bluuebunny/crossref_metadata_2025_split huggingface dataset:
Critical care outreach services and early warning scoring systems: a review of the literature
Authors: McArthur‐Rouse Fiona 
Published: March 2003

Critical care outreach services and early warning scoring systems: a review of the literature Aim. The aim of this paper is to explore the literature relating to critical care outreach services and the use of early warning scoring systems to detect developing critical illness. Background. Several studies have identified how suboptimal care may contribute to physiological deterioration of patients with major consequences on morbidity, mortality and requirement for intensive care. In a review of adult critical care services, the Department of Health (DOH) (England) recommended in 2000 that outreach services be established to avert admissions to Intensive Care, to enable discharges and to share critical care skills. Methods. A literature search was carried out of the BIOMED and NESLI databases using the key words ‘outreach’, early warning signs/systems’ and ‘suboptimal care’. The literature review was limited to the past 10 years, and primary research articles of particular relevance were included in the review. The literature is examined within the context of recent findings relating to the provision of suboptimal care within general wards prior to cardiac arrest and/or admission to Intensive Care Units (ICU), and subsequent government initiatives. Discussion. The discussion explores the potential contribution of critical care outreach services and early warning scoring systems to the care of patients in acute general wards, including the role that education can have in developing the knowledge base and assessment skills of ward nurses. Conclusion. The paper concludes that further study is required to evaluate the effectiveness of critical care outreach services and early warning scoring systems, and that ward staff need to be educated to identify those patients at risk of developing critical illness. Finally, it is suggested that nurses’ decision‐making in relation to calling the outreach team requires further investigation.
Starry night: using story to inform aesthetic knowing in women’s health nursing
Authors: Leight Susan B. 
Published: March 2003

Starry night: using story to inform aesthetic knowing in women’s health nursingAim of the Paper. This paper describes the use of story as a vehicle to inform aesthetic knowing in nursing. Because health care demands that nurses know two distinct languages, the language of nursing science with its quantifiable outcomes as well as the experiential observations of health and illness, it is critical that nurses be fluent in each discourse.Background. Nursing scholars have long voiced a commitment to two epistemological domains: scientifically derived knowledge (empirics) as well as the expressive, creative, intuitive application of knowledge (aesthetics). In recognition of the need for these interpretive paradigms for practice, nursing scholars have sought to identify the kinds of knowing which provide the nursing discipline with its unique perspective.Discussion. Stories mould every human encounter and telling one’s story in the context of a trusting relationship allows women and nurses to journey together to uncover and discover the meanings inherent in the story. Through this mutual process of unfolding the story, nurses engage the women in deep reflection and focus on what ‘might be’ so that possibilities for the future are illuminated. This is important in all nursing, but particularly in women’s health nursing because the emergence of story suggests that contextual, phenomena‐centred knowledge has found its voice in the nursing care of women as a way of knowing that focuses on personal experience and relies on methods in which woman‐to‐woman caring facilitates the disclosure of the human health‐illness experience.Conclusions. Storytelling is a useful strategy to inform aesthetic knowing in nursing. Stories supply a foundation for nursing scholarship because truly to hear women’s stories require nurses analyse information, formulate hypotheses, and seek to understand the causal relationships as expressed by women. Through this analysis and attention to detail, nurses are able to glimpse possibilities for the future, thus transforming the experience.
A study of skill mix issues in midwifery: a multimethod approach
Authors: McKenna Hugh , Hasson Felicity 
Published: March 2003

A study of skill mix issues in midwifery: a multimethod approach Background. While skill mix studies are quite commonplace in health care, most have focused on the most effective use of staff and skill distribution in the field of nursing; few relate specifically to the midwifery profession. In Ireland there is no recognized midwifery assistant grade. Aims. This paper describes a study that investigated the skill mix requirements of a midwifery service based in the Republic of Ireland. The project was built on previous research, which showed that due to undertaking a number of ‘nonmidwifery duties’, midwives were unable to undertake fully the work for which they were trained. Research methods. Data were collected using a variety of methods. These included postal questionnaires and the Delphi technique. The ‘Delphi’ was used to gain a level of consensus from hospital midwives (all grades) (n=194) and student midwives (n=79) on what are and what are not nonmidwifery duties. Analysis of secondary data (duty rotas and staff turnover data) was also undertaken. Results. Findings indicate that the respondents spent a large proportion of their time undertaking clerical, domestic, portering and stock duties. They would welcome the introduction of midwifery assistants into the ward team and were able to identify those duties that such persons could undertake. Conclusions. Skill mix requirements and organizational strategies to deal with the workforce changes are highlighted. Due to the current shortage of midwives in many countries and the dearth of extant research in this area, the results and recommendations have implications for midwives nationally and internationally.
Being in a fragmented and isolated world: interviews with carers working with a person with a severe autistic disorder
Authors: Hellzen Ove , Asplund Kenneth 
Published: March 2003

