bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tracheal suctioning: an exploration of nurses' knowledge and competence in acute and high dependency ward areas
Authors: Day Tina , Farnell Sarah , Haynes Sheila , Wainwright Steven , Wilson‐Barnett Jenifer 
Published: March 2003

Background and rationale.  With an increasing demand for intensive care beds more nurses in acute and high dependency wards will be expected to care competently for patients with tracheostomy tubes. Tracheal suctioning is an essential aspect of effective airway management. However, this has many associated risks and complications, ranging from trauma and hypoxaemia to, in extreme cases, cardiac arrest and death. It is imperative that nurses are aware of these risks and are able to practice according to current research recommendations. Aims.  This study was designed to explore nurses' knowledge and competence in performing tracheal suctioning in acute and high dependency ward areas and to investigate discrepancies between knowledge and practice using method triangulation. Methods.  Twenty‐eight nurses were observed using nonparticipant observation and a structured observation schedule. Each subject was interviewed and questioned about their tracheal suctioning practices, and subsequently completed a knowledge‐based questionnaire. Scores were allocated for knowledge and practice. Findings.  The findings demonstrated a poor level of knowledge for many subjects. This was also reflected in practice, as suctioning was performed against many of the research recommendations. Many nurses were unaware of recommended practice and a number demonstrated potentially unsafe practice. In addition, there was no significant relationship between knowledge and practice. However, during the interviews, many nurses were able to provide a rationale for specific aspects of practice that were perhaps not based on current research recommendations. Conclusions.  The study raised concern about all aspects of tracheal suctioning and has highlighted the need for changes in practice, clinical guidelines and focused practice‐based education.
Patient‐controlled analgesia: what information does the patient want?
Authors: Chumbley Gillian M. , Hall George M. , Salmon Peter 
Published: March 2003

Aims of the study.  To formulate and evaluate an information leaflet for patients using patient‐controlled analgesia (PCA), incorporating information thought to be important by patients. Rationale.  The benefit of current information leaflets, written by professionals, has not been studied and their value to patients is unknown. Background.  Previous studies have shown that information leaflets were poorly designed and written in language too difficult for patients to understand. Research methods.  Seven focus groups were conducted to establish what information patients wanted to know about PCA. This information was incorporated into a new information leaflet. One hundred patients were randomized to receive either the new leaflet or the old leaflet in current use. A questionnaire was used to establish whether the new leaflet was more clear and informative than the old one. Results.  Patients wanted to know that the drug used in PCA was morphine. They wanted more information about side‐effects, needed to be reassured that it was safe, and that they could not overdose or become addicted. They wanted detailed instructions and diagrams about the technique. The questionnaire study established that the new leaflet was clearer and more informative. Conclusion.  Patients' contribution led to major change, producing a leaflet which was clearer, more attractive, more informative and which proved more satisfactory to patients.
Partnership: an analysis of the concept within the nurse–client relationship
Authors: Gallant Mae H. , Beaulieu Marcia C. , Carnevale Franco A. 
Published: March 2003

Background/Rationale. Current nursing literature that describes the nurse–client relationship as a partnership provides little clarity about the elements and processes of this partnership. This is hardly surprising as conceptual definitions of partnership differ in scope and vary according to the context of the partnership and types of partners.Aims of the paper. This paper examines the concept of partnership using Rodgers's (2000) evolutionary approach to concept analysis. The paper describes the antecedents, attributes and consequences of partnership as well as changing socio‐political and economic contexts that illuminate how and why nurse–client partnership emerged. Temporal changes in the concept of partnership are also examined.Findings. The nurse–client relationship as partnership evolved from a growth in democratic thinking and progress in clarifying how to honour basic human rights in health care relationships. The attributes of partnership include structural and process phenomena. The structure of partnership includes the phases of the relationship, focus and aims of each phase, and roles and responsibilities of the partners. The process of partnership embodies power sharing and negotiation. The main consequence of partnership is client empowerment, which is understood to be the improved ability of the client to act on his/her own behalf.Conclusions. The paper concludes with suggestions for further development of the concept of partnership through empirical research.
Patients' experiences of illness, operation and outcome with reference to gastro‐oesophageal reflux disease
Authors: Nilsson Gunilla , Larsson Sylvia , Johnsson Folke , Saveman Britt‐Inger 
Published: March 2003

