bluuebunny/crossref_metadata_2025_split huggingface dataset:
The use of randomized control trials in complementary therapies: exploring the issues
Authors: Richardson Janet 
Published: March 2003

The use of randomized control trials in complementary therapies: exploring the issues The current popularity of complementary therapies presents an interesting challenge to nurses and midwives. If they are to deliver such therapies themselves, or support patients in choosing appropriate therapies they will need to consider the professional and legal issues, in particular those regarding safety. Evidence for the effectiveness for complementary therapies is also a requirement in order that their integration into nursing practice can be justified. Purchasers are currently hampered by the lack of credible evidence for effectiveness and until that evidence is provided, access to such therapies through the National Health Service (NHS) will remain limited. The form that evidence should take has led to a lively debate about possible methodological approaches. There appears to be a clash between the medical profession and those working in the field of complementary therapy research, with the medical establishment advocating randomized control trials (RCTs). This contrasts with the view held by some advocates of complementary therapies that the RCT approach is reductionist and not applicable to such approaches. The pivot of the debate on the methodological approaches for evaluating complementary therapies is the contrast of two apparently different and diverse world‐views, and the assertion that methods developed in one world‐view are not transferable to the other. There is also some confusion within the field of complementary therapy over the applicability of RCTs to therapies such as acupuncture, and the mistaken assumption that trials which include a control group, are also required to be double‐blind. This paper is based on the need for good quality evidence of effectiveness in complementary therapy. It will set out the concerns associated with the use of RCTs within complementary therapy, together with the benefits and limitations of this approach. The paper will go on to review research options and propose some suggestions for future methodological approaches.
A model of burnout and life satisfaction amongst nurses
Authors: Demerouti Evangelia , Bakker Arnold B. , Nachreiner Friedhelm , Schaufeli Wilmar B. 
Published: March 2003

A model of burnout and life satisfaction amongst nurses This study, among 109 German nurses, tested a theoretically derived model of burnout and overall life satisfaction. The model discriminates between two conceptually different categories of working conditions, namely job demands and job resources. It was hypothesized that: (1) job demands, such as demanding contacts with patients and time pressure, are most predictive of exhaustion; (2) job resources, such as (poor) rewards and (lack of) participation in decision making, are most predictive of disengagement from work; and (3) job demands and job resources have an indirect impact on nurses’ life satisfaction, through the experience of burnout (i.e., exhaustion and disengagement). A model including each of these relationships was tested simultaneously with structural equations modelling. Results confirm the strong effects of job demands and job resources on exhaustion and disengagement respectively, and the mediating role of burnout between the working conditions and life satisfaction. These findings contribute to existing knowledge about antecedents and consequences of occupational burnout, and provide guidelines for interventions aimed at preventing or reducing burnout among nurses.
Quality of life in old age described as a sense of well‐being, meaning and value
Authors: Sarvimäki Anneli , Stenbock‐Hult Bettina 
Published: March 2003

Quality of life in old age described as a sense of well‐being, meaning and value The purpose of the study was to present a model of quality of life and related factors, to study quality of life in a group of elderly subjects, and to do preliminary testing of the model. Quality of life was defined as a sense of well‐being, meaning and value. The model includes health, functional capacity, and coping mechanisms as intra‐individual conditions for quality of life, while factors in the biophysical and sociocultural environment are described as external conditions. The study sample consisted of 300 subjects, aged 75 or older and living in Finland. Data were gathered by means of structured personal interviews. The participants’ quality of life was generally quite good. The correlations among the variables related to quality of life were significant, but the results of the regression analyses showed that the individual aspects of quality of life did not have identical explanatory models. The internal consistency of the instruments was good. The results give preliminary support to the model, but in future studies more attention must be paid to the conceptual and theoretical validity. In order to achieve results that can be applied in gerontological nursing practice, different groups and contexts must be investigated.
Care under threat in the modern world
Authors: Peacock John W. , Nolan Peter W. 
Published: March 2003

