bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nursing‐led in‐patient units for intermediate care: a survey of multidisciplinary discharge planning practice
Authors: GRIFFITHS PETER 
Published: March 2003

• The effectiveness of post‐acute intermediate care in nursing‐led intermediate care in‐patient units (NLIU) has been studied over the past 20 years.• Accounts, both positive and negative, have tended to view it as a uni‐disciplinary intervention. The previous studies are in effect a series of single case studies and as such need to be accompanied by richer descriptions of care processes in order to be useful.• A survey was conducted, in parallel with a randomized‐controlled trial (n=177), to compare multidisciplinary care and discharge planning practice on the NLIU with 16 wards that referred patients to it.• The findings identify that a wide range of professions participate in care on the NLIU with physiotherapists and occupational therapists most widely involved.• In general the team composition and care processes differed little between the NLIU and control wards. There was some evidence that there was lower participation in care on the NLIU from occupational therapy and social work. It is concluded that the NLIU is a complex multidisciplinary intervention.• Positive results from some NLIUs may only be generalizable to settings with similar skill mix across the multidisciplinary team as that found in the acute hospital. Reduced skill mix may be a causal factor leading to extended stays and increased total care costs.• This caution should be extended to other models of intermediate care, whether or not they are nursing‐led.
Nurses' altered conceptions of work in a ward with all‐RN staffing
Authors: LUNDGREN SOLVEIG M. , SEGESTEN KERSTIN 
Published: March 2003

• The aim of this study was to investigate how nurses' conceptions of their patients and work changed after reorganization to all RN‐staffing and the adoption of a patient‐in‐focus philosophy on the ward.• The study builds on the perspective that the individual's conception of work precedes and forms the basis for the development of knowledge, skills and attributes used in accomplishing work.• The findings are based on a secondary analysis of two open interviews with 22 nurses on the ward. These interviews were conducted on two occasions with an interval of 2 years. The third interview was carried out 6 months later, when 10 nurses were asked to talk about a patient's care episode in a narrative form.• The nurses' conceptions changed towards a holistic view of the patient, they developed a new approach to work and they used the altered circumstances in their work.
Exploring multi‐agency working in services to disabled children with complex healthcare needs and their families
Authors: WATSON DEBBY , TOWNSLEY RUTH , ABBOTT DAVID 
Published: March 2003

• Children with complex healthcare needs typically require technical and/or medical equipment in the home. This growing group of children and families need support that crosses agency and professional boundaries, necessitating effective multi‐agency working.• There are many examples of multi‐agency working around the United Kingdom (UK), some specifically designed to meet the needs of children with complex healthcare needs and their families. Recent legislation and policy statements have highlighted the importance of joint planning and working. Currently no research exists that examines the impact of these initiatives on disabled children with complex healthcare needs and their families.• The `Working Together' project is an ongoing research study based at the Norah Fry Research Centre, University of Bristol, Bristol, UK. The project aims to explore the impact of multi‐agency work on children with complex healthcare needs and their families.• This paper examines the literature on barriers to disabled children and the need for multi‐agency working. It also considers the concept of multi‐agency working and how different approaches to working together might be perceived by children and families.
Cross‐boundary working: implications for the multiprofessional team
Authors: SCHOLES JULIE , VAUGHAN BARBARA 
Published: March 2003

• This paper explores cross‐boundary working and the impact it may have on the manner in which multiprofessional teams function. It draws on data collected for a study commissioned by the Department of Health, Human Resource Initiative entitled Evaluating New Roles in Practice (ENRiP).• A series of case studies formed one part of the study that aimed to map the process of implementation of new roles in practice, identify the organizational barriers and levers that affected the implementation process and explore the meaning of the new roles from the perspective of postholders, patients and stakeholders.• A naturalistic approach to enquiry was taken using a combination of participant observation, interviews and reflection.• The article includes an overview of the current context in which cross‐boundary work is developing, a review of current literature related to multiprofessional issues and team‐working, a brief descriptions of the typology of new roles that emerged as one strand of the ENRiP study, and the impact that these roles had on both interprofessional and multiprofessional working.• It concludes with a discussion of the implications for practice and the need to ensure that both education and policy are considered in planning for the future.
Need for appropriate written information for patients, with particular reference to head and neck cancer
Authors: SEMPLE CHERITH J. , McGOWAN BRIAN 
Published: March 2003

