bluuebunny/crossref_metadata_2025_split huggingface dataset:
A typology of knowledge for district nursing assessment practice
Authors: Kennedy Catriona M. 
Published: December 2004

Background. This paper reports on part of a larger study, the aim of which was to explore the nature of knowledge required by district nurses (DNs) to carry out first assessment visits, and the relationship of this to the decisions they make. Assessment of need is a key and complex component of the DN role. To date, there has been limited exploration of the knowledge underpinning needs assessment in district nursing practice.Aim. The aim of this paper is to identify and categorize the knowledge in use by DNs undertaking first assessment visits, by presenting it in the form of the typology of knowledge which emerged from the study.Methods. The study used a qualitative, ethnographic design. Eleven DNs were observed undertaking first assessment visits and interviewed twice: following the observed visit and 1 year later, after preliminary data analysis had been undertaken. Approaches to analysis were data driven, and constructing the typology involved uncovering and linking what the DN was seeing, asking and doing. Data were collected during 1997 and 1998.Findings. The findings revealed a breadth and depth of community nursing knowledge that seemed to incorporate an amalgam of theoretical (knowing that) and practice‐based (knowing how) knowledge. The findings depict the range and scope of the knowledge in use by the DNs, and challenge the utility of theoretical models that remove knowledge from the context in which it is used and applied.Conclusion. The findings presented here provide fresh insight into the ‘know‐how’ of district nursing assessment practice. Whilst the typology requires further testing and refinement in order to enhance understanding of practice, it conceptualizes aspects of district nursing assessment knowledge and addresses the current lack of underpinning principles in district nursing practice.
Complexity in caring for patients with advanced cancer
Authors: Tishelman Carol , Bernhardson Britt‐Marie , Blomberg Karin , Börjeson Sussanne , Franklin Liselotte , Johansson Eva , Leveälahti Helena , Sahlberg‐Blom Eva , Ternestedt Britt‐Marie 
Published: December 2004

Background.  The gap between nursing research and practice is readily acknowledged in literature, with a variety of strategies suggested for reducing this gap. It is necessary not only to address problems of research implementation in practice, but also to find strategies that strengthen the influence of practitioners on research agendas through more collaborative relationships in order to have an impact on care of patients. A multi‐centre research project was therefore initiated by two universities and three health care facilities, aiming to improve quality of care for patients with advanced cancer through a knowledge‐exchange programme between nurse researchers, practitioners and students.Aim.  The aim of this article is to explore how clinical staff reason about care provision for patients with advanced cancer, through analysis of 20 focus group discussions conducted with staff in three different health care facilities in two Swedish cities. An initial analysis based on grounded theory was complemented with consideration of the interactive process in the focus group discussions, and carried out by a team consisting of senior nurse researchers, clinical experts and nursing instructors.Findings.  The findings of the focus group discussions emphasize the complexity of caregiving for patients with advanced cancer. The tension between caregiving ideals and limits imposed by the realities of caregiving in today's health system were striking. Practitioners discussed the organization of care, different constellations of relationships between patients, family members and professionals, and theoretical and experiential knowledge as equally important aspects in dealing with all concrete situations in daily practice. The importance of reflective practice, use of self and ethical reasoning also permeated the focus group discussions.Conclusions.  These findings highlight an integrated need both to influence organizational structures and working relationships, along with increasing knowledge, if sustainable change is to be effected.
Improving the postnatal outcomes of new mothers
Authors: Morse Carol , Durkin Sarah , Buist Anne , Milgrom Jeanette 
Published: December 2004

