Veronica M. , Jacoby Ann
Published: March 2003

Mothers’ coping in chronic childhood illness: the effect of presymptomatic diagnosis of vesicoureteric reflux

Aims of the study were to.Assess coping strategies of mothers who have a child with vesicoureteric reflex (VUR), determine mothers’ understanding of VUR before and after diagnosis, assess mothers’ perceived needs for support when coping with their child’s VUR and compare the above aims between two groups of mothers of children with VUR.

Background.Vesicoureteric reflex (VUR) is a chronic, congenital, asymptomatic condition which when combined with urinary tract infection (UTI) can result in reflux nephorpathy (RN), contributing to 20% of kidney transplants. Unfortunately, VUR is not usually diagnosed until after proven UTI, by which time RN has often developed. However, recent research, the familial ureteric reflux study (FURS) identified for the first time VUR in a cohort of new‐borns investigated because of family history. Early detection and prompt treatment of UTI in the presence of VUR may significantly reduce the development of RN but this requires extreme vigilance by mothers, who are usually the primary carers.

Design.As mothers’ experiences and perceptions were the focus, a qualitative design using semistructured, in‐depth interviews was used. After obtaining ethical approval, mothers of 15 children with VUR diagnosed presymptomatically (i.e. after particpation in the FUR study) and mothers of 14 children with VUR diagnosed post symptomatically were selected using a theoretical sampling matrix. All mothers gave informed consent and interviews were taped, transcribed and analysed using the ‘Framework’ technique.

Findings.Findings for both groups fall into three discrete phases: the prediagnostic, diagnostic and postdiagnostic. Analysis showed that mothers in the post symptomatic diagnosis group experienced most problems in coping, particularly because of difficulty in engaging medical intervention in the prediagnostic phase. Generally, mothers in the presymptomatic group coped well apart from those who themselves had VUR and/or RN who expressed guilt about their child inheriting the condition and consequently difficulty in coping.

Conclusion.Early diagnosis of VUR improved mothers’ coping. However, both groups identified a major need for improved information provision and support to assist coping with the sustained uncertainty of the condition.
Spirituality and psychosocial factors in persons living with HIV
Authors: Tuck Inez , McCain Nancy L. , Elswick Jr Ronald K.
Published: March 2003

Spirituality and psychosocial factors in persons living with HIV

Aim of the study. This pilot study was designed to examine the relationships among spirituality and psychosocial factors in a sample of 52 adult males living with human immunodeficiency virus (HIV) disease and to determine the most reliable spirituality measure for a proposed longitudinal study.

Background. HIV disease is among the most devastating of illnesses, having multiple and profound effects upon all aspects of the biopsychosocial and spiritual being. Although research has suggested relationships among various psychosocial and spiritual factors, symptomatology and physical health, much more research is needed to document their potential influences on immune function, as well as health status, disease progression, and quality of life among persons with HIV disease.

Methods. This descriptive correlational study explored the relationships of spirituality and psychosocial measures. Spirituality was measured in terms of spiritual perspective, well‐being and health using three tools: the Spiritual Perspective Scale, the Spiritual Well‐Being Scale, and the Spiritual Health Inventory. Five psychosocial instruments were used to measure aspects of stress and coping: the Mishel Uncertainty in Illness Scale, Dealing with Illness Scale, Social Provisions Scale, Impact of Events Scale, and Functional Assessment of HIV Infection Scale. The sample was recruited as part of an ongoing funded study. The procedures from the larger study were well‐defined and followed in this pilot study. Correlational analyses were done to determine the relationship between spirituality and the psychosocial measures.

Findings. The findings indicate that spirituality as measured by the existential well‐being (EWB) subscale of the Spiritual Well‐Being Scale was positively related to quality of life, social support, effective coping strategies and negatively related to perceived stress, uncertainty, psychological distress and emotional‐focused coping. The other spirituality measures had less significant or non significant relationships with the psychological measures.

