bluuebunny/crossref_metadata_2025_split huggingface dataset:
The feasibility of a nurse practitioner‐led primary health care clinic in a school setting: a community needs analysis
Authors: Clendon Jill , White Gillian 
Published: March 2003

The feasibility of a nurse practitioner‐led primary health care clinic in a school setting: a community needs analysis Aim. The aim of this New Zealand study was to determine the feasibility of establishing a nurse practitioner‐led, family focused, primary health care clinic within a primary school environment as a means of addressing the health needs of children and families. A secondary aim was to ascertain whether public health nurses (PHNs) were the most appropriate nurses to lead such a clinic. Method. Utilizing a community needs analysis method, data were collected from three sources – known demographic data, 17 key informant interviews and two focus group interviews. Questions were asked regarding the health needs of the community, the perceptions of participants regarding the role of the PHN, and the practicalities of establishing a clinic including the services participants would expect a clinic to provide. Analysis was exploratory and descriptive. Results. Findings included the identification of a wide range of health issues. These included asthma management and control issues, the need to address poor parenting, and specific problems of the refugee and migrant population. Findings also demonstrated that participant understanding of the role of the PHN was less than anticipated and that community expectations were such that for a PHN to lead a primary health care clinic it would be likely that further skills would be required. Outcomes from investigating the practicalities of establishing a nurse practitioner‐led clinic resulted in the preparation of a community‐developed plan that would serve to address the health needs of children and families in the area the study was undertaken. Services that participants identified as being appropriate included health information, health education, health assessment and referral. Conclusion. Overall findings indicated that the establishment of a nurse practitioner‐led, family focused, primary health care clinic in a primary school environment was feasible. While a PHN may fulfil the role of the nurse practitioner, it was established that preparation to an advanced level of practice would be required.
How do we facilitate carers’ involvement in decision making?
Authors: Walker Esther , Jane Dewar Belinda 
Published: March 2003

How do we facilitate carers’ involvement in decision making? Background. Government health care policy urges service providers to involve service users in the decision‐making process. Research studies have recommended changes to current health care practice to facilitate this involvement. However, carers’ organizations continue to highlight a gap between policy and practice in relation to involvement. Aim. The aim of the study reported on in this paper was to investigate involvement in a specific health care context with a view to identifying both opportunities for change and practical, realistic ways of bringing about that change. This was a qualitative case study using a case study design. The field site selected was a respite and assessment (23 bedded) ward within the Psychiatric Unit of a hospital specializing in the care of older people. Informal carers (n=20) and members of the multidisciplinary team (n=29) were interviewed about their views and experiences. The interviews were audiorecorded and transcribed. Family meetings, multidisciplinary team meetings and ward routines were the focus of non‐participant observation. Field notes from these observations, together with the interview data were analysed using constant comparative method. Results and Conclusions. The reported experiences of carers in this study highlighted four markers of satisfactory involvement: feeling that information is shared; feeling included in decision making; feeling that there is someone you can contact when you need to; and feeling that the service is responsive to your needs. The majority of carers felt dissatisfied with the level of involvement. The situation we found echoed that found in other studies, i.e. the majority of informal carers (henceforth ‘carers’) interviewed were dissatisfied with the level of their involvement. However, our investigation, in which the views of health care professionals as well as those of carers were sought, provided invaluable insight into why this might be the case. Two main sources of difficulty were found: hospital systems and processes, and the relationship between nursing staff and carers. The argument made is that practitioners themselves must notice and challenge these barriers if carer involvement is to be facilitated.
Subject positions theory – its application to understanding collaboration (and confrontation) in critical care
Authors: Sundin‐Huard Deborah 
Published: March 2003

Subject positions theory – its application to understanding collaboration (and confrontation) in critical care Background.  Doctors and nurses do not usually take a collaborative approach to the ethical challenges of the critical care environment. This leads to the stresses that produce moral anguish and burnout – both for nursing and medical staff. A more collegial relationship between nurses and physicians should improve patient care. If we are to promote this collegiality, one way to proceed is to investigate the interactions between health care professionals in order to develop an understanding of the barriers to, and supports for collaboration. Aim.  Subject positions theory offers a method of explaining and elucidating the interactions between nurse and physician in terms of power dynamics, mutual expectations and the discourse available to each individual. This paper aims to demonstrate how subject positions theory can facilitate the interpretation of the interactions between health professionals in terms of the power dynamics influencing those interactions. Discussion.  This paper will use the example of a case study from my own research to demonstrate the application of this theory and its usefulness in the analysis of the interactions between health care professionals. Conclusions.  Application of this theory is used to demonstrate the author’s argument that the current political and cultural structure of the health care system does not support the subject position – nurse advocate.
The relationship between support and stress in forensic community mental health nursing
Authors: Coffey Michael , Coleman Mick 
Published: March 2003