• Patients need and want written information. There is evidence that giving comprehensible information increases overall satisfaction with the care given by healthcare professionals.• This paper provides a review of the literature on patients' need for appropriate information, with particular reference to head and neck cancer, based on searches of electronic databases.• Head and neck cancers are among the least common cancers in the UK but these patients have very specific and great needs.• Written information is a cost‐effective intervention that complements verbal advice given by healthcare professionals.• Evidence suggests that patient information leaflets are poor and are in language that is difficult for the public to understand.• Considerable time, effort and user involvement are required to produce acceptable and appropriate information leaflets for patients.
An experimental study on the use of manual pressure to reduce pain in intramuscular injections
Authors: CHUNG JOANNE W. Y. , NG WINNIE M. Y. , WONG THOMAS K. S. 
Published: March 2003

• To investigate whether the application of manual pressure to the injection site before intramuscular injection reduces pain.• An experimental study with intrasubject comparison was conducted using manual pressure to reduce pain associated with intramuscular injection.• Seventy‐four subjects, participating in an immunization vaccination campaign, were recruited by convenience sampling from a university. They were required to receive two doses of vaccines via intramuscular injections. One was given in a conventional way, i.e. without manual pressure being applied prior to the injection (control condition). The other was given with manual pressure being applied prior to the injection (experimental condition) for 10 seconds. The two conditions were randomly allocated for each subject. The instrument for measuring the perceived pain intensity was the Pain Intensity Verbal Rating Scale (Cantonese). To ensure the consistency of manual pressure being applied to the injection site, a mechanical pressure sensor device was used to record the manual pressure being applied.• The mean manual pressure applied was 190.82 mmHg (SD=5.25). Results demonstrated a significant difference in the perceived pain intensity for experimental and control conditions. Subjects with manual pressure applied before injections reported lower pain intensity scores, whilst those without the application of manual pressure before injections reported higher pain intensity scores.• Applying manual pressure to an injection site before performing an injection could be an effective means of decreasing pain intensity.
Patients' learning needs after hip arthroplasty
Authors: JOHANSSON KIRSI , HUPLI MAIJA , SALANTERÄ SANNA 
Published: March 2003

• The purpose of this study was to describe patients' learning needs after hip arthroplasty and compare them prior to and 2 weeks after hospital discharge.• Data were collected in two phases from 22 surgical wards in 17 hospitals in Finland using a Canadian Patient Learning Needs Scale (Galloway et al., 1996). The first questionnaire (n=212, 81%) was completed before hospital discharge and the second (n=144, 55%) was completed at home after hospital discharge.• Results indicated that patients' learning needs diminished significantly after hospital discharge. In both questionnaires patients felt that the most important information was about complications and symptoms. Information about medication was ranked the second most important.• Demographic variables such as age, gender, education and working life were clearly related to learning needs. Women over 60 years old, and less educated and retired respondents had many learning needs.
Clinical group supervision in an intensive care unit: a space for relief, and for sharing emotions and experiences of care
Authors: Lindahl Berit , Norberg Astrid 
Published: March 2003

Summary•  Much has been written about models, aims and the concept of clinical group supervisional, although few studies are empirical or focus on intensive care.•  The aim of the study was to illuminate the process and describe, using qualitative content analysis, the content of conversations carried out during the course of clinical group supervision sessions among Registered Nurses (RN) and enrolled nurses (EN) working in an intensive care unit (ICU).•  During the supervision sessions, ENs talked about their life‐world from a caring perspective, while RNs focused on their professional development. Both ENs and RNs regarded the supervision sessions as a space for relief and for sharing emotions and caring experiences, which helped to manage complex nursing care.•  The findings are viewed in the light of Roach's theoretical framework describing the attributes of professional care as five Cs. Clinical group supervision is interpreted as supportive in developing interpersonal skills and a sensitive nursing practice.
Attitudes toward patient aggression amongst mental health nurses in the ‘zero tolerance’ era: associations with burnout and length of experience
Authors: Whittington Richard 
Published: March 2003

Summary•  UK government policy now officially encourages an attitude of ‘zero tolerance’ towards aggression against health care staff.•  This study examines levels of such tolerance amongst a group of mental health care staff and associations between tolerance and other occupational and stress factors.•  Thirty‐seven staff completed a Tolerance Scale (from the Perceptions of Aggression Scale) and the Maslach Burnout Inventory.•  Tolerance for aggression was higher amongst more experienced staff (P < 0.01) and high tolerance was associated with low emotional exhaustion, low depersonalization and high personal accomplishment (P < 0.01).•  Some staff endorse positive statements about patient aggression and a tolerant attitude may be linked to low burnout.•  Nurse attitudes to patient aggression therefore are complex and do not necessarily equate with an approach of ‘zero tolerance’.
Changes in self‐esteem during a 3‐year pre‐registration Diploma in Higher Education (Nursing) programme
Authors: Randle Jacqueline 
Published: March 2003

