bluuebunny/crossref_metadata_2025_split huggingface dataset:
The quest for ordinariness: transition experienced by midlife women living with chronic illness
Authors: Kralik Debbie 
Published: March 2003

Aims.  This paper reports the findings of research that aimed to elucidate the meaning of midlife women's experiences of living with chronic illness. Background.  A lack of awareness by health professionals of the context in which women must live with chronic illness often results in women feeling overwhelmed, alienated and without voice within the delivery of health care. This inquiry privileged women's voices. Design.  The construct of ‘transition’ in chronic illness experience evolved from this collaborative and participatory research with midlife women living with adult onset chronic illness. Over a 1‐year timeframe, 81 women were asked to tell their stories of living with a chronic illness. These correspondence data were thematically analysed to provide storied accounts. Guided by feminist principles, women were empowered through research processes and have actively participated in the development of the transition construct. Findings.  The research revealed that when women are first confronted with a chronic illness they appear to move through a complex trajectory that involves an ‘extraordinary’ phase of turmoil and distress; however, they may then make the transition toward an ‘ordinary’ phase that involves incorporating chronic illness into their lives. Transitions in chronic illness experience involve movement from extraordinariness to ordinariness and sometimes back again and were found to be processes that are nonlinear, sometimes cyclical and potentially recurring throughout a woman's life. Four major constructs emerged from women's narratives: How quickly life changes; extraordinariness: confronting life with illness; The illness experience as transforming and ordinariness: reconstructing life with illness. Conclusion.  Nurses are in a position where they may make a difference to women who live with chronic illness. Understanding illness transitions offers a framework that will enable nurses to move beyond the bio‐medically orientated concepts of nursing practice, towards a holistic approach to the provision of nursing care.
Can a home‐based pelvic examination be used in assessing reproductive morbidity in population‐based studies? A Jordanian experience
Authors: Al‐Qutob Raeda , Mawajdeh Salah , Massad Diana 
Published: March 2003

Can a home‐based pelvic examination be used in assessing reproductive morbidity in population‐based studies? A Jordanian experience Rationale. Most estimates of reproductive morbidity in a community are derived from health service‐based studies. However, these numbers do not reflect the actual magnitude of the problem because of barriers to health care and differences in health‐seeking behaviour. As a result, this study uses an alternative method to measure reproductive morbidities amongst women in a Jordanian community. Objective. To assess the validity of a home‐based pelvic examination in detecting signs of reproductive morbidity when compared with a clinic‐based examination. Methodological design. Descriptive study in which women were randomly selected from the study area to participate in the study. Research methods. Three hundred and seventy nine women, 18 years and above were randomly selected, and general and pelvic examinations were conducted in each woman’s home. Thirty‐two of these women were again randomly selected and consented to a second pelvic examination in a clinical setting. Instruments. Two trained female obstetricians conducted the pelvic examination which included examination of the vulva, examination of the vagina and a bimanual examination. Outcome measures. Strength of association between the presence or absence of physical signs of reproductive morbidity detected by the home‐based pelvic examination and the same signs identified by the clinic‐based examination, deemed in this study as the ‘truth’. Results. The overall sensitivity, specificity, positive and negative predictive values of the home‐based pelvic examination were 66, 86, 69 and 84%, respectively. Study limitations. The sample size was small, so further studies are recommended to replicate the findings here. Conclusions. Results suggest home‐based pelvic examinations can be used in population‐based studies for a comprehensive assessment of women’s reproductive morbidities.
Effectiveness of breast self‐examination nursing interventions for Taiwanese community target groups
Authors: Lu Zxy‐yann Jane 
Published: March 2003

