bluuebunny/crossref_metadata_2025_split huggingface dataset:
The case for a more epidemiologically informed nursing profession
Authors: Mulhall Anne 
Published: March 2006

This paper argues that a more epidemiologically informed nursing profession could confidently challenge conventional medical epidemiology, and yet retain those concepts useful to a more holistic interpretation of the discipline and its practice. Situated within biomedicine and based on natural science, epidemiology has often been ignored by nursing, which has developed a more holistic model of health and illness and a wide range of research methodologies. However, epidemiology is evolving as mainstream approaches to research using quantitative methodologies are challenged by qualitative techniques and the emergence of 'popular epidemiology'. An epidemiology which examined questions of sickness and health from different epistemological and methodological perspectives would have more in common with prevailing ideologies in nursing. Complications arise as disciplines such as nursing and epidemiology, with different epistemologies and theoretical approaches, attempt to tackle similar problems. The difficulties are not only with paradigm incompatibility: each profession will be jealously guarding its particular territory and area of expertise. There has been little exploration of mutual or overlapping concepts and the new insights which these might bring to both disciplines. This paper attempts to redress this gap and argues that nursing has the potential to consolidate an increasingly divergent epidemiology, while gaining valuable skills to add to its own 'tool-box'.
Community nursing achievements in tackling inequalities in health in Northern Ireland
Authors: Lazenbatt Anne , Orr Jean , Bradley Martin , McWhirter Liz 
Published: March 2006

Targeting health and social need is an important theme in the Northern Ireland Regional Strategy, Health and Well-being into the Next Millennium: A regional strategy for health and social well-being, 1997-2002 (Department of Health and Social Services for Northern Ireland, 1996), which is concerned with addressing inequalities in health status and social well-being. This paper describes a project which assessed the contribution made by nurses, midwives and health visitors to targeting health and social need (THSN). While there is a considerable body of research and information on variations in health and social well-being, few evaluative research interventions improve the health of disadvantaged groups. The initial project was commissioned by the Department of Health and Social Services (DHSS) for one year, had a timetable that covered three phases and was jointly conducted by the schools of nursing at The Queen's University of Belfast and the University of Ulster. In the first phase a survey questionnaire was distributed to a purposive sample of nurses working with both community and voluntary groups to assess their contribution to THSN (n=1000). The paper describes the results from the 392 questionnaires returned (a response rate of almost 40%) and the work carried out in phase 2 of the study, in which the responses were analysed to allow further investigation. By using selection criteria devised by the Project Advisory Board, the interventions were reduced to 22. In an overview of each of these, a number of characteristics kept recurring that could serve to define aspects of 'good practice'. The results highlight nursing competencies gained through their work, the lessons learnt and the problems and difficulties encountered. Importantly, the 22 case studies demonstrate the efforts made by nurses and health professionals to change behaviour, practice, the community and the environment. The paper concludes that the use of qualitative research opens the door to measures of social position that reflect the ways in which people define themselves and the relationships which sustain them. Although there is still some way to go in understanding the different approaches to evaluation, an environment which fosters the monitoring and assessment of practice might be created in the future within the nursing community.
Patient perceptions of crisis pain management in sickle cell disease: a cross-cultural study
Authors: Smith-Wynter Lilieth , van den Akker Olga 
Published: March 2006

Sickle cell disease has a variety of signs and symptoms, the most common being painful vaso-occlusive crises. Due to the severity of the pain, narcotic analgesia is described in the literature as the drug of choice for pain relief. The UK, in line with many other countries, uses narcotic analgesia in crisis management. In Jamaica, however, mild analgesia is the usual drug of choice for the patient in crisis. This difference in management approaches between the two countries was seen as an area for exploration to determine the factors which may reflect the nursing strategies used. This paper describes a cross-cultural survey of patients' perceptions of the painful crises and their management within the home and healthcare settings in Jamaica (West Indies) and Birmingham (UK). The results of the study show many areas of similarities, particularly in relation to the causes of the crises, home management and in-patient admissions. However, there were significant differences in crisis length and the in-patient management of crises. The study highlighted areas of crisis management which must be improved in the UK if patients are to receive optimum care from primary care and hospital nurses, as well as from general practitioners.
Benchmarking evidence-based nursing
Authors: Cole Nick , Tucker Linda F. , Foxcroft David R. 
Published: March 2006