Summary• Nurses’ self‐esteem affects patient care.• This study measured self‐esteem of pre‐registration nursing students over their 3‐year training programme.• Quantitative data were measured by the Professional Self‐Concept Nursing Inventory and the Tennessee Self‐Concept Scale.• Students's self‐esteem decreased during their training programme.• Results indicate a need to address the damaging effects of the process of becoming a nurse.
The sustainability of consumer credit growth in late twentieth century Australia
Authors: Griffiths Margaret 
Published: March 2003

AbstractThis article reports on a study about the use of credit by Australian consumers between 1980 and 1996. Considerable growth in the use of credit by consumers was coupled with an increasing reliance on credit to finance purchase transactions as consumers’ other sources of purchase finance became depleted. An increasing number of consumers were found to be experiencing difficulty meeting their debt‐ servicing commitments. These results suggest that the growth in use of consumer credit that has occurred in Australia may not be in the long‐term interest of consumers or the economy.
Changes in family food habits: the role of migration
Authors: Opare‐Obisaw Clara , Fianu Docea A. G. , Awadzi Kezia 
Published: March 2003

AbstractThe food habits of people generally dictate their nutritional well‐being, which subsequently affects their physical and mental health. A change in environment is one of the major factors that could bring about positive or negative changes in food consumption patterns. The food habits of 50 migrant families living in a suburb of Accra were studied to find out what changes have taken place as a result of a change in living environment. The homemaker in each family was interviewed to obtain information on socioeconomic characteristics, past and present food procurement and consumption patterns, food avoidances and factors that influence food selection and consumption. The findings revealed that, although the majority stuck to foods they were accustomed to, there were striking changes in sources of food procurement, the number of meals prepared at home and the relative frequency of consumption of some staple foods. One‐third of the study group felt that their diets had become poorer as a result of the change in environment. Two factors, time and money, were associated with the changes that had taken place. The study provides some evidence for the existence of inadequate diets among migrant families. This might even reflect a more serious situation facing the numerous migrant youth, who have no families to cater for them and, hence, put their health at risk. Home economists and other related professionals could be instrumental in drawing up intervention programmes to ensure adequate selection and consumption of food to promote good health among migrants to the city.
Problems of large‐scale fashion designers in Accra, Ghana
Authors: Fianu Docea A.G. , Zentey Evelyn Araba 
Published: March 2003

AbstractA survey was conducted to investigate the problems faced by large‐scale fashion designers in Ghana. Data were analysed using the Statistical Package for Social Sciences (SPSS). The problems the respondents encountered were manpower, economic, logistic and social. Additional training in fashion design outside Ghana and a high level of education were identified as assets in the export trade. Suggestions to the Ghanaian Government and other stake holders, to improve the fashion industry and thus enable the industry to contribute effectively to the realization of the economic goals outlined in ‘Ghana’s Vision 2020’ (development plan), are discussed.
Spatial and temporal variation in population size of Eichhornia paniculata in ephemeral habitats: implications for metapopulation dynamics
Authors: Husband Brian C. , Barrett Spencer C. H. 
Published: March 2003

1 The annual plant Eichhornia paniculata occurs in discrete, ephemeral habitats formed by pools, wet ditches and flooded pastures in arid north‐eastern Brazil. We conducted a large‐scale geographical survey of populations four times over a 7‐year period (1982–89) and measured population size, population persistence and patch occupancy. In total, 167 populations were censused. 2 To investigate the importance of local and regional influences on population size, we posed the following specific questions. Are fluctuations in population size independent of their initial size and independent among years? Is persistence uniform among populations of different size and age? Are the proportion of patches occupied related to the density of habitat patches in a region? What are the relations between the size, persistence and density of populations? 3 Population size averaged 86 over the 4‐year period with 52% of populations containing less than 100 individuals. Sixty‐four per cent of populations persisted from one year to the next, but the rate at which populations became absent from a patch was independent of initial population size and time since the last census. For populations that persisted, there was a significant positive correlation between the initial census number and their size in subsequent years. 4 In 29 transects through different regions of north‐eastern Brazil, an average of 21.6% (range 3.8–47.2%) of suitable habitat patches were occupied by E. paniculata. The proportion of patches occupied was positively correlated with the density of patches in a region. No populations were found when the density of patches fell below 0.23 patches km−1 or 0.18 patches km−1 in 1988 and 1989, respectively, indicating the probable existence of a habitat threshold for species persistence within a region. There was no correlation between patch occupancy and either the average number of individuals per population or the probability of persistence in a region. Hence, even when E. paniculata is regionally common, it is not necessarily locally abundant. 5 We conclude that the distribution of E. paniculata populations in north‐eastern Brazil is governed, in part, by metapopulation dynamics.
Differences in seedling growth behaviour among species: trait correlations across species, and trait shifts along nutrient compared to rainfall gradients
Authors: Wright Ian J. , Westoby Mark 
Published: March 2003