Effectiveness of breast self‐examination nursing interventions for Taiwanese community target groups Background. Because of the increasing morbidity and mortality from breast cancer, the Health Department in Taiwan in 1992 has identified early detection of breast cancer as one of the national health objectives. The effectiveness of Breast Self‐Examination (BSE) in detecting breast cancer depends not only on frequency, but also on accuracy. This study explored the effects of nursing intervention on the BSE intention, BSE frequency and BSE accuracy among beauticians as community target groups. Design. This study was comprised of two stages. In the first stage, 198 beauticians in Taipei County were surveyed. Those women with perceived barrier scores ≥15 points in the first stage were selected for the second stage with the quasi‐experimental design. The experimental group was provided with BSE instruction for the enhancement of BSE competence, personalized strategies to reduce barriers to BSE and monthly telephone reminders after BSE instruction class for 3 months. The study instruments were Champion's BSE questionnaire, Lashley's 15 BSE steps and BSE items of social norm referenced Lierman et al. Results. The mean age of the 198 beauticians was 28 (±8·6), the mean year of education was 10 (±2·4) and 60% of participants were married. The results of the study indicate that the program significantly increased BSE frequency, BSE accuracy, perceived benefit of BSE, perceived competence in BSE and decreased perceived susceptibility to breast cancer and perceived barriers to practice BSE. Multiple regression analysis indicated that the perceived competency, susceptibility and social normative influence accounted for 25% of the variance in BSE intention. Perceived competency and social normative influence accounted for 15% of the variance in BSE frequency, while intention, social normative influence and perceived competency accounted for 21% of the variance in BSE accuracy.
The haemodialysis machine as a lifeline: experiences of suffering from end‐stage renal disease
Authors: Hagren Birger , Pettersen Inga‐Märta , Severinsson Elisabeth , Lützén Kim , Clyne Naomi 
Published: March 2003

The haemodialysis machine as a lifeline: experiences of suffering from end‐stage renal disease Aim. The aim of this study was to describe patients' experiences of suffering from end‐stage renal disease (ESRD). Rationale. The rationale was to investigate how persons find meaning or make sense of their situation and how they experience suffering. The theoretical basis for the study was to view suffering at three levels. The first level was related to sickness and treatment. The second level was related to the care provided and the third level was related to each person's unique life experience and existence. Method. Data were collected by interviews focusing on questions concerning daily life, needs, and expectations for the future. A qualitative interpretative content analysis was used. Fifteen patients between the ages of 50–86 participated in the study. Findings. Two main themes were identified describing these patients suffering. The first theme, `the haemodialysis machine as a lifeline' consisted of three subthemes: `loss of freedom', `dependence on the caregiver', and `disrupted marital, family and social life'. The second theme `alleviation of suffering' consisted of two subthemes: `gaining a sense of existential optimism' and `achieving a sense of personal autonomy'. Conclusion. This study indicated that, in the lives of patients on haemodialysis, the main areas of suffering were related to loss of freedom expressed as dependence on the haemodialysis machine as a lifeline and, the caregivers. This time‐consuming and tiring dependence affected marital, family and social life. Alleviation of suffering could be achieved by accepting dependence on the haemodialysis machine and maintaining autonomy by being seen as an individual by the caregivers.
Professional and organizational learning: analysing the relationship with the development of practice
Authors: Clarke Charlotte L. , Wilcockson Jane 
Published: March 2003

Professional and organizational learning: analysing the relationship with the development of practice Background. Organizational and professional learning are interrelated processes that underpin the contemporary drive for a quality evidence‐based delivery of health care in the United Kingdom (UK). Design. A soft systems methodology was used to explore the pervasiveness of practice developments. Three case study sites were identified using matrix sampling and data collected through 29 individual interviews and two focus group interviews, with the interviews augmented with a tool designed to maximize analysis of the processes of developing practice. Findings. The resultant model of developing health care practice includes three processes: using and creating knowledge, understanding and practice of patient care, and effecting development. The whole model was underpinned by professional and organizational learning in which `expert thinkers' engaged in double loop learning to reconceptualize care rather than just perpetuate existing patterns of care delivery.
Back to the bedpans: the debates over preregistration nursing education in England
Authors: Meerabeau Elizabeth 
Published: March 2003

Back to the bedpans: the debates over preregistration nursing education in England Aims of the paper. This paper aims to examine the recent debates in both the general and professional press over the future of preregistration education in England, in the light of the sociological literature on the professions, and the nature of nursing knowledge. The literature on the Project 2000 reforms, although by now well worn, will also be discussed briefly. Background/Rationale. The bulk of nursing education in England moved into higher education in the 1990s. Unlike other higher education in England, it is not funded by the Department for Education and Employment, but commissioned by the National Health Service (NHS), to which it is expected to be highly responsive. Design/Methods. This paper is based on a brief literature survey, plus policy documents and media reports. Findings/Conclusion. It will be argued that the process of professionalization is not a straightforward one, and has its potential for reversals of fortune, and that nursing occupies a marginal place in higher education in England.
Disclosure of minor mental health problems: an exploratory theoretical study
Authors: Williams Brian , Healy David 
Published: March 2003