Background.  Describing the illness‐story from a patient perspective could increase understanding of living with a chronic disease for health professionals and others, facilitate decision‐making about treatment and enhance information about the outcome from a patient perspective. Aim.  To illuminate patients' illness experiences of having a gastro‐oesophageal reflux disease (GORD), going through surgery and the outcome. Methods.  Twelve patients were interviewed 5 years after having had the operation; six patients had had fundoplication via laparoscopy and six via open surgery. Each patient was asked to talk openly about their experiences, thoughts, feelings and consequences of living with the illness, going through surgery and the period from surgery to the day of interview. A qualitative content analysis was performed concerning the context of the data and its meaning. Findings.
Three central categories were identified and nine subcategories: living with GORD– symptoms of the disease affecting daily living, taking medicines, work, family and social life; concerns related to surgery– decision‐making about the operation, influence by physicians; life after the operation– outcomes and consequences, side‐effects and complications of the operation, sick leave, information and sharing experiences with future patients. All patients were free from symptoms of the illness after surgery independent of type of surgery, but side‐effects from surgical treatment varied individually. Interviewees would have liked information concerning side‐effects after surgery from previous patients. Conclusions.  This study contributes to knowledge about patients' long‐term suffering, their control of symptoms and how they have tried to cure themselves, but also about their concerns about surgery and the importance of surgical treatment to their quality of life. They wanted information about treatment, outcome and consequences, not only from a health care perspective but also from previous patients having had the same treatment.
The meaning of models of nursing to practising nurses
Authors: Wimpenny Peter 
Published: March 2003

Background.It is contended that models of nursing have lost the momentum and challenge that they promised the profession. Their use, value and purpose have been seriously questioned and new perspectives on their use and implementation in practice, education and research are required. In addition, limited evidence exists on the implementation of models into clinical areas.Aim.To explore the meaning of models of nursing to practising nurses.Methods.Serial interviews with qualified nurses who were undertaking an educational programme or module that explored and examined models of nursing.Findings.The outcome reveals that the use of the terms, models of nursing or nursing model, are limited and confusing as the terms can encompass a range of meanings. It is suggested that a three‐model typology exists that clarifies more fully the present position of nursing models. The three models are Theoretical Model, Mental Model and Surrogate Model.Limitations.The focus on data collection through serial interviews with qualified practitioners could have been broadened to include a range of data sources such as teachers and clinical areas, which could have enriched the phenomenon of models of nursing.Conclusions.There is a greater need to understand nursing models within the framework of the three‐model typology and to reconsider their introduction and use in this context.
Governing the conduct of conduct: are restraints inevitable?
Authors: Irving Kate 
Published: March 2003

Background.  The purpose of this article is to provide an interpretation of how restraint use is maintained and legitimized despite negative reports on its efficacy and questions about its ethicality. My research examined the use of restraint on a patient requiring care in an acute teaching hospital in Australia. This article examines one case study that was part of a PhD research project. The literature reveals evidence of the harm that restraints cause, as well as their ineffectiveness as a safety measure. In addition, it indicates that the prevalence of restraint use is high. Methods.  The study is framed by a Foucauldian approach to discourse analysis. This report is an in‐depth case study including observations of the patient, interviews with members of the multidisciplinary team and analysis of medical, physiotherapy and nursing notation. Findings.  Discourses from the health care team are identified by which restraint use is justified, and legitimized by staff. An important discursive practice is ‘constituting the patient's inability to self govern' and their resulting marginalization from the services provided by the team. Limitations.  There are certain philosophical limitations including classical arguments about the position of postmodernism and specifically the ideas of Michel Foucault as opposed to other philosophy's ability to make sense of a phenomenon. The study was carried out in Australia and thus the discursive practices may be dissimilar in other countries. Conclusions.  Through these discursive practices we can understand how staff maintain a monopoly over the truth and perpetuate claims about the inevitability of restraint use.
Systematic review of patient handling activities starting in lying, sitting and standing positions
Authors: Hignett Sue 
Published: March 2003