1 Species‐pairs from woody dicot lineages were chosen as phylogenetically independent contrasts (PICs) to represent evolutionary divergences along gradients of rainfall and nutrient stress, and within particular habitat types, in New South Wales, Australia. Seedlings were grown under controlled, favourable conditions and measurements were made for various growth, morphological and allocation traits. 2 Trait correlations across all species were identified, particularly with respect to seedling relative growth rate (RGR) and specific leaf area (SLA), a fundamental measure of allocation strategy that reflects the light‐capture area deployed per unit of photosynthate invested in leaves. 3 Across all species, SLA, specific root length (SRL) and seed reserve mass were the strongest predictors of seedling RGR. That is, a syndrome of leaf and root surface maximization and low seed mass was typical of high RGR plants. This may be a high‐risk strategy for individual seedlings, but one presumably mitigated by a larger number of seedlings being produced, increasing the chance that at least one will find itself in a favourable situation. 4 Syndromes of repeated attribute divergence were identified in the two sets of gradient PICs. Species from lower resource habitats generally had lower SLA. Thus, in this important respect the two gradients appeared to be variants of a more general ‘stress’ gradient. 5 However, trends in biomass allocation, tissue density, root morphology and seed reserve mass differed between gradients. While SLA and RGR tended to shift together along gradients and in within‐habitat PICs, no single attribute emerged as the common, primary factor driving RGR divergences within contrasts. Within‐habitat attribute shifts were of similar magnitude to those along gradients.
The influence of nectar and pollen availability on pollen transfer by individual flowers of oil‐seed rape (Brassica napus) when pollinated by bumblebees (Bombus lapidarius)
Authors: Cresswell James E. 
Published: March 2003

Summary 1 Levels of nectar and pollen were manipulated in individual flowers of oil‐seed rape, Brassica napus, which were then offered to foraging bumblebees (Bombus lapidarius) for a single visit. 2 The durations of flower visits by bumblebees increased with the amount of nectar, but were unaffected by the level of available pollen. The bees’ flower‐handling routine may have become behaviourally fixed by the expectation of low pollen rewards, which prevailed in the experimental garden. 3 The effects of nectar provision on both pollen import (deposition on stigma) and export (removal from anthers) were studied. The amount of pollen transferred during a bumblebee’s visit was affected only by the amount of pollen that the flower presented. 4 Manipulated flowers that presented a large amount of available pollen received approximately three times more pollen on their stigmas during a bee’s visit than flowers with little available pollen, which suggests that autogamous pollen transfer contributes substantially to pollen deposition when pollen availability is high. The gradual dehiscence of the anthers in this species means that available pollen accumulates only if pollinator visits are infrequent, when the increased autogamy may act to ensure adequate pollination. 5 There was no relation between the quantity of nectar residue that a bee left after visiting a manipulated flower and the mean duration of its visits to unmanipulated flowers. Therefore, variation among individuals in the duration of visits to unmanipulated flowers apparently resulted from differences in foraging speed rather than from variation in the thoroughness of nectar removal.
The genesis of two Picea–Cladina forests in northern Sweden
Authors: Hörnberg G. , Östlund L. , Zackrisson O. , Bergman* I. 
Published: March 2003

Summary 1
In northern Fennoscandia a rare forest type, characterized by Cladina species and Picea abies, occurs on dry productive sites outside the range of permafrost but close to the Scandes mountains. 2
We determined the history of vegetation development and disturbance of two Picea–Cladina forests to test the hypothesis that this forest type has a natural origin. 3  We used a combination of several retrospective vegetation history and archaeological methods, i.e. the analysis of pollen, macroscopic charcoal, dendroecological data, written historical sources, maps and ancient remains. 4
The results suggest that the Picea–Cladina forests investigated are not the products of purely natural factors. 5
Under the influence of harsh climatic conditions and anthropogenic impact, mainly by repeated fires, grazing, trampling and probably also selective cutting of Pinus, mixed coniferous forests, dominated by feather mosses and dwarf shrubs, may have evolved into the Picea–Cladina type. 6
Repeated anthropogenic use of fire, already established c. 2000 years ago, may have been used to create lichen‐dominated areas, initially to attract game but later to improve winter grazing resources for reindeer. This finding contradicts the general view that Saami nomads did not use fire to alter forest vegetation.