Disclosure of minor mental health problems: an exploratory theoretical study Aim. The aim of this study was to explore people’s experiences, concerns and beliefs about disclosing minor mental health problems by focusing on the ways in which such disclosures are interpreted. Background. Approximately half of people with mental health problems do not seek help. The decision to consult represents just one aspect of the process of revealing one’s illness to others. People with mental health problems are known to be reluctant to reveal the existence of those problems through fear of how others might then view them. Design. A qualitative approach was employed. In‐depth interviews were carried out with 47 users and nonusers of community mental health services. Interviews were tape‐recorded, transcribed and analysed. Results. The data suggest that when people reveal minor mental health problems others interpret these in relation to a number of perceived contextual factors. These include perceptions of the severity and duration of any possible causes, the inner ‘strength’ of the person, the expected ability of the person to either solve or suppress the experience, and the form and context of the expression itself. The data presented included individuals who were seeking help for relatively ‘minor’ mental health problems (primarily depression and anxiety) and individuals who had no current mental health problems but routinely managed expressions of their own emotions. Throughout the data there appeared to be no distinct difference between these two groups other than one of the severity of psychological experience. Conclusion. The key elements involved in the interpretation of people’s expressions of sadness were essentially the same as those involved in the interpretation of expressions of depression. An appreciation of these contextual factors influencing the interpretation and disclosure of minor mental health problems may aid the development of more person‐centred mental health services and inform the content of health education in the mental health field.
Pre‐ and post‐test evaluation of a project to facilitate research development in practice in a hospital setting
Authors: Clifford Collette , Murray Sarah 
Published: March 2003

Pre‐ and post‐test evaluation of a project to facilitate research development in practice in a hospital setting Background. This paper describes a project designed to facilitate the use of research in nursing practice in one acute hospital. A university team worked in collaboration with staff from the hospital to develop and evaluate the impact of development work designed to enhance knowledge and use of research in practice. Design/methods. A research utilization questionnaire was administered as a pre‐test (stage 1); a development phase was implemented (stage 2) and a post‐test survey (stage 3) was administered to evaluate the impact of the development work. In stage 1, the total population of nursing and midwifery staff in the hospital (n=473) were targeted and 235 returned the questionnaire, giving a response rate of 50%. Data from the pre‐test and focus group discussions with staff were used to plan stage 2 of the project. The development stage involved an educational strand in which open learning research materials were made available to staff, who were also offered tutorial support in their learning. A second strand supported the development of clinical research projects and funds were identified for clinical staff to apply for project development awards to enable them to develop skills in research and development activity under the supervision of a research fellow. Stage 3 involved a post‐test survey of staff who had completed the questionnaire in stage 1 (n=81). Findings. There were no significant differences in findings between the pre‐test and post‐test. Qualitative data from those involved in the clinical projects in stage 2 indicated factors impacting on the feasibility of undertaking research in practice.
Development of quality of nursing care in Thailand
Authors: Kunaviktikul Wipada , Anders Robert L. , Srisuphan Wichit , Chontawan Ratanawadee , Nuntasupawat Ramual , Pumarporn Orapun 
Published: March 2003