The relationship between support and stress in forensic community mental health nursing Aims of the study/paper.  This paper reports the results of a survey of forensic community mental health nurses (FCMHNs) in England and Wales which aimed to ascertain the level of stress and burnout experienced by this group. Background/Rationale.  Several studies have identified that mental health nursing is a stressful activity and the relationship between factors such as age, experience, support, caseload size and perceived stress have been explored. However, until recently, no studies have examined the situation of FCMHNs and this paper extends the analysis of studies completed by the main author, considering issues related to coping abilities and support systems. Design/Methods.
The survey involved respondents completing a demographic questionnaire and a range of standardized validated measures (Maslach Burnout Inventory, General Health Questionnaire and Community Psychiatric Nurse Stress Questionnaire). The population for the study was all identified FCMHNs attached to the 26 National Health Service (NHS) Medium Secure Units in England and Wales (n=104). Results/Findings.
A high response rate of 77% (n=80) was achieved. The results identified that a number of respondents were experiencing burnout. Statistically significant associations were found between caseload size and level of stress. The results also suggest that support from managers and colleagues were an important factor in ameliorating the experience of stress and show that individuals in this study experiencing high levels of stress adopted palliative behaviours such as use of alcohol. Conclusions.  The paper concludes by suggesting that such findings should be considered when delivering stress management programmes and reinforce the potential benefit of effective clinical supervision as a means of staff support.
Power and self‐perceived health in blind diabetic and nondiabetic individuals
Authors: Leksell Janeth K. , Johansson Ingrid , Wibell Lars B. , Wikblad Karin F. 
Published: March 2003

Power and self‐perceived health in blind diabetic and nondiabetic individuals Aims. The aims of this study were: (1) to explore perceptions of power in blind individuals and relate presence or absence of power to self‐perceived health and (2) to compare self‐perceived health in blind individuals with that of the general population. Background. The theoretical framework of this study was Barrett’s Power theory, which is based on The Rogerian nursing theory. Power is defined as being aware of what one is choosing to do, feeling free to doing it, and do it intentionally. Methods. Thirty‐nine blind subjects at three adjacent ophthalmology centres agreed to participate in the study. Of those 23 had become blind because of late complications of diabetes. Power was explored during semi‐structured interviews and self‐perceived health was measured with the Swedish health‐related quality of life questionnaire. Data on socio‐economic, rehabilitative and diabetes‐related variables were also collected. Findings. Power was experienced by 19 of the 39 respondents and was more frequently found in nondiabetic subjects than in diabetic subjects. Those experiencing power reported a better emotional and general health compared with individuals lacking power. The perception of having power was not significantly related to any other of the studied variables. When compared with age‐ and gender‐matched controls from the general population, nondiabetic blind subjects scored higher in positive feelings and lower in physical functioning. In contrast diabetic subjects experienced poorer general health, less satisfaction with physical health and more negative feelings, but they reported that they did not experience limitation as a result of these emotions. Conclusion. One way of improving health in diabetic blind individuals could be to increase the subject’s perception of power.
Patients with congestive heart failure and their conceptions of their sleep situation
Authors: Broström Anders , Strömberg Anna , Dahlström Ulf , Fridlund Bengt 
Published: March 2003

Patients with congestive heart failure and their conceptions of their sleep situation Aim. To describe, from a nursing perspective, how patients with CHF conceived their sleep situation. Background. Sleep disturbances are very common in patients with congestive heart failure (CHF). Polysomnographic studies have shown that the total duration of sleep is shorter and the sleep structure disturbed, with frequent arousals and sleep stage changes. Methods. A qualitative descriptive design inspired by a phenomenographic approach was employed. Conceptions were collected through interviews with 20 strategically chosen CHF patients. Findings. The findings showed that the patients’ sleep was affected by their daily activities, the disease itself and cardiac symptoms. The sleep disturbances gave effects such as fatigue, listlessness, loss of concentration and loss of temper. These effects led to a need for daytime sleep, seclusion, counselling and information. Patients handled their sleep disturbances through coping mechanisms related to developed patterns of daily life and through support from their psychosocial environment. Conclusions. Through an increased awareness of the causes of sleep disturbances in CHF patients, nurses can more effectively meet their caring needs and reduce the psychological stressors that patients develop. Information and education, both to patients and the next of kin, about the disease and the sleep situation, especially good sleeping habits, can help patients to better cope with sleep disturbances.
Changes, challenges and choices for the primary health care workforce: looking to the future
Authors: Jenkins‐Clarke Susan , Carr‐Hill Roy 
Published: March 2003

