bluuebunny/crossref_metadata_2025_split huggingface dataset:
Occupational therapy in accident and emergency departments: a randomized controlled trial
Authors: Hendriksen Hazel , Harrison Roger A. 
Published: March 2003

Occupational therapy in accident and emergency departments: a randomized controlled trial Background. The National Service Framework for Older People published in 2001 requires action to improve the discharge process of older people from hospital. Currently, many older people released from accident and emergency departments are unable to perform basic activities of daily living. This could delay recovery and increase demand for emergency primary care services. Aims. To evaluate the potential for an occupational therapist in an accident and emergency department to reduce unmet functional needs after releasing patients aged 75 years or more with a primary diagnosis of limb, rib or back trauma. Methods. A randomized controlled trial was employed, with the intervention group receiving an occupational therapy assessment and given, or arrangements made, for appropriate treatments and equipment before release. Controls received routine care. All patients were reassessed at home, 7 days later. Results. Of 72 patients, 39 were recruited with 19 randomized to the intervention group and 20 to the control group. The median age was 81 years (75–92 years) and 31 (79%) were female. At baseline, 20 (51·2%) patients had problems in performing one or more of four basic activities assessed. At the follow‐up assessment, in the intervention group the proportion of patients having no problems with these activities increased by 54% over and above the change in the control group, compared with that at baseline (P < 0·001). No effect on anxiety or demand for primary care was observed. Conclusions. In our local hospital, over 50% of older patients with limb, rib or back trauma would have left the accident and emergency department unable to perform basic activities of daily living. This might be overcome by employing occupational therapists to assess and meet the functional needs of these patients before sending them home. These results need confirming in a larger study.
Developing culturally competent researchers
Authors: Papadopoulos Irena , Lees Shelley 
Published: March 2003

Developing culturally competent researchers Background. Whilst we live in multicultural societies most health researchers tend to take the cultural perspective of the majority ethnic group at the expense of the perspective of minority ethnic groups. Aim. This paper discusses the need for the development of culturally competent health researchers in all areas of research and proposes a model for the achievement of this. Design. A snapshot review of research textbooks used in nursing curricula was conducted to identify whether culturally competent research was being promoted. Results. The review found that whilst a few textbooks touched on ethnicity, race and culture, none of them addressed the issue of cultural competence. Subsequently the authors adapted their existing model of culturally competent health care practice, and in this paper they propose it as a model for the development of culturally competent researchers. Discussion. The model put forward by the authors consists of four concepts: cultural awareness, cultural knowledge, cultural sensitivity and cultural competence. A culturally competent researcher is one who is able to apply the related skills and knowledge in project design, data collection, analysis, report writing and dissemination. Furthermore, the authors identify two layers of cultural competence, those of culture‐generic (knowledge and skills that are applicable across ethnic groups) and culture‐specific competence (knowledge and skills that relate to a particular ethnic group). The relationship between these two layers is a dynamic and spiralling process as illustrated by the model. Conclusion. Current health policy in many developed countries focuses on inequalities of health and managing diversity, including ethnicity. Thus the authors conclude that the development of culturally competent researchers will lead to both valid research and culturally competent practice by health care professionals.
Feminist poststructuralism: a methodological paradigm for examining clinical decision‐making
Authors: Arslanian‐Engoren Cynthia 
Published: March 2003

Feminist poststructuralism: a methodological paradigm for examining clinical decision‐making Aim.  To present the philosophical framework of feminist poststructuralism, discuss its use as an innovative research approach and its implications for nursing knowledge development and practice. Background.  This perspective examines the construction of meaning, power relationships, and the importance of language as it affects contemporary healthcare decisions. It seeks to identify and expose biases that marginalize the healthcare needs of women and contribute to healthcare disparities for this population. Additionally, a feminist poststructuralist perspective seeks to develop new knowledge for understanding gender differences. Nursing application.  A feminist poststructuralist perspective represents an alternative paradigm for studying the phenomenon of clinical decision‐making. An empirical application example of a feminist poststructuralist perspective is provided. This exemplar investigated emergency department registered nurses’ triage decisions for men and women with symptoms suggestive of coronary heart disease.
Getting evidence into practice: the meaning of `context'
Authors: McCormack Brendan , Kitson Alison , Harvey Gill , Rycroft‐Malone Jo , Titchen Angie , Seers Kate 
Published: March 2003

