bluuebunny/crossref_metadata_2025_split huggingface dataset:
Restraint use in elder care: decision making among registered nurses
Authors: Karlsson Stig , Bucht Gösta , Rasmussen Birgit H. , Sandman  
Published: March 2003

•  This study aimed to illuminate nurses’ reasons for using physical restraint in nursing practice, and in addition, to explore the relationship between nurses’ attitudes and decisions regarding physical restraint use.•  To provide data about nurses’ reasoning when deciding whether or not to use restraints, 30 registered nurses working in two nursing homes were asked to read a written clinical vignette describing a fall‐prone person with dementia who refused to be physically restrained. The association between the decision made and the nurses’ attitudes toward restraint use was measured by Perceptions of Restraint Use Questionnaire (PRUQ).•  Twenty‐one nurses would at first disregard the patient’s wish and use the restraint in the given situation while nine would not. When new relevant facts were provided all nurses except two were ready to change their decision. A significant relationship between nurses’ decisions and their attitudes toward restraint use was also found.•  The results showed that, although nurses endeavour to decide what they consider to be in the patient’s best interests, this ambition is affected by a variety of variables, especially in relation to the working conditions and the nurses’ willingness to take the risk when not restraining the patient.
Searching for sustainable change
Authors: Balfour Mags , Clarke Charlotte 
Published: March 2003

•  Change in nursing practice has been dogged by factors which have been perceived to be outside the autonomy of nurses. Consequently, projects have been initiated which have then faltered or even ceased altogether.•  This paper reports on an action research study that was carried out in Newcastle from 1997 to 1999 and used the process within a focus group setting to rekindle and sustain an innovative change.•  The aim of the study was to look at staff perceptions surrounding development of the practice of self‐administration of medication for patients.•  The findings support the view that all disciplines need to be involved in health service change.•  Health service employees should have a knowledge of the theory associated with the change process and be open about their views of proposed alterations in practice.•  They also need to have a sense of dissatisfaction with the present, a clear outline of what the problem is and the direction which they intend to take.•  Change involves many complex issues. It should be worked through from a bottom‐up approach and consist of repeated evaluation exercises which are akin to a cyclical strategy and include a reflective process.
Living the revolution: Cuban health workers
Authors: Warman Andrea 
Published: March 2003

• The cuban government has placed a very high emphasis on health since 1959 and vaccination and health education campaigns, as well as access to a comprehensive free healthcare system, have contributed to dramatic improvements in the population’s health status.• Much that has been written about the Cuban health service has relied on published sources, but this article is based on 18 months spent carrying out ethnographic fieldwork in the country, with particular emphasis on the daily lives of women employed in the health sector. Data were collected by participant observation, interviews and life‐story work. Family doctors are usually young women completing their specialist training. They work in health centres in apartment blocks in which they also live. They work closely with nurses and other health and social service workers.• Health workers are expected to live and work in their own communities, to act as role models for their patients, and to be available at all times.• Whilst this has led to an extremely well‐informed population and accessible healthcare, it has brought costs to healthcare workers in terms of very high expectations, a feeling that they do not have a private life, and stress caused by the inability to meet patient demands in the face of shortages of medicines and other supplies as a result of the continuing US trade blockade.• These pressures and frustrations for healthcare workers may have parallels in Western healthcare services which are subject to resource constraints.
Evidence‐based practice: tap water cleansing of leg ulcers in the community
Authors: Selim Pam , Bashford Chris , Grossman Cheryl 
Published: March 2003

• To establish and encourage wound management practices based on evidence, a Community Nursing Organization in metropolitan Adelaide began a series of research initiatives in 1997.• Based on the results of a wound management survey, and through the processes of participatory action research with clinicians, many wound management practice changes were instigated throughout the Community Nursing Organization.• One question remains unanswered: What is the evidence for the use of sterile saline or clean tap water for cleansing of leg ulcers in the community?• In this paper we describe a project where we applied the three principles of planning, action and evaluation.• Application of these principles enabled clinicians to collaborate in the search for evidence to support or refute tap water cleansing of leg ulcers.• To conclude, we report on a pilot research project undertaken to obtain further evidence either to support or refute the use of tap water cleansing for leg ulcers in the community.
Adherence to self‐care and social support
Authors: Toljamo Maisa , Hentinen Maija 
Published: March 2003

