bluuebunny/crossref_metadata_2025_split huggingface dataset:
Invisible nursing: exploring health outcomes at a global level. Relationships between infant and under‐5 mortality rates and the distribution of health professionals, GNP per capita, and female literacy
Authors: Robinson Jane , Wharrad Heather 
Published: March 2003

Invisible nursing: exploring health outcomes at a global level. Relationships between infant and under‐5 mortality rates and the distribution of health professionals, GNP per capita, and female literacyAimsTo explore the relationship between the global distribution of health professionals (physicians and nurses), gross national product per capita (GNP), female literacy and the health outcome indicators of infant, and under‐5 mortality rates using available data from United Nations’ (UN) sources. To consider the reliability and validity of the variables included, and the implications of the findings for health policy and practice, and for further research.DesignUsing a database on 155 countries, regression analyses were performed using GNP, female literacy, numbers of physicians per 1000 population and numbers of nurses per 1000 population as independent variables, and infant mortality (IMR) and under‐5 mortality rates (u5MR) as dependent variables.ResultsLinear regression analyses give R2values for the two mortality indicators (IMR and u5MR) of 63% and 66% for physicians and 51% and 52% for nurses. Multiple linear regression analyses reveal a more complex picture. Countries with high ratios of physicians and nurses to population relative to their GNP also tend to show low IMRs and u5MRs. However, when female literacy is included in the model, the majority of these outlying countries move back towards the regression line. Nurses disappear from the model altogether when regressed with physicians, GNP per capita and female literacy for both outcome indicators.ConclusionsDespite the acknowledged need for caution in the validity and reliability of the UN data sources used in the analyses, interesting positive relationships are identified between the input variables and mortality outputs. The implications for future health policy, practice and research are considered. These include the need for more reliable, comprehensive and up‐to‐date data sets.
Stigma of visible and invisible chronic conditions
Authors: Joachim Gloria , Acorn Sonia 
Published: March 2003

Stigma of visible and invisible chronic conditions Nurses deliver care to people with various forms of chronic illnesses and conditions. Some chronic conditions, such as paraplegia, are visible while others, such as diabetes, are invisible. Still others, such as multiple sclerosis, are both visible and invisible. Having a chronic illness or condition and being different from the general population subjects a person to possible stigmatization by those who do not have the illness. Coping with stigma involves a variety of strategies including the decision about whether to disclose the condition and suffer further stigma, or attempt to conceal the condition or aspects of the condition and pass for normal. We present a beginning framework that describes the relationship between the elements of stigma and the decision to disclose or hide a chronic condition based on its visibility or invisibility. The specific aims were to combine the results from a meta‐study on qualitative research with a review of the quantitative literature, then develop a theoretical framework. Although an understanding of how patients cope with stigmatizing conditions is essential for nurses who aim to deliver comprehensive individualized patient care, there is little current literature on this subject. The relationship between visibility and invisibility and disclosure and non‐disclosure remains poorly understood. A framework to facilitate a deeper understanding of the dynamics of chronic illnesses and conditions may prove useful for practice.
Determinants of absconding by patients on acute psychiatric wards
Authors: Bowers Len , Jarrett Manuela , Clark Nicola , Kiyimba Frank , McFarlane Linda 
Published: March 2003

Determinants of absconding by patients on acute psychiatric wards Absconding by patients from acute psychiatric wards is a high risk behaviour and has been linked to harm to self and others. Previous research on the characteristics of absconders has been overly reliant on officially generated statistics and small numbers of variables, limiting the conclusions that may be drawn. This paper reports on a prospective study of absconders from 12 acute admission wards in three English National Health Service Trusts over 5 months, compared to a control group matched for ward. Extensive data on absconder and control characteristics were collected from case records and from nursing staff. Absconders were significantly different from controls in many respects. Absconding is linked to other forms of non‐compliant patient behaviour, e.g. medication refusal and involvement in violent incidents. Significant variations in the rates of absconding were found between different wards, and between different consultant psychiatrists. Predictive factors were identified by logistic regression. Study in the diverse fields of non‐compliance should be brought together as these phenomena are likely to be interrelated. Further investigation is required to determine exactly what it is that consultant psychiatrists and ward nurses do that affects absconding rates.
Adults with terminal illness: a literature review of their needs and wishes for food
Authors: Hughes Nic , Neal Richard D. 
Published: March 2003