Getting evidence into practice: the meaning of `context'Aim of paper. This paper presents the findings of a concept analysis of `context' in relation to the successful implementation of evidence into practice.Background. In 1998, a conceptual framework was developed that represented the interplay and interdependence of the many factors influencing the uptake of evidence into practice [Kitson A., Harvey G. & McCormack B. (1998)Quality in Health Care7, 149]. One of the key elements of the framework was `context', that is, the setting in which evidence is implemented. It was proposed that key factors in the context of health care practice had a significant impact on the implementation and uptake of evidence. As part of the on‐going development and refinement of the framework, the elements within it have undergone a concept analysis in order to provide some theoretical and conceptual rigour to its content.Methods.  Morse's [Morse J.M. (1995)Advances in Nursing Science17, 31; Morse J.M., Hupcey J.E. & Mitcham C. (1996)Scholarly Inquiry for Nursing Practice. An International Journal10, 253] approach to concept analysis was used as a framework to review semi‐nal texts critically and the supporting research literature in order to establish the conceptual clarity and maturity of `context' in relation to its importance in the implementation of evidence‐based practice.Findings: Characteristics of the concept of context in terms of organizational culture, leadership and measurement are outlined. A main finding is that context specifically means `the setting in which practice takes place', but that the term itself does little to reflect the complexity of the concept. Whilst the themes of culture and leadership are central characteristics of the concept, the theme of `measurement' is better articulated through the broader term of `evaluation'.Conclusions. There is inconsistency in the use of the term and this has an impact on claims of its importance. The concept of context lacks clarity because of the many issues that impact on the way it is characterized. Additionally, there is limited understanding of the consequences of working with different contexts. Thus, the implications of using context as a variable in research studies exploring research implementation are as yet largely unknown. The concept of context is partially developed but in need of further delineation and comparison.
Impact of a nurse‐led counselling service on quality of life in patients with inflammatory bowel disease
Authors: Smith Graeme D. , Watson Roger , Roger Derek , McRorie Euan , Hurst Nigel , Luman Widjaja , Palmer Kelvin R. 
Published: March 2003

Impact of a nurse‐led counselling service upon quality of life in patients with inflammatory bowel disease Aim. Health related quality of life is impaired in patients suffering from inflammatory bowel disease. Although counselling directed towards physical and psychological morbidity is assumed to improve health related quality of life, this has never been demonstrated. Methods. Physical and psychological well‐being were assessed using questionnaires administered to 100 out‐patients in the United Kingdom suffering from inflammatory bowel disease, 50 subjects not suffering from inflammatory bowel disease and a disease control group comprising 28 patients with psoriatic arthritis. A specific nurse led counselling package was given to half the inflammatory bowel disease group and health related quality of life was assessed at baseline, 6 and 12 months. Results. Inflammatory bowel disease and psoriatic arthritic patients had a range of physical disease activity, although none were severely ill during the course of the study. Medical therapy was similar in both groups throughout the duration of the trial. The mean Short Form 36 (SF‐36) scores for mental health were low in inflammatory bowel disease patients; 62·9 ± 9·1 (SD) in ulcerative colitis, 60 ± 9·8 (SD) in Crohn's disease, compared with 72·4 ± 7·2 (SD) in healthy controls (P < 0·05). Mean SF‐36 scores for social function were also reduced in Crohn's disease patients; 68·4 ± 10·1 (SD) in Crohn's disease, compared with 87 ± 10·1 (SD) in healthy controls (P < 0·05). As expected, the mean SF‐36 scores in psoriatic arthritic patients were significantly low 61·9 ± 1·5 (SD) compared with 82·4 ± 14 (SD) in healthy controls (P < 0·05).Crohn's disease patients were significantly more anxious than the other groups, mean HAD score was 10 ± 3·7 (SD) in Crohn's disease patients and 6·86 ± 3·5 (SD) in healthy volunteers (P < 0·05), although mean HAD scores for depression were similar in all groups. Maladaptive coping mechanisms were present in a significant proportion of Crohn's disease patients. At follow‐up all aspects of psychological morbidity returned to the normal range in the Crohn's disease patients without significant change in the mean physical disease index. Conclusion. Health related quality of life can be improved over 6 months by provision of a nurse led counselling service but the effects are not sustained for 12 months.
A risk assessment scale for the prediction of pressure sore development: reliability and validity
Authors: Lindgren Margareta , Unosson Mitra , Krantz Ann‐Margret , Ek Anna‐Christina 
Published: March 2003