The aim of this formative evaluation (action research) study was to develop and apply a set of criteria for benchmarking evidence-based nursing. There were three phases: the identification (through literature searches and contact with experts) of previous work on the development and assessment of evidence-based nursing; the development (through a consultation exercise) of criteria for measuring and benchmarking evidence-based nursing; and applying these criteria (through semi-structured interviews) in six discrete clinical areas. Numerous papers were found that discussed evidence-based nursing and barriers to research utilisation, but no previous work on benchmarking or assessing evidence-based nursing was found. Fourteen 'benchmarking evidence-based nursing' criteria were developed, organised around four key themes for achieving effective practice: Selecting a particular aspect of practice to question or examine; finding out from the literature, professional networks and other sources what is current best practice, and critically appraising the available literature and sources of information; implementing and/or learning how to provide best-known clinical practice; and confirming that you are providing best practice. All six clinical areas were generally poor on all 14 benchmarking criteria. However, there were some positive attributes: nurses with degree level post-registration education had better knowledge of searching for and critically appraising research; some senior clinical specialists were supportive of evidence-based changes; and one ward had stronger communication/dissemination links for relevant evidence with related clinical areas (paediatrics). It was concluded that the benchmarking tool developed in the study was useful in identifying positive and negative aspects of evidence-based nursing practice. The tool may be helpful to other organizations considering how to take forward evidence-based nursing practice.
A comparison of soap, alcohol and glove use during the nappy-changing procedure in a special care baby unit
Authors: Chuadleigh Jane , Buckingham Christopher D. 
Published: March 2006

This study was conducted in a special care baby unit (SCBU) in a district general hospital and concentrated on hand decontamination and glove-wearing during the nappy-changing procedure. The aims were to determine whether or not nurses were adhering to existing infection control policies and guidelines, and to determine the most appropriate product to be used for hand decontamination. Nurses were observed carrying out nappy changes to determine their existing hand-washing and glove-wearing practices. A microbiological analysis of nurses' hands during the nappy change was performed in order to compare the effectiveness of soap, alcohol, and glove use in eliminating bacteria from the hands. The observation study demonstrated that not all nurses were adhering to existing infection control policies and guidelines. The microbiological analysis found that on the majority of occasions, alcohol was better than soap at removing bacteria from the hands but that gloves provided the best protection overall for both babies and nurses by preventing the acquisition of bacteria. Together these findings suggest that nurses' hands may be providing a route for the transmission of hospital-acquired infection in the SCBU. Ideally, nurses should be wearing gloves during the nappy-changing process and using alcohol to decontaminate their hands.
Is the research necessary? Equipoise and other fundamental ethical considerations
Authors: Scullion Philip 
Published: March 2006

This paper examines issues concerning the necessity of research as an essential ethical question fundamental to ethical scrutiny of research proposals. In particular, the concept of 'equipoise' as a pre-condition to conducting a clinical trial is examined. Equipoise refers to the degree of uncertainty over what constitutes best practice: existing or experimental interventions or various approaches to care. It is applied to individual practitioners, the profession as a whole and communities of patients and their advocates. Nurses' positive response to current government views on the evidence basis of practice and decision-making within the new NHS gives prominence to research feeding into the clinical governance process. This paper contributes to the ethical debates over nursing research and takes account of the view that some research - clinical trials in particular - should not proceed in the absence of equipoise.
Critical reflexivity: A politically and ethically engaged research method for nursing
Authors: Freshwater Dawn , Rolfe Gary 
Published: March 2006

Traditional interpretations of research tend to bifurcate research knowledge and practice knowledge, with knowledge derived from practice and direct interaction with patients being perceived as knowledge that is not formally admissible by the traditional scientific model. This paper proposes a research method that legitimises practice as a source of knowledge. Building upon the concepts of situational understanding and contingent knowledge, we advocate an integral research methodology, one which draws on the notion of the researcher-practitioner. Beginning with an analysis of knowledge and power we explore the contribution of reflexivity to the development of a politically and ethically engaged research process in nursing. In discussing critical reflexivity as a research method, we will outline the focus of reflexive research and the role of the reflexive researcher. Arguing against the superiority of theoretical research over practitioner research, we present a challenge to technical rationality, suggesting not only a new approach to research but also a new approach to practice.
Benchmarking in healthcare
Authors: Pantall John 
Published: March 2006

