bluuebunny/crossref_metadata_2025_split huggingface dataset:
Betwixt and between: a critical ethnography of comfort in New Zealand residential aged care
Authors: Bland Marian 
Published: May 2007

Aims and objectives.  This research sought to explore the nature of comfort within the context of three New Zealand nursing homes and examine how nursing and other actions contribute to residents’ comfort.Background.  Comfort has been acknowledged as a key nursing goal since the days of Florence Nightingale, but the nature of comfort and how nurses can contribute to and enhance patient/resident comfort is unclear. Comfort is often considered to be merely the absence of discomfort.Design.  A critical ethnographic approach was used to facilitate understanding of nursing home residents’ comfort. Fieldwork included 90 days of participant observation, interviews with 27 residents and 28 staff and extensive document examination.Results.  Comfort was multidimensional, idiosyncratic, dynamic and context dependent, rather than merely the absence of discomfort. This multidimensional nature meant residents could be ‘betwixt and between’ comfort and discomfort simultaneously. The constraints of one‐size‐fits‐all care delivery practices and the tensions inherent in communal living compounded residents’ discomfort.Conclusions.  Individualized care, based on comprehensive and accurate nursing assessment, is fundamental to the comfort of residents.Relevance to clinical practice.  Staff working in nursing homes must re‐examine their care delivery practices to ensure these do not disempower residents. Ensuring the comfort of each resident is a nursing priority and the key component of individualized care.
Effectiveness of bran supplement in older orthopaedic patients with constipation
Authors: Kaçmaz Zennure , Kaşıkçı Magfiret 
Published: May 2007

Aim.  The purpose of the study was to evaluate the effectiveness of planned nursing interventions, including bran supplement, on the bowel management of older orthopaedic patients.Background.  Constipation is prevalent among older people. Constipation is also well‐known to be a problem for a range of orthopaedic patients. Orthopaedic diseases or conditions may, because of the specific problems, cause this. The problem may also arise as a result of the orthopaedic treatment options undertaken by patients.Design.  A quasiexperimental design was employed.Methods.  The patients were recruited from an orthopaedic clinic at a university hospital in Erzurum, eastern Turkey. Descriptive statistics, independent sample test t‐test, chi‐square and McNemar test were used to analyse the data. Constipation problems were identified through interviews by using the Constipation Diagnosis Form. Interviews were performed within the fourth postoperative day. After that, while the patients in the control group received routine nursing care according to clinic routine, the patients in the experimental group received bran supplement together with planned nursing interventions. The patents in both groups were followed by using the Constipation Follow Form.Results.  While patients in the experimental group showed significant improvements in most characteristics of bowel elimination such as time of defecation, intensity of faeces, colour of faeces and amount of faeces, the control group showed a significant improvement in only duration of defecation.Conclusions.  The results of the study indicate planned nursing interventions including bran supplement are more effective than routine nursing interventions for management of constipation problems in older orthopaedic patients.Relevance to clinical practice.  Nurses have an important part to play in both prevention and management of constipation. Constipation is a problem especially for older orthopaedic patients. Planned nursing interventions that include bran supplements may be more effective than routine nursing interventions for management of constipation problems in older orthopaedic patients.
A survey of Chinese nurses’ current knowledge of pain in older people
Authors: Yu Hui‐Dan , Petrini Marcia A. 
Published: May 2007

Aim.  To investigate the current level of Chinese nurses’ knowledge of pain and pain management in older people.Background.  Most research about nurses’ knowledge regarding pain has taken place in developed countries; however, limited research in this area has taken place in developing countries and particularly in China.Methods.  Registered Nurses (n = 621) in three different hospitals were surveyed with the questionnaire about pain and pain management with respect to older people.Results.  The finding showed that a significant knowledge deficit in this area exists. There were no significant differences among nurses in terms of education background, position and whether or not there was attendance in an educational session on pain management. However, there were statistically significant differences based on age; hospital of employment and clinical area in which employed.Conclusion.  This survey suggested that nurses’ knowledge of pain in older people should be improved. Basic and continuing education of nurses in this area should be enhanced and their active participation in pain management should be encouraged.Relevance to clinical practice.  The findings in this survey highlight a significant pain management knowledge deficit among the nurses in the clinical practice. The findings may help the nurses realize their knowledge deficit in this area and may also suggest curriculum changes for the nurses to improve pain management knowledge.
Patients’ experiences of being delirious
Authors: Sörensen Duppils Gill , Wikblad Karin 
Published: May 2007