A risk assessment scale for the prediction of pressure sore development: reliability and validity Background. The ability to assess the risk of a patient developing pressure sores is a major issue in pressure sore prevention. Risk assessment scales should be valid, reliable and easy to use in clinical practice. Aim. To develop further a risk assessment scale, for predicting pressure sore development and, in addition, to present the validity and reliability of this scale. Methods. The risk assessment pressure sore (RAPS) scale, includes 12 variables, five from the re‐modified Norton scale, three from the Braden scale and three from other research results. Five hundred and thirty patients without pressure sores on admission were included in the study and assessed over a maximum period of 12 weeks. Internal consistency was examined by item analysis and equivalence by interrater reliability. To estimate equivalence, 10 pairs of nurses assessed a total of 116 patients. The underlying dimensions of the scale were examined by factor analysis. The predictive validity was examined by determination of sensitivity, specificity and predictive value. Results. Two variables were excluded as a result of low item–item and item–total correlations. The average percentage of agreement and the intraclass correlation between raters were 70% and 0·83, respectively. The factor analysis gave three factors, with a total variance explained of 65·1%. Sensitivity, specificity and predictive value were high among patients at medical and infection wards. Conclusions. The RAPS scale is a reliable scale for predicting pressure sore development. The validity is especially good for patients undergoing treatment in medical wards and wards for infectious diseases. This indicates that the RAPS scale may be useful in clinical practice for these groups of patients. For patients undergoing surgical treatment, further analysis will be performed.
Dealing with uncertainty: parental assessment of pain in their children with profound special needs
Authors: Carter Bernie , McArthur Elizabeth , Cunliffe Mary 
Published: March 2003

Dealing with uncertainty: parental assessment of pain in their children with profound special needsBackground. Despite advances in the assessment and management of children's pain, children with profound special needs are especially vulnerable to poor pain management. Their underpinning condition often severely compromises their ability to express pain through the usual verbal and behavioural routes. The lack of any appropriate framework for assessment results in a suboptimum and inaccurate approach to an important aspect of their care.Purpose. The purpose of the study was to explore the ways in which parents of children with profound special needs assess and manage their children's pain.Methods. Qualitative case study design underpinned the study using guided interviews with the 15 parents/carers (of 12 children aged 5–16 years with profound special needs).Ethical approval. Ethics Committee approval was gained.Findings. A number of themes emerged from the data including learning to live with pain, dealing with uncertainty, expression of pain and making decisions.Conclusions. Parents felt that their child had learned to live with significant levels of chronic and acute pain. Assessment of pain was an uncertain and complex process requiring parents to draw on skills and knowledge developed over a number of years. Parents used different strategies for both the assessment and management of pain based on an intimate knowledge of their child's usual nonpain state. Even with a limited repertoire of behaviours available to them, children were able to express pain. Parents often felt isolated in relation to pain management and under‐used as a resource by health professionals.
Older Swedish women's experiences of living with symptoms related to Parkinson's disease
Authors: Caap‐Ahlgren Marianne , Lena Lannerheim PhD RN  , Ove Dehlin MD PhD  
Published: March 2003

Background.  Approximately 1% of the population over 65 years of age is afflicted with Parkinson's disease (PD). The number of patients with the disease will most probably increase in the future because of the increased longevity of the population. There is no curative therapy for the disease. Aim.  To explore women's experiences of living with symptoms related to PD, and to analyse how the symptoms influence their quality of life. Methods.  A phenomenological‐hermeneutic method, inspired by the philosophy of Ricoeur was used. The study focuses on eight women between 63 and 80 years of age who have been diagnosed with PD for 5–15 years. The women all lived at home, were moderately to severely disabled and cognitively intact. Findings.  In the analysis, four themes emerged: (1) wish for a stable body image; (2) wish to keep traditional female competence; (3) need to feel accepted for the person she is; and (4) perceived stigmatization. All themes showed that trying to adapt to unpredictable fluctuations in physical and psychosocial competence has a great impact on the females' lives. It became clear that fluctuations in competence and not knowing when to expect impaired mobility are connected with frustration and social withdrawal. Conclusion.  The experience of PD from eight disabled female patients has revealed that the disease affects quality of life not only for the person who has it, but also for her family. Thus, it is equally urgent that patients, relatives, nurses and caregivers gain better knowledge and more understanding of PD, so as to ease the impact of the disease on the patient's daily life.
Issues in educating health professionals to meet the diverse needs of patients and other service users from ethnic minority groups
Authors: Chevannes Mel 
Published: March 2003

Aim.  The main aim of the study was to undertake training needs analysis among a multi‐professional group for the purpose of improving care for ethnic minority patients and other service users. Background.  Evidence from the literature identifies that some of the explanations advanced for the failure of health professionals to meet the needs of ethnic minorities include lack of understanding of cultural diversities, racism, racial stereotyping, lack of knowledge, exclusiveness, and ethnocentrism. While these issues have been addressed in different countries, little work has been carried out to examine these from the perspective of health professionals caring for ethnic minorities. This study is therefore an attempt to find out what health professionals know about caring for patients and other service users from minority ethnic groups and their perception of training needs in this area of work. Methods.

