bluuebunny/crossref_metadata_2025_split huggingface dataset:
A conceptual framework for evaluating the nurse practitioner role in acute care settings
Authors: Sidani Souraya , Irvine Diane 
Published: March 2003

A conceptual framework for evaluating the nurse practitioner role in acute care settings The conceptualization and enactment of the ACNP role varies across settings, potentially leading to variability in outcome achievement. A conceptual framework for evaluating the ACNP role is proposed. The framework is an adaptation of the Nursing Role Effectiveness Model which was developed to facilitate the identification and investigation of nursing‐sensitive outcomes. The framework represents the complex system of interrelated factors that are present in the ACNP practice situation and that affect role effectiveness. It includes three components: (i) structure — encompassing patient, ACNP and organizational variables; (ii) process — consisting of the ACNP role components (clinician, educator, researcher and administrator) and the ways in which the role is enacted; and (iii) outcomes — including patient‐ and cost‐related outcomes. The framework proposes specific relationships among the structure, process and outcomes components. Empirical support for the framework propositions is provided, based on a review of pertinent literature. Implications for future ACNP impact studies are discussed.
The contingent nature of advanced nursing practice
Authors: Woods Leslie P. 
Published: March 2003

The contingent nature of advanced nursing practice This paper examines the issues faced by advanced nurse practitioners in the United Kingdom as they attempt to implement a new role in practice. The discussion draws on evidence gathered during a longitudinal study of a small number of graduates from a Master’s degree programme who subsequently took up posts as advanced nurse practitioners. The paper focuses on one of the key findings to emerge from the inquiry, that of the identification of the contingent nature of advanced nursing practice. The data for the study were collected over a 2‐year period via interviews, observation of clinical practice and self‐report role development diaries. Following analysis it was revealed that, whilst the passage from experienced nurse to advanced nurse practitioner can be considered to be highly individual and complex, practitioners appear to move through three discrete stages during the transitional process. The first of the three stages is represented by a state of ‘idealism’ on the part of advanced practitioners. During the second phase, termed ‘organizational governance’, practitioners discover that, in contrast to their initial optimism, the orientation, goal and delivery of their role is controlled by key stakeholders within the organization. The final stage, ‘resolution’, is only reached when practitioners have been in post for more than 1 year and can be summarized as a state of acquiescence and compromise. A conceptual model is presented which illustrates the contingent nature of advanced nursing practice.
The quality of mothers’ solutions to child‐rearing problems: what difference does setting internal or external to the family make?
Authors: Pridham Karen F. , Pascoe John 
Published: March 2003

The quality of mothers’ solutions to child‐rearing problems: what difference does setting internal or external to the family make? In this study we examined the difference the setting of a child‐rearing problem, either internal or external to the family, made for mothers’ generation of solutions likely to assist a child’s development of problem‐solving competencies. In addition, the direct effect of a mother’s personal resources (age, education, number of children parented, and verbal ability) and the direct and mediating effect of the extent to which a mother took the child’s perspective on her generation of assistive solutions were explored. Adult mothers (n = 128) of children ranging in age from 1 month to 18 years were interviewed by telephone concerning eight hypothetical child‐rearing problems. Mothers generated a greater proportion of assistive solutions and took the child’s perspective more often for external problems than for internal problems. For internal problems, a mother’s verbal ability made a significant contribution to the proportion of assistive solutions generated. For external problems, number of children made a significant negative contribution. For external problems, perspective taking had a mediating effect on the relationship of number of children with the proportion of assistive solutions generated. The nature of a mother’s perspective taking and the function that it has in solution generation for child‐rearing problems merit exploration.
Recovering from stroke: a qualitative investigation of the role of goal setting in late stroke recovery
Authors: Lawler John , Dowswell George , Hearn Jeff , Forster Anne , Young John 
Published: March 2003

Recovering from stroke: a qualitative investigation of the role of goal setting in late stroke recovery This article examines the role of goal setting in the continuing relationship between specialist nurse and patients recovering from stroke. The nurse intervention was intended to ease the patient through the stages of recovery from stroke, focusing on emotional and social recovery rather than physical function. Literature on the use of goals in the nursing process is discussed. The article uses data from contemporary nurse records and from interviews with nurses and with patients and caregivers. The data from each of these elements were subjected to content analysis and were then synthesized using a grounded theory approach to interpret their significance. The perspective of patients and caregivers provides an additional insight into the use and limitations of goal setting which is largely developed in the literature from a nursing perspective. Nurses were found to have different interpretations of the use of goal setting. Some used it explicitly in their relationships with patients, whilst others used the concept to inform their actions whilst being less explicit and more informal. In all cases they demonstrate the tension between establishing and supporting progress towards realistic recovery goals and recognizing the limitations now placed on stroke victims.
Chinese elderly patients’ perceptions of their rehabilitation needs following a stroke
Authors: Lui May H.L. , Mackenzie Ann E. 
Published: March 2003

