bluuebunny/crossref_metadata_2025_split huggingface dataset:
The meaning of fatigue for women with multiple sclerosis
Authors: Olsson Malin , Lexell Jan , Söderberg Siv 
Published: December 2004

Aim. This paper reports the findings of a study that aimed to elucidate the meaning of fatigue for women with multiple sclerosis (MS).Background. Living with chronic illness can involve giving up usual activities. MS is a chronic autoimmune disease of the central nervous system. Fatigue is a common experience among people with MS; however, little is known about the meaning of fatigue experienced by women with this condition.Method. Ten women with MS were interviewed about their experience of fatigue. A phenomenological hermeneutic method influenced by Ricoeur was used to interpret the transcribed interviews.Findings. The findings were presented in two major themes with five subthemes; experiencing the body as a barrier and experiencing a different absence. Fatigue seemed to give rise to an experience of being absent and divided into two parts. This also led to a feeling of not being able to participate in the surrounding world. The feeling of being an outsider and lacking the ability as a healthy person is interpreted as a form of suffering. Although the fatigue had a great impact on the women's daily life, the women still hoped for some relief. Fatigue seemed to imply that instead of working as an implement to manage in the world the body has become an enemy of survival.Conclusion. This study highlights the importance for nurses of understanding how women with MS experience fatigue, which is a prerequisite for communication based on a shared understanding. This awareness would enhance nurses’ opportunities to alleviate suffering. More research is needed to investigate what kinds of interventions can help these women to manage their everyday lives and to maintain a sense of normality despite their fatigue and illness. Such interventions should be subject to empirical evaluation research.
Predicting pressure ulcers: cases missed using a new clinical prediction rule
Authors: Schoonhoven Lisette , Grobbee Diederick E. , Bousema Mente T. , Buskens Erik ,   the prePURSE study group
Published: December 2004

Aim.  The aim of this paper is to report a study describing patients with pressure ulcers that were incorrectly classified as ‘not at risk’ by the prediction rule and comparing them with patients who were correctly classified as ‘not at risk’.Background.  Patients admitted to hospital are at risk of developing pressure ulcers. Although the majority of pressure ulcers can be predicted using a recently developed prediction rule, up to 30% of patients with pressure ulcers may still be misclassified.Methods.  Between January 1999 and June 2000 a prospective cohort study was conducted in two large hospitals in the Netherlands. Patients admitted to neurology, internal, surgical, and elder care wards for more than 5 days were included (n = 1229), and were examined weekly. Information on potential prognostic determinants for pressure ulcers mentioned in the literature was recorded. Outcome was defined as occurrence of a pressure ulcer grade 2 or worse during hospital admission.Results.  Patients who developed pressure ulcers experienced more problems with ‘friction and shear’ and underwent surgery more often and longer. Also, they were more often admitted because of malignant conditions.Conclusion.  We found no specific characteristics that clearly distinguished patients with pressure ulcers that were incorrectly classified as ‘not at risk’ by the prediction rule from patients who were correctly classified as ‘not at risk’. It appears difficult to improve further on the prediction of pressure ulcers using available clinical information.
On becoming dependent on home mechanical ventilation
Authors: Lindahl Berit , Sandman Per‐Olof , Rasmussén Birgit H. 
Published: December 2004

Aim. The aim of this paper is to illuminate meanings of becoming dependent on home mechanical ventilator treatment.Background. People suffering from chronic alveolar hypoventilation and requiring home mechanical ventilation represent a small but increasing group in society, and are some of the most vulnerable individuals with chronic disabilities.Method. Thirteen people about to begin ventilator treatment at home were interviewed. Data were tape‐recorded and analysed according to a phenomenological‐hermeneutic method.Findings. Findings revealed two contrasting meanings of being in the process of becoming dependent on a ventilator, interpreted as getting breath or holding breath. This interpretation is presented in two composite stories.Conclusions. The findings imply possibilities and deficiencies in meeting patients’ existential needs, such as helping them to breathe spiritually by supporting them as they get their breath after such a life‐changing event as becoming dependent on a ventilator.
Women's experiences of bulimia nervosa
Authors: Broussard Brenda B. 
Published: December 2004