• The purpose of the study reported in this paper was to describe adherence to self‐care, perceived difficulties and social support in a group of adult patients (n=213) with insulin‐treated diabetes from two outpatient clinics in Northern Finland.• Data were collected by questionnaire. The instruments were developed to measure adherence to self‐care, difficulties in self‐care and social support. The response rate was 76%.• One‐way ANOVA, logistic regression analysis, contingency and Pearson’s correlation coefficients were used in the statistical analysis.• A fifth of the respondents were neglecting their self‐care. The others undertook flexible, regimen‐adherent or self‐planned self‐care.• The subjects had no difficulties with insulin treatment, but had more problems with other aspects of self‐care.• Poor metabolic control, smoking and living alone predicted neglect of self‐care, but if patients had support from family and friends, living alone was not a predictor of neglect of self‐care.• Those with poor metabolic control perceived themselves as getting peer support from other persons with diabetes.
Consumer issues in navigating health care services for type I diabetes
Authors: Rasmussen Bodil , Wellard Sally , Nankervis Alison 
Published: March 2003

• Despite increasing interest in consumer awareness and participation in health care service delivery, there has been little exploration of consumer views in relation to services for people with type I diabetes.• The purpose of this qualitative exploratory study was to identify strategies people with type I diabetes used to access health services and the barriers they perceived in accessing the services they needed.• Data gathered in semi‐structured interviews revealed that consumers experience significant barriers when navigating the health care system.• Three dominant themes were identified. They relate to access to specialist medical skill, to the transition from teenager to young adult and to pre‐pregnancy and obstetric care.• Directions for change in service delivery and policy development are discussed.
Learning intravenous cannulation: a comparison of the conventional method and the CathSim Intravenous Training System
Authors: CHANG KATHERINE KA‐PIK , CHUNG JOANNE WAI‐YEE , WONG THOMAS KWOK‐SING 
Published: March 2003

• Intravenous cannulation is a nursing procedure carried out in some clinical units that may induce trauma and discomfort. Nurses should be well prepared before practising the procedure with clients.• Conventionally, a plastic arm was used for practice but, with innovative developments in technology, a computer program called the CathSim Intravenous Training System (CathSim ITS) is available for this purpose. This study was conducted to compare the effectiveness of learning using a plastic arm with the CathSim ITS.• Twenty‐eight nurses were divided into two groups and randomly assigned to the two different methods: plastic arm (control group) or CathSim ITS (experimental group). Both groups were provided with 1 hour of theory input and 2 hours of nursing laboratory work.• When the nurses felt ready to practise on clients, their performances were assessed by researchers with an intravenous cannulation qualification using a validated checklist. Prior to the assessment, trait and state anxiety levels were measured using the State‐Trait Anxiety Inventory (Hong Kong Chinese adaptation) to check whether anxiety would affect the performance. Following the assessment, a semi‐structured interview was conducted to reveal any knowledge acquired through using the selected method.• Both the control and CathSim ITS groups demonstrated a high success rate, scoring 100% and 92.86%, respectively, with their first client.• The semi‐structured interviews revealed that the CathSim ITS group appreciated several features of their assigned method. However, there is room for further development.
Working with women experiencing mid‐trimester termination of pregnancy: the integration of nursing and feminist knowledge in the gynaecological setting
Authors: HUNTINGTON ANNETTE D. 
Published: March 2003

• Working with women experiencing a mid‐trimester termination of pregnancy is part of clinical practice in many gynaecological services. In this paper recent research with nurses working in the gynaecological area is drawn on to explore the issues for nurses working with women experiencing mid‐trimester termination. Mid‐trimester terminations are those carried out between approximately 12 and 20 weeks.• Mid‐trimester termination results in the delivery of a fetus and this event requires sensitive management as it is has the potential to cause distress for the women due to the psychological and physical impact of the procedure. However, health professionals involved can also find this a distressing clinical event due to the complex nature of the management and care required.• Consideration of this clinical event from a feminist perspective led to my exploring the way in which feminist theory could be applied in the situation of mid‐trimester termination. Using notions from feminist theory can assist in the management of this process, and feminist concepts related to the centrality of women's experience can be integrated into actual practice.• A series of recommendations are provided in this paper to show the way in which feminist concepts can be integrated into clinical practice. Integrating feminist principles into practice can support both the woman experiencing the abortion and the nurse whose role in the event is sustained and intimate, and result in positive outcomes for both women. This can result in an environment that is safe and supportive for all women involved in mid‐trimester terminations.
Nurses' decision‐making in collecting information for the assessment of patients' nursing problems
Authors: JUNNOLA TARJA , ERIKSSON ELINA , SALANTERÄ SANNA , LAURI SIRKKA 
Published: March 2003