Chinese elderly patients’ perceptions of their rehabilitation needs following a stroke Stroke is the third leading cause of death and disability among Chinese elderly patients in Hong Kong and yet the rehabilitation needs of these patients are rarely explored. The aim of this study was to identify the rehabilitation needs of Chinese elderly patients following a stroke. The study adopted an ethnographic approach, information being gathered by the researcher through interviews with 15 key informants selected by purposive sampling. The perceptions of patients as to their own needs were sought at three stages of recovery — in the acute and rehabilitation settings and at 1 month following discharge.Ethical approval was gained from the Chinese University Faculty of Medicine ethical committee and access agreed by the hospital authorities. Verbal approval was gained from the patients before each interview, following confirmation of the voluntary nature of participation and assurance of confidentiality and anonymity. The researcher’s role was also clearly stated.Analysis of the interview data produced five categories of patient need at the three stages of recovery, namely informational, physical, psychological, social and spiritual. The most frequently stated, but largely unmet, need in all settings was the need for information, particularly information about the reasons for stroke and about the activities that promote recovery. In the acute and rehabilitation settings patients’ responses indicated a need to be respected as individuals, to be addressed by name and to be provided with privacy. Although the Barthel Index administered during interviews charted recovery at different rates, nurses did not always make links between the level of functional ability and the help needed with physical tasks. They also failed to recognize the relationship between physical and psychological needs and the equal importance of both in recovery from stroke. As Chinese elderly patients tend to take a passive role in seeking help and information, nurses play a significant role in the identification of individual rehabilitation needs. Implications for nursing practice are discussed.
Acute care nurses’ experiences of moral certainty
Authors: Wurzbach Mary Ellen 
Published: March 2003

Acute care nurses’ experiences of moral certainty Moral certainty is a common, vivid experience for many nurses, but it may be a mixed blessing. From one perspective moral certainty provides comfort for the ethical decision‐maker and may prompt necessary action which would have been impossible without it. From another perspective, moral certainty stifles dialogue and in‐depth discussion of moral issues. Despite the fact that moral certainty is ubiquitous in health care, few research studies have explored both the positive and negative aspects of this complex and sometimes troubling concept. A qualitative design was used to describe the experiences of 20 acute care nurses with moral certainty. They were interviewed and the interviews analysed using Colaizzi’s method for qualitative data analysis. These nurses’ primary responses to moral certainty were ‘speaking up’, ‘standing up’ and ‘refusing to participate’. Their experiences with moral certainty, responses to it, reasons for responding as they did, and clinical prompts are described. The author concluded that moral certainty may have positive and negative aspects. Making an effort to hear alternative views is suggested.
Individuals’ perception of their quality of life following a liver transplant: an exploratory study
Authors: Robertson Gillian 
Published: March 2003

Individuals’ perception of their quality of life following a liver transplant: an exploratory study This study explores individuals’ perceptions of the effect of a liver transplant on their quality of life, focusing on the progression from dependence to independence physically, socially and psychologically. A phenomenological design using taped semi‐structured interviews was used. The sample consisted of five patients attending the out‐patients clinic at least 1 year following a liver transplant for chronic liver disease. The data were analysed using cluster analysis of transcribed interviews. Categories were identified as physical, social and psychological factors affecting their progression from dependence to independence pre‐ and post‐transplant and specific factors were identified as significant in overcoming the stressors affecting this progression. The findings reflected Maslow’s Hierarchy of Needs. Pre‐transplant their physical problems prevented them fulfilling personal goals and addressing psychological issues, e.g. dying. Post‐transplant any physical problems identified were insignificant to the participant. They were keen to socially integrate and be treated as normal; however, family and friends restricted their independence by continuing to ‘wrap them in cotton wool’ as they had before their transplant. Personality, incentives and Unit support were identified as imperative in their progression from dependence to independence. The findings demonstrate a need to impress on family and friends of patients following a liver transplant, their role in assisting the patient’s progression from dependence to independence.
Incontinence and sexuality: findings from a qualitative perspective
Authors: Roe Brenda , May Carl 
Published: March 2003