Conclusions. The study findings support the inclusion of spirituality as a variable for consideration when examining the psychosocial factors and the quality of life of persons living with HIV disease. The spiritual measure that best captures these relationships is the EWB subscale of the Spiritual Well‐Being Scale.
Being overwhelmed by the feeling of having a home and family. One aspect of the meaning of being dependent on care: a study of one patient and two of his nurses
Authors: Strandberg Gunilla , Norberg Astrid , Jansson Lilian
Published: March 2003

Being overwhelmed by the feeling of having a home and family. One aspect of the meaning of being dependent on care: a study of one patient and two of his nurses

Rationale. This article is part of an ongoing study which aims at disclosing the meaning of being dependent on care. From a larger body of data, interviews with one patient and two of his nurses were selected to study.

Aim. The aim was to deepen understanding of the meaning of being dependent on care when this appears desirable for the patient.

Methods. A phenomenological–hermeneutic approach was used to interpret the material. Interviews were recorded and transcribed verbatim.

Findings/discussion. The interpretation discloses the meaning of being dependent on care as an overwhelming, unfamiliar feeling of having a home and family. The patient is beguiled into believing he is the ruler in an established relationship and his dependency on care gives him an opportunity to be surrounded by loving, altruistic, helpful people. Being dependent on care is overwhelming and irresistible, i.e. coveted, but simultaneously it is like walking on thin ice, i.e. treacherous. The irresistible desire concerns being unconditionally cared about. The danger is that this ‘family membership’ will not last. It is brought to the patient because of his dependency on care and it is based on his terms. There is reflection about the patient being unprepared for dealing with his own world of loneliness.
Characteristics of an Accident and Emergency liaison mental health service in East London
Authors: Callaghan Patrick , Eales Sarah , Leigh Laurie , Smith Angie , Nichols Joe
Published: March 2003

Characteristics of an Accident and Emergency liaison mental health service in East London

Aim of the study. To analyse the work of a liaison mental health service at the Accident and Emergency (A & E) department of a hospital in East London.

Background. The English National Service Frameworks (NSF) for Mental Health recommend that A & E departments provide liaison mental health services and this study reports how a service in East London is responding to this challenge.

Research methods. Data were collected during a 14‐month period using a specially designed audit form.

Results. The typical referral was aged 36, of either sex, United Kingdom (UK) non‐White with a diagnosis of depression. The majority of referrals were in the afternoon and seen immediately. A slight majority were known to mental health services; many were new referrals. Older and male clients were more likely, and Bengali and other Asian clients were less likely, to be registered with a psychiatrist. There were seasonal variations in referral type. Emergency referrals tended to have a diagnosis of schizophrenia; urgent and non‐urgent referrals were more likely to be depressed. The outcome for the majority of referrals was referral to appropriate community services. The majority of non‐clinical referrals were for advice, information and support.

Discussion and conclusions. The service seems a useful resource for A & E staff, and clients with mental health problems. The service is a channel through which people access mental health services and appears to address the NSF for Mental Health.
Nurse‐environment misfit and nursing practice
Authors: Takase Miyuki , Kershaw Esme , Burt Lorraine
Published: March 2003

Nurse‐environment misfit and nursing practice

Aim of the study. The purpose of the following descriptive correlational study was to investigate nurses’ responses to the image discrepancy between the public and nurses, and its relationships with their self‐concept, job satisfaction and performance.

Background. It has been long said that nurses live in a dual structure wherein the nurse’s journey toward professionalization is constrained by nursing stereotypes in a society. This duality of the nursing universe is assumed to have created a person‐environment misfit which could lead to nurses’ job dissatisfaction and low job performance. Nonetheless, little study has been done in this area.

Design/Methods. The study was conducted in 1999 with ethical approval from an Australian University. A sample of 80 Australian registered nurses participated by completing the Porter Nursing Image Scale, Index of Work Satisfaction (IWS) and Six‐Dimension Scale of Nursing Performance. Data were analysed using descriptive statistics and Pearson correlation.

Results. The results suggested that there is a discrepancy in the images of the nursing profession between nurses and the public, which can contribute to the nurse‐environment misfit. The results also supported a negative correlation of the misfit with nurses’ job satisfaction and performance.

Conclusion. Despite the limited sample size and characteristics, this study provides evidence to encourage nurses to improve the public image of nurses, which will enhance the professionalization of nursing.
Practice nurse and health visitor management of acute minor illness in a general practice
Authors: Pritchard Alison , Kendrick Denise
Published: March 2003

Practice nurse and health visitor management of acute minor illness in a general practice

Objective. To evaluate practice nurse (PN) and health visitor (HV) management of patients with acute minor illnesses, monitor the effect on general practitioner (GP) workload, and describe the range of conditions seen by nurses.