Aim.  This paper reports a study to interpret and understand bulimia nervosa as women experience it.Background.  Research into bulimia nervosa has focused on prevalence rates, health complications, comorbidity, neurochemical dysregulation, and cultural influences. Despite a multitude of investigations, little published research appraised bulimic women's personal experiences and understanding of this disorder. Such an understanding would assist health care professionals in providing sensitive, empathetic care.Method.  The principles of Heideggerian phenomenology guided the study. Participants were 13 actively bulimic women, aged 18–36 years, with lengths of illness from 1 to 23 years. Data were obtained through interviews, personal diaries, and demographic questionnaires.Findings.  Participants’ narratives revealed four themes that characterized the experience of living with bulimia: isolating self, living in fear, being at war with the mind, and pacifying the brain. The practices bulimic women engage in are carried out in secret, and hence participants experienced isolation. Binge eating and self‐induced vomiting are considered abnormal behaviours; therefore, participants believed that they were subjected to negative public perceptions, which led to the experience of living in fear. The women feared being judged if others knew about the disorder. Several feared living without bulimia because it had become a significant part of their identity. In addition, these women were terrified of gaining weight or becoming fat. They experienced an internal struggle with the mind. In order to pacify the inner voice, many fed the compulsion to eat, and this resulted in guilt. The women subsequently balanced the experience by getting rid of fullness and erasing guilt, which was primarily achieved through self‐induced vomiting.Conclusions.  Understanding the experience of bulimia for women who suffer from this disorder is important. Bulimia often presents as a chronic and potentially lifelong health issue. Awareness of bulimic women's perspectives could promote a comprehensive appreciation of bulimia, its aetiology, and directions for treatment alternatives.
Ostomy patients’ perceptions of quality of care
Authors: Persson Eva , Gustavsson Bengt , Hellström Anna‐Lena , Lappas George , Hultén Leif 
Published: December 2004

Aim.  This paper reports a study whose aim was to assess the quality of care in ostomy patients seen from a patient perspective.Background.  A stoma operation causes profound changes in a patient's life because of resulting physical damage, disfigurement, loss of bodily function, and change in personal hygiene. Such changes are a cause of major concern for patients and raise important issue for the quality of care.Methods.  The study group comprised patients who had undergone a colostomy for rectal cancer or an ileostomy for ulcerative colitis, all attending a stoma outpatient clinic. Quality of care was assessed using the identity‐oriented dimension of the validated questionnaire ‘Quality of Care from the Patient's Perspective’. Forty‐two ileostomy and 49 colostomy patients completed the questionnaire.Result.  While the vast majority of patients in both groups thought that most topics in the questionnaire were important, most rated many aspects of their quality of care as unsatisfactory. One‐third of the colostomy patients and one‐half of the ileostomy patients were dissatisfied with the information they received about the results of medical examinations and laboratory tests, and an even higher proportion was dissatisfied with their opportunities to participate in the decision‐making process or to discuss sexual matters. Stoma‐related complications, which occurred in 71% of the ileostomy patients and in 43% of the colostomy patients, had no impact on these results.Conclusion.  Information and counselling for patients having ostomies, both on the part of specialist nurses and colorectal surgeons, appeared to deficient, suggesting that standards for quality of care require continuous evaluation and revision.
Lived experiences of the time preceding burnout
Authors: Ekstedt Mirjam , Fagerberg Ingegerd 
Published: December 2004