Incontinence and sexuality: findings from a qualitative perspectiveIncontinence remains a taboo where myths and misconceptions abound. The objectives of this study were to explore the impact of incontinence on an individual’s sexuality and to identify the impact of health interventions for the management of incontinence on sexuality. A quota sample of subjects whose incontinence was regarded as being either successfully managed (n=14) or unsuccessfully managed (n=12) by continence advisers, community nurses and health visitors from two National Health Service Trusts were interviewed. A further subject whose incontinence was not classified was also interviewed, bringing the total number of interviews to 27. One Trust had an established continence advisory service of some 19 years, while the other Trust did not have a specific continence advisory service and relied upon members of the primary health care team to meet the needs of individuals suffering from incontinence. The qualitative data from this study were analysed using the constant comparative technique and were grouped into themes relating to clothing and appearance, intimacy and caring, management techniques and relationships and life trajectory. This is the first study to have examined management techniques for incontinence and their relationship to an individual’s sexuality and therefore has important implications for clinical practice. It has also set the findings of incontinence and sexuality in the context of chronic conditions and their related patient careers and life trajectory.
Gender, adolescence and the management of diabetes
Authors: Williams Clare 
Published: March 2003

Gender, adolescence and the management of diabetes Health professionals view adolescence as a difficult time in which to manage diabetes. Adherence to treatment may be a problem, and there is also an expectation that young people should become independent in self‐care. Drawing on data from a qualitative study which interviewed teenagers with diabetes and their mothers, this paper focuses on the ways in which gender and adolescence interact to affect how young people live with diabetes. Key themes explored include: the gendered meanings of diabetes; gendered management strategies; gendered dependencies; and adherence to treatment regimes. Gender was found to have a major impact on how young people managed diabetes. Gender also impacted on the involvement of mothers, with the mothers of sons much more likely to be involved in helping their sons than the mothers of daughters. In discussing some of the implications for health policy, it is suggested that in their ways of managing diabetes, young people should be seen as acting rationally within the confines of their gendered identities. Therefore, a uniform policy which promotes the independence of young people may not always be an appropriate way of working with young people or their families.
A description of health care professionals’ experiences of encounters with patients in clinical settings
Authors: Takman Christina A.S. , Severinsson Elisabeth I. 
Published: March 2003

A description of health care professionals’ experiences of encounters with patients in clinical settingsThe aim of this study was to describe health care professionals’ way of experiencing their encounters with in‐ or outpatients, while working in acute medical care hospitals. One main question was addressed: What are the experiences which health care professionals have of their encounters with in‐ or outpatients in clinical settings? Eleven health care professionals (physicians, registered nurses and enrolled nurses) were interviewed and a phenomenographic approach was used, where data were analysed qualitatively. The results indicate that the health care professionals’ way of experiencing their encounters with patients in acute medical care hospitals could be separated into three categories of description: a gain in personal knowledge and understanding of the patients’ different ‘ways’ of communicating experienced suffering; making the patient feel confident and; focusing on the medical problems, not understanding the patient’s different ‘ways’ of communicating their experienced suffering. The first two categories of description showed encounters where the health care professionals felt that they could understand the patients’ expressions of suffering. The third showed encounters where the health care professionals experienced difficulty in understanding the patients’ expressions of suffering. There is a need therefore to support health care professionals in improving their understanding of patients’ suffering.
The biopsychosocial impact of end‐stage renal disease: the experience of dialysis patients and their partners
Authors: White Yvonne , Grenyer Brin F.S. 
Published: March 2003

The biopsychosocial impact of end‐stage renal disease: the experience of dialysis patients and their partners This phenomenological study was conducted to investigate the biopsychosocial impact of end‐stage renal disease on dialysis patients and their partners. Forty‐four participants were interviewed separately (22 patients and their partners) by way of two open‐ended questions, and multiple themes were identified from verbatim transcripts. Both the patients and partners viewed their relationship very positively, and both were overwhelmed by the impact of dialysis on their lives. Anger, depression and hopelessness were evident in the patients, whilst a pervasive sadness, resentment, guilt and loss were prevalent in the partners. This study gives a unique perspective on the negative impact which dialysis can have on couples, yet it also suggests that some are able to cope in a positive way despite the many life‐style adjustments required by dialysis. The results of this study indicate that nurses need to recognize and respond to the tremendous emotional impact that chronic illness and its treatment can have on families in an era where it is possible to sustain life for years with the use of life support technology.
Perceptions of research utilization: comparisons between health care professionals, nursing students and a reference group of nurse clinicians
Authors: Kajermo Kerstin Nilsson , Nordström Gun , Krusebrant Åsa , Björvell Hjördis 
Published: March 2003