Aim.  The aim was to describe patients’ experiences of being delirious.Background.  Delirium is a serious psychiatric disorder that is frequently reported from hospital care settings, particularly among older patients undergoing hip surgery. It involves disturbances of consciousness and changes in cognition, a state which develops over a short period of time and tends to fluctuate during the course of the day. It is a certified fact that delirium is poorly diagnosed and recognized although the state often is described as terrifying. To be able to give professional care, it is of the utmost importance to know more about patients’ experience of delirium.Method.  Included in the interviews were patients who had undergone hip‐related surgery and during the hospital stay experienced delirium. Fifteen patients participated in the interviews. Of these, six had experienced episodes of nightly delirium (sundown syndrome) and nine experienced delirium during at least one day. The interviews were analysed by qualitative content analysis.Results.  The entry of delirium was experienced as a sudden change of reality that, in some cases, could be connected to basic unfulfilled physiological needs. The delirium experiences were like dramatic scenes that gave rise to strong emotional feelings of fear, panic and anger. The experiences were also characterized by opposite pairs; they took place in the hospital but at the same time somewhere else; it was like dreaming but still being awake. The exit from the delirium was associated with disparate feelings.Relevance to clinical practice.  It is necessary to understand patients’ thoughts and experiences during the delirious phase to be able to give professional care, both during the delirium phase and after the recovery.
Factors associated with delirium severity among older patients
Authors: Voyer Philippe , McCusker Jane , G Cole Martin , St‐Jacques Sylvie , Khomenko Lioudmila 
Published: May 2007

Aim.  The goal of this study was to determine whether the factors associated with delirium varied according to the severity of the delirium experienced by the older patients.Background.  Delirium among older patients is prevalent and leads to numerous detrimental effects. The negative consequences of delirium are worse among older adults with severe delirium compared with patients with mild delirium. There has been no study identifying those factors associated with delirium severity among long‐term care older patients newly admitted to an acute care hospital.Design.  This is a descriptive study.Methods.  This is a secondary analysis study of institutionalized older patients newly admitted to an acute care hospital (n = 104). Upon admission, patients were screened for delirium with the Confusion Assessment Method and severity of delirium symptoms were determined by using the Delirium Index.Results.  Of the 71 delirious older patients, 32 (45·1%) had moderate‐severe delirium while 39 (54·9%) presented mild delirium. In univariate analyses, a significant positive relationship was observed between the level of prior cognitive impairment and the severity of delirium (p = 0·0058). Low mini‐mental state examination (MMSE) scores (p < 0·0001), the presence of severe illness at the time of hospitalization (p = 0·0016) and low functional autonomy (BI: p = 0·0017; instrumental activities of daily living: p = 0·0003) were significantly associated with moderate‐severe delirium. Older patients suffering from mild delirium used significantly more drugs (p = 0·0056), notably narcotics (p = 0·0017), than those with moderate‐severe delirium. Results from the stepwise regression indicated that MMSE score at admission and narcotic medication use are the factors most strongly associated with the severity of delirium symptoms.Conclusions.  This present study indicates that factors associated with moderate‐severe delirium are different from those associated with mild delirium. Given the result concerning the role of narcotics, future studies should evaluate the role of pain management in the context of delirium severity.Relevance to Clinical Practice.  As moderate‐severe delirium is associated with poorer outcomes than is mild delirium, early risk factor identification for moderate‐severe delirium by nurses may prove to be of value in preventing further deterioration of those older patients afflicted with delirium.
Nursing home placement: perspectives of community‐dwelling older persons
Authors: M Y Tse Mimi 
Published: May 2007

Objectives.  To explore nursing home‐related beliefs among older Hong Kong Chinese and identify strategies that make nursing homes a better place to live.Background.  Increased life expectancy has markedly increased the prevalence of age‐related disease and disability, which limits the self‐caring ability of older persons. Nursing home placement offers one possible alternative. However, the perspectives of older persons on nursing home admission have been seriously neglected and under‐reported.Methods.  The research was a qualitative descriptive study. Clients of a community centre for older people were approached and invited for an interview.Results.  Participants included 118 older persons (61 female and 57 male) age from 60–89 years. Ninety per cent had chronic diseases and needed regular follow‐up. Half of participants had never visited a nursing home. Of them, 85% would not want to live in a nursing home upon getting old and their nursing home‐related beliefs were found to be negative. Participants expressed the feeling of being abandoned by their family members, insecure and lonely regarding the nursing home placement. Living in a nursing home was considered as ‘living in jail’ and that their privacy would be lost. Nevertheless, positive aspects of nursing home placement were mentioned, and strategies were explored that would make nursing homes a better place for older people to live.Relevance to Clinical Practice.  Positive aspects of nursing home placement need to be promoted. Nurses should be advocates for the health of the elderly, and help make nursing homes a better place to live.
Violence in municipal care of older people in Sweden as perceived by registered nurses
Authors: Josefsson Karin , Sonde Lars , Wahlin Tarja‐Brita Robins 
Published: May 2007