• The paper addresses two questions: Firstly, what kind of information do nurses acquire from cancer patients for purposes of judging their patients' problems and preparing a care plan? Secondly, how systematically do nurses proceed in the decision‐making process from the formulation of initial assumptions about the patient's situation to the final definition of problems?• The instrument used for data collection was a computer‐simulated case description compiled by a team of four nursing researchers and one medical researcher. The case description was based on a real patient history.• The sample consisted of 107 Registered Nurses on four oncology, two internal medicine and five surgical wards of two central university hospitals in Finland. Data were collected in autumn 1998 and spring 1999 using a laptop computer and a tape recorder.• The four most important problems identified by nurses at baseline were pain (85%), pain medication (59%), family situation (66%) and spread of cancer (49%). Presented with a list of 23 options, they obtained additional information on average on 13 areas. Almost one‐third collected information from 16 to 22 areas. On average nurses identified 12 of the 28 nursing problems specified. A statistically significant association was observed between information acquisition and problem definition in seven different variables. These had to do with pain, general condition and prognosis.• Nurses adequately prioritized their patients' problems and systematically collected data on those problems. On the other hand they also identified a number of problems that were not relevant to the situation.
Nursing care and collaborative practice
Authors: KESBY SHEILA G. 
Published: March 2003

• This article argues that the time is right for nurses in the UK to become the case managers in all healthcare settings. The re‐launch of family health nursing, as a model for the organization and delivery of nursing care in the community, and the advent of the GP practice‐based self‐managed integrated nursing teams, offer the means by which to take up the opportunities presented by recent legislation and the national strategies for promoting partnership working and collaborative practice.• Nurses could approach this by combining their current involvement with developing the single assessment process for older people with the overall development of interprofessional collaborative practice across all boundaries in health and social services. Despite the new opportunities, this will not be straightforward because of the still existing problems associated with the health and social care divide.• In order to generate high quality care, it is imperative for nurses and their patients that the profession gains control and ownership of its own policy, remit and practice.• Nursing care should be defined according to the patient's condition, so that their dependency level, diagnostic picture and potential for rehabilitation govern the eligibility criteria for health or social care and not the level of technicality in the task itself.
Crossing boundaries, re‐defining care: the role of the critical care outreach team
Authors: COOMBS MAUREEN , DILLON ANN 
Published: March 2003

• There is clear indication that both government and professional policy in the United Kingdom supports a radical change in the role of healthcare practitioners, with a move towards a patient‐focused service delivered by clinical teams working effectively together.• Recent health service imperatives driving the agenda for flexible clinical teams have occurred simultaneously with an increased public and political awareness of deficits in availability of critical care services.• Against this policy backdrop, working across professional and organizational boundaries is fundamental to supporting quality service improvements. In the acute care sector, the development of critical care outreach teams is an innovation that seeks to challenge the traditional support available for sick ward patients.• Activity data and observations from the first 6‐month evaluation of two critical care outreach teams identify the need for clinical support and education offered by critical care practitioners to ward‐based teams.• The experiences from such flexible clinical teams provides a foundation from which to explore key issues for intradisciplinary and interdisciplinary working across clinical areas and organizational boundaries.• Adopting innovative approaches to care delivery, such as critical care outreach teams, can enable clinical teams and NHS trusts to work together to improve the quality of care for acutely ill patients, support clinical practitioners working with this client group, and develop proactive service planning.
‘The Hidden Client’– women caring for husbands with COPD: their experience of quality of life
Authors: Bergs Dóróthea 
Published: March 2003

Summary• The purpose of this phenomenological study was to describe the experience of quality of life of women, taking care of husbands with chronic obstructive pulmonary disease (COPD).• Unstructured, in‐depth, tape‐recorded personal interviews were used to collect data from six women living with husbands with COPD.• The women ranged from 47 to 69 years in age and their husbands had given up work because of the illness.• The wives in the study were dissatisfied with their lack of recreation, as well as support from friends, families and health care providers.• Factors that increased the wife's quality of life were children andgrandchildren and being able to please the husband and care for him until the very end.
Hierarchy of evidence: a framework for ranking evidence evaluating healthcare interventions
Authors: Evans David 
Published: March 2003

Summary• A number of hierarchies of evidence have been developed to enable different research methods to be ranked according to the validity of their findings. However, most have focused on evaluation of the effectiveness of interventions. When the evaluation of healthcare addresses its appropriateness or feasibility, then existing hierarchies are inadequate.• This paper reports the development of a hierarchy for ranking of evidence evaluating healthcare interventions. The aims of this hierarchy are twofold. Firstly, it is to provide a means by which the evidence from a range of methodologically different types of research can be graded. Secondly, it is to provide a logical framework that can be used during the development of systematic review protocols to help determine the study designs which can contribute valid evidence when the evaluation extends beyond effectiveness.• The proposed hierarchy was developed based on a review of literature, investigation of existing hierarchies and examination of the strengths and limitations of different research methods.• The proposed hierarchy of evidence focuses on three dimensions of the evaluation: effectiveness, appropriateness and feasibility. Research that can contribute valid evidence to each is suggested. To address the varying strengths of different research designs, four levels of evidence are proposed: excellent, good, fair and poor.• The strength of the proposed hierarchy is that it acknowledges the valid contribution of evidence generated by a range of different types of research. However, hierarchies only provide a guide to the strength of the available evidence and other issues such as the quality of research also have an important influence.
Variation in the effects of vegetation and litter on recruitment across productivity gradients
Authors: Suding Katharine NasH. , Goldberg Deborah E. 
Published: March 2003