Background. Over the last 20 years a number of methods have been recommended in professional guidelines for moving patients. This review was undertaken as it was recognized that there was a need for clinical work involving handling patients (systems of work and equipment) to be based on scientific evidence. Aims. The aim of this paper is to report the methodology, search strategy and results relating to work involving the care, treatment and transfer of patients starting in lying, sitting and standing positions. Methods. An unusual philosophical stance has been taken by appraising studies within a study type rather than comparatively. This facilitated the inclusion of a wide range of study designs (quantitative and qualitative). A string search was run on eight databases and supplemented by other search strategies. A published checklist was selected and inter‐rater reliability established before the main review commenced. A systematic process for inclusion, exclusion, appraisal, extraction and synthesis was undertaken. Results. Thirty‐two studies were included: nine for activities with the patient starting in a lying position and 23 for the sitting position. No studies were found with respect to patient handling activities starting in a standing position. These data were synthesized into evidence statements. Conclusions. The evidence statements support the use of hoists (for nonweight bearing patients), standaids, sliding sheets (double thickness rollers), lateral transfer boards, walking belts and adjustable height beds and baths. It is suggested that these items should constitute a minimum equipment list for any clinical environment where patient handling takes place on a regular basis. The lack of research relating to patient handling in standing is of particular concern and it is recommended that this area should be a high research priority to address concerns about patient handling in rehabilitation activities.
Long‐term consequences of changes in territory quality on feeding and reproductive strategies of vervet monkeys
Authors: LEE  , HAUSER  
Published: March 2003

1.  Food availability and quality are important determinants of mammalian reproductive success, and long‐term changes in food availability were assessed for their impact on diets and reproduction of three adjacent groups of vervet monkeys in Amboseli, Kenya in two periods spanning an interval of 9 years. 2.  Diets were largely restricted to the products of two species of acacia trees (Acacia xanthophloea and Acacia tortilis), with food selection primarily determined by availability (tree density, size and seasonal production of foods). 3.  Over this period the overall abundance of major foods, measured through absolute species density, declined while territory size increased. 4.  Despite significant changes in food plant densities, diets remained relatively stable, suggesting a component of consistency in diet choice. Limited options or high costs for incorporation of novel foods are suggested as factors maintaining this stability, with deleterious consequences in the face of very long‐term habitat changes. 5.  This study suggests that the habitat deterioration, assessed by reduction in food densities, initiated local group extinction. An increased energy expenditure in foraging, high mortality and low reproductive rates ultimately led to a population crash under conditions of reduced food availability.
Population size dependence, competitive coexistence and habitat destruction
Authors: HUXEL GARY R. , HASTINGS ALAN 
Published: March 2003

1.  Spatial dynamics can lead to coexistence of competing species even with strong asymmetric competition under the assumption that the inferior competitor is a better colonizer given equal rates of extinction. Patterns of habitat fragmentation may alter competitive coexistence under this assumption. 2.  Numerical models were developed to test for the previously ignored effect of population size on competitive exclusion and on extinction rates for coexistence of competing species. These models neglect spatial arrangement. 3.  Cellular automata were developed to test the effect of population size on competitive coexistence of two species, given that the inferior competitor is a better colonizer. The cellular automata in the present study were stochastic in that they were based upon colonization and extinction probabilities rather than deterministic rules. 4.  The effect of population size on competitive exclusion at the local scale was found to have little consequence for the coexistence of competitors at the metapopulation (or landscape) scale. In contrast, population size effects on extinction at the local scale led to much reduced landscape scale coexistence compared to simulations not including localized population size effects on extinction, especially in the cellular automata models. Spatially explicit dynamics of the cellular automata vs. deterministic rates of the numerical model resulted in decreased survival of both species. One important finding is that superior competitors that are widespread can become extinct before less common inferior competitors because of limited colonization. 5.  These results suggest that population size–extinction relationships may play a large role in competitive coexistence. These results and differences are used in a model structure to help reconcile previous spatially explicit studies which provided apparently different results concerning coexistence of competing species.
Biases in the estimation of the demographic parameters of a snowshoe hare population
Authors: Haydon Daniel. T. , Gillis Elizabeth. A. , Stefan Carol. I. , Krebs Charles. J. 
Published: March 2003

1. Survival rates and natalities for a population of snowshoe hares in the Yukon were estimated independently of and simultaneously with estimates of population change during the increase phase of a hare cycle. 2. Simple demographic models are used to show that even though the estimated survival rates and natalities were high relative to previously published estimates, the observed demographic parameters are unable to explain the extent of population increase, and we conclude that some of these parameters must be underestimates. 3. A sensitivity analysis is used to examine the potential influence of changes in these demographic parameters on the population growth rate. During most years of the hare cycle the population growth rate is potentially most sensitive to changes in juvenile postweaning survival. Only during crash years is adult survivorship likely to be a more important determinant of the rate of population change. 4. Examination of previously published data sets on two full population cycles suggests that while survival rates are positively correlated with population growth rates, their incorporation into demographic models results in frequent underestimation of the rate of population increase.
Predation, group size and mortality in a cooperative mongoose, Suricata suricatta
Authors: Clutton‐Brock T. H. , Gaynor D. , McIlrath G. M. , Maccoll A. D. C. , Kansky R. , Chadwick P. , Manser M. , Skinner J. D. , Brotherton P. N. M. 
Published: March 2003