Aims. The main aim was to describe registered nurses’ perceptions of violence and threats, as well as their access to prevention measures and routines for handling violent behaviour in municipal care of older people. Another aim was to compare nurses’ perceptions working solely in dementia care with those working in general elder care where older people have diverse diagnoses.Background. Violence is often reported in care of older people. The development of dementia units and the implementation of reform have changed care of older people. Dementia disorders have been shown to be a predisposing factor to violence.Design. A non‐experimental, descriptive design with a survey research approach was used. The setting was 60 special types of housing with subunits in a large town. The response rate was 62% (n = 213). Forty‐five per cent (n = 95) of the nurses worked in dementia care and 55% (118) in general elder care.Method. A questionnaire.Results. Nurses had experienced a high degree indirect threats (dementia care, 45%; general elder care, 51%), direct threats of violent acts (dementia care, 35%; general elder care, 44%) and violent acts (dementia care, 41%; general elder care, 43%). Nurses had witnessed violence and threats towards staff (dementia care, 49%; general elder care, 38%). Even care receivers (dementia care, 20%; general elder care, 19%) were subjected to violence and threats. No statistical differences were found between groups. The nurses in dementia care had more access to education in managing violence and threats, as well as routines for handling violence and a door with a lock to their working unit.Conclusion. Violence occurred frequently in municipal care of older people without any difference between dementia care and general elder care. Nurses in dementia care were more often offered education on how to manage violence and had routines for when violence occurs.Relevance to clinical practice. Municipal authorities should increase staff education for handling violence and creating safety routines. Violence needs to be taken seriously with a ‘zero tolerance’ attitude.
Problem‐solving experiences among elders living alone in eastern Taiwan
Authors: Tsai Hsiu‐Hsin , Tsai Yun‐Fang 
Published: May 2007

Aim.  To explore problem‐solving experiences among older people living alone in eastern Taiwan.Background.  Elders living alone in Taiwan have a low participation rate in government social support programmes. Providing sufficient care for this population of elders requires knowing not only their problems, but also how and when they seek help solve their problems.Design.  Qualitative research was used to gain a deeper understanding of the problem‐solving experiences of older people living alone.Methods.  Elders living alone (n = 9) were recruited from a remote area of Taiwan. Data were gathered in audiotaped, semi‐structured interviews and analysed by content analysis.Results.  Participants used both internal and external resources to solve problems through an appraisal process. Their internal resources included self‐perception of health status, preventive coping strategies, flexible coping ability and being resigned to one's situation. Their external resources included both human and environmental resources. Based on their lived experience, participants appraised the usefulness of both internal and external resources before deciding whether to seek help from external resources.Conclusion.  In Chinese society, maintaining a balance between internal and external resources is an important mechanism for elders in solving problems.Relevance to clinical practice.  Our findings may enhance policy makers’ and healthcare providers’ understanding of the problem‐solving experiences of elders who live alone in Taiwan. In practical terms, these findings can be used to improve the elderly people's use of support systems in their community.
Patients experiencing local anaesthesia and hip surgery
Authors: Mauleon Annika L , Palo‐Bengtsson Liisa , Ekman Sirkka‐Liisa 
Published: May 2007

Aims and objectives.  The aim of this study was to show what the experience of local anaesthesia and a surgical situation meant to patients.Background.  Many patients who receive local anaesthesia will remain awake during surgery. The very fact of staying awake causes psychological and psychosocial needs. These needs must be met and it is therefore important to identify them.Design/method.  Seven patients (aged 61–79) experiencing local anaesthesia and hip surgery (hip replacement surgery or repair of fractured hip) were interviewed. An interpretive phenomenological method developed by Benner was used to extract the experience of what it means to be in local anaesthesia and surgery. One paradigm case is used to illustrate the results.Results.  Results show that the well‐being and comfort of patients is compromised by challenges such as severe pain and long waits, which may be experienced as endless and which leave the patient thinking of nothing else. By contrast, the experience of trust helps the patient to feel control even in situations where the treatment is hard to grasp.Conclusions.  The results highlight that local anaesthesia and surgery force patients to overcome and handle experiences of pain, trust and distrust as well as feelings of alienation and unreality.Relevance to clinical practice.  The results illustrate the patient's needs, as seen from the patient's perspective. A shared experience makes it possible to understand, and thus to recognize, the required qualitative care to facilitate and to help the patient to remain in control and face the psychological challenges presented by anaesthesia care and surgical situations.
Using action research to construct national evidence‐based nursing care guidance for gerontological nursing
Authors: Booth Jo , Tolson Debbie , Hotchkiss Rhona , Schofield Irene 
Published: May 2007