Design. Patients requesting ‘urgent’ appointments (within 24 hours) were offered consultations with a PN or HV trained in the management of acute minor illness. Comparative data were collected before and after the establishment of the acute minor illness service.

Setting. A general practice in Nottingham, England.

Main outcome measures. Patient satisfaction, consultation rate, prescriptions, investigations, referrals and urgent re‐consultations for the same condition within 2 weeks.

Results. About 2056 urgent consultations were recorded in the study period, of which 332 (16·1%) were seen by PNs and 46 (2·2%) by a HV. High levels of patient satisfaction were reported for all health professionals. Patients seeing the HV reported higher levels of satisfaction than those consulting GPs (P=0·033) and PNs (P=0·010). There was no difference by health professional for prescription rates (P=0·76), re‐consultations (P=0·14), or referrals to secondary care (P=0·07). General practitioners were more likely to initiate further investigations than the PNs or HV (P < 0·001).

Conclusion. With suitable training, PNs and HVs can successfully manage patients with a range of conditions. General practitioner workload can be reduced while maintaining high patient satisfaction levels.
A stepwise multivariate analysis of factors that contribute to stress for mental health nurses working in the community
Authors: Edwards D. , Burnard P. , Coyle D. , Fothergill A. , Hannigan B.
Published: March 2003

A stepwise multivariate analysis of factors that contribute to stress for mental health nurses working in the community

Aims. The aim of the study was to examine the variety, frequency and severity of stressors experienced by community mental health nurses (CMHNs) in Wales.

Background. Numerous studies undertaken throughout the United Kingdom (UK) have indicated that those health professionals working as part of community teams are experiencing increasing levels of stress and burnout. Sample sizes have tended to be small and participants have been drawn mainly from sites in England.

Methods. A questionnaire booklet, which included a number of validated measures, was distributed to 614 CMHNs. These included Maslach Human Services Survey, Community Psychiatric Nursing (CPN) Stress Questionnaire, PsychNurse Coping Questionnaire, Rosenberg Self‐Esteem Scale and General Health Questionnaire GHQ‐12. The study was the largest of its kind conducted in the UK.

Results. Data were collected from 301 CMHNs, representing a response rate of 49%. Community mental health nurses identified the most stressful issues as trying to maintain a good quality service in the midst of long waiting lists and poor resources and having too many interruptions while trying to work in the office. The best demographic predictors of high stress scores were having an unsupportive line manager, working with a specific client group and not having job security. These factors accounted for 20% of the variance in the total stress score. When the results from the psychometric instruments were included, 46% of the variance in the total stress score was accounted for. The predictive variables were emotional exhaustion, working with a specific client group, job security and alcohol consumption.

Conclusions. These findings indicate that there is a need to create more supportive environments both in terms of job security and management support, especially for those working in the fields of severe mental illness and rehabilitation.
Psychosocial rehabilitation after disfiguring injury or disease: investigating the training needs of specialist nurses
Authors: Clarke Alex , Cooper Clare
Published: March 2003

Psychosocial rehabilitation after disfiguring injury or disease: investigating the training needs of specialist nurses

Aim of this study. To investigate the training needs of specialist nurses working with patients who have disfiguring conditions.

Background. As the psychosocial impact of disfiguring illness and disease becomes more widely recognized and understood, there are increasing issues about who can provide this kind of input. Whilst nurses have been identified as the health professionals who are often the most appropriate to fulfil this role, there is less evidence that they feel confident in their skills to provide it. The volume of requests from health professionals, particularly nurses, to a lay‐led organization specializing in facial disfigurement suggested both an acknowledgement of the importance of providing psychosocial support to this population, together with a perceived lack of skill in this area.

Design/Method, Study 1. This study used a cross‐section design. Two groups of nurses working either in burns or in head and neck cancer were surveyed by questionnaire.

Results, Study 1. Both the burns group and head and neck group rated their skills in the social rehabilitation of their patient group as significantly lower than their skills in physical rehabilitation.