Being in a fragmented and isolated world: interviews with carers working with a person with a severe autistic disorderAim. To illuminate the meaning of being a carer for a person with a severe autistic disorder.Background. Carers working with people with severe autism are occasionally exposed to residents' self‐injurious behaviours and violent actions and at time residents appear resistant to all forms of treatment.Design/method. A qualitative case study was conducted. Six Swedish carers enrolled nurses (ENs), working on a special ward in a nursing home were interviewed about their lived experiences when caring for an individual with a severe autistic disorder. Narrative interviews were conducted and interpreted using a phenomenological‐hermeneutic method inspired by Paul Ricoeur.Findings. Two themes were formulated which describe the carers' reality and their dream of an ideal. This ideal described carers' experiences of being trapped in a segmented and isolated care reality and their longing to achieve a sense of wholeness. The findings were interpreted and reflected on in the light of a framework inspired by the German philosopher Karl Jaspers in order to achieve a deeper understanding of the text.Conclusions. In their desperation, the carers used their empirical knowledge based on scientific knowledge, which could be understood as a substitute for their vision of a consolating wholeness. This paper shows that searching for a substitute to consolation seems to be an important aspect of the meaning of being a carer for a person with a severe autistic disorder.
The meaning of mobility for residents and staff in long‐term care facilities
Authors: Bourret E.M. , Bernick L.G. , Cott C.A. , Kontos P.C. 
Published: March 2003

The meaning of mobility for residents and staff in long‐term care facilities Background. Although the physical and psychological effects of decreased mobility have been documented, little is known about what it means to be mobile from the institutionalized elders' perspective. Even less is known about nurses' perceptions regarding institutionalized elders' mobility and about mobility enhancing strategies. Aim. The purpose of this study was to generate knowledge about the phenomenon of mobility from both the nurses' and institutionalized elders' perspective. Design. An exploratory qualitative design was used. Focus groups with residents and nursing staff were conducted in three long‐term care facilities in a large metropolitan city in 1998. Ethical approval was received from the ethics committees in all three facilities prior to study implementation. Twenty long‐term care facility residents and 15 nursing staff participated in the study. Methods. A trained facilitator used an interview guide to moderate discussions in which residents' and nurses' opinions and feelings about mobility were solicited. The group responses were tape recorded, transcribed and coded. The codes reflected major concepts or abstractions of the data and emerged from the participants' verbal responses to the research questions. Findings. Both groups identified mobility as being pivotal to the residents' quality of life and well‐being. The residents viewed mobility as a means of freedom, choice and independence, and they made great efforts to maintain their mobility. The nurses also valued the importance of mobility and assisted the residents through preparatory care, environmental modifications and encouragement. Factors that related to the residents' willingness to be mobile, environmental barriers and the impact of waiting were compared between the two groups. Conclusion. Mobility involves more than the movement from one point to another. The nature of the assistive nurse‐client relationship and the resident's subjective perspective must become central to understanding the meaning of mobility for residents in a long‐term care facility.
Assessing the skills for family planning nurse prescribing: development of a psychometrically sound training needs analysis instrument
Authors: Hicks Carolyn , Tyler Claire 
Published: March 2003