Perceptions of research utilization: comparisons between health care professionals, nursing students and a reference group of nurse clinicians The study reported in this paper was carried out to investigate a group of nursing teachers’ (n=37), nursing students’ (n=166), nursing administrators’ (n=33) and physicians’ (n=127) perceptions of barriers to and facilitators of nurses’ use of research findings in clinical practice. The results were compared with the corresponding figures for a reference group of nurse clinicians (n=237). The Barriers Scale and a questionnaire for the demographic issues were used for data collection. The organization and the communication of research were seen as barriers to research utilization by the nursing teachers, students and administrators in agreement with the nurse clinicians. The nurses’ research‐related competence and awareness were seen as barriers by the nursing teachers, students and administrators to a greater extent than by the nurse clinicians themselves. The physicians perceived barriers to a lesser extent than the other groups did. The students’ perceptions were closest to the nurse clinicians, while the physicians’ perceptions differed most. Education to increase the nurses’ knowledge of research and to develop their competence to evaluate research results, increased resources for education, more staff, support from the administration and research presented in a user‐friendly way were the most frequently suggested facilitators. The nurses’ isolation from knowledgeable colleagues with whom to discuss the research was seen as a barrier by the majority of the participants. This indicates a need for positions in clinical practice for nursing researchers, in order to promote a research‐based, nursing practice.
Barriers to, and facilitators of, research utilization among nurses in Northern Ireland
Authors: Parahoo Kader 
Published: March 2003

Barriers to, and facilitators of, research utilization among nurses in Northern Ireland It is clear from the nursing literature that there are a number of factors which can impede or facilitate the use of research in practice. It is important that these are identified and addressed, both at local and national levels, if evidence‐based practice is to become a reality. This study surveyed nurses’ perceptions of barriers to, and facilitators of, research utilization. The Barriers Scale was administered to a convenience sample of 2600 nurses in 23 hospitals in Northern Ireland. The number of completed questionnaires was 1368 (52·6%). The results show that the top barrier was ‘The nurse does not feel she/he has enough authority to change patient procedures’ followed by ‘statistical analyses are not understandable’. Seven out of the top 10 barriers were related to ‘setting’. The implications of these and other findings are discussed.
Men’s lived experiences following transurethral prostatectomy for benign prostatic hypertrophy
Authors: Pateman Brian , Johnson Martin 
Published: March 2003

Men’s lived experiences following transurethral prostatectomy for benign prostatic hypertrophy The aim of this study was to illuminate the lived experience of prostatectomy recovery by means of semi‐structured interviews. Despite the commonality of prostatic enlargement and the corrective transurethral procedure, surprisingly little is known of the impact upon the men’s social and psychological well‐being. The interviews have produced very rich data, which illustrate the extent to which the men are initially very reluctant to identify ‘problems’ either with their hospital experience or their subsequent recovery period. However, once respondents appeared to feel more comfortable, we began to learn of their very substantial difficulties both before and after the operation.
Cultural challenges in end‐of‐life care: reflections from focus groups’ interviews with hospice staff in Stockholm
Authors: Ekblad  , Marttila  , Emilsson  
Published: March 2003

Cultural challenges in end‐of‐life care: reflections from focus groups’ interviews with hospice staff in Stockholm During the past few decades, Swedish society has changed from a society with a few ethnic groups to one with over a hundred groups of different ethnic backgrounds, languages and religions. As society is becoming increasingly multicultural, cultural issues are also becoming an important feature in health care, particularly in end‐of‐life care where the questions of existential nature are of great importance. However, cultural issues in health care, especially at hospices, have not been studied sufficiently in Sweden.The purpose of this study was to gather reflections about cultural issues among hospice staff after a 3‐day seminar in multicultural end‐of‐life care, by using a qualitative focus groups method. The 19 participants (majority nurses) were divided into three groups, one per hospice unit. A discussion guide was developed with the following themes: 1) post‐training experiences of working with patients with multicultural background; 2) experiences gained by participating in the course of multicultural end‐of‐life care; 3) post‐training reflections about one’s own culture; 4) ideas or thoughts regarding work with patients from other cultures arising from the training; and 5) the need for further training in multicultural end‐of‐life care. One of the study’s main findings was that to better understand other cultures it is important to raise awareness about the staff’s own culture and to pay attention to culture especially in the context of the individual. The findings from focus groups provide insight regarding the need for planning flexible training in cultural issues to match the needs of the staff at the hospice units studied.