bluuebunny/crossref_metadata_2025_split huggingface dataset:
Why is pain management suboptimal on surgical wards?
Authors: Schafheutle Ellen Ingrid , Cantrill Judith A. , Noyce Peter R. 
Published: March 2003

Why is pain management suboptimal on surgical wards? Background. During a patient’s stay on a surgical ward, nurses hold a great deal of responsibility for pain management, especially when analgesics are prescribed on a PRN (‘as needed’) basis. Despite the availability of effective analgesics and new technologies for drug administration, studies continue to demonstrate suboptimal pain management. Aim of the study. To identify perceived barriers to effective pain management in nursing practice. Methods. The data are drawn from six nurse interviews and a survey of 180 nurses in 14 United Kingdom (UK) hospitals, which built upon detailed observations of nurses on surgical wards. Results. In a question about possible reasons for suboptimal pain management, nurses identified a number of barriers that concerned organizational aspects such as workload and lack of staff, and also legal or institutional constraints. Nurses further stated that analgesic prescribing was sometimes inadequate, or that doctors or the pain team were unavailable to review medication. Further barriers that nurses may be less aware of were identified in a question concerning nurses’ reasons for not asking patients a pain‐related question during drug rounds. Previous observations had shown this to be the predominant time for pain questioning. The most commonly mentioned reasons were that patients were asleep, on epidural or patient controlled analgesia (PCA), or had recently had an analgesic. Nurses’ replies also revealed that they relied considerably on patients’ nonverbal behaviour and used this to assess analgesia requirements. Nurses’ views and judgements regarding pain management were further supported in replies to a number of attitude statements and a question about the aim of administering analgesia. Conclusion. The strength of this work is that it identified two types of potential barriers to effective pain management, recognized and more subconscious ones, and both need to be addressed before introducing systems aimed at improving pain management.
Focus groups as a research method: a critique of some aspects of their use in nursing research
Authors: Webb Christine , Kevern Jennifer 
Published: March 2003

Focus groups as a research method: a critique of some aspects of their use in nursing research Objective. To evaluate and critique reports in the nursing literature in the period 1990–1999 of the use of focus groups as a research method. Methods. The articles were identified by a computerized search of the CINAHL database and subjected to critical review. Findings. The result of the search was that very few articles were found that reported on a specific piece of research using the method. Methodological discussions were more common and these were sometimes at a somewhat superficial level without analysis or critique. The largest category of articles was concerned with service development projects. The research‐based articles were found to be relatively unsophisticated in their use of the method, in particular in relation to data analysis and social interaction within focus groups. Terms such as ‘content analysis’ and ‘grounded theory’ were used in nonrigorous ways and incompatibility between the underlying research approach and implementation of the method was identified in the cases of phenomenology and grounded theory. Whilst selection of the focus group method was often justified in terms of the benefits that participant interaction could yield, this interaction was rarely reported or discussed in the articles. One author proposed a scheme for analysing this type of interaction, and this is recommended to future researchers as a possible framework for interaction analysis. Conclusions. The article concludes by calling for more in‐depth consideration at the research planning stages of the underlying assumptions of methodological approaches that may be used to underpin focus group research and methods to be used to analyse and report the data generated.
Negotiating motherhood: the struggles of teenage mothers
Authors: Hanna Barbara 
Published: March 2003

Negotiating motherhood: the struggles of teenage mothers Aims. This article presents the results of an ethnographic study exploring how teenagers negotiated motherhood. The main aims of the study were to explore how the young women negotiated motherhood and how they constructed their own identities and relationships through teenage parenting. Background. Approximately 10% of all births occur to teenage mothers worldwide. This phenomenon is of concern because teenage mothers are reported to be disadvantaged financially, educationally, and cognitively in both the short and long term. Many teenage mothers find strength and fulfillment in their motherhood role but this does not come without cost to themselves or their children, as many teenagers are considered unsuitable to be parents and do not have adequate support. Design. This interpretive study incorporated ethnographic practices and was guided by feminist principles. After ethical approval from the university, data was collected over a 12‐month period from five homeless Australian sole‐supporting teenage mothers. Methods used included observation, interviews, field notes, journalling, and discussions with key informants. Findings. The five participants described stories of disrupted lives, unhappiness in childhood, turmoil during adolescence and a need to find love and connection in their lives. Analysis of the data revealed four major themes; transforming lives and opportunities for change, accommodating the challenges, tolerating the abandonment of supports and living publicly examined lives. Conclusions. It was concluded that becoming a sole‐supporting mother during the teenage years was a difficult struggle for the young women, because of their youth, their lack of preparation for motherhood and their reliance on welfare supports. In addition, they experienced negative public attitudes directed towards them wherever they went, and this included their visits to community child health centres. Recommendations are made for nurses to take a different approach when working with teenage mothers to help ameliorate the negative impact of poor parenting.
Nonpharmacological methods in relieving children’s postoperative pain: a survey on hospital nurses in Finland
Authors: Pölkki Tarja , Vehviläinen‐Julkunen Katri , Pietilä Anna‐Maija 
Published: March 2003