Development of quality of nursing care in Thailand Background. In Thailand there is a need to establish definitions of quality of nursing care and to determine how it is measured. There is an urgent need to focus more closely on indicators of nursing quality. In Thailand there is no agreed upon definition of quality nursing care or indicators by which to measure it. Purpose. The purpose of this research was to develop a definition of quality of nursing care and to begin the process of defining quality of care indicator measures to evaluate the care given in acute care settings. Methods. This descriptive study was conducted in Thailand. The process included two phases. The first phase used individual interviews and focus group discussion and the second phase included consultation with quality of nursing care experts. An interview guide was used to structure the interviews and the draft definitions of quality and suggested indicators were used when consulting with the experts in the second phase of the study. Findings. The findings are organized into two sections: (1) definition of quality of nursing care and quality of nursing indicators; and (2) consultation with Thailand quality experts to refine the definition and quality of care indicators. The indicators were categorized into three groups: structure, process, and outcome. Limitations. This descriptive study using qualitative method relied upon the opinions of various stakeholders. Their opinions may or may not have any direct relationship to the scientific literature related to quality. Many of the indicators need to be further refined. Conclusions. The findings generally support the initial work done in the United States of America. There is a need to further refine the various Thailand indicators. This study is the first in Thailand that has attempted to address quality of nursing care.
Improving community mental health nurse targeting of people with severe and enduring mental illness: experiences from one English health district
Authors: Barr Wally , Cotterill Lesley , Hoskins Ann 
Published: March 2003

Improving community mental health nurse targeting of people with severe and enduring mental illness: experiences from one English health district Background. Successive governments have urged mental health service providers to target their attentions on people with severe and enduring mental illness (SEMI). However, community mental health teams (CMHTs) in general, and community mental health nurses (CMHNs) in particular, have been criticized for failing to meet this requirement. This paper reports selected findings from a wider study that assessed the impact of an initiative designed to facilitate service targeting: the establishment of registers of patients with SEMI in general practices throughout an English health district. The paper describes changes in the nature of community mental health nursing contacts with a sample of patients on these registers. Methods. Six general practices were randomly selected from the 65 practices in the district and comparisons made between patients on the six mental health registers who either had, or did not have, community mental health nursing contact. These comparisons related to the year before the establishment of the registers, the year during which they were being established and the year following this. Results. A total of 274 patients were included on the sample registers, with practices varying considerably in relation to proportions of mental health registered patients with community mental health nursing contact. Overall, the number of patients in contact with CMHNs was found to have decreased over time, except for those on level 2 of the Care Programme Approach. Conclusions. No evidence was found to support the hypothesis that the establishment of the registers had improved CMHN targeting of patients with SEMI. However, findings were inconclusive because shortages of CMHNs and the disruption associated with widespread service reorganization meant the registers were never fully implemented in practices during the study period.
Inequalities in health care provision: the relationship between contemporary policy and contemporary practice in maternity services in England
Authors: Hart A. , Lockey R. 
Published: March 2003

Inequalities in health care provision: the relationship between contemporary policy and contemporary practice in maternity services in England Aim. The project Addressing Inequalities in Health: new directions in midwifery education and practice (Hart et al. 2001) was commissioned by the English National Board for Nursing, Midwifery and Health Visiting (ENB). Here, we draw on those research findings to consider current midwifery policy and practice in England. Background. Little guidance on providing equality of care exists for midwives. The Code of Conduct [United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) 1992] makes no specific requirement for midwives to address issues of inequalities of health in their practice. Recent policy documents emphasize the need to work towards reducing inequalities and to target practice to `disadvantaged clients' without giving guidelines on how to identify and care for target groups. Methods. In‐depth studies of midwifery education and service provision were conducted in three very different parts of England. Three months of fieldwork were undertaken at each site, comprising a series of interviews with midwifery educators, managers, students, midwives and service users. Focus groups were also held and observation of classroom sessions and midwifery practice undertaken. Findings. A lack of clear and specific strategies concerning inequalities in health was evident at managerial level. Patchy knowledge of current policy was also evident amongst practising midwives. Specific projects with disadvantaged clients usually resulted from a particular midwife's personal interest or evident local need. All midwives emphasized the importance of `equality of care'. How this was operationalized varied, and `individualized' or `woman‐centred' care was assumed to encompass the concept. In the few examples where care was systematically targeted in accordance with policy directives, the midwife's public health role was increased. Conclusion. In the absence of a co‐ordinated strategic vision driven by managers, practitioners find difficulty in prioritizing care and targeting resources to disadvantaged clients in line with policy directives. Tensions between policy and practice in the care of `disadvantaged' women clearly exist. Successful implementation of policy at practice level needs: commitment from managers; clarity of purpose in documentation; and provision of specific targets for practitioners. However, the latter should remain flexible enough for the delivery of care to be appropriate and sensitive to individual needs.