Aim. This paper reports a study to illuminate the complex interaction between person and their life world during the burnout development period.Background. Burnout is a construct describing the psychological state resulting from ineffective strategies for coping with enduring stress in both client and non‐client work. Role conflict and role ambiguity, or long‐term stress and frustration caused by strain in daily life, promote or exacerbate burnout, indicating that the person's entire life world is involved. There is still a lack of description of lived experiences of the time preceding manifest burnout.Method. Data were collected from interviews with eight people suffering from burnout and analysed using a phenomenological method.Findings. The essential meaning of the phenomenon of burnout is understood as being trapped with stimulating challenges as a self‐nourishing drive on one side and with responsibilities and demands on the other. This essence can be illuminated by its eight constituents: inner incentive, feeling responsible, threatened self‐image, cutting off, bodily manifestations, psychological manifestations, fatigue and reaching the bottom line.Conclusions. The lived experiences of the time preceding manifest burnout are an ambiguous struggle. Cutting off is understood as a mean to shelter the threatened self‐image in a state of vulnerability and weakened strength. Accordingly, a better understanding of how to reach behind the defence of ‘cutting off’ and thus help to open up for consolation and self‐acceptance is an essential skill for nurses, health care professionals and others encountering the burnout sufferers. Furthermore this study illuminates early signs of burnout and an important issue is how to strengthen the individuals’ ability to shelter their need for recovery and restitution.
Modelling novice clinical reasoning for a computerized decision support system
Authors: O'Neill Eileen S. , Dluhy Nancy M. , Chin Elizabeth 
Published: December 2004

Aim. The aim of this paper is to introduce the theoretical framework that directs the project.Background. The Novice Computer Decision Support (N‐CODES) Project is developing a point‐of‐care system to assist novice acute care nurses while making clinical judgements. Unlike prior approaches, N‐CODES is guided by a theoretical understanding of nurses’ decision‐making processes, including the manner by which novices develop this skill.Framework. Assumptions within information processing theory guided the clinical decision‐making framework. The framework is composed of a clinical decision‐making model and a second embedded model depicting the clinical reasoning development of novice nurses.Models. The model is developed within a pluralistic perspective synthesizing theoretical and empirical knowledge on clinical decision‐making and the development of novice reasoning skills. A visual representation of experienced nurse decision‐making is presented. A central element is the nurse's use of pre‐encounter data and working knowledge. A second model integrates empirical data on the developing clinical reasoning of the novice. This knowledge is loosely scattered through 25 years of literature. The intersection of these models provides a novel perspective on the way novices begin to identify working knowledge patterns and develop a sense of saliency.Conclusions. Previous attempts to build comprehensive clinical decision support systems have disregarded important theoretical considerations hindering the success of these projects. Grounding a Decision Support System in a theoretical model of novice nurse decision‐making will strengthen the utility and acceptance of the Decision Support System. Additionally, a conceptualization of novice nurse development is an asset to nurse educators, managers and scientists interested in improving clinical decision‐making.
Psychometric evaluation of the Cognitive Appraisal of Health Scale with patients with prostate cancer
Authors: Ahmad Muayyad M. 
Published: December 2004

Aim.  This study was designed to investigate the psychometric properties of the Cognitive Appraisal of Health Scale, specifically with prostate cancer patients.Background.  Measurement of appraisal is considered a relatively new area in the health studies literature. Cognitive appraisal of potentially stressful events becomes important when individuals face a crisis such as a change in their health status. So far, confirmatory factor analysis (CFA) has not been used to study the factor structure of the Cognitive Appraisal of Health Scale.Methods.  The structure of the questionnaire was analysed by exploratory factor analysis, CFA using structural equation modelling and an Analysis of Moment Structure procedure with a sample of 133 patients with prostate cancer.Results.  The results support the three‐factor model for the Cognitive Appraisal of Health Scale because it has robust structure and excellent goodness‐of‐fit indices. Several of the 23 items were grouped into different factors from those in Kessler's scale.Conclusion.  The use of the reduced version of Cognitive Appraisal of Health Scale with men under health stress is recommended.
Nurses’ experiences of distance education programmes
Authors: Hyde Abbey , Murray Maurice 
Published: December 2004

