bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dedicated psychiatric care within general practice: health outcome and service providers' views
Authors: Bruce Julie , Watson Diane , Teijlingen Edwin R. van , Lawton Ken , Watson M. Stuart , Palin Alastair N. 
Published: March 2003

Dedicated psychiatric care within general practice: health outcome and service providers' views Health service reforms have led to relocation of care of the chronic mentally ill from institutions to the community, with subsequent demands on the primary health care team. Few studies have attempted to identify satisfactory models of care for this patient group. This study explores the impact of the employment of a community psychiatric nurse (CPN) by a general practice in Aberdeen city to co‐ordinate care of discharged long‐stay psychiatric patients resettled in hostels. A similar general practice with a comparable group of registered patients was selected as a control group. Patient health outcome was measured using the Health of the Nation Outcome Scales (HoNOS) and service providers' views on dedicated psychiatric care within general practice were explored using qualitative methods. Improvements in communication, liaison and drug management were reported in the intervention practice. A primary care‐based CPN service dedicated to the care of the chronic mentally ill promoted a smooth transfer of care from long‐term institutionalized care to the community setting.
On the phenomenology of empathy in nursing: empathy or sympathy?
Authors: Yegdich Tania 
Published: March 2003

On the phenomenology of empathy in nursing: empathy or sympathy? In her recent phenomenological study Baillie attempted to describe the essential structure of empathy in surgical nursing. The study is important in that it utilizes a qualitative research method to investigate the phenomena of empathy, in contrast to previous quantitative studies. Although the phenomenological approach is clearly identified and ascribed to Husserl as the founder of the phenomenological movement, as well as utilizing the peculiarly Husserlian notion of bracketing, or epoché, in an attempt to describe the essence (another Husserlian objective) of the phenomenon under investigation (empathy), the research method does not reflect Husserl’s philosophy. The results reflect nurses’ subjective views on empathy, an exercise consistent with the nurse‐phenomenologists quoted, who without exception, all believe Husserlian phenomenology concerns itself with subjective experience. However, in seeking the essence of phenomena unclouded by subjective opinion, Husserl stands in contrast to nursing interpretations of phenomenology’s famous catch phrase, ‘back to the things themselves’ (zu den Sachen selbst). Nurse‐phenomenologists have misunderstood the intention of Husserlian phenomenology, and despite their opposition to traditional scientific methods, are still mired in the Kantian notion of science as a reality independent of mind. A theme consistent with the ‘things‐in‐themselves’, not the things themselves. As such, nursing’s use of the phenomenological method is questionable, and therefore the research findings on the phenomenon of empathy need to be reformulated. Interestingly, the phenomenon of empathy challenges us to question such underlying assumptions on how we view the world.
Representing nursing judgements in the electronic health record
Authors: Moen Anne , Henry Suzanne Bakken , Warren Judith J. 
Published: March 2003

Representing nursing judgements in the electronic health record The naming of nursing phenomena and representing the phenomena in a standardized manner suitable for encoding in computer‐based systems is a challenge for the nursing profession at the national and the international level. Considerable progress has been made in the development of classification systems for nursing practice. The focus of this article is on language systems developed to represent nursing judgements in computer‐based systems, in particular the electronic health record. A review of two current systems and their proposed revisions (North American Nursing Diagnosis Association, NANDA, Taxonomies I and II, and the International Classification for Nursing Practice, ICNP, Alpha and Beta versions), according to the features suggested by the Computer‐based Patient Record Institute (CPRI) for classification systems appropriate for implementation in computer‐based systems, suggests that the evolving versions extend the current versions in terms of sufficient granularity (depth and level of detail) and atomic and compositional character. However, it is not clear from the literature available to date whether the characteristics that are most closely related to definition of a formal terminology (i.e. clear and non‐redundant representation of concepts, syntax and grammar for logical constructions of compositional terms, synonyms and language independence) will be part of the evolving vocabularies. Formal terminology models and related tools have the potential to complement, extend, and refine existing nursing classification systems.
Implementing new health visiting services through action research: an analysis of process
Authors: Cowley Sarah , Billings Jennifer Ruth 
Published: March 2003