1. In social mammals where group members cooperate to detect predators and raise young, members of small groups commonly show higher mortality or lower breeding success than members of large ones. It is generally assumed that this is because large group size allows individuals to detect or repel predators more effectively but other benefits of group size may also be involved, including reduced costs of raising young and more effective competition for resources with neighbouring groups. 2. To investigate the extent to which predation rate affects survival, we compared mortality rates in two populations of suricates (Suricata suricatta), one living in an area of high predator density (Kalahari Gemsbok Park) and one living in an area of relatively low predator density (neighbouring ranchland). Most aspects of feeding ecology and growth (including time spent feeding, daily weight gain, growth, adult body weight, breeding frequency and neonatal mortality) were similar in the two populations. In contrast, mortality of animals over 3 months old was 1·7 times higher in the Park than on ranchland. 3. Mortality of juveniles between emergence from the natal burrow and 6 months of age was higher in small groups than large ones in the Park but significantly lower in small groups than large ones on ranchland. Adult mortality declined in larger groups in both areas. 4. The tendency for survival to be low in small groups had far‐reaching consequences for the risk of group extinction. During a year of low rainfall in the Park, all groups of less than nine animals became extinct and population density declined to around a third of its initial level. We argue that high group extinction rates are to be expected in species where survival declines in small groups and mortality rates are high.
The structure of a leafminer–parasitoid community
Authors: Rott A.S. , Godfray H.C.J. 
Published: March 2003

Summary 1. Quantitative food webs were constructed describing the community of leafmining moths in the genus Phyllonorycter (Gracillariidae) and their parasitoids at a site in southern England. 2. Twelve species of Phyllonorycter were reared from four species of tree. The moths were attacked by 27 species of hymenopterous parasitoids. 3. Four webs were constructed for successive moth generations over 2 years. A summary web was built and a comparison made between webs expressed in terms of number of mines and number of females recruiting to the next generation. 4. All hosts and most parasitoids were recorded in the first year, but new host–parasitoid associations were discovered throughout the sampling period. The diversity of mines and parasitoids was similar across generations. 5. The structure of the parasitoid community was strongly influenced by the host plant. 6. The extent of potential indirect interactions between hosts was assessed by constructing quantitative parasitoid overlap diagrams. The measure of influence used was the importance of one species as a source of parasitoids attacking the other. The greatest potential for apparent competition was between species of host attacking the same species of plant.
The spatio‐temporal distribution of Mycobacterium bovis (bovine tuberculosis) infection in a high‐density badger population
Authors: Delahay R. J. , Langton S. , Smith G. C. , Clifton‐Hadley R. S. , Cheeseman C. L. 
Published: March 2003

Summary 1. The European badger (Meles meles) is implicated as a reservoir of Mycobacterium bovis (bovine TB) infection for cattle in Britain and Ireland. In the present study the spatio‐temporal distribution of M. bovis infection was investigated. Analyses were carried out on data from a long‐term epidemiological and ecological study of the dynamics of bovine TB in a wild population of badgers at Woodchester Park in south‐west England. 2. During the 15 years of the capture–mark–recapture study (1982–96), 3316 trapping and post‐mortem records were obtained from 1270 individual badgers. Annual prevalence of infection based on positive serological and bacterial tests varies between 10·3% and 17·7% of the population. 3. Infection was aggregated in social groups in the west of the study area, confirming the findings of previous studies. However, temporal trends in disease were not synchronized amongst neighbouring groups, suggesting low rates of disease transfer between them. 4. There was significant serial correlation in the disease status within groups over time, suggesting that infection persists for many years in some social groups. The presence of infectious adult female badgers in groups was associated with new infections, and provides further evidence for their importance in the maintenance of infection within groups. However, no statistically significant correlations were detected between the demographic characteristics of social groups and group infection status. 5. The distribution of disease reflects stable persistent foci of infection in the badger population, with limited evidence of transfer between social groups. The accurate identification of stable foci of infection would allow a range of management strategies for the control of bovine TB to be efficiently targeted in such populations. However, the extent to which this pattern of infection is representative of low‐density and disturbed badger populations is unknown.