Adults with terminal illness: a literature review of their needs and wishes for food Food refusal can be a source of conflict between dying people and their caregivers. This review examines: the nature and purpose of food; some reasons for and implications of anorexia in terminal illness; ethical principles underpinning responses to declining appetite and food refusal; social transactions between dying people and their caregivers in relation to needs and wishes for food; and the need for further empirical research. The nature and purpose of food in human societies has been studied extensively by anthropologists but the knowledge gained is not often imported into health care practice, where eating is seen from a medical rather than an anthropological perspective. Food refusal may be a consequence of anorexia which is the result of physiological or psychological changes or it may be a deliberate choice in acceptance of impending death. Ethical principles underpinning responses to declining appetite and food refusal have been studied extensively and clear guidance obtained about what would be appropriate behaviour in given circumstances. There is little published empirical work on social transactions between dying people and their caregivers in relation to needs and wishes for food. As the contribution made to effective care‐giving by high‐quality interpersonal relationships is widely recognized, further knowledge about how best to sustain such relationships in these important circumstances would be useful. Moreover, as such interpersonal relationships often occur in an institutional context, it may be that more can be learnt from close examination of social transactions about how best to structure organizational processes to maximize autonomy and comfort for patients at the end of life. Further research is indicated.
Effects of pressure support ventilation and continuous positive airway pressure on diaphragm performance
Authors: Isaacson Janalee , Smith‐Blair Nan , Clancy Richard L. , Pierce Janet D. 
Published: March 2003

Effects of pressure support ventilation and continuous positive airway pressure on diaphragm performance Many patients who are on mechanical ventilation are on ventilator modes called pressure support ventilation (PSV) and continuous positive airway pressure (CPAP) particularly when they are being weaned. As the diaphragm is responsible for approximately 75% of breathing, it is important to promote diaphragm shortening to optimize weaning from mechanical ventilation. The purpose of our 1998 quasi‐experimental study was to explore the effects of PSV and CPVP on diaphragm shortening. An animal model was utilized using four Sprague–Dawley rats from the same litter purchased from Sasco (Kansas City, USA). Also measured in this study were intrathoracic pressure (ΔITP), positive inspiratory pressure, respiratory rate, tidal volume, end‐tidal carbon dioxide, central venous pressure (CVP) and mean arterial pressure (MAP). Pressure support was increased in increments of 5 cm H2O at CPAP levels of 0, 2 and 4 cm H2O. A direct assessment of diaphragm shortening was achieved through the adherence of a miniaturized ultrasonic sensor to the inferior surface of the middle costal surface of the right hemidiaphragm of four Sprague–Dawley rats. Limitations of this study included a small sample size, anaesthetized rats and abdominal dissection for insertion of the ultrasonic sensor. As PSV was increased, there was a decrease in MAP, CVP, respiratory rate and end‐tidal CO2. When increasing levels of CPAP were added to PSV, a decrease in diaphragm shortening was observed. These results support that higher levels CPAP may hinder diaphragmatic function thus prolong mechanical ventilation. The purpose of this pilot study was to explore the effects of PSV and CPAP on diaphragm shortening. Also measured were ΔITP, positive inspiratory pressure, respiratory rate, tidal volume, end‐tidal carbon dioxide, CVP and MAP. Pressure support was increased in increments of 5 cm H2O at CPAP levels of 0, 2 and 4 cm H2O. A direct assessment of diaphragm shortening was achieved through the adherence of a miniaturized ultrasonic sensor to the inferior surface of the middle costal surface of the right hemidiaphragm of four Sprague–Dawley rats. Limitations of this study included a small sample size, anaesthetized rats and abdominal dissection for insertion of the ultrasonic sensor. As PSV was increased, there was a decrease in MAP, CVP, respiratory rate and end‐tidal CO2. When increasing levels of CPAP were added to PSV, a decrease in diaphragm shortening was observed.
Journey towards recovery following physical trauma
Authors: Richmond Therese S. , Thompson Hilaire J. , Deatrick Janet A. , Kauder Donald R. 
Published: March 2003

Journey towards recovery following physical traumaConvalescence and recovery following illness are of central importance to nursing. These themes have been explored increasingly in the literature. The focus, however, has been primarily on the process of integrating chronic illness into one’s life. Recovery from physical injury is rarely addressed. A body of work focusing on physical trauma demonstrates that recovery is often not complete after injuries that have not been viewed as disabling. To illuminate understanding of recovery following physical trauma, the purpose of our 1997 study was to describe more thoroughly the nature of recovery. A total of 63 adults, in a convenience sample, who survived serious physical trauma, were interviewed 2·5 years after injury using an open‐ended semistructured interview guide. Three themes were identified: event, fallout, and moving‐on. These themes provided the organizing structure for exploring the journey to recovery. This journey, as disclosed by the seriously injured, does not necessarily correspond with the views of most trauma clinicians. Traumatic events create a line of demarcation, separating lives into before and after. The event becomes the starting point of a journey to resume one’s life. The event itself is more than the trauma; it is the perceptual and contextual experience that needs to be incorporated into a person’s essence. Fallout from the injury is multifaceted and includes physical, psychological, social, and spiritual dimensions. Moving‐on in this journey is nonlinear as survivors recognize their lives are forever different. The survivors’ accounts suggest that nurses should carefully consider the question, ‘What is successful recovery?’
Parents and partners: lay carers' perceptions of their role in the treatment and care of adults with cystic fibrosis
Authors: Lowton Karen 
Published: March 2003