Background.  Postnatal depression persists worldwide as a troubling issue for many new mothers and their families. The practice of early discharge within 72 hours after birth from maternity hospitals in Australia requires community‐based care of new mothers, typically provided by community midwives initially, and then by maternal and child health nurses (MCHN). This latter workforce encounters the onset of distress/depression in vulnerable women and is expected to manage their care, but their training does not equip sufficiently them to do this.Aims.  The aim of the study was to evaluate the effectiveness of brief training for MCHN in early detection and effective management of mildly distressed new mothers.Methods.  A controlled comparative longitudinal study was carried out with a group of first‐time mothers recruited through antenatal clinics at four major hospitals in a large Australian city. Forty MCHN were allocated to the intervention group. Those in the intervention group received training in the identification and management of distressed mothers. Intervention group nurses also had access to a liaison psychiatric network for consultation and referrals. Other nurses were allocated to the control group, which provided standard management services to new mothers in their catchment areas. Mothers’ outcomes in psychological and psychosocial functioning were assessed; comparing those cared for by the nurses who had received the intervention with those cared for by standard practices. Mothers’ satisfaction with the maternal and child health nurse services was also assessed.Results.  Levels of distress peaked in early pregnancy in both groups and reduced over the study period. Rates and group levels of psychological distress and psychosocial functioning did not differ over time between mothers receiving care from the enhanced trained nurses and those receiving standard care. Differential group findings were apparent in attrition, with the more distressed mothers withdrawing from the control group and the less distressed withdrawing from the intervention group. Satisfaction with maternal and child health nurse services was high in both groups. Limitations of the study included events occurring while the study was in progress, such as staffing upheaval and unrest following the introduction of compulsory competitive tendering requirements, heavy workloads and the concurrent introduction of computerized case records that required the rapid familiarization with computer usage.Conclusions.  Findings indicate that the extra training of MCHN did not substantially assist in the detection and management of postnatal distress in these new mothers. Unexpected ecological conditions of workforce disruption and extra workloads may have mitigated against the success of the programme. Limitations of the study are examined and the implications for future research are discussed.
Successful adherence after multiple HIV treatment failures
Authors: Enriquez Maithe , Lackey Nancy R. , O'Connor Mary C. , McKinsey David S. 
Published: December 2004

Background.  Non‐adherence to human immunodeficiency virus (HIV) medications often results in irreparable drug resistance and poor outcomes. Hence, care providers generally think that treatment of HIV disease should be delayed until a person is ‘ready’ to adhere. However, little research has focused on understanding the process that results in readiness for successful adherence.Aim.  The aim of this phenomenological study was to describe and understand the experience and decision‐making processes of people who became adherent to their HIV medication regimens after previously failing treatment because of non‐adherence.Method.  A Husserlian phenomenological approach was taken, and in‐depth interviews were analysed using Giorgi's method of phenomenological description and analysis.Findings.  Thirteen HIV‐positive men and women who had previously failed two or more treatment regimens because of non‐adherence were purposefully selected from two infectious diseases clinics in the Midwest region of the United States. They had achieved and sustained adherence to their HIV medications for 1 year or longer without formal intervention. All participants experienced a ‘trigger’ event preceding the process that led to the ability to incorporate lifestyle and health behaviour changes necessary for successful adherence. Factors associated with the process leading to adherence were: changing attitudes towards HIV medication, finding the right health care provider, creating the right support system, getting control of life and having goals.Conclusions.  This study demonstrated that HIV‐positive individuals who had been non‐adherent and had been viewed as ‘difficult to treat’ nonetheless successfully adhered to treatment once they became ‘ready’. Findings from this study implicate that readiness may be a necessary component for successful adherence, particularly in HIV‐positive individuals who have previously failed treatment. Understanding the relationship between the phenomenon of readiness and subsequent HIV treatment adherence has implications for clinical decision‐making and for development of interventions that enhance adherence and prevent HIV drug resistance.
Enhancing Delphi research: methods and results
Authors: Kennedy Holly Powell 
Published: December 2004

Background. The Delphi method provides an opportunity for experts (panelists) to communicate their opinions and knowledge anonymously about a complex problem, to see how their evaluation of the issue aligns with others, and to change their opinions, if desired, after reconsideration of the findings of the group's work. Delphi studies have the potential to provide valuable information, yet few researchers have taken further steps to support or refine their findings. Without this step there is a potential threat to the applicability, or external validity, of the results.Aims. The purpose of this article is to present an argument for further inquiry to enhance and support Delphi findings, and specific approaches to this will be considered.Methods. Methods to enhance, expand, or refine Delphi study findings are described. Mixed method design within a Delphi study on midwifery practice is described, and a follow‐up narrative study to examine the findings is presented.Findings. Selected results from the follow up narrative study are presented to convey how the narrative data clarified the Delphi findings. Together, the studies provide a more robust depiction of midwifery practice, process, and outcomes. Although there were similarities to the dimensions identified previously, there was a more dynamic focus and explanation of the interaction between the midwife, the woman who had received midwifery care, and the health care system.Study limitations. Lack of diversity in the sample and the midwives’ familiarity with the author's past research represent a potential threat to the findings. Prolonged interviews and multiple narratives were gathered in an effort to control for this.Conclusion. Delphi studies are research exercises conducted by a panel of experts. Designing studies to further enhance, clarify, or refine their findings from the context of practice holds promise for their ability to influence clinical care.
Enhancing the quality of hermeneutic research: decision trail
Authors: Whitehead Lisa 
Published: December 2004