Design/Method, Study 2. Using a multiple baseline design, a pilot intervention consisting of a specifically focused resource pack and 1‐day training course was delivered to eight head and neck cancer nurses.

Results, Study 2. Postintervention, only the targeted skills (those concerned with social rehabilitation) were rated as significantly improved. Research continues to establish the extent to which these skills are implemented by nurses in the clinical setting and passed on to patients.

Conclusions. These findings suggest that although nurses do not feel as skilled in delivering psychosocial support to patients as they do in delivering more traditional aspects of physical nursing care, they can very easily take on this role when given simple training and access to appropriate resources. This training can be provided by a lay‐led organization.
Insufficient sleep, cognitive anxiety and health transition in men with coronary artery disease: a self‐report and polysomnographic study
Authors: Edéll‐Gustaffson Ulla M.
Published: March 2003

Insufficient sleep, cognitive anxiety and health transition in men with coronary artery disease: a self‐report and polysomnographic study

Aims. To explore possible links between sleep quality, cognitive anxiety and the effects of sleep disturbances on health, daytime functioning and quality of life, for assessment in a larger study. Hypotheses were: (a) patients with coronary artery disease have insufficient sleep as measured by self‐reported sleep and by polysomnography, (b) self‐reported sleep is associated with polysomnographically measured sleep, (c) reduced sleep quality is associated with physical and mental health, and interferes with quality of life as measured by means of interviews and polysomnography, (d) reduced sleep quality is associated with reduced resilience to stress.

Background. It has become increasingly evident that poor sleep with sleep initiation difficulties is an independent risk factor for cardiac events among men, and requires more attention in clinical nursing practice.

Design. Descriptive, correlative and explorative study.

Sample. Forty‐four men, aged 45–70, about to undergo coronary artery bypass surgery at a Swedish University Hospital.

Research methods. Interviews and 24‐hour continuous ambulatory polysomnography were performed. For the interviews, the Uppsala Sleep Inventory, Spielberger State Anxiety Scale and the Nottingham Health Profile instruments were used.

Results. Seventeen patients (38·6%) had insufficient sleep and 12 had sleep initiation difficulties. Logistic regressions revealed that reduced stage 3–4 sleep predicted poorer overall health, initiation of sleep difficulties, predicted insufficient sleep and involuntary thoughts predicted fragmented sleep. Poorer quality of life was predicted by reduced deep sleep. Independent predictors for emotional distress were sleep efficiency below 85%, fragmented sleep and a daytime nap longer than 15 minutes.

Conclusions. Objective sleep was associated with several subjective sleep variables. The results provide empirical support for significant variables included in a theoretical framework relating to sleep quality, cognitive anxiety, health and quality of life. A larger study is recommended that includes both men and women.
Challenging contemporary mental health policy: time to assuage the coercion?
Authors: Hannigan Ben , Cutcliffe John
Published: March 2003

Challenging contemporary mental health policy: time to assuage the coercion?

Background. In the United Kingdom (UK) and elsewhere throughout the world, the policy and legal frameworks that surround the provision of mental health care are becoming increasingly coercive. For example, emerging mental health policy in the UK includes a commitment to the introduction of compulsory treatment in the community.

Aims. In this paper, our aims are: to explore the context in which this more coercive mental health policy has arisen in the UK; to challenge the assumptions and the evidence that lie behind the introduction of proposed new mental health policies; and to consider the impact that a more coercive policy is likely to have on the practice of mental health nursing.

Discussion. In the UK, representatives of central government have declared that `care in the community has failed'. This view has been reinforced by media representations of mental health issues. Policy documents have drawn attention to the risks posed by people with mental illnesses. Correspondingly, proposed initiatives emphasize the need to more closely `manage' people with mental health problems, and set out a new legislative and policy framework to achieve this. We question the assumptions and evidence that underlie these planned new developments. We argue that, contrary to government assertions, there is no unequivocal evidence that `community care' has failed. We observe, too, that people with mental health difficulties are often amongst the most vulnerable members of society. Finally, we consider the impact that a more coercive policy framework will have on the work of mental health nurses, and argue that the shift towards a more `controlling' role is likely to run counter to what many nurses see as the `core' of their work.
Cuff width influence on blood pressure measurement during the pregnant‐puerperal cycle
Authors: Oliveira Sonia M. Junqueira V. , Arcuri Edna A.M. , Santos Jair Licio F.
Published: March 2003

Cuff width influence on blood pressure measurement during the pregnant‐puerperal cycle

Background. The correct evaluation of blood pressure (BP) during pregnancy is a crucial factor in the prevention of eclampsia. Following American Heart Association (AHA) guidelines to employ a correct cuff width (CCW), 20% larger than arm diameter, we demonstrate that the standard cuff width (SCW), 12 cm wide, is too large for lean women causing underestimation of BP.