Background.  Cystic fibrosis (CF) is the most common autosomal recessive genetic disease in Caucasian people, traditionally conceptualized as a condition whereby sufferers died in childhood. However, the current median survival age of 30 and a predicted median survival age of 40 for those born with the disease over the last decade ensure that families members will assist hospital staff with treatment and care well into most patients' adulthood. Aims.  This study explores the perceptions and experiences of lay care‐giving amongst parents and partners of adults with CF who were being treated at a specialist CF centre in England. Methods.  Thirty‐one relatives of adults with CF were interviewed in their own homes using an interview topic guide. All interviews were audiotape recorded and transcribed verbatim. Analysis of data was assisted by ATLAS‐ti, a software package for qualitative research. Findings.  Two main themes surrounding lay carers' role in treatment and care were identified. Firstly, the notion of lay carers giving ‘expert’ care, both in hospital and at home was recognized. Parents' expertise was greater than that of partners until the patient required intensive hospital interventions, when partner expertise increased. Secondly, the degree of lay carers' felt inclusion in the hospital consultation appeared to depend on the nature of their relationship with the patient and the patients' health state. Conclusion.  Lay carers are routinely performing tasks for adults with CF that were once the remit of trained nurses. Families need higher levels of nursing and social support when certain treatments are used at home. Attention needs to be directed to how lay carers of adult patients can be included in hospital consultations.
Biological correlates of Reiki Touchsm healing
Authors: Wardell Diane Wind , Engebretson Joan 
Published: March 2003

Biological correlates of Reiki Touchsm healing Background. Despite the popularity of touch therapies, theoretical understanding of the mechanisms of effect is not well developed and there is limited research measuring biological outcomes. Aims. The aim of this study was to test a framework of relaxation or stress reduction as a mechanism of touch therapy. Methods. The study was conducted in 1996 and involved the examination of select physiological and biochemical effects and the experience of 30 minutes of Reiki, a form of touch therapy. A single group repeated measure design was used to study Reiki Touch’ssm effects with a convenience sample of 23 essentially healthy subjects. Biological markers related to stress‐reduction response included state anxiety, salivary IgA and cortisol, blood pressure, galvanic skin response (GSR), muscle tension and skin temperature. Data were collected before, during and immediately after the session. Results. Comparing before and after measures, anxiety was significantly reduced, t(22)=2·45, P=0·02. Salivary IgA levels rose significantly, t(19)=2·33, P=0·03, however, salivary cortisol was not statistically significant. There was a significant drop in systolic blood pressure (SBP), F(2, 44)=6·60, P < 0·01. Skin temperature increased and electromyograph (EMG) decreased during the treatment, but before and after differences were not significant. Conclusions. These findings suggest both biochemical and physiological changes in the direction of relaxation. The salivary IgA findings warrant further study to explore the effects of human TT and humeral immune function.
The concept of spiritual care in mental health nursing
Authors: Greasley Peter , Chiu Lai Fong , Gartland Reverend Michael 
Published: March 2003

The concept of spiritual care in mental health nursing Aim. In this paper we aim to clarify the issue of spiritual care in the context of mental health nursing. Background. The concept of spirituality in nursing has received a great deal of attention in recent years. However, despite many articles addressed to the issue, spiritual care remains poorly understood amongst nursing professionals and, as a result, spiritual needs are often neglected within the context of health care. Methods. A series of focus groups was conducted to obtain the views of service users, carers and mental health nursing professionals about the concept of spirituality and the provision of spiritual care in mental health nursing. Results. According to the views expressed in our focus groups, spiritual care relates to the acknowledgement of a person’s sense of meaning and purpose to life which may, or may not, be expressed through formal religious beliefs and practices. The concept of spiritual care was also associated with the quality of interpersonal care in terms of the expression of love and compassion towards patients. Concerns were expressed that the ethos of mental health nursing and the atmosphere of care provision were becoming less personal, with increasing emphasis on the ‘mechanics of nursing’. Conclusions. The perceived failure of service providers to attend adequately to this component of care may be symptomatic of a medical culture in which the more readily observable and measurable elements in care practice have assumed a prominence over the more subjective, deeply personal components. In order for staff to acknowledge these issues it is argued that a more holistic approach to care should be adopted, which would entail multidisciplinary education in spiritual care.
From individual to group: use of narratives in a participatory research process
Authors: Aranda Sanchia , Street Annette 
Published: March 2003