Changes, challenges and choices for the primary health care workforce: looking to the future Aims. The main aim of this paper is to draw attention to problems facing the primary health care workforce in terms of demand for treatment of minor illness over the next two decades. These predictions have implications for the community nursing workforce in particular and the flexibility of primary health care teams in general. Background. Care delivered in the primary care sector influences, and is influenced by, the characteristics of the health care workforce. These characteristics fall into two main groups: firstly, the shape of the present medical and nursing workforce and manpower trends; and secondly, the changes in doctors’ and nurses’ workloads. Design. This paper draws on two studies, both commissioned by the Department of Health; the first study focusing on skill mix and delegation in primary health care teams and the second addressing the implications of skill mix for medical workforce scenarios in the changing policy environment. Findings. From the first study, general practitioners across ten general practices were prepared to delegate at least one topic from over a third of 836 consultations and a further 17% of entire consultations. This potential delegation fell mainly to practice nurses and nurse practitioners. The second study used data extracted from the National Morbidity Surveys of 1981 and 1991 predicting that minor consultations are set to increase by 11 million from the 1990s to 2020 – a minimal estimate. The authors argue that many of these extra predicted consultations will find their way onto practice nurses’ and nurse practitioners’ caseloads. Conclusions. Workforce issues and questions of professional roles and boundaries, in the context of the ‘greying’ community nursing workforce, demand solutions if patient/client demand is to be met over the next two decades.
A systems approach to the reduction of medication error on the hospital ward
Authors: Anderson David J. , Webster Craig S. 
Published: March 2003

A systems approach to the reduction of medication error on the hospital ward Aims. To discuss a potentially powerful approach to safer medication administration on the hospital ward, based on principles of safety developed in other high‐risk industries, and consistent with recent national reports on safety in health care released in the United Kingdom (UK) and United States of America (USA). To discuss why punitive approaches to safety on the hospital ward and in the nursing literature do not work. Background. Drug administration error on the hospital ward is an ever‐present problem and its occurrence is too frequent. Administering medication is probably the highest‐risk task a nurse can perform, and accidents can lead to devastating consequences for the patient and for the nurse’s career. Drug errors in nursing are often dealt with by unsystematic, punitive, and ineffective means, with little knowledge of the factors influencing error generation. Typically, individual nurses are simply blamed for their carelessness. By focusing on the individual, the complete set of contributing factors cannot be known. Instead, vain attempts will be made to change human behaviour – one of the most change‐resistant aspects of any system. A punitive, person‐centred approach therefore, severely hampers effective improvements in safety. By contrast, in other high‐risk industries, such as aviation and nuclear power, the systems‐centred approach to error reduction is routine. Conclusions. Accidents or errors are only the tip of the incident iceberg. Through effective, nonpunitive incident reporting, which includes reports of near‐misses and system problems in addition to actual accidents, the systems‐approach allows the complete set of contributing factors underlying an accident to be understood and addressed. Feedback to participants and targeted improvement in the workplace is also important to demonstrate that incident data are being used appropriately, and to maintain high levels of on‐going reporting and enthusiasm for the scheme. Drug administration error is a serious problem, which warrants a well‐reasoned approach to its improvement.
Meeting the needs of consumers in the community: a working partnership in mental health in New Zealand
Authors: Crowe Marie , O'Malley Jane , Gordon Sarah 
Published: March 2003