Nonpharmacological methods in relieving children’s postoperative pain: a survey on hospital nurses in Finland Aim of the study. The aim of this study was to describe nurses’ use of selected nonpharmacological methods in relieving 8–12‐year‐old children’s postoperative pain in hospital. Methods. The convenience sample consisted of 162 nurses working on the paediatric surgical wards in the five Finnish university hospitals. An extensive questionnaire, including a five‐point Likert‐scale, on the nurses’ use of selected nonpharmacological methods and demographic data was used as a method of data collection. The response rate was 99%. Descriptive statistics as well as nonparametric Kruskall–Wallis ANOVA and the chi‐squared test were used as statistical methods. Results. The study indicates that emotional support, helping with daily activities and creating a comfortable environment were reported to be used routinely, whereas the cognitive‐behavioural and physical methods included some less frequently used and less well known strategies. The results also show that attributes, such as the nurses’ age, education, and work experience, the number of children the nurses had, the nurses’ experiences of hospitalization of their children as well as the hospital and the place of work, were significantly related to the use of some nonpharmacological methods. Conclusions. The nurses used versatile nonpharmacological methods in children’s postoperative pain relief, although some defects could be observed. More research is needed on the methods used by nurses to relieve children’s pain in different patient groups and the factors which hinder or promote nurses’ use of pain alleviation methods in the clinical practice.
Mutual relating: developing interpersonal relationships in the community
Authors: McCann Terence V. , Baker Helen 
Published: March 2003

Mutual relating: developing interpersonal relationships in the community Aim of the paper. This paper, which is part of a larger study that examined how community mental health nurses promoted wellness with young adult who were experiencing an early episode of psychotic illness, aims to explicate how nurses develop interpersonal relationships with these consumers. Rationale. Research into the development of interpersonal skills is important because they are an essential foundation to the promotion of wellness in psychotic illness. Design/methods. The study used Strauss and Corbin’s approach to grounded theory methodology. Concurrent data collection and analysis was undertaken incorporating interviews and observations. The study took place in the community, in rural and regional New South Wales, Australia, and involved consumers, significant others, and community mental health nurses. Results. The findings show that several strategies are associated with mutual relating. Attempting to understand necessitates nurses trying to see it from insiders’ points of view, while acknowledging that they can never completely understand their illness experience. Being friendly indicates that the qualities of a friendly relationship should be implicit in a professional friendship. Tuning in involves taking account of and adjusting to consumers’ ways of dressing, communicating, and the types of approaches that consumers prefer. Revealing oneself is a process that helps put both consumers and nurses at ease, and helps dispel the perception consumers take part in a one‐sided relationship. Being there for them, is a particular type of obligation that entails nurses being accountable for the care they provide, being a spokesperson for consumers, if required, and avoiding collusion with others. Related to avoiding collusion, is the issue of maintaining confidentiality, particularly within the context of interacting with significant others. Conclusion. The results of the study have implications for the way nurses develop and maintain interpersonal relationships with consumers, and this is affected by nurses’ personal and professional attributes.
Adherence to self‐care and glycaemic control among people with insulin‐dependent diabetes mellitus
Authors: Toljamo Maisa , Hentinen Maija 
Published: March 2003

Adherence to self‐care and glycaemic control among people with insulin‐dependent diabetes mellitus Aim of the study.  Factors associated with adherence to self‐care and glycaemic control were studied in 213 people with insulin‐dependent diabetes mellitus using a self‐report questionnaire and a biochemical indicator (glycosylated haemoglobin). Methods.  The data were collected in the Oulu Health Center and the Central Hospital of Lapland in Northern Finland. The response rate was 76%. In order to verify the reliability and validity of the instruments, we used correlation coefficients, factor analysis and item‐total analysis. Internal consistency was checked by Cronbach’s α. The connections between self‐care and the background variables were examined by cross‐tabulation. Findings.
The majority of subjects accomplished their insulin treatment as scheduled, but had more difficulties with the other aspects of self‐care. According to the findings, a fifth (19%) of the respondents were neglecting their self‐care. The others undertook flexible (46%), regimen‐adherent (16%) or self‐planned self‐care (19%). The subjects who were adherent to self‐care had better metabolic control than those who neglected self‐care. According to logistic regression analysis, poor metabolic control (P=0·003), smoking (P=0·009) and living alone (P=0·014) were associated with neglect of self‐care. Gender, concurrent diseases and complications as a result of diabetes increased the risk, but had no significant association with adherence to or neglect of self‐care. Conclusion.  The findings demonstrated that adherence to self‐care does not always lead to good metabolic control, but neglect of self‐care is likely to lead to poor metabolic control.
Health education, behavioural change and social psychology: nursing’s contribution to health promotion?
Authors: Whitehead Dean 
Published: March 2003