Aim.  This paper reports on a study exploring the experiences of nurses undertaking distance education (DE) programmes.Background.  While DE has many advantages in terms of the flexibility, autonomy and freedom that it affords to learners, the literature reports that students undertaking these programmes can also experience feelings of being disconnected and isolated.Methods.  A convenience sample of 15 participants was selected, and data were collected using in‐depth interviews. Data were analysed using a qualitative design that drew most heavily on the methodological procedures of grounded theory.Findings.  Habermas’ theory of communicative action was found to be relevant to the interpretation of data and four categories were constructed to explain participants’ experiences in relation to DE, namely: lifeworld lamented; lifeworld experienced; lifeworld ceded and learning within a bounded system. These categories reflect the manner in which participants experienced the lifeworld component (the interactive and subjective dimensions) and the system component (objective and outcome oriented dimensions) of the educational realm. While data indicated diversity in how the boundedness of the programmes was experienced, overall such standardized, instrumental courses were viewed favourably by participants within the limitations of their own personal circumstances.Conclusion.  Distance education as a means of disseminating nursing knowledge should be strengthened. The challenge for nurse educators is to develop DE programmes that minimize their limitations and maximize their potential.
Effects of a postqualification course in palliative care
Authors: Adriaansen Marian J.M. , Van Achterberg Theo , Borm George 
Published: December 2004

Aim.  This paper reports a study to determine the effectiveness of a postqualification course in palliative care in terms of increased knowledge, insight and self‐efficacy among Registered and Licensed Practical Nurses.Background.  The importance of measuring the effectiveness of postqualification courses in palliative care for nurses is widely recognized. The benefits of such courses are often merely described in terms of satisfaction of the course participants.Method.  A convenience sample of nurses was studied. The effect measurement comprised a pretest/post‐test quasi‐experimental design. Two instruments were used: a comprehensive variant of the Palliative Care Quiz for Nurses and an especially developed domain specific self‐efficacy instrument for palliative care. These were used before and after the course.Findings.  The course had a positive effect on knowledge and insight level as well as on level of self‐efficacy. The main improvements were related to pain and symptom management. Participants seemed to be able to increase the effects of the course by implementing certain products on the wards, such as clinical lessons, a pain assessment scale and relaxation massage.Conclusions.  Palliative care courses can make a significant contribution to nurses’ knowledge and insight, as well as their self‐efficacy in providing palliative care.
In vitro activity of telithromycin against mefA and ermB erythromycin‐resistant viridans streptococci isolated from bacteremia of oral origin in Spain
Authors: Tomás I. , Alvarez M. , López‐Meléndez C. , Limeres J. , Tomás M. , Diz P. 
Published: December 2004

Erythromycin‐resistant viridans streptococci are often responsible of bacteremias following dental manipulations. The aim of this study was to evaluate the in vitro activity of telithromycin against erythromycin‐susceptible and erythromycin‐resistant viridans streptococci. Venous blood samples were collected from 84 patients, 30 s after dental extractions. Viridans streptococci were identified by conventional microbiological techniques. A set of 36 viridans streptococci were selected to investigate the in vitro activity of telithromycin by the agar dilution method. Macrolide resistance genes were amplified with specific primers for the mefA and ermB genes and visualized by electrophoresis.For erythromycin‐susceptible viridans streptococci, telithromycin minimal inhibitory concentration90 (MIC90) was <0.008 μg/ml. For erythromycin‐resistant viridans streptococci, telithromycin MIC90 was 1 μg/ml. The MIC90 to telithromycin of the mefA‐positive and ermB‐negative viridans streptococci was lower than that of the mefA‐negative and ermB‐positive viridans streptococci (0.128 μg/ml versus 1 μg/ml).The in vitro activity of telithromycin was high, irrespective of the erythromycin susceptibility and the mechanism of erythromycin resistance identified.
Virulence, phenotype and genotype characteristics of endodontic Enterococcus spp.
Authors: Sedgley C. M. , Molander A. , Flannagan S. E. , Nagel A. C. , Appelbe O. K. , Clewell D. B. , Dahlén G. 
Published: December 2004