Assessing the skills for family planning nurse prescribing: development of a psychometrically sound training needs analysis instrument Rationale and aims. Family planning nurses have been identified for early development for prescribing authority in the United Kingdom (UK). Currently, no psychometrically founded training needs analysis instrument exists that can reliably assess the nature and extent of the specific educational provision required for this role. This paper is concerned with the development of an instrument capable of defining the development needs for family planning nurse prescribing. Methods. A national survey was conducted with 388 family planning nurses, using a modified training needs analysis instrument. Respondents were required to assess the importance of 40 tasks, firstly for the role of the family planning nurse (FPN), and again for the role of the family planning nurse prescriber (FPNP). The data from each set of ratings were separately factor analysed using orthogonal Varimax rotations and Cronbach’s α was computed for each factor. Results. Six factors emerged from the family planning nurse ratings (‘professional development’, ‘managing patient consultations’, ‘critical appraisal’, ‘clinical information giving and professional accountability’, ‘collaborative working and current National Health Service (NHS) issues’ and ‘dispensing of drugs’) and nine factors emerged from the FPNP ratings (‘research and practice development’, ‘prescribing and professional accountability’, ‘management/leadership’, ‘clinical decision making and risk assessment’, ‘advanced health assessment’, ‘critical appraisal’, ‘referral processes’, ‘core nursing skills’ and ‘dispensing of drugs’. This suggests that the role of the FPNP is more extended and, moreover, that the two roles are configured very differently but in a way that makes logical and coherent sense within existing research and government policy. This indicates that the instrument is valid. Moreover, all but two of the factors had a Cronbach’s α score of >0·7 and so can be considered reliable. Conclusions. The results indicate that the modified instrument is valid and reliable and therefore can be used with confidence to assess the training needs of FPNPs. In addition, the factors have outlined a cogent definition of the role of the FPNP, which can be used both to inform educational programmes and to assess their efficacy.
Aspects of curriculum policy in preregistration nursing education in the Republic of Ireland: issues and reflections
Authors: Fealy Gerard M. 
Published: March 2003

Aspects of curriculum policy in preregistration nursing education in the Republic of Ireland: issues and reflections Aims. This paper sets out to examine critically aspects of curriculum policy related to preregistration nursing education in the Republic of Ireland. Background. Following a period of industrial unrest concerned with pay, promotional opportunities and conditions of employment amongst nurses and midwives in the Republic of Ireland, a Commission on Nursing was established in March 1997. Along with a series on recommendations pertaining to the role and the professional development of nurses and midwives, the final report of the Commission on Nursing contained recommendations on the educational preparation of nurses. Specifically, the Commission recommended that the future framework for preregistration nursing education in the Republic of Ireland be based on a 4‐year degree programme, fully integrated into higher education. As a means of giving effect to this recommendation, the Commission also recommended the establishment of a Nursing Education Forum, whose task it was to develop a strategic framework for the introduction of the proposed preregistration nursing degree programme. The Forum published its final report in October 2000 and this report constituted the most explicit statement of official policy on the nursing curriculum in the Republic of Ireland. Design. The paper constitutes a critical analysis of selected aspects of the report of the Nursing Education Forum, in the light of scholarly literature on curriculum philosophy and curriculum policy. Summary of content. The paper considers some of the implications for curriculum development and design arising out of the recommendations of the Nursing Education Forum. Among a list of core principles underpinning curriculum regulation and design, the report included the principle of ‘eclecticism’. The paper considers this principle with reference to nursing epistemology, pedagogical practice and curriculum policy, and seeks to challenge some of the assumptions underlying this principle. Conclusions. The epistemological identity and the structural integrity of primary forms of knowledge in the preregistration curriculum need to be maintained if students are to develop their knowledge and understanding of nursing science.
The role of ritualistic ceremonial in removing barriers between subcultures in the National Health Service
Authors: Brooks Ian , Brown Reva Berman 
Published: March 2003

The role of ritualistic ceremonial in removing barriers between subcultures in the National Health Service Background. One of the ways in which it is possible to achieve successful organizational change is through the elimination of those ceremonies that reinforce or preserve the negative aspects of professional and work group autonomy, thus maintaining the barriers between subcultures. Conversely, the encouraging of ceremonies which reinforce positive aspects is likely to achieve more flexible, team‐orientated changes. Aim. The paper considers those ceremonies, which perpetuate barriers in a National Health Service (NHS) Trust, and explores new ceremonies which may question, weaken or eliminate current dysfunctional practices. Design. Our research approach was mainly phenomenological, as we wished to elicit the symbolic significance of organizational routines. The primary source of data was spoken language. The findings are based on purposive sampling of informants by means of semi‐structured interview and observation. Other types of information were also collected, including business plans, reports and brochures. Informants included the Chief Executive and four Board members, three consultants, the director of nursing and midwifery, 10 middle managers and eight junior, nonmedical and nonmanagerial employees. Findings. Two broad bands of ceremonies have been identified – those which preserve the existing norms and autonomy of professional and worker groups, which we have named Ceremonies of Preservation, and those which encourage change, which we have called Ceremonies of Change. Considerable data are provided to help to `tell the story'. Conclusion. The paper argues that attention to ceremonial in the wider change process may facilitate the desired, specific change or changes in practice. It suggests that changes which confront unnecessary demarcation, but which do not undermine professional integrity, can create real benefits for NHS hospitals.
Benner's remnants: culture, tradition and everyday understanding
Authors: Paley John 
Published: March 2003