Health education, behavioural change and social psychology: nursing’s contribution to health promotion? Aims.  To critically review the complex processes that underpin the modification of a client’s health‐related behaviour. This paper also seeks to contextualize the operational differences between health‐educating and health‐promoting activities – as a means of rationalizing current practice. Background.  In ‘health promotional’ encounters, there is a plethora of evidence that suggests that nurses work predominantly within a ‘traditional’ preventative framework of practice. The prevalence of a culturally inherent biomedical framework, governing most nursing practice, tends to reduce health‐related client interventions to little more than one‐off, reductionist information‐giving exercises. The expectation on clients to respond to and subsequently modify their health behaviour, when presented with such information, is unrealistic in most cases. Nurses are often unaware of the extremely complex human phenomena associated with modifying health‐related behaviours and the resultant change processes. In nursing‐related health encounters, the planned or unplanned intervention and the subsequent outcomes are mostly viewed within a too simplistic and superficial context. Design.  A selective review of the relevant literature. Conclusion.  Where many nurses believe themselves to be health promotionalists, the likelihood is that they are instead more likely to be traditional health educationalists. Not that this is the main problem, in itself – but if nursing is to progress on this issue, it must first become more effective in delivering its current health education initiatives. Armed with further knowledge and understanding of their practices, health educators are far more likely to achieve a degree of success in their behavioural‐change encounters as well as approach the intervention with a far more realistic expectation of outcome. Without this further understanding, it is argued that the integration of health educational initiatives into nursing practice will generally do little or nothing to change the health status of clients.
A study of practising nurses’ perceptions and experiences of intimacy within the nurse–patient relationship
Authors: Williams Angela 
Published: March 2003

A study of practising nurses’ perceptions and experiences of intimacy within the nurse–patient relationship Aim. This study investigated the perceptions and experiences of intimacy within the nurse–patient relationship. Background. Intimacy is an increasingly recognized nursing concept, which is intrinsically related to the therapeutic potential of nursing. However, the nature of intimacy as practised in nursing remains largely unexplored. A qualitative design was used and a purposive sample of 10 nurses was involved. Data were collected by means of semistructured interviews and diaries. Findings. Content analysis of the data yielded five categories relating to the nature of intimacy, involvement, resources, affinity for the patient and the rejection of intimacy. This paper focuses on the first of these categories. Intimacy emerged as a complex concept and included the subcategories of disclosure, levels of disclosure, sharing personal experiences, patient dependency and vulnerability, instrumental touch and intimacy and intimacy as an inappropriate term for the nurse–patient relationship. These findings are discussed in the light of existing theories and recommendations made for further research to expand and develop the issues highlighted. Conclusions. The paper concludes by highlighting the complexity of the concept and identifies some of the constraints to intimacy in practice such as insufficient resources, the health care system and role changes.
Women’s narratives during the acute phase of their myocardial infarction
Authors: Svedlund Marianne , Danielson Ella , Norberg Astrid 
Published: March 2003

Women’s narratives during the acute phase of their myocardial infarction Aim. The purpose of this study was to illuminate the meaning of lived experiences during the acute phase of an acute myocardial infarction (AMI). Method. Ten women (< 60 years old) afflicted with AMI narrated their experiences during their stay in the coronary care unit (CCU). The interview texts were interpreted using a method with a phenomenological hermeneutic approach, inspired by the philosophy of Ricoeur. The text was divided into meaning units that were condensed and abstracted. Three themes were then extracted from the text. Findings. One theme was ‘oneself as vulnerable’ with the subthemes: ‘the feeling of being dependent upon others’, ‘the feeling of being insulted’ and ‘the feeling of being a troublesome person’. Another theme was ‘oneself as distanced’, with the subthemes: ‘not facing the reality’, ‘captive in an unreal situation’, and ‘inhibition out of concern for others’. The last theme was: ‘oneself as making sense’ with the subthemes: ‘acquirement of some insight’ and ‘discovery of a new meaning with life’. Conclusion. The reported comprehensive understanding revealed the phenomena guilt and shame. These, in combination with the experience of being in an unreal situation and the withholding of feelings may have led to a deterioration of communication. It seems that relatives and the staff at CCU were not allowed to share the burden of being afflicted with an AMI.
Improvements in the quality of co‐ordination of nursing care following implementation of the Resident Assessment Instrument in Dutch nursing homes
Authors: Achterberg Wilco P. , Holtkamp Chantal C. M. , Kerkstra Ada , Pot Anne Margriet , Ooms Marcel E. , Ribbe Miel W. 
Published: March 2003