Aims. To identify the arm circumference (AC) in pregnant women and the corresponding cuff width; to compare BP records from CCW vs. SCW; and to identify under‐ and overestimation of BP in SCW reading.

Design. A follow up study of BP was performed in 104 pregnant women using two cuffs widths (CCW vs. standard one). The investigation was carried out during all antenatal appointments and postpartum stage in two maternity hospitals. In every appointment BP was registered three times with each type of cuff; and the means of those three readings were compared.

Methods. The CCW for each woman was selected according to AHA recommendation for cuff width size (20% larger than arm diameter), which was based on the classical European and North‐American studies.

Results. Arm circumference varied from 20 to 38 cm requiring a cuff width from 8 to 14 cm. The CCW most employed was 10 cm wide. The SCW (12 cm) was employed as CCW in only 13·4% of the subjects. Statistical difference was found on BP means when comparing both cuffs (P < 0·05), reaching 23 mmHg in systolic values and 20 in diastolic ones. Such differences showed a serious underestimation when SCW was employed in 80·8% of the subjects and overestimation in 5·8% of obese subjects.

Conclusion. Our findings showed that the SCW underestimates BP of pregnant women. Our hypothesis is that such underestimation may lead to the misdiagnosis of pre‐eclampsia, particularly in lean pregnant women.
Predictors of nursing home placement and home nursing services utilization by elderly patients after hospital discharge in Taiwan
Authors: Shyu Yea‐Ing Lotus , Lee Hsiao‐Chin
Published: March 2003

Predictors of nursing home placement and home nursing services utilization by elderly patients after hospital discharge in Taiwan

Background. Providing appropriate follow‐up health/long‐term care services after hospital discharge for elderly persons is important to enhance health and quality of life. Therefore, identifying factors that affect follow‐up service utilization has become an important concern. Most studies of predictors of follow‐up service utilization for elderly persons after discharge were conducted in the United States of America (USA). Taiwan differs substantially from the USA in health care system, clinical practice, case‐mix, culture, and social organization; thus the findings from the USA need to be validated in Taiwan to ensure appropriate discharge referrals.

Aim. To investigate pre‐discharge predictors of follow‐up care including home nursing services and nursing home placement for elderly patients, discharged from hospitals in Taiwan.

Methods. A prospective study with a case‐control design was used.

Findings. The strongest predictors of institutionalization in a nursing home at 1, 3 and 6 months after discharge were the elderly person's pre‐admission institutionalization (0·33 to 0·48) and the caregiver's preference for institutional displacement (0·23 to 0·85). The strongest predictors of use of home nursing services were the elder's self‐care ability (0·69 to 0·76), conscious level (0·51 to 0·73), and tubes remaining before discharge (0·58 to 0·79). These predictors were stable at 1, 3 and 6 months after discharge and could correctly classify 60–89% of sample.

Conclusions. When taking nursing home and home nursing utilization into considerations at the same time, the elderly person's pre‐admission institutionalization and the caregiver's preference for institutional displacement strongly predicted nursing home utilization after hospital discharge. The elder's self‐care ability, conscious level, and tubes remaining before discharge strongly predicted the use of home nursing services after discharge.
Measuring the outputs of Australian nursing research published 1995–2000
Authors: Borbasi Sally , Hawes Cathy , Wilkes Lesley , Stewart Michel , May Donna
Published: March 2003

Measuring the outputs of Australian nursing research published 1995–2000

Aims. To analyse the research published in refereed nursing journals by Australian authors from 1995 to 2000.