Meeting the needs of consumers in the community: a working partnership in mental health in New Zealand Aim. The aim was to evaluate whether the services community mental health nurses provide are meeting the needs of consumers in the community. Rationale. The role of the mental health nurse in the community is changing as a result of deinstitutionalization, the consumer movement and the market model of health care delivery. In this context it is important for mental health nurses to evaluate whether the service they are currently providing is meeting the needs of consumers. Design. This was a joint project between nurses and consumers. It was a service‐specific descriptive research project utilizing qualitative methods of data collection and analysis that provides a model for working in partnership. Findings. The results of this research identify collaboration in planning care and sharing information as two areas of concern but generally the consumers were very satisfied with the care provided by community mental health nurses. The analysis of the data suggests that consumers value nursing care because nurses provide support in their own home; they help consumers develop strategies for coping with their illness and their life; they provide practical assistance when it is required; they are vigilant about any deterioration or improvement; and they are available and accessible. Conclusion. The results of this study have demonstrated that nurses will remain critical to the success of community‐based care because of their ability and willingness to be flexible to the demands of their own organization and the users of services.
Nursing students’ perceptions of research: usefulness, implementation and training
Authors: Ax Susanne , Kincade Eddie 
Published: March 2003

Nursing students’ perceptions of research: usefulness, implementation and training Aims. The present study explored students’ perceptions of the usefulness of research for nursing practice; beliefs about difficulties in implementing research on the wards; and finally, their satisfaction with the research training received. Background. Anecdotal reports of nursing students’ dislike of research. Method. Recruiting preregistration students for the present study was the first obstacle, and so the sample size remained small, consisting of 12 students. Semi‐structured interviews were conducted and later transcribed. Results. The findings indicated that resistance, both by students and by qualified nurses, was a recurring issue. Several students disagreed with the training and expressed a need for more practical experience. Conclusions. Overall, the present study suggests that educational and organizational improvements need to be introduced to transform nursing into a research‐active profession.
A concept analysis of malnutrition in the elderly
Authors: Chen Cheryl Chia‐Hui , Schilling Lynne S. , Lyder Courtney H. 
Published: March 2003

A concept analysis of malnutrition in the elderly Purpose. Malnutrition is a frequent and serious problem in the elderly. Today there is no doubt that malnutrition contributes significantly to morbidity and mortality in the elderly. Unfortunately, the concept of malnutrition in the elderly is poorly defined. The purpose of this paper is to clarify the meaning of malnutrition in the elderly and to develop the theoretical underpinnings, thereby facilitating communication regarding the phenomenon and enhancing research efforts. Scope, sources used. Critical review of literature is the approach used to systematically build and develop the theoretical propositions. Conventional search engines such as Medline, PsyINFO, and CINAHL were used. The bibliography of obtained articles was also reviewed and additional articles identified. Key wards used for searching included malnutrition, geriatric nutrition, nutritional status, nutrition assessment, elderly, ageing, and weight loss. Conclusions. The definition of malnutrition in the elderly is defined as following: faulty or inadequate nutritional status; undernourishment characterized by insufficient dietary intake, poor appetite, muscle wasting and weight loss. In the elderly, malnutrition is an ominous sign. Without intervention, it presents as a downward trajectory leading to poor health and decreased quality of life. Malnutrition in the elderly is a multidimensional concept encompassing physical and psychological elements. It is precipitated by loss, dependency, loneliness and chronic illness and potentially impacts morbidity, mortality and quality of life.
Power and partnership: a critical analysis of the surveillance discourses of child health nurses
Authors: Wilson Helen Vivien 
Published: March 2003

Power and partnership: a critical analysis of the surveillance discourses of child health nurses Aims. To explore surveillance discourses within New Zealand child health nursing and to identify whether surveillance practices have implications in this context for power relations. Background. In New Zealand child health nurses are called Plunket nurses, who are employed by a voluntary organization, the Royal New Zealand Plunket Society (RNZPS). These nurses primarily work in the community with the families of new babies and preschool children. Their work is called child health surveillance and this is considered to involve routine and unproblematic practices, which are generally carried out in homes and clinics in the context of an ongoing relationship between the Plunket nurse and the mother of a baby. However, suggestions in the literature that surveillance, wherever it is practised, has implications for power relations cast doubt on official claims that this nurse–mother relationship is mediated through a partnership model of care. Methods. Five experienced and practising Plunket nurses were each interviewed twice. The texts generated by these semi‐structured interviews were analysed using a Foucauldian approach to critical discourse analysis. Results. In contrast with the conventional view of power as held and wielded by one party, this study revealed that, in the Plunket nursing context, power is exercised in various and unexpected ways. Although the relationship between the mother and the nurse cannot be said to operate as a partnership, it is constituted in the nurses’ discourses as a dynamic relationship in which the mother is actively engaged on her own terms. The effect of this is that it is presented by the nurses as a precarious relationship that has significant implications for the success of their work.