Improvements in the quality of co‐ordination of nursing care following implementation of the Resident Assessment Instrument in Dutch nursing homes Aim. To study the effect of implementation of the Resident Assessment Instrument (RAI) on the quality of co‐ordination of nursing care in Dutch nursing homes. Background. The Resident Assessment Instrument (RAI) was designed to improve the quality of care and quality of life in nursing homes. Until now, only noncontrolled studies on the effects of implementation of the RAI have been carried out. Design/methods. Quasi‐experimental; intervention wards with RAI compared with wards with no intervention. We used the co‐ordination of nursing care instrument, which includes measures for case history, care plan, end of shift report, communication, patient allocation and patient report. The scores on these scales represent the quality of nursing procedures on a ward. The measurements were done 1 month before and 8 months after RAI‐implementation in 18 wards in 10 nursing homes in the Netherlands. Results. Out of 348 somatic patients on the participating wards who met the inclusion criteria and signed an informed consent, 278 could be measured at the first and 218 at the second data collection. 175 residents could participate twice. We used a meta‐analysis technique to study the mean differences between eight couples of RAI/control wards before and after the intervention. The mean difference scores showed significant positive improvement in the RAI group for case history, there were minor (not statistically significant) improvements for all other scores and the total score. These results are encouraging especially in light of the fact that RAI‐implementation in all the experimental wards did not proceed according to plan, owing to staffing and software problems. Conclusions. We conclude that the RAI has the potential to improve the quality of co‐ordination of care in nursing homes.
Planning strategies for the avoidance of pitfalls in intervention research
Authors: Pruitt Rosanne H. , Privette Arlene B. 
Published: March 2003

Planning strategies for the avoidance of pitfalls in intervention research Background. With the exception of large clinical trials, few studies in nursing and other social sciences test interventions. The discipline of nursing needs to maintain a full range of research designs for continued knowledge development. Intervention research presents unique opportunities and challenges for the novice as well as the seasoned researcher. Some of these methodological challenges include the complex nature of human subjects and interventions, including many factors that interfere with the study variables. Preliminary studies often reveal challenges that may not always be predicted or reflected in research texts. These challenges may be as important as the study results for success in future research efforts. Purpose. Difficulties encountered in intervention research and suggested strategies for maintaining the integrity of the study are addressed. These challenges include maintaining an adequate sample size, intervention demands, measuring variables, timing issues, and experiencing unexpected events. Findings and conclusions. Strategies presented include the importance of extensive planning, minimizing subject expectations and rewarding efforts, attention to control group members, incorporating retention strategies, expanding knowledge of variables and the study population, preliminary studies as well as anticipating unexpected events. The need for enhanced communication among nurse researchers, educators and clinicians is addressed. In the current health care arena, nurse researchers must understand organizational dynamics and marketing strategies. Collaborative research efforts can increase the visibility of nursing research as well as funding opportunities.
Adaptation of an instrument to measure the informational needs of men with prostate cancer
Authors: Templeton Hazel R.M. , Coates  
Published: March 2003

Adaptation of an instrument to measure the informational needs of men with prostate cancer Aim of the study. The aim of this study is to adapt an instrument suitable for assessment of the informational needs of men with prostate cancer. Background. In recent years prostate cancer has become an important public health problem world‐wide with considerable social and economic consequences. It is reported that it is the most common cancer affecting British men, with an average lifetime risk of occurrence of one in twelve. Design/methods. Methodological research was conducted to develop an instrument to assess the informational needs of men with prostate cancer on hormonal manipulation therapy (HMT) regarding their disease and treatment. The Toronto Informational Needs Questionnaire (TINQ‐BC) (Galloway et al. 1997) was modified for use with this client group and was applied to a sample of 90 men generated from three urology centres in Northern Ireland. Results/findings. Construct and content validity of the instrument was established. Internal consistency reliability using Cronbach’s α was calculated and found to be satisfactory (0·92). Using confirmatory factor analysis, factor loadings ranging from 0·37 to 0·90 were obtained and considered satisfactory. The subsections of the TINQ‐BC categorized as Disease, Investigative tests, Treatment, Psychosocial and Physical needs were confirmed as individual factors. These results indicate that this instrument can be validly applied to this client group. As the instrument was initially developed in Canada and successfully used in the United Kingdom (UK), it is suggested that this instrument also has the potential for cross‐cultural application. It has the potential to be used as a clinical reference instrument to assess the informational needs of this patient group. Health care professionals must be aware of the domains of information that these men perceive important so that educational interventions can be accurately and appropriately planned.