Background. Analysis of the research topics and types of methodologies used by Australian nurse researchers has not been recently undertaken. The study was similar to an analysis of United Kingdom (UK) nursing research between 1988 and 1995 to allow comparison between the two countries.

Design. A quantitative approach analysed the research abstracts for the topic researched, source of data, location of data collection, paradigm and methodology used and funding source.

Results. A total of 509 articles from 11 generalist Australian and UK nursing journals were analysed. The highest numbers of articles were published in Australian Journal of Advanced Nursing and Journal of Advanced Nursing. The most popular topics were education of nurses (18·7%, n=95) and practice issues relating to patient care (15·3%, n=78). However, scant attention was paid to major Australian health issues. Most research was undertaken in the hospital setting (55·8%, n=247). Data were most often drawn from nurses themselves (40·7%, n=206), followed by patients (25·5%, n=129). Both quantitative (41%, n=203) and qualitative approaches (47%, n=230) were employed. A minority of studies acknowledged any funding (14·9%, n=76).

Conclusions. Research findings need to be applied in practice to improve patient care. Nurse researchers need to publish their findings and align their research interests to meet national health priorities. They need to be involved in setting these health priorities to ensure that nursing has a place in health research.
Application of a computerized nursing care plan system in one hospital: experiences of ICU nurses in Taiwan
Authors: Lee Ting Ting , Yeh Chao‐Hsing , Ho Lun‐Hui
Published: March 2003

Aim of the study.  The purpose of this paper is to present ICU nurses' experiences with a computerized nursing care plan system at a medical centre in Taiwan.

Background.  Computerized nursing care plans have been implemented in recent years, but users' perceptions of this technology have not been comprehensively explored. It is believed that by taking into consideration users' experiences with computer use, strategies and programs can be developed to help users adapt to new systems.

Methods.  A qualitative study, involving one‐to‐one interviews, was conducted with 12 Registered Nurses. Data were analysed according to Miles and Huberman's data reduction, data display and conclusion verification process.

Findings.  Themes related to the clinical impact of system use were: ‘saves paper/time’, ‘time‐consuming for print‐outs’, ‘de‐individualization of care plan’, ‘routine/paperwork requirement’, ‘no consensus for nursing diagnoses’, and ‘guidelines for the novice’.

Conclusions.  Nurses prefer tools that can help them save time with paperwork and focus on targeting patient problems. With careful assessment and evaluation of nurses' experiences in the use of clinical computer systems, the success of computer implementation can be enhanced.
Parents' experiences of midwife‐managed care following the loss of a baby in a previous pregnancy
Authors: Caelli Kate , Downie Jill , Letendre Angeline
Published: March 2003

Aims of the study. This article reports on research that explored the impact of the Special Delivery Service, a midwife‐managed intervention, developed as an addition to routine care to support and educate high‐risk pregnant women and their partners subsequent to the death of a baby in a previous pregnancy.

Background. Approximately 40 000 families suffer the trauma of a neonatal death*annually in the USA, while statistics for Canada and Australia give similar numbers relative to population. Since many more babies die than those accounted for in these statistics, through stillbirth, miscarriage and Sudden Infant Death Syndrome, more than the above‐cited 2% of childbearing couples will face the trauma of the loss of a baby.

Rationale. The resultant threat that this situation may pose to the health of the mother has been extensively documented in the literature. However, despite the recent growth in knowledge about the impact of perinatal loss and bereavement, few interventions are specifically designed to support Australian and Canadian women and their partners during a pregnancy following the loss of a baby.

Methodology. This phenomenological study explored women's and their partners' experiences of grief and loss and the support offered to them through the Special Delivery Service programme.

Results & Discussion. In the face of funding and organizational changes to both the Australian and Canadian health care systems that have eliminated or reduced some services, this research reinforced the need for individualized, compassionate midwifery care and the urgent need for genuinely empathic and supportive health care services for these women and their partners. It also emphasized the need for couples to be informed and supported so that gender differences in grieving do not become a divisive element in the relationship.