Care under threat in the modern world Despite enormous progress in the understanding and treatment of disease during the 20th century, the amount of care individuals receive from health professionals is arguably less than in previous decades. Being in the presence of caring people who practised human caring has always been the bedrock of services to individuals who were ill. With the rise of scientific positivism in the mid‐19th century, traditional ways of caring for sick people, not susceptible to scientific investigation and intervention, were either abandoned or discouraged. The spread of outcome‐orientated health services has led to care being redefined as the provision of the finest form of treatment that is financially viable. The spectre of a service in which the human dimension of caring is either prescribed or seen as invalid gives cause for concern. This paper argues for urgent re‐examination of what we understand by ‘care’.
Development and definition of the role of the operating department nurse: a review
Authors: McGarvey Helen E. , Chambers Mary G.A. , Boore Jennifer R.P. 
Published: March 2003

Development and definition of the role of the operating department nurse: a review In the current cost‐conscious National Health Service (NHS), the role of the nurse during anaesthesia and surgery is one that has interested health service managers keen to know what happens behind the closed doors of the operating department. It is clear that if nurses working within this specialized setting are to secure a future in providing care for surgical patients, then it is important to clarify and articulate exactly what it is that their role involves. The aim of this paper is to examine the role of the operating department nurse. First, it will illustrate how the role of the nurse has evolved alongside medical and technical advances in surgery, particularly in the last century. Second, it will highlight that while definition of the role has received attention in the North American literature, references in the British literature as to what it is that operating department nurses do, are scant. Finally, it will address the evolving role of the contemporary perioperative nurse highlighting the changes and challenges that nurses who work within this setting are currently facing. It is suggested here that nurses need to engage in role definition in order to be clear about their direction for the future, particularly within the fast changing, technologically driven environment of the operating department.
Waiting for coronary artery bypass surgery: a qualitative analysis
Authors: Fitzsimons Donna , Parahoo Kader , Stringer Maurice 
Published: March 2003

Waiting for coronary artery bypass surgery: a qualitative analysis Waiting lists for coronary artery bypass surgery (CABS) are common in many developed countries. Yet, there is limited information available regarding patients’ health care needs at this time. This paper reports on a prospective study which aimed to investigate the experience of waiting for CABS from a qualitative perspective. An inductive research approach was used to conduct interviews with 70 randomly selected patients at three intervals over the first year on the waiting list – referral for surgery, again after waiting 6 months (n=49), and finally after waiting for 1 year (n=28). Attrition was mainly caused by surgery having been performed (n=36), although death (n=4) and refusal to participate (n=2) also contributed. Domicilliary interviews were taped and transcribed verbatim. Thematic content analysis identified three central themes in this experience – uncertainty, chest pain and anxiety; with six secondary themes – powerless, dissatisfaction with treatment, anger/frustration, physical incapacity, reduced self‐esteem, and altered family and social relationships. The nature and meaning inherent in each theme is described using interview quotations, and a model is proposed which summarizes this data and the relationship between themes. From this analysis, uncertainty, chest pain and anxiety emerge as important indicators of a negative outcome for these patients. This report strongly suggests that patients awaiting bypass surgery require more information regarding the waiting time for such a surgery. Nurses should also offer advice regarding pain management to help improve patients’ skills and decrease the fear associated with angina. Nursing intervention and support should also be directed at reducing patients’ anxiety levels. This is the first known qualitative study which specifically examines patients’ perception of the waiting period prior to bypass surgery. It may therefore provide new evidence on which to base practice for nurses in both hospital and community, and may also stimulate further research in this area.
The critical incident technique and nursing care quality research
Authors: Kemppainen Jeanne K. 
Published: March 2003

The critical incident technique and nursing care quality research The critical incident technique, is a highly flexible qualitative research method used in solving practical problems. Although this research method has been extensively used in the service industry to evaluate consumers’ expectations and perceptions, applications to the study of health care quality are just beginning. This article describes critical incident methodology, reviews previous applications of the technique to the study of health care quality and provides illustrations from research. This practical research methodology offers the following important advantages to those interested in designing studies of care quality: identifying patients’ experiences in health care settings, exploring dimensions of nurse–patient interactions and identifying patients’ responses to illness and health care treatment.
A case study of nurse management of upper respiratory tract infections in general practice
Authors: Butler Christopher C. , Rees Mags , Kinnersley Paul , Rollnick Steven , Hood Kerenza 
Published: March 2003