Background.  Researchers have ethical and professional obligations to produce research of a high standard. The constituents of quality in research appear to differ between authors, leaving readers unsure about which pathway to follow. This can reflect inadequate consideration of the theoretical framework guiding the study. Many papers fail to consider the theoretical underpinnings of the methodology chosen and the link between these and the methods employed. These need to be accessible to readers in order to assess the trustworthiness of the research.Aim.  This paper discusses the development of trustworthiness in hermeneutic phenomenological research.Discussion.  Referring to a study on lived experience of Chronic Fatigue Syndrome/myalgic encephalitis, I describe the decision trail and discuss the strengths and limitations of the choices made throughout the study.Conclusion.  The methodology focused my approach more fully on the importance of recognizing the influences that I brought to the study and the impact of these in generating the data. It highlighted the fact that the process of setting out my horizon can never be complete, the importance of analysing the data at a macro and micro level, acknowledging the evolution of the data over time, and ensuring that analysis does not move beyond the data and out of the hermeneutic circle. In seeking to make the decision trail clear to others, researchers must distill the philosophical principles of the methodology and set these out in a way that is accessible and open to scrutiny.
Morphine is not the only analgesic in palliative care: literature review
Authors: Wootton Margaret 
Published: December 2004

Background.  No comprehensive review has been published to date, which provides information for nurses on pharmaceutical alternatives to morphine in palliative care. As nurses are often the health professional most involved with terminally ill patients, there is a clear need for a review of current practices which is accessible to nurses.Aim.  The aim of this review is to examine the pharmaceutical alternatives to morphine use in palliative care that are currently available.Methods.  Searches were made of the CINAHL and MEDLINE databases for articles published between 1990 and 2000, using the keywords ‘pain management’, ‘cancer pain’ and ‘morphine’.Findings.  Most evidence on the use of pharmaceutical alternatives to morphine is anecdotal, demonstrating a need for more research to be conducted in this field. Evidence presented in this review shows encouraging results following the administration of methadone, fentanyl or ketamine to patients with difficult pain problems.Conclusion.  Nurses need to be aware of treatment options that may benefit patients with difficult pain problems. Although positive experiences have been documented when using alternatives to morphine, more research must be conducted to allow practitioners to add more pharmaceutical alternatives to their pain management armouries.
Psychological distress: concept analysis
Authors: Ridner Sheila H. 
Published: December 2004

Background.  The term ‘distress’ is frequently used in nursing literature to describe patient discomfort related to signs and symptoms of acute or chronic illness, pre‐ or post‐treatment anxiety or compromised status of fetuses or the respiratory system. ‘Psychological distress’ may more accurately describe the patient condition to which nurses respond than does the term ‘distress’. Psychological distress is seldom defined as a distinct concept and is often embedded in the context of strain, stress and distress. This creates confusion for nurses attempting to manage the care of people experiencing psychological distress.Aims.  This paper is a concept analysis of psychological distress based on Walker and Avant's (1995) criteria that identifies the attributes, antecedents, and consequences of psychological distress based upon the findings of the literature review. In addition, empirical references are identified and constructed cases presented.Methods.  A literature search was conducted using MEDLINE, CINAHL, Ovid, PsychINFO, and Cancer Lit databases over the last 50 years. The purposes of this concept analysis were: (1) to establish the concept of psychological distress as a clear and distinct concept, separate from strain, stress and distress, and (2) to provide nurses with a base of knowledge from which to plan effective clinical interventions.Findings.  Content analysis of the literature revealed that, although used frequently in health care literature, the origin of the concept of psychological distress has not been clearly articulated and is ill‐defined.Conclusions.  Psychological distress is a serious problem faced by many of the people whom nurses encounter on a daily basis. An understanding of the concept of psychological distress will help nurses ameliorate this problem in patients. Nursing research related to the exploration of psychological distress is also needed.
Maternal support during the first year of infancy
Authors: Börjesson Britt , Paperin Christina , Lindell Marianne 
Published: December 2004