This paper examines the process of benchmarking and the ways in which it can be used to secure improvement and best practice. Classic definitions are presented and their appropriateness to present-day conditions is considered. The four types of benchmarking — internal, competitive, functional and generic — are examined and the advantages and disadvantages of their use in healthcare settings presented. The benefits of considering and comparing practice in a wide range of organisations are emphasised. The paper argues that performance measurement is not an end in itself but a means of comparing practice and the impact of changes in practice intended to secure improvement. The three major stages in the benchmarking process are examined — defining what to benchmark, the collection and analysis of data and the action. The key role of the service-user for determining what to benchmark and what is best practice are highlighted. The importance of always using the benchmarking process to secure improvement is emphasised, and the need to integrate benchmarking with other approaches to quality at the strategic level is stressed. The dangers of fragmented initiatives are also considered. Finally, the importance of having an appropriate organisation culture and management leadership to facilitate improvement is described.
An evaluation of the recruitment of black and minority ethnic students to pre-registration nursing
Authors: Chevannes Mel 
Published: March 2006

This paper reviews the literature on the recruitment of minority ethnic students to pre-registration nursing courses and goes on to examine the evidence of ethnic minority under-recruitment and possible explanations for it, exploring the relationship between stated institutional policy on equality of opportunity, student choice of institution, and new data on the way the selection process operates in nursing course admissions. While the perception of the institutions' policy towards minority ethnic students may affect the numbers applying, recent research shows that 6.7% of applicants were from minority ethnic groups (who make up 6% of the general population), but that only 3% went on to become students, a fact that could not be explained fully on the grounds of entry qualification or choice of nursing specialty at the time of application. New data on recruitment of minority ethnic students to pre-registration nursing courses at Leicestershire in 1998/99 indicate that black and other minority ethnic students apply in large numbers but that their numbers diminish as they reach the shortlisting stage and reduce still further when they are offered a place on the course, with minority ethnic students remaining under-represented. The challenge of the situation requires universities to implement equality of opportunity policy in the selection process, undertake ethnic monitoring, train all staff involved with students' admission, and set targets on diversity.
A qualitative survey of staff responses to an integrated care pathway pilot study in a mental healthcare setting
Authors: Hall Julie 
Published: March 2006

This qualitative study set out to discover a multidisciplinary team's impressions of an integrated care pathway pilot. Specific aims were: to explore participants' beliefs about the effectiveness and limitations of the pilot and its impact on practice, and to use the findings to develop recommendations for the future of integrated care pathways within the clinical area. The research setting was an in-patient dementia assessment service, forming part of the mental health directorate of an NHS trust in the east of England. Data were generated through semi-structured interviews with a purposive sample of the multidisciplinary team, based on the premise that a qualitative approach develops an insider view of the team's experiences, beliefs and perceptions. Theoretical analysis was conducted, based on the analytical framework described, and facilitated through the use of QSR.NUD.IST IV content analysis software. Four categories emerged, which focused on: the clinical impact of the pathway; team performance; pathway effectiveness; and practice development. The team's impressions corroborated experiences of integrated care pathways outlined in the literature. Benefits identified by the team were the pathway's influence on managing care, increased efficiency, better team working and perceived positive impact on the experience of patient and carer. Particular new insights focused on the pathway's impact on professional roles and responsibilities. The study indicated that the pathway concept was adaptable to this mental health setting and that benefits had been derived. The study's limitations are the inherent complexities associated with validity and reliability. Recommendations relate to local evaluation of the integrated care pathway pilot and wider research considerations.
The BARRIERS scale: Does it 'fit' the current NHS research culture?
Authors: Closs S. Jose , Bryar Rosamund M. 
Published: March 2006

The BARRIERS scale was developed in the US as a method of identifying the main barriers to research utilisation reported by nurses. However, its appropriateness for assessing such barriers in the UK is not clear. The current drive for evidence-based practice makes it desirable to assess the availability of an instrument to measure the progress of nurses who have implemented research. Information about the appropriateness of the BARRIERS scale for use in the UK would allow its potential as a monitoring instrument to be assessed. This paper is a section of a wider study aimed at producing a general picture of the underlying types of barrier to the implementation of research findings. Objectives included exploring those factors which acted as barriers to research implementation; assessing the construct validity and the internal consistency of the BARRIERS scale in the UK; and identifying barriers which might be excluded or added in future studies. A census survey of practice nurses and nurses from two hospital and two community trusts within one health authority, and one community trust from another health authority, was undertaken. The BARRIERS questionnaire was sent by mail to 4,501 nurses, with a 44.6% response rate. Exploratory factor analysis was used to identify key factors underlying the 29 items of the BARRIERS scale which acted as barriers to the utilisation of research findings. Four factors were identified, which were conceptualised as: the benefits, quality and accessibility of research, and resources for implementation. These were similar, but not identical, to factors identified in the original US study. One factor appeared mainly to be concerned with critical appraisal, which could be considered to be a facilitator rather than a barrier. More than one-fifth of the original items were not included in the UK model. Under-reported (mainly research issues) and additional barriers (mainly organisational issues) were identified. The four-factor solution was roughly comparable with that derived in the US, although fewer items were retained (22 instead of 28), and some of the factors were conceptually a little different. It was concluded that the internal reliability of the four-factor solution was fair. The scale may not be suitable for use in the UK without further development: a scale which includes positive as well as negative aspects of research culture, with a greater emphasis on organizational issues, may be more useful.
Substance use and misuse: A public health perspective
Authors: Hussein Rassool G. , Marshall Fiona 
Published: March 2006