A case study of nurse management of upper respiratory tract infections in general practice Background.  Nurses increasingly manage acute illness in United Kingdom (UK) general practice. Few data exist about patients routinely consulting with these nurses. There are concerns that providing this additional service will lower thresholds for consulting with an overall increase in workload. Upper respiratory tract infection (URTI) is the commonest reason for consulting. Inappropriate antibiotics promote resistant bacteria. Nurse management of URTI is an ideal opportunity to promote self‐care and nonantibiotic management. Aims.  To describe the effects of a specially trained practice nurse managing URTI in a general practice in Cardiff, UK. Methods.  Descriptive study. Results.
Data were collected on 132 patients consulting with the nurse. We also collected data on 234 patients consulting general practitioners (GPs) in the same practice. Patients seen by the nurse were younger and less likely to be given antibiotics at the time of their index illness than those who saw GPs (7% vs. 93%; P < 0·001). During the year following the consultation with the nurse, patients consulted slightly less often and received antibiotics for URTI less often compared with the year preceding this consultation (P=0·02). Their consultation rate for all conditions did not change. The consultation rates for URTI of the patients managed by the GPs remained constant and consultations for all conditions increased (P < 0·01). Conclusions.  Nurse management of URTI did not lower patients’ threshold for future consulting, and patients who saw her were prescribed antibiotics less often.
The nature and effect of communication difficulties arising from interactions between district nurses and South Asian patients and their carers
Authors: Gerrish Kate 
Published: March 2003

The nature and effect of communication difficulties arising from interactions between district nurses and South Asian patients and their carers Aim. The overall aim of the study was to examine how policy directives concerning the provision of individualized care were modified in their transformation into practice and the implications this carried for the care provided to patients from different ethnic backgrounds. This paper is concerned with one aspect, namely, examining the nature and effects of communication difficulties between the nurses and South Asian patients and their carers. Methods. An ethnographic approach was used. The study was undertaken in an English community National Health Service (NHS) Trust serving an ethnically diverse population. It comprised two stages. First, an organizational profile of the trust was undertaken in order to analyse the local policy context. Data were collected by means of in‐depth interviews with managers and a review of policy documentation and caseload profiles. Second, a participant observational study was undertaken focusing on six district nursing teams. Purposive sampling was used to identify four teams with high ethnic minority caseloads and two teams with predominately white ethnic majority caseloads. Interview transcripts and fieldnotes were analysed by drawing upon the principles of dimensional analysis. Findings. Over half of South Asian patients had little or no understanding of spoken English with women and older people the least likely to speak English. The limited use of professional interpreters and the concomitant heavy reliance on family members to translate highlighted how ethnic minority patients and carers who were not fluent in English were disadvantaged. The observed language barriers suggested that the content of advice on matters such as compliance with treatment regimes might not be fully understood. Psychological support of patients and carers was severely restricted. Moreover, the fact that follow‐up visits were on occasions made to patients for whom there was no one available to interpret constrained on‐going assessment of patients’ needs. Conclusions. The findings raise concerns regarding the quality of care provided to patients and carers who are nonusers of English and provide evidence of inequalities in service provision. However, not speaking English should not be a barrier to appropriate and effective nursing care. District nurses need to appreciate their responsibility to provide equitable services irrespective of a patient’s linguistic background and seek to overcome the disadvantage experienced by ethnic minority patients.
Symbolic interactionism as a theoretical perspective for multiple method research
Authors: Benzies K. M. , Allen M. N. 
Published: March 2003

Symbolic interactionism as a theoretical perspective for multiple method research Rationale. Qualitative and quantitative research rely on different epistemological assumptions about the nature of knowledge. However, the majority of nurse researchers who use multiple method designs do not address the problem of differing theoretical perspectives. Traditionally, symbolic interactionism has been viewed as one perspective underpinning qualitative research, but it is also the basis for quantitative studies. Rooted in social psychology, symbolic interactionism has a rich intellectual heritage that spans more than a century. Underlying symbolic interactionism is the major assumption that individuals act on the basis of the meaning that things have for them. Aim. The purpose of this paper is to present symbolic interactionism as a theoretical perspective for multiple method designs with the aim of expanding the dialogue about new methodologies. Conclusion. Symbolic interactionism can serve as a theoretical perspective for conceptually clear and soundly implemented multiple method research that will expand the understanding of human health behaviour.
Comparisons of the cost‐effectiveness among hospital chronic care, nursing home placement, home nursing care and family care for severe stroke patients
Authors: Chiu Lian , Shyu Woei‐Cherng , Liu Yu‐Hwa 
Published: March 2003