Conclusions. The findings have implications for both nurses and midwives in their practice in countries where optimum care of this vulnerable population is not routinely available. The research supports midwife‐managed models of care to ensure women and their families are appropriately supported in crisis. The findings provide insight also into the diverse grief response among couples and the difficulties experienced in a pregnancy following the loss of a baby.
Foucault could have been an operating room nurse
Authors: Riley Robin , Manias Elizabeth
Published: March 2003

Background.  Operating room nursing is an under‐researched area of nursing practice. The stereotypical image of operating room nursing is one of task‐ and technically‐orientated aspects of practice, where nurses work in a medical model and are dominated by constraints from outside their sphere of influence. This paper explores the possibility of understanding operating room nursing in a different way.

Aim.  Using the work of Michel Foucault to analyse the work of operating room nursing, this paper argues the relevance of the framework for a more in‐depth analysis of this specialty area of practice.

Content.  The concepts of power, discipline and subjectivity are used to demonstrate how operating room nursing is constructed as a discipline and how operating room nurses act to govern and construct the specialty. Exemplars are drawn from extensive professional experience, from guidelines of professional operating room nursing associations, as well as published texts. The focus is predominantly on the regulation of space and time to maintain the integrity of the sterile surgical field and issues of management, as well as the use of the ethical concept of the ‘surgical conscience’.

Conclusion.  This form of analysis provides a level and depth of inquiry that has rarely been undertaken in operating room nursing. As such, it has the potential to provide a much needed, different view of operation room nursing that can only help to strengthen its professional foundations and development.
Discrepancies between patients and professionals in the assessment of patient needs: a quantitative study of Norwegian mental health care
Authors: Hansen Thomas , Hatling Trond , Lidal Eli , Ruud Torleif
Published: March 2003

Background.  Sensitivity to and respect for the user perspective are important facets of user‐centred services and empowerment in contemporary mental health care. Little is known about the extent to which new policies influence mental health work in practice.

Aims.  To investigate discrepancy between patients and professionals in the assessment of patient needs. Analyses could indicate emphasis on user orientation in Norwegian mental health care.

Methods.

 Patients and their respective health professionals (
n  = 1080) completed separate questionnaires regarding patient characteristics and needs. Identifiers were removed from the data locally and then entered into a national database. Descriptive statistics and multiple regression analysis were used to explore mean levels of discrepancy and predictors of discrepancy.

Results.  Mean discrepancy was low, as, on average, 30 of the listed 40 needs were considered absent by both the patients and their respective professional. However, the parties showed distinct disagreement as to the amount and type of needs that were present. Specifically, professionals identified more needs than patients (9·3 vs. 4·3, respectively) and this difference was characterized by a strong professional emphasis on needs regarding professional monitoring and follow‐up. Results showed that symptoms of severe cognitive disability were over‐represented in the group of patients with the highest level of discrepancy, however, the majority of high‐discrepancy patients were not severely disabled on cognitive functions. A multiple regression analysis revealed 10 predictors of high discrepancy.

Discussion.  A low professional emphasis on user‐orientation may be indicated in some cases. Results are discussed with relation to the tension between autonomy and beneficence. Suggestions for practice and further research conclude the paper.
Exploring nurse learner wastage/persistence using a discursive approach: towards a theoretical understanding of the subject
Authors: Kotecha Mehul
Published: March 2003

Rationale and aims of the study.  This article summarizes the findings of an exploratory study of nurse learner wastage/persistence conducted in England between 1996 and 2000. Given the lack of theorizing in much of the literature on nurse learner wastage/persistence, this study sought to generate a theoretical standpoint from which to explore voluntary nurse learner wastage.

Design/Methods.  The theoretical standpoint developed drew together the theme of integration, derived from the work of Tinto, with the themes of identity and discourses, as conceptualized by Foucault. Accordingly, integration was defined in terms of how well the learner was able to subscribe to the subjectivities made available by the institutional discourses. One of the chief strengths of this approach was that it facilitated an understanding of the interaction between the individual and the institution in relation to wastage/persistence. A multiple case study strategy was used which focused on learners in the first year of a Project 2000 course. The case study strategy utilized a range of qualitative research methods.

Findings and conclusion.  The findings indicated that the institution was constituted by two major discourses: the ‘apprentice’ discourse and the ‘autonomous’ discourse. It was found that the stayers were much more integrated into the institution, hence they were able to persist on the course, by virtue of being able to manage the contradictions in their identity as a nurse and a learner that these two discourses engendered.
Establishing methodological rigour in international qualitative nursing research: a case study from Ghana
Authors: Mill Judy E. , Ogilvie Linda D.
Published: March 2003

Background.  Attention to rigour, from the identification of the problem to the dissemination of the findings, is essential in all qualitative research. In this paper, research carried out in Ghana in 1999 is used to highlight methodological issues in relation to rigour in international qualitative nursing research.