From individual to group: use of narratives in a participatory research processAims. This paper provides a theoretical understanding of narrative research and its use in research. It aims to expose the ways narrative research, when taken beyond the researcher’s lone analysis of text, can contribute to the development of clinical knowledge.Background. Methodological approaches involving the construction of narratives are increasingly apparent in the nursing and allied health literature. Narratives, constructed from stories of nursing practice, become texts available for analysis. This is undertaken predominantly by a researcher engaged in a lone activity with little involvement of those contributing the stories.Methods. This paper is drawn from a critical praxis study of nurse–patient friendship utilizing participatory research processes. The nurses involved in the study were co‐researchers in an indepth study of their relationships with patients.Findings. The paper traces the movement from naïve story, through individual narratives during interviews with each nursing and demonstrates the changes in understanding about the narrative accounts that occurred during the participatory group process.Conclusion. The nurses involved in this study were able, through the use of narrative stories reexamined in a group context, to develop new insights and understandings about their practice. Knowledge generated in these ways remains grounded in the real life world of clinical nursing and gives voice to the complexity of those aspects of nursing practice that are taken for granted.
Axillary and tympanic membrane temperature recording in the preterm neonate: a comparative study
Authors: Bailey Judi , Rose Pat 
Published: March 2003

Axillary and tympanic membrane temperature recording in the preterm neonate: a comparative study Study aims. The aim of this study is to compare axillary temperature recordings with those of the tympanic membrane, in healthy preterm neonates, to ascertain whether there is any significant difference between the two recordings, in particular in relation to postnatal age, and if so to evaluate the clinical implications. Rationale. Immature thermoregulatory mechanisms, and small body size, mean preterm neonates are prone to temperature maintenance problems, and thermal stress is associated with increased morbidity and mortality. In order to ensure minimal handling, the ideal method of temperature recording would be rapid, painless and reproducible, and accurately reflect core temperature, whilst considering safety, comfort, ease of procedure and cost effectiveness. Recording of the tympanic membrane temperature is rapid and noninvasive, however, the accuracy of this method in preterm neonates has not been established. Study design. A comparative descriptive design was used, to describe differences in the recorded temperature in healthy preterm neonates, of gestational age of 27–37 weeks, related to temperature recording method. A second comparison was undertaken to establish difference in mean temperature recordings dependant on postnatal age of the baby in days. The sample included all babies fitting the selection criteria, admitted to the Neonatal Unit during the study period. Following approval by the local research ethics committee tympanic membrane and axillary temperatures were recorded consecutively for 7 days (n=154), using the Genius Model 3000A tympanic thermometer and a glass and mercury thermometer. Results. A t‐test demonstrated a statistically significant difference between the recordings (P < 0·05), tympanic membrane recordings being higher. However, analysis of variance indicated that this difference was not associated with postnatal age, and thus the presence of vernix in the auditory canal (P > 0·05). The findings were not, however, deemed clinically significant in that no change in care or treatment resulted from differences in temperature recordings. Conclusions. Whilst the findings cannot be applied to sick preterm neonate, it was concluded that tympanic membrane temperature recordings in healthy preterm neonates are safe, accurate, easy, and comfortable for the baby, and appropriate with this client group provided staff are trained in the technique.
Myth of empowerment in chronic illness
Authors: Paterson Barbara 
Published: March 2003

Myth of empowerment in chronic illnessAims. This article presents several findings of a study, conducted between 1996 and 1998, to investigate self‐care decision making in diabetes.Rationale. The underlying assumption of many practitioners is that an invitation to people with chronic illness to participate as equal partners is sufficient to guarantee their empowerment.Design. Using grounded theory, the research examined self‐care decision making using a convenience sample of 22 Canadian adults with longstanding type 1 diabetes nominated as expert self‐care managers. Participants audiotaped their decision making as it occurred for 3 weeks over the course of one calendar year. These audio‐recordings were followed by an interview to clarify participants’ decision making and factors that affected their decisions.Findings. Participants identified several covert and subtle ways that practitioners contradict their stated goal of empowerment in their interactions with diabetics. Participants revealed that despite their intention to foster participatory decision making, practitioners frequently discount the experiential knowledge of diabetes over time and do not provide the resources necessary to make informed decisions.Conclusion. The article concludes with a discussion of the implications of the findings for practice.