Comparisons of the cost‐effectiveness among hospital chronic care, nursing home placement, home nursing care and family care for severe stroke patients Aim.  This study compared the cost and effectiveness of long‐term institutional care and home care for stroke patients with severe physical disabilities. Background.  Whether home care is more economical or effective than institutional care for patients with chronic illnesses remains controversial when the cost of family labour is considered. Thus, decisions concerning the appropriate type of care setting for patients with severe chronic illness remain difficult. Methods.  From November 1995 to March 1996, 313 hospitalized stroke patients with severe physical disabilities treated at one of five hospitals in the Taipei metropolitan area were followed from the day of hospital discharge until the third month after discharge. These 313 patients were divided into four groups as follows: (1) 106 who were admitted to a chronic care unit in a hospital, (2) 60 who were admitted to nursing homes, (3) 60 who received professional home nursing care and (4) 87 who returned home without receiving professional care. The change of physical functional status in the patient was examined as the difference between activities of daily living (ADL) scores measured at discharge and at the end of the third month after discharge. Results.  Information on family costs for caregiving, including pay for long‐term services utilized, labour costs for caregiving and out‐of‐pocket expenditures for miscellaneous materials was obtained during a weekly telephone interview. The results indicated that caring for patients in their own homes was not only more expensive but was also less effective in improving ADL scores than caring for patients in nursing homes and in chronic care units of hospitals. Conclusions.  The results suggest that caring for patients with severe physical disabilities in institutions is more appropriate than caring of them at home.
A method to develop a nursing intervention: the contribution of qualitative studies to the process
Authors: Gamel Claudia , Grypdonck Mieke , Hengeveld Michiel , Davis Bryn 
Published: March 2003

A method to develop a nursing intervention: the contribution of qualitative studies to the process Aim of the paper. To describe how to develop a patient‐centred nursing intervention (NI). Background. The stimulus for scrutinizing methods and techniques to develop a NI was a research project concerning the contribution of information and support to the sexual adaptation of women with gynaecological cancer. Within this project, a NI for sexual teaching (ST) was developed because the literature review revealed no tested NI for this purpose. How patients experience and perceive received information influences the usefulness and efficacy of a teaching intervention. Qualitative methods provide insight and understanding of patients’ experience. Consequently, qualitative methods are appropriate to use when developing interventions that aim to influence patients’ situations through the provision of information. Method. Previously reported approaches for developing an intervention did not match the goals and underlying premises identified for the intervention under development. An alternative method, consisting of a design phase and a testing phase, was developed. The goal of the design phase was to develop a working definition of the intervention and to formulate recommendations for carrying out the intervention. Written guidelines provided concrete examples of the topics to discuss and how to discuss them. During the design phase, a qualitative study was conducted to describe the lived‐experience of the phenomenon that the information should influence, namely sexuality after treatment for gynaecological cancer. In the testing phase, a different type of qualitative study took place. The patients’ experience of receiving information and the nurses’ experience of providing it were investigated in order to refine the proposed intervention, to identify the results patients hope to achieve (or achieved) and to explore the underlying theoretical explanation of the intervention. During the testing phase, the feasibility and acceptability of the modified intervention were both established. Conclusion. Even when the starting point is advice from care‐givers, an intervention can be developed that is in harmony with the patient perspective when qualitative studies are part of the process.
Levels of compliance shown by hypertensive patients and their attitude toward their illness
Authors: Lahdenperä Tiina S. , Kyngäs Helvi A. 
Published: March 2003

Levels of compliance shown by hypertensive patients and their attitude toward their illness Aim. The aim of this paper is to describe hypertensive patients' compliance by finding out more specifically what compliance, intention, activity, responsibility and collaboration mean in the treatment of hypertensive patients. A further aim was to clarify their attitudes toward their illness. Rationale. This study is part of a project titled `Patients' self‐motivated control of hypertension. Method. The intervention consists of a multimedia computer program and effective lifestyle counselling. Nine male and 12 female patients from one municipality were included in an intervention programme. Data were collected through thematic interviews and analysed using content analysis. Findings. Four levels of compliance were found: subconscious, cognitive, action and attitudinal level. Patients also had four different ways of feeling about hypertension and its treatment: some were careless, some were serious, some adjusted well and yet others felt frustrated. Conclusion. Health care professionals should recognize each patient's way of complying with his/her treatment and his/her attitude toward the illness. Different patients need different kinds of care and support. In addition health care professionals should also recognize their own attitudes toward hypertension and the patient's position in the health care system.