Drug, alcohol and tobacco misuse (generically known as substance misuse) is a universal phenomenon that affects all levels of society. Increasing drug use generally has caused a host of social, behavioural, psychological and physical problems among populations. Substance use and misuse impinges on the five key areas for health promotion outlined in the Health of the Nation document (DoH, 1992): coronary heart disease and stroke, prevention of accidents, cancer, sexual health, mental health. The widespread misuse of psychoactive substances in the general population demands a healthcare workforce that can offer nursing interventions; is capable of providing effective preventive strategies; can offer counselling; and is qualified to give specialist care when necessary to substance misusers and their families.The care of substance misusers is not the domain of any one profession or organisation, although professionals in both primary healthcare and hospital settings are usually the first point of contact for clients who have potential or even early substance use problems. From the late '80s, prevention and treatment have become much higher on the political and service agendas. Public health campaigns have been introduced that maximise awareness of the risks of tobacco smoking, of drink driving, and of the misuse of over-the-counter drugs, alcohol, prescribed and illicit drugs. As a result, the public health triangular model, which involves interaction between the host (the individual), the agent and the environment, has become more prominent. The increase in substance misuse means that research that identifies why nurses and other healthcare workers are unable to identify the factors that lead to substance misuse is of paramount importance. If nurses and other healthcare professionals are to respond to substance misusers, there need to be new models of care from those that have traditionally guided the work of generic healthcare professionals. This paper considers substance misuse in general, but concentrates particularly on drug misuse.
Organisation of care: Primary care organizational responses to mental health needs
Authors: MVcCollam Allyson , Hopton Sane 
Published: March 2006

This paper considers a number of factors that give renewed prominence to organizational dimensions in developing primary care responses to mental health needs as the context for a new collaborative research programme in this area. A typology is proposed to describe a range of organizational responses to mental health need in primary care. This serves to draw attention to the fact that research and practice and service development have tended to focus on organizational arrangements that clarify the relationship between primary care and secondary mental health services and relate largely to the care and treatment of people with severe and enduring mental illness, with considerably less exploration of other forms of organisational responses for different types of mental health need. The authors conclude by suggesting the need to develop greater understanding of lay perceptions of mental health and mental health needs, along with further exploration of help-seeking behaviour and of factors that promote self-care.
Open awareness and dying: The use of denial and acceptance as coping strategies by hospice patients
Authors: Copp Gina , Field David 
Published: March 2006

This paper examines the use of denial and acceptance as interdependent and fluctuating coping strategies by dying patients in a hospice, and discusses some of the reasons why denial and acceptance operate for these patients. 'Open awareness' of dying is now accepted as a central feature of palliative care, and full disclosure of prognosis and diagnosis is seen as a desirable element of care for patients who are dying. However, such openness is not without its tensions and conflicts. The study was conducted in a hospice where patients and nurses interact within an 'open awareness' context and where most patients live in the knowledge of 'certain death but at an unknown time'. The paper examines use of denial and acceptance by hospice patients at various times during their dying. The data are derived from the findings of a prospective qualitative study on the experiences of 12 hospice patients and those of their nurses. Unstructured interviews and participant observation were used as the primary methods of collecting data. Data from interviews were coded and comparative analyses between cases were performed. Denial and acceptance of dying among patients fluctuated during the period of dying and appeared to form an important aspect of their coping process. Denial and acceptance appeared to be used to avoid threats as well as to preserve existing relationships within the context of open awareness. In contrast to some commonly held beliefs, which tend to view denial and acceptance as 'singular, either/or entities', denial and acceptance are best seen as interdependent and fluctuating strategies, used continually by dying patients.