A pre‐ and post‐training design phase structured the qualitative approach. A purposive sample of individuals working across five health service organizations located in a multi‐racial city yielded a multi‐professional group of participants. Views of 22 participants were obtained by semi‐structured interviews at a pretraining phase. Training needs of health professionals drew on
Walklin's (1992 ) six stages used to structure data collection, data analysis and delivery of training. The post‐training phase used questionnaires to evaluate immediate learning that based on a 4‐week period of reflection and applied to practice. The questionnaires were complemented by a facilitator‐lead focus group. Results.  The majority of the participants confirmed that no attention was given in their initial education to the health care needs of minority ethnic groups. Instead, participants engaged in self‐initiated learning to improve their knowledge and understanding. The issue of communication was viewed with dissatisfaction and seen as affecting the sufficiency of caring for these patients. All participants rated meeting the needs of ethnic minorities as very important and believed that they had gained a better understanding of the concepts of ethnicity and race and resources available in local communities as a result of the training. They also reported changes in thinking about ethnic minorities and had started to acquire greater confidence to engage with colleagues about different cultural values and practices and the implications of these for caring. While a quarter of the participants had transferred some learning to practice, the majority were not able to bring about any change. This majority response challenged the sustainability of learning about ethnic minorities when training takes place away from the context in which professionals practise. Conclusion.  Training embedded in clinical and nonclinical environment where patients and other service users and professionals interact is offered as a major finding.
The efficacy of acupressure to prevent nausea and vomiting in post‐operative patients
Authors: Ming Jin‐Lain , Kuo Benjamin Ing‐Tiau , Lin Jaung‐Geng , Lin Li‐Chan 
Published: March 2003

Background.  Post‐operative nausea and vomiting is a common complication following general anaesthesia. Traditional Chinese medicine indicates that acupressure therapy may reduce nausea and vomiting in certain ailments. Aim(s) of the study.  The aim of this study was to examine the effect of stimulating two acupressure points on prevention of post‐operative nausea and vomiting. Design and methods.  A randomized block experimental design was used. The Rhodes Index of Nausea, Vomiting and Retching (INVR) questionnaire was used as a tool to measure incidence. To control the motion sickness variable, the subjects who underwent functional endoscopic sinus surgery (FESS) under general anaesthesia were randomly assigned to a finger‐pressing group, a wrist‐band group, and a control group. There were 150 subjects in total with each group consisting of 50 subjects. The acupoints and treatment times were similar in the finger‐pressing group and wrist‐band pressing group, whereas only conversation was employed in the control group. Results.  Significant differences in the incidence of the post‐operative nausea and vomiting were found between the acupressure, wrist‐band, and control groups, with a reduction in the incidence rate of nausea from 73·0% to 43·2% and vomiting incidence rate from 90·5% to 42·9% in the former. The amount of vomitus and the degree of discomfort were, respectively, less and lower in the former group. Conclusion.  In view of the total absence of side‐effects in acupressure, its application is worthy of use. This study confirmed the effectiveness of acupressure in preventing post‐operative nausea and vomiting.
Do Not Resuscitate orders and older patients: findings from an ethnographic study of hospital wards for older people
Authors: Costello John 
Published: March 2003

Background and aim.  This paper reports on the findings from an ethnographic study involving three wards in two hospitals in the Northwest of England and focuses on the controversial issue of Do Not Resuscitate (DNR) orders. The study aimed to explore the way in which terminal care was provided to older patients and examined the way in which DNR orders were a socially constructed part of the practices of both nurses and doctors. Method.  An ethnographic approach was adopted that used participant observation and semi‐structured interviews with nurses and doctors. A purposive sample of 28 qualified nurses and five medical staff were interviewed. The decision‐making process of DNR orders became the focus of the interview questions. Findings.  The findings reveal that DNR decision‐making was largely socially constructed from the interactions of hospital staff. Patients were not asked their preference and were excluded from any decision‐making about Cardiopulmonary Resuscitation (CPR) or DNR orders. Two major findings emerge. First, DNR orders and the non‐use of CPR could be seen as a form of medical beneficence, resulting from the often described paternalistic attitudes of hospital doctors. Second, there was a clear indication that DNR orders and the non‐use of CPR for certain patients was based on improving the quality of patients' lives. Conclusion.  The study raises issues about the quality of care received by frail older patients whom the nurses felt would not survive a futile medical procedure. The conclusion considers the need for hospitals to formulate and implement CPR policies, particularly in the prevailing climate in which patients are encouraged to become active participants in their own health care.