Implementing new health visiting services through action research: an analysis of process An action research project based in a single fundholding practice on the South Coast of England aimed to identify needs relevant to families with resident children, then to use the contracting system to redirect health visiting practice to meet those needs. The naïvety of this plan was well recognised, so the processes that occurred during implementation of the proposed changes were recorded throughout. An analysis of these participant observation data revealed various organisational constraints and facilitators that arose during contract negotiations. Two new full time health visiting posts were established, each with an innovative and somewhat controversial focus. One health visitor was employed to establish a community development project in an underserved area of the town, while the other was to provide a home visiting service for the families of school aged children. The processes involved in structuring decisions about ‘health needs’ and how these are best met are analysed for each of the two new posts. The analysis reveals powerful influences that affect the implementation of new health visiting services.
Planning for information technology key skills in nurse education
Authors: Sinclair Marlene , Gardner John 
Published: March 2003

Planning for information technology key skills in nurse education New recruits to courses in nursing, midwifery and health visiting come from a wide range of educational backgrounds and it is reasonable to expect that this diversity will also be reflected in the range of their experience and competence with information technology (IT). Accommodating such variety can make the planning of appropriate training to enhance and develop their IT skills difficult. In order to explore the likely extent of diversity in IT experience and skills in today’s recruits, the project reported here examined the competence, attitudes and previous IT training of two consecutive cohorts of new entrants to a higher diploma programme. The surveys add weight to the view that nurse educators do face a considerable diversity in new students’ competence and experience with IT. Further analysis has also shown that subgroups of the cohorts, characterized by their age, gender, education or previous IT training, differed significantly in a ‘knowledge of computers’ score but not in their attitudes to IT. Arising from the results, the paper argues that, in seeking to develop a consistent level of IT literacy, core IT competence should be identified and all courses should have the clear objective of raising students’ confidence in using computers.
A taxonomy of needs assessment, elicited from a multiple case study of community nursing education and practice
Authors: Cowley Sarah , Bergen Ann , Young Kate , Kavanagh Ann 
Published: March 2003

A taxonomy of needs assessment, elicited from a multiple case study of community nursing education and practice The role and expectations of community nurses in carrying out needs assessments changed when an internal quasi‐market was introduced to the British health service under the National Health Service (NHS) & Community Care Act 1990. This paper reports on a study commissioned by the English National Board for Nursing, Midwifery and Health Visiting (ENB) to investigate the changing educational needs of community nurses with regard to needs assessment in the context of this legislation. A multiple case study design was utilized and four cases identified, incorporating the geographical variation in England. Recently qualified practitioners (health visitors and district nurses) were observed during a regular shift (n=134 visits), concentrating on their practice of assessing needs, and on liaison and collaboration within teams and across sectors. Participants were interviewed after the observation period (n=33 practitioners), to determine the extent of formality they attached to each assessment, and to elicit information about aspects which may be embedded in everyday practice. Single and multiple case analyses across the four cases used an iterative process of pattern‐matching, replication logic and explanation building. The preliminary analysis yielded a descriptive ‘taxonomy’ which could serve as a basis for classifying the variants of needs assessment and help to clarify the whole phenomenon. When applied further to the data, this revealed the complex interactions between the different ideals (relating to policy, nursing and ascribed worth), the various types (purpose, formality/specificity and complexity) and timing (in relation to client, service and practice issues) within needs assessment.
Sharing the evidence: clinical practice benchmarking to improve continuously the quality of care
Authors: Ellis Judith 
Published: March 2003

Sharing the evidence: clinical practice benchmarking to improve continuously the quality of care It is unacceptable for health care professionals to acquiesce quietly to inconsistencies in the quality of health care received by patients. In the United Kingdom, the introduction of clinical governance has formalized the expectation that professionals’ practice will meet recognized standards of care consistently. It is being stated that all available evidence is being used to identify national standards of excellence. This will inform professionals not only of expected outcomes but of also the structures and processes that need to be in place to support the attainment of such outcomes. Clinical practice benchmarking is one continuous quality improvement approach, which is being used by paediatric units in 27 National Health Service Trusts in the north‐west of England to promote the utilization of available evidence in to practice. The evidence base for benchmarks of best practice is considered continuously using a hierarchy of evidence. This clarifies the different evidence available, upon which benchmarks or standards of excellence can be based, but reinforces the kudos awarded quantitative research evidence within health care. Once benchmarks have been agreed, benchmarking activity supports practitioners in a continuous cycle of comparison and sharing that is aimed at ensuring that children and their families receive evidence‐based care, wherever they are admitted in the north‐west of England.
Effects of infant and caregiving conditions on an infant’s focused exploration of toys
Authors: Pridham Karen , Becker Patricia , Brown Roger 
Published: March 2003