Aim.  This paper explores the development of a low‐cost, involving methodology for constructing nursing‐focused evidence‐based national care guidance, known as Best Practice Statements, the intended users of which are gerontological nurses practising throughout Scotland.Design.  The Best Practice Statement construction methodology forms one cycle in a five‐year longitudinal action research study that aims to achieve evidence‐based nursing, facilitate professional networking to support practice development and promote the principles and practice of gerontological nursing. Achieving these aims involved designing a virtual Practice Development College.Methods.  A Community of Practice comprising practising gerontological nurses, expert advisors, academic teaching and research nurses collaborated in face‐to‐face meetings and in the virtual Practice Development College to delineate and refine the procedural model for Best Practice Statement construction. Focus groups, telephone interviews, analysis of on‐line archives and documentary outputs formed the analytic dataset.Results.  Qualitative analysis indicated that, from the perspective of the community of practice, the emerging methodology facilitated the melding of knowledge sources reflecting the dominant evidence hierarchy with other forms of evidence valued by gerontological nurses, in the Best Practice Statement.Relevance to clinical practice.  Current methods of care guidance construction rarely address the concerns of nurses and the evidence from which guidelines are developed is narrowly defined with regard to inclusion and acceptability. In contrast this model focuses on nursing issues, embraces a wider definition of evidence and ensures that the published Best Practice Statements are credible and achievable in gerontological practice, where they are tested and refined as an inherent aspect of the development process.
Specificity and resilience in the arbuscular mycorrhizal fungi of a natural woodland community
Authors: HELGASON THORUNN , MERRYWEATHER JAMES W. , YOUNG J. PETER W. , FITTER ALASTAIR H. 
Published: May 2007

Summary

The composition of communities of arbuscular mycorrhizal (AM) fungi can have a large effect on the performance of their plant hosts. The role of individual fungal species in shaping this response is as yet unresolved.
We have used the fungicide benomyl to alter the community of AM fungi in undisturbed monoliths of soil in a natural community. Changes in the community were characterized by root colonization (%RLC), cloning, sequencing and tRFLP of a partial SSUrDNA fragment. Eleven plant species were sufficiently abundant in the monoliths to be examined.
In the highly mycorrhiza‐dependent perennial herb Ajuga reptans, phosphate concentration was significantly reduced after benomyl treatment over a full growing season. The other plant species showed low colonization and no significant difference in phosphate concentration after benomyl treatment.
Although colonization in A. reptans was reduced, many mycorrhizal fungi survived in the roots. Some became more abundant following fungicide treatment, suggesting competitive release. Fungi that increased were generalists that have been identified in field samples from published studies colonizing a wide range of plant species. Those that declined were specialists with a narrow host range; five types had not been recorded previously in field samples.
AM fungi in this study differed greatly in their response to perturbation, independent of the identity of the host plant. If such functional diversity is widespread, then elucidating the part played by AM fungal diversity in regulating plant community structure will be key to our understanding and management of ecosystems.
Differences in resprouting ability are not related to seed size or seedling growth in four riparian woody species
Authors: CHONG CAROLINE , EDWARDS WILL , WAYCOTT MICHELLE 
Published: May 2007

Summary

Resprouting is a key plant attribute facilitating persistence in disturbance‐prone environments. Resprouting ability in seedlings may depend on both developmental ontogeny and seed size. However, the relationships between these factors are not well explored, especially for woody species with comparatively small seeds and epigeal germination.
We investigated resprouting capacity in seedlings from four subtropical, riparian, Myrtaceous tree species, Melaleuca leucadendra, Asteromyrtus symphyocarpa, Eucalyptus camaldulensis var. obtusa and Tristaniopsis laurina, displaying these characteristics. We recorded resprouting in response to simulated disturbance as a function of seed mass and developmental age (5–150 days post‐emergence) and examined the acquisition of resprouting ability in relation to growth and biomass allocation patterns.
Patterns of resprouting were distinct among species, but the acquisition of resprouting ability was not determined by seed mass. The ‘small’ seeded M. leucadendra and the ‘intermediate’ seeded E. camaldulensis showed unexpectedly high shoot resprouting vigour from cotyledon stage (70% resprouting at 5 days post‐emergence), as well as greatest ongoing allocation to root mass and lateral root development. In contrast, in A. symphyocarpa (another species with ‘intermediate’ seed mass) and T. laurina (a ‘large’ seeded species) resprouting rates during early development were much lower (< 10%), although there was a trend towards increasing resprouting ability with age in A. symphyocarpa (> 150 days). Resprouting capacity was also independent of seedling size and relative growth rate.
Our results indicate that the size‐dependency of resprouting capacity varies considerably among these species. This suggests physiological and morphological species traits other than those directly related to reserve size or relative growth rate may convey survivorship in river environments.
Our findings show that resprouting capacity was not related to seed size and seedling growth patterns in these four species. This is different to evidence from comparative studies undertaken in fire‐prone and other temperate environments. A broader survey of seedling resprouting ability including more species is required to determine the generality of our findings in riparian species.