Aim.  The purpose of this paper is to review the literature in relation to rigour in qualitative research, highlight the methodological decisions enhancing rigour during this research project, and describe the criteria used to assess rigour during the research process.

Design.  A participatory action research design was used to explore the cultural, social, economic, and political factors that influenced Ghanaian women's vulnerability to HIV infection. Collaboration with participants and partnerships with key professionals were integral to the design of the study.

Findings.  Participatory action research provided a flexible, socially, and culturally adaptable framework to guide this international research project. Prior to the initiation of international research it was essential to establish the relevance and feasibility of the proposed project. This international research project posed additional methodological challenges to the establishment of rigour. Patience, flexibility and sensitivity were required of the researcher to overcome these challenges.

Conclusion.  Collaboration with participants and with culture‐specific ‘experts’ may be key to culturally competent scholarship, particularly in unfamiliar settings.
Acute pain teams and the management of postoperative pain: a systematic review and meta‐analysis
Authors: McDonnell A. , Nicholl J. , Read S.M.
Published: March 2003

Background.  The introduction of acute pain teams (APTs) in every hospital performing surgery in the UK has been recommended in order to reduce postoperative pain. However, recent evidence suggests that many APTs are under‐resourced. Purchasers may be more prepared to invest in these services if they are persuaded that they result in measurable improvements in patient outcomes.

Aim.  A systematic review of the literature and meta‐analysis were performed to determine the effectiveness of APTs in improving the quality of analgesia and other postoperative outcomes of adult patients undergoing surgery.

Methods.  A broad search strategy using the terms ‘pain team’ and ‘pain service’ was adapted for a variety of databases. Key journals were hand‐searched and reference lists of selected reports were reviewed. Subject experts and study authors were contacted. Studies describing the impact of the APT/acute pain service (APS) on postoperative pain relief, other postoperative outcomes or the processes of postoperative pain were included. Study quality was assessed using a multidimensional instrument. A broad qualitative overview of the included studies was conducted. Continuous outcome data for pain in the first 24 hours postoperatively (in one case worst pain at 24–48 hours) were pooled.

Results.  Fifteen studies were included in the review. There were considerable differences in study design and quality, the nature of the APT and the outcomes measured. Of the nine studies measuring pain, it was possible to present data as Standardized Mean Differences for only four studies. Quantitative synthesis indicates a statistically significant overall estimate of effect using a fixed effects model only.

Limitations.  Only published studies in English were included. Study inclusion decisions and data extraction were performed by one reviewer only.

Conclusion.  There is insufficient robust research to assess the impact of APTs on postoperative outcomes of adult patients or on the processes of postoperative pain relief.
Constructing experience in individual interviews, autobiographies and on‐line accounts: a poststructuralist approach
Authors: Hardin Pamela K.
Published: March 2003

Aims. A poststructuralist orientation to language contends that individuals inherit the language they present to others – and in the context of research, stories and accounts are understood because researchers and research participants share such inheritances. Nurse theorists have foregrounded the constructive aspects of language yet few scholars have focused on how context and different narrative structures affect story construction. Story presentations are always sculpted by the context in which they are told. Thus, the construction of individual experience is neither a‐historical nor a‐contextual.

Methods. This work emanates from a larger study that focused on the social construction of anorexia nervosa and in which data were collected from 12 individual interviews, autobiographical accounts and postings from a public Internet group. A poststructuralist orientation to how data are theorized and analysed was used for the study. This article focuses on the differences of account presentation between the three different types of data.

Conclusions. Individuals inherit not only shared language, but the customs in which language is exchanged, for example, how interviews are performed, memoirs are written, and on‐line conversations are constructed. Focusing on context foregrounds the notion that stories have different functions and outcomes, depending on the purpose of the telling. Hence, the social and cultural frameworks in which stories are communicated are not incidental, but instrumental to what can be articulated in the production of individual experience.