Effects of infant and caregiving conditions on an infant’s focused exploration of toys An infant’s exploration of toys, in the context of the mother’s regulating actions, is a setting for cognitive and social development. The aim of this study was to examine the contribution of infant and caregiving conditions to the quantity of focused exploration of toys for 8‐month‐old infants. Infant biological conditions were gender and birth weight, including a range of both prematurely and term‐born infants. The infant behavioural condition was responsiveness to care. Caregiving conditions included mother’s education, the supportive, stimulating and sustaining quality of the home environment, and the attention‐directing and ‐supporting behaviour of the mother during play. The direct and indirect effects of these conditions on focused toy exploration were modelled using multiple regression. The sample of 79 mother–infant dyads included 43 full‐term infants and 36 premature infants. The mother’s attention‐directing behaviour was a significant negative predictor of focused toy exploration. Infant birth weight did not have a significant direct effect on focused toy exploration. Birth weight did not interact significantly with responsiveness to care or with any of the caregiving environment conditions to affect focused toy exploration. Further study of infant responses to the mother’s attention‐regulating and emotion‐regulating behaviour during play is recommended to better understand how the caregiving environment supports or thwarts focused toy exploration.
A comparison between the ethics of justice and the ethics of care
Authors: Botes Annatjie 
Published: March 2003

A comparison between the ethics of justice and the ethics of care The parameters of the problem within which the principal aim of the present article will be addressed can be described as follows. When making ethical decisions there are different perspectives that health care professionals may use. This may lead to conflict and insufficient co‐operation between the members of the health team. Two of these perspectives are the ethics of justice and the ethics of care. The ethics of justice constitutes an ethical perspective in terms of which ethical decisions are made on the basis of universal principles and rules, and in an impartial and verifiable manner with a view to ensuring the fair and equitable treatment of all people. The ethics of care, on the other hand, constitutes an ethical approach in terms of which involvement, harmonious relations and the needs of others play an important part in ethical decision‐making in each ethical situation. To seek some sort of way of avoiding conflict and promoting a mutual understanding about ethical decisions in the health team, there is a need to examine the ethics of justice and ethics of care. In order to understand the ethics of justice and ethics of care, the purpose of this article is to compare the two ethical perspectives. It is argued that the ethics of justice and the ethics of care represent opposite poles. If the members of the health team were to use only one of these two perspectives in their ethical decision‐making, certain ethical dilemmas would almost certainly remain unresolved. Both the fair and equitable treatment of all people (from the ethics of justice) and the holistic, contextual and need‐centred nature of such treatment (from the ethics of care), ought therefore to be retained in the integrated application of the ethics of justice and the ethics of care.
Dementia care mapping: an approach to quality audit of services for people with dementia in two health districts
Authors: Younger Dennis , Martin Geoffrey W. 
Published: March 2003

Dementia care mapping: an approach to quality audit of services for people with dementia in two health districts The audit reported in this paper and submitted to the Psychiatry of Old Age Management group, assessed six units within each of two health districts in the UK. Using a nonparticipatory observation method in the units selected, the aim was to measure quality and the environment of care. Dependency levels of the clients/residents were also estimated to give a clearer picture of the setting and the care requirements. This was intended to establish a baseline for the units mapped and to enable care developments to be focussed upon intended outcomes. Results led to a number of observations related to the levels of interaction between staff and clients/residents, the need for a wider range of activities to promote person–centred care, and a suggested route to the improvement in quality of life for this vulnerable group of people. Assessment of dependency levels linked to the results of the mapping showed that high dependency does not lead automatically to a lower quality of person centred care.
Getting it right? An exploration of issues relating to the biological sciences in nurse education and nursing practice
Authors: Clancy John , McVicar Andrew , Bird David 
Published: March 2003

Getting it right? An exploration of issues relating to the biological sciences in nurse education and nursing practice Concerns have been expressed that bioscience education is not meeting the needs of nursing students in the UK. This paper explores the situation further by comparing student perceptions with those of experienced practitioners (Part One of the study) and also evaluates the confidence of staff nurses in explaining the rationale for care applied to a common but specific disorder (influenza; Part Two). Questionnaires were used. Responses were elicited from DipHE Nursing (Project 2000) adult/child branch students (n=153) from two universities and from adult/child care staff from their local clinical placements (n=171 in Part One of study; n=266 in Part Two). The questions asked followed two themes: (1) confidence in understanding biological science and (2) issues of teaching and learning. Most questions utilized a rating scale from 1 to 10; this scale provides no central value and a vertical line was drawn to encourage respondents to identify which half of the scale their responses came under (basically, a negative or positive viewpoint). The significance of the data distribution either side of the midline was analysed statistically (simple sign test), as were any differences in distribution between the groups (chi‐square test). Median values were also determined. The data do not provide support for views that the biosciences are being significantly diminished by modern curricula, but also show no evidence for a great improvement in the bioscience knowledge base in recent years. What was surprising was the lack of confidence expressed by staff nurses: one illuminating finding was the lack of confidence in articulating their knowledge to patients and, even less so, to other health professionals. The paper reiterates a need for a national teaching and learning strategy for pre‐ and postregistration education in the biosciences. In particular, a means to raise the level of understanding of staff nurses must be identified urgently so that the mentoring of students in these subjects is improved.
Delayed clarification: information, clarification and ethical decisions in critical care in Norway
Authors: Bunch Eli Haugen 
Published: March 2003