Background/aims:  Enterococci have been implicated in persistent root canal infections but their role in the infection process remains unclear. This study investigated the virulence, phenotype and genotype of 33 endodontic enterococcal isolates.Methods:  Phenotypic tests were conducted for antibiotic resistance, clumping response to pheromone, and production of gelatinase, hemolysin and bacteriocin. Genotype analysis involved polymerase chain reaction amplification of virulence determinants encoding aggregation substances asa and asa373, cytolysin activator cylA, gelatinase gelE, gelatinase‐negative phenotype ef1841/fsrC, adherence factors esp and ace, and endocarditis antigen efaA. Physical DNA characterization involved pulsed‐field gel electrophoresis of genomic DNA, and plasmid analysis.Results:  Potential virulence traits expressed included production of gelatinase by Enterococcus faecalis (n = 23), and response to pheromones in E. faecalis culture filtrate (n = 16). Fourteen strains produced bacteriocin. Five strains were resistant to tetracycline and one to gentamicin, whereas all were susceptible to ampicillin, benzylpenicillin, chloramphenicol, erythromycin, fusidic acid, kanamycin, rifampin, streptomycin and vancomycin. Polymerase chain reaction products encoding efaA, ace, and asa were detected in all isolates; esp was detected in 20 isolates, cylA in six isolates, but asa373 was never detected. The gelatinase gene (gelE) was detected in all isolates of E. faecalis (n = 31) but not in Enterococcus faecium (n = 2); a 23.9 kb deletion sequence corresponding to the gelatinase‐negative phenotype was detected in six of the eight E. faecalis isolates that did not produce gelatinase. Pulsed‐field gel electrophoresis and plasmid analyses revealed genetic polymorphism with clonal types evident. Plasmid DNA was detected in 25 strains, with up to four plasmids per strain and a similar (5.1 kb) plasmid occurring in 16 isolates.Conclusions:  Phenotypic and genotypic evidence of potential virulence factors were identified in endodontic Enterococcus spp., specifically production of gelatinase and response to pheromones.
Comparative analysis of the antibacterial effects of combined mouthrinses on Streptococcus mutans
Authors: Menendez A. , Li F. , Michalek S. M. , Kirk K. , Makhija S. K. , Childers N. K. 
Published: December 2004

Background/aims:  Chlorhexidine has been proposed as a potent chemotherapeutic agent against oral bacteria. However, there are some inconsistent results regarding the usefulness of chlorhexidine mouthrinse as an antimicrobial for Streptococcus mutans. The purpose of this study was to investigate the effectiveness of combining oral rinses to reduce S. mutans levels in human saliva.Methods:  Sixteen healthy adult subjects were randomly assigned to one of four rinse groups using a 4‐cell crossover design. The groups rinsed twice a day for 7 days with one of the following: 0.12% chlorhexidine (PerioGard®), 1.5% hydrogen peroxide (Peroxyl®), a combined chlorhexidine + hydrogen peroxide, or water (control). Every 5 weeks, each group initiated a different rinse. Saline wash samples were collected on days 7 and 21 for assessment of S. mutans and total streptococci.Results:  No significant differences were seen in S. mutans levels among the groups; however, the levels of total streptococci on day 7 samples were significantly lower in the chlorhexidine and chlorhexidine + hydrogen peroxide groups than in the hydrogen peroxide and control groups. There was no additional decrease seen in S. mutans or total streptococci levels in the group receiving chlorhexidine + hydrogen peroxide compared to chlorhexidine alone.Conclusions:  Sample variation was high throughout the study, with a significant trend toward lower counts as the study progressed. Adding hydrogen peroxide to the chlorhexidine mouthrinse did not result in a further decrease in S. mutans levels.