Background. Benner's account of meaning and embodiment in nursing depends on a theory which she has never fully articulated, although she makes numerous allusions to it. Behind the background of shared meanings hovers something called ‘culture’, which provides each individual with meaning, determines what counts as real for her, and actively hands down interpretation‐laden practices. This view is based, Benner claims, on the Heideggerian assumption that the meaning and organization of a culture precedes individual meaning‐giving activity.Aim. I explore Benner's implicit view of culture, drawing on her published work over 15 years, and offer an appraisal of it. In doing so, I attempt to make sense of some rather strange remarks Benner has recently made about ‘remnants’ of Cartesian and Kantian thinking being found in the everyday understandings of people with asthma.Methods. The concept of culture is developed with reference to both Benner's own work and that of the anthropologist, Clifford Geertz, whose work she frequently cites. Having identified the principal tenets of what we might conveniently call the Benner–Geertz theory, I proceed to interrogate the theory, using the recent anthropological literature – and, in particular, materialist attacks on the idea of culture as a system of meanings – in order to cast doubt on it. I also review, very briefly, an alternative way of understanding ‘culture’, which is not vulnerable to the same criticisms.Conclusions. Benner's implicit theory of culture is revealed, somewhat ironically, as an inverted form of Cartesian dualism. Its intellectual provenance is not Heidegger, who appears to reject it, but the sort of American sociology associated with Talcott Parsons. As a corollary, it is suggested that Benner's ‘remnants’ analogy cannot be justified, and that the idea of Cartesian and Kantian concepts permeating Western culture, infecting both the providers and receivers of health care, is a myth.
Staff nurses' perceptions of supernumerary status compared with rostered service for Diploma in Nursing students
Authors: Hyde Abbey , Brady Dympna 
Published: March 2003

Background/rationale.  In the Republic of Ireland, the amount of clinical teaching expected of staff nurses has increased substantially in the wake of the transfer of nursing education to universities, and the advent of supernumerary status for students. A modicum of previous research noted that staff nurses are unclear about their role in relation to facilitating the clinical learning of supernumerary students. Aims of the paper.  To explore staff nurses' perceptions of their role in the facilitation of learning for university‐educated diploma students in the clinical area and their attitudes towards these students. Design/methods.  Sixteen staff nurses were interviewed in depth using semi‐structured interviews. Data were analysed qualitatively, using content analysis, with the help of the software package NUD*IST. Findings.  Among the central themes to emerge, upon which this article is focused, was participants' perceptions of supernumerary status compared with rostered service for diploma students. Data suggested that the rostered status of students was generally favoured by staff nurses over and above supernumerary status because, unlike supernumerary students, rostered students did not disrupt the existing social structure within the clinical setting. Both structuration theory and role theory are drawn upon to explain the reproduction of the prevailing social structure, where the concentration is on getting through nursing work with little emphasis on the supervised learning of supernumerary students. Study limitations.  This study is constrained by eliciting only the views of staff nurses. Further studies are required of student nurses' experiences of rostered service and supernumerary status. Conclusions.  Because staff nurses are part of the system within which they work, they need to modify their role to include active student teaching as a legitimate component of that role.
In the spirit of creativity: the learning and teaching of ethics in nursing
Authors: Doane Gweneth Hartrick 
Published: March 2003

Aim. This paper discusses the development of a pedagogy that nurtures not only the caring and the critical, but also the creative spirit of nursing. To explore the idea of creative pedagogy the learning/teaching of ethics in nursing is considered.Background. Based on the understanding of ethics as a deeply personal process that is lived in the complexity and ambiguity of everyday nursing work I describe a pedagogy that seeks to support students to ‘become’ moral agents – to see ethics as something they are, not merely as something they follow, and to develop the knowledge and ability to live in and navigate their way through the complex, ambiguous, and shifting terrain of ethical nursing practice. An example of one student's experience is used to illustrate how a pedagogy of creativity can promote the development of students' creative capacity in their everyday ethical practice.