1 We tested predictions about how the effect of vegetation and litter on seedling establishment varies among sites and herbaceous community types (sand barrens, prairies, fens). For both vegetation and litter, we also separated direct interactions from indirect interactions and interaction modifications along the gradient. 2 Although the intensity of the effects varied across sites, the direct effects of vegetation or litter alone were consistently facilitative along the productivity gradient. Predominance of facilitative effects may be due to the focus on the seedling establishment phase. 3 However, inclusion of indirect interactions and interaction modifications caused the net effects of both vegetation and litter to become largely negative. While one layer of biomass may be advantageous to ameliorate some moisture stress, the addition of another layer may be disadvantageous if this layer limits light proportionally more than it relieves moisture stress. 4 One exception to this pattern occurred at high productivity when the net effect of vegetation, even in the presence of litter, remained facilitative. The net effect of vegetation was competitive at low productivity and grew increasingly facilitative with productivity. Thus, indirect effects of litter may alter interaction patterns across this gradient.
Calcareous groundwater raises bogs; the concept of ombrotrophy revisited
Authors: Lamers Leon P. M. , Farhoush Cornelis , Van Groenendael Jan M. , Roelofs Jan G. M. 
Published: March 2003

Summary1 Raised bogs are traditionally regarded as being solely dependent upon atmospheric influences. However, these terrestrial carbon stores may also be affected by calcareous (bicarbonate‐rich) groundwater, which is often found in deeper peat layers.2 Field data from a bog area in the Netherlands were used to select appropriate levels of bicarbonate supply for an aquarium mesocosm experiment. The effects of 0, 0.1, 0.5, 1 and 2 mmol HCO3–l–1, and 1 mmol HCO3–l–1 + 2 mmol SO42–l–1, on the biogeochemistry of peat monoliths, including theirSphagnumvegetation, were investigated.3 Slightly increased alkalinity rapidly stimulated buoyancy of livingSphagnumdue to higher inorganic carbon concentrations in the water layer. Moderate HCO3–concentrations also stimulated buoyancy of the entire peat monoliths after 3 weeks, because of increased methane production rates. High alkalinity, however, led to rapid internal phosphate mobilization, peat disintegration andSphagnumdie‐off. This detrimental effect was stronger when sulphate was supplied simultaneously.4 The results are discussed with respect to the carbon dynamics and overall functioning of peat bogs, in relation to hydrology and hydrochemistry (groundwater influence, sulphate pollution).
Positive and negative interactions at different life stages of a colonizing species (Quercus humilis)
Authors: Rousset Olivier , Lepart Jacques 
Published: March 2003

Summary 1 The downy oak Quercus humilis has recently recolonized the Causse du Larzac plateau in southern France. We studied the influence of the shrubs Buxus sempervirens and Juniperus communis on Q. humilis establishment, and of Buxus on the growth of established Q. humilis individuals. 2 Percentage germination of experimentally planted Q. humilis was higher under shrubs than in nearby open areas and higher on the north than the south side of the canopy. Germination where part of the canopy has been removed was similar to that away from the shrubs, suggesting that the facilitation mechanism is related to changes in microclimate rather than to a soil effect. 3 When exposed to sheep for 1 month, 100% of 326 unprotected oak seedlings were grazed, causing 44% mortality. The presence of Buxus and Juniperus improved seedling survival by protecting them against sheep grazing and summer drought. Predation by rodents was however greater under shrub cover. 4 The highest leaf dry mass of oak seedlings was recorded under Juniperus where light conditions seem more favourable for growth than under Buxus (direct effect) or in grassland (indirect effect). The growth of naturally established individuals of Q. humilis (in terms of total leaf mass per annual branch and width of rings) was lower under Buxus than in grassland but the values became similar once the canopy was overtopped. 5 The balance between positive and negative interactions varied in relation to the life stage of Q. humilis and the two shrub species. Regeneration of Q. humilis in open grassland was prevented by grazing. The protection offered by shrubs continues to offset the negative interference on growth, particularly under Buxus, so that plants could survive to overtop the shrub canopy and reach maturity. The succession pathway therefore depends closely on the distribution of shrubs in the grassland.