Delayed clarification: information, clarification and ethical decisions in critical care in Norway Following the analysis of about 150 hours of field observation on a critical care unit in Norway a theory was generated to explain the actual ethical decision‐making process. This was grounded in the empirical reality of physicians, nurses and family. The core theme in this study was a delayed clarification in assessing the prognosis of accident victims with neurosurgical traumas. The physicians, nurses and family had to wait for the clinical picture to clarify, during which time there was an exchange and emergence of information. Exchanging information, a subprocess to delayed clarification, involved a continuous flow of collecting and dispersing information about the clinical status of the patient. The nurses engaged in two useful strategies: grading information to family when the patient prognosis was poor, and providing grieving strategies for themselves, colleagues and family members. The core variable, delayed clarification has three dimensions: clinical, psychological and ethical. The nurses participated in the decision‐making process to discontinue treatment as passive participants, they did not engage in collegial deliberations with the physicians. Ethical dilemmas were end of life questions, resource allocations, and questions of justice and organ transplants.
Storytelling and the interpretation of meaning in qualitative research
Authors: Bailey Patricia Hill , Tilley Stephen 
Published: March 2003

Aim. This paper reviews literature on narrative analysis and illustrates the meaning‐making function of stories of chronic illness through analysis and discussion of two case studies from a study of acute episodes of chronic obstructive pulmonary disease (COPD).Background. Individuals living with COPD experience acute exacerbations characterized by extreme dyspnea, but there has been little research to provide understanding of these events from the perspectives of individuals with COPD, family caregivers, and nurses. Narrative analysis – considered in the context of the aims of qualitative research – illuminates how these people make sense of acute exacerbation events by telling stories.Design and methods. In an ethnographic study, 10 patient–family nurse units in two Canadian general hospitals participated in interviews concerning acute episodes of COPD. Narrative analysis enabled identification of several story forms and their functions.Results. Examples were found of a story told twice with different meanings, and of a patient's ‘death story’ used to communicate distrust of the nurse's ability to recognize the seriousness of distress and implications for its potential course. These examples are presented, and interpreted with respect to issues of meaning.Conclusions. The analysis indicates that stories told by patients in the context of nurse–client interactions inform understanding of the individual's acute exacerbation events beyond the biophysical.
Changing surgical practice through feedback of performance data
Authors: Reilly Jacqueline , McIntosh Jean , Currie Kay 
Published: March 2003

Background.  Changing health care practice is commonly attempted by feedback of performance data measured by clinical audit. However, empirical evidence of the effectiveness of clinical audit in changing practice is limited. Few studies have attempted to evaluate practice development or clinical outcomes within the conceptual framework of change theory. Several published studies have used passive feedback in an attempt to promote a change in practice. Sending information to health care workers on their performance is one of the simplest ways of attempting to change performance. Aims.  To evaluate the impact on infection rates of the passive feedback of surgical wound infection rate data to nurses and surgeons within an empirical rational approach to change, and the active feedback of data within a normative re‐educative approach to change. Methods.
A prospective cohort study over a 3‐year period of all surgical patients undergoing clean elective surgery (n = 2241). Patients were monitored whilst an inpatient and up to 30 days postoperatively by an independent observer to determine surgical wound infection rates. The method employed was ‘gold standard’ surveillance, whereby patients were followed up into the community setting. Interventions.  Interventions of feedback and withdrawal of feedback of infection rate data and introduction of guidelines for evidence‐based surgical practice within a change theory framework were monitored by the incidence of infection during the periods of the particular intervention. Results.
Although the feedback of infection rate data impacted on the subsequent infection rates, the reduction was not statistically significant. However, a significant reduction in the infection rates was achieved following the introduction of guidelines for best surgical practice (P < 0·05). Conclusions.  The findings indicate that if change in practice is to be achieved by the feedback of performance data, then the process of feedback should be active and within a normative re‐educative approach to change.