Background.  Mental health problems among children and adolescents are becoming more visible and some research indicates that they are increasing. Several studies suggest that social support counteracts the increasing risk of ill‐health in families with children. However, there is a lack of studies which focus on the support that expectant mothers and parents might need.Aim.  The aim of the study was to describe mothers’ experiences of pregnancy, labour and homecoming, support needs, and sources of support in their role as parents.Methods.  One hundred and twenty‐two mothers participated in the study by answering a questionnaire consisting of 37 questions. Data were analysed using descriptive statistics, chi‐square tests and content analysis.Findings.  Mothers of infants had a great need to talk about their experiences of labour soon afterwards and over the following months. Most of the mothers had generally received support from their partners. However, in some situations, other people in their networks, and maternity and child health services had been more supportive than partners.Discussion.  The study highlights how important it is for expectant mothers and new mothers to be confirmed in their mothering role. Nurses in the maternity and child health services have an important task to support people in becoming and being parents, with regard to their emotional state. There is a need for more resources within these services for establishing parent groups, including groups for fathers. This could improve parents’ physical, psychological and emotional health, and decrease their need for health and social services.
Living with a terminal illness: patients’ priorities
Authors: Carter Helen , MacLeod Rod , Brander Penny , McPherson Kath 
Published: December 2004

Background.  Our understanding of terminal illness and its consequences has been predominantly based on models derived from expert definition, rather than the patient's perspective. More recently, quality of life tools have been developed to enable patient choice in responses. However, an even broader approach may be needed to help identify goals for care for patients who are terminally ill.Aim.  The aim of this paper is to report on an exploratory, qualitative study exploring what people living with terminal illness considered were the areas of priority in their lives.Methods.  Ten people living with terminal cancer were interviewed. Analysis of the interviews incorporated principles of narrative analysis and grounded theory.Findings.  Over 30 categories were identified and collated into five inter‐related themes (personal/intrinsic factors, external/extrinsic factors, future issues, perceptions of normality and taking charge) encompassing the issues of importance to all participants. Each theme focused on ‘life and living’ in relation to life as it was or would be without illness. Practical issues of daily living and the opportunity to address philosophical issues around the meaning of life emerged as important areas. The central theme, ‘taking charge’, concerned with people's levels of life engagement, was integrally connected to all other themes.Conclusions.  The findings suggest that the way in which health professionals manage patients’ involvement in matters such as symptom relief can impact on existential areas of concern. Understanding patients' perspectives in relation to each theme may assist health professionals to develop management strategies appropriate to their needs. The findings challenge some aspects of traditional ‘expert‐defined’ outcome measures. As this was an exploratory study, further work is needed to test and develop the model presented.
Resident‐oriented care in nursing homes: effects on nurses
Authors: Berkhout Afke J.M.B. , Boumans Nicolle P.G. , Van Breukelen Gerard P.J. , Abu‐Saad Huda Huijer , Nijhuis Frans J.N. 
Published: December 2004

Background.  In a resident‐oriented care model the assignment of patients to primary nurses takes place. These primary nurses are responsible for the total nursing care of their patients and make use of the nursing process. According to job demand‐control models, these enlarged and enriched jobs can be described in terms of autonomy, job demands and social support, and the presence of these work characteristics has a positive influence on workers’ psychological and behavioural outcomes.Aims.  This paper reports a study to investigate the extent to which the various features of resident‐oriented care were implemented and its effects nurses’ on work characteristics and on psychological and behavioural outcomes in three Dutch nursing homes.Methods.  In a quasi‐experimental design, experimental and control groups were followed over 22 months, using a pretest and two post‐tests with questionnaires, interviews and qualitative observations.Results.  The quantitative data showed significant increases in resident assignment, the two variables measuring the nursing process and, in the psycho‐geriatric experimental group, on resident‐oriented tasks. The qualitative data showed that a partly task‐oriented division of labour was still used and that the planned delegation of coordination tasks to primary nurses was not fully achieved. Effects on work perceptions were limited. After implementation of the new system, the experimental group showed an increase in job autonomy.Conclusions.  The intervention appeared to be only partly successful. Most of the expected results regarding work characteristics and psychological and behavioural outcomes did not materialize. Theoretical and methodological reflections are presented in the light of these findings.