bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nurses' cognitive structural models of work‐based stress
Authors: Taylor Shirley , White Bob , Muncer Steven 
Published: March 2003

Nurses' cognitive structural models of work‐based stress¶ This study examined the causes of stress experienced by National Health Service nurses in England over the course of a single week with the aim of generating a cognitive structural model. Qualitative data served as the foundation of a network study which employed inductive eliminative analysis. These data were also analysed using conventional qualitative methods and by content analysis.The results were consistent with previous studies that identified a number of primary sources of stress. However, the network study indicated that two systems of causation were operating. The first centres on inadequate staffing levels, which were seen as leading to poor attitudes and abilities among colleagues, multiple work roles and lack of support. Lack of support also contributed to powerlessness and poor attitudes and abilities. The behaviour of managers was strongly endorsed as a direct cause of stress, but the strongest explanatory link was through staffing levels and powerlessness. The second system of causation related patients' suffering to stress. The qualitative data validated the network study results through elaborating the understanding of the respondents' nominated causes. Discussion focused on the pressure and frustration experienced by nurses because of organizational factors and interaction effects with the caring nature of nursing work. It is suggested that nursing discourse is subordinated to managerial and biomedical discourse reflecting the relative powerlessness of nurses. The extent to which such powerlessness is primarily a result of the failure of nurses to assert themselves or intrinsic organizational factors is not clear. The consequences of a stressed and demoralized nursing workforce on the quality of patient care and risk profile are identified as the focus for future research.
Mastectomy, body image and therapeutic massage: a qualitative study of women's experience
Authors: Bredin Mary 
Published: March 2003

Mastectomy, body image and therapeutic massage: a qualitative study of women's experience Despite the wealth of literature concerning the impact of breast loss on a woman's body image, sexual and psychological adjustment, there have been few studies within the medical and nursing literature directly quoting a woman's private perspective; how in her words she experiences her changed body. Furthermore, there is a lack of evidence‐based interventions for addressing the problem of altered body image (ABI); healthcare professionals often feel at a loss in knowing how to help women cope ( Hopwood & Maguire 1988). In this study in‐depth interviews were undertaken to explore three women's experiences of breast loss with particular focus on body image issues; a second phase piloted a massage intervention as a means of helping them adjust to living with their changed body image. Listening to their experience, in combination with the therapeutic massage, allowed deep access and insight into the nature of the women's trauma. The experiences of the three women in this study suggest there may be a group of women whose needs are overlooked and who, despite their prosthesis and reassurances that they are disease‐free, opt to conceal the problems they have in living with a changed image. The availability of a body‐centred therapy might help with certain aspects of adjustment as revealed by this study.
The meaning of suicidal psychiatric in‐patients' experiences of being cared for by mental health nurses
Authors: Talseth  , Lindseth  , Jacobsson  , Norberg  
Published: March 2003

The meaning of suicidal psychiatric in‐patients' experiences of being cared for by mental health nursesTwenty‐one psychiatric in‐patients who had thought about, expressed the wish or even attempted to commit suicide narrated their experiences of receiving care from mental health nurses. The interview texts were transcribed and interpreted using a phenomenological–hermeneutic method, inspired by Ricoeur's philosophy. Two main themes with subthemes were found:Confirming: attending to patients' basic needs; seeing patient; having time for patient; being with patient; listening to patient without prejudice; being open to patient; accepting patient's feelings; communicating hope to patient; andLack of confirming: overlooking patient's basic needs; not seeing patient; not having time for patient; leaving patient to herself or himself; listening to patient with prejudice; not being open to patient; denying patient her or his feelings; communicating hopelessness to patient. These findings were interpreted in the light of Hegel's philosophy of mutual recognition and confirmation. When relating episodes of good or bad nursing care suicidal patients emphasized their need for confirmation during their interaction with nurses when in hospital after suicide attempts.
A framework for the study of coping, illness behaviour and outcomes
Authors: Shaw Chris 
Published: March 2003

A framework for the study of coping, illness behaviour and outcomes This paper presents a theoretical framework for the study of coping, illness attribution, health behaviour and outcomes. It is based upon models developed within health psychology and aims to provide a theoretical basis for nurse researchers to utilize psychosocial variables. It is an interactionist model which views outcomes as dependent upon both situation and person variables. The situation is viewed as the health threat or illness symptoms as well as the psychosocial context within which the person is operating. This context includes socio‐economic factors, social support, social norms, and external factors such as the mass media. The experience of health threat is dependent upon individual appraisal, and the framework incorporates Folkman and Lazarus' transactional model of stress, as well as Leventhal's illness representation model. Behaviour and the perception of threat are also dependent upon outcome expectancies and the appraisal of one's own coping resources, and so the concepts of locus of control and self‐efficacy are also incorporated. This framework allows one to identify determinants of behaviour and outcome, and will aid nurses in identifying areas for psycho‐social intervention.
The new public management and the new nursing: related by rhetoric? Some reflections on the policy process and nursing
Authors: Hewison Alistair 
Published: March 2003

The new public management and the new nursing: related by rhetoric? Some reflections on the policy process and nursing The importance of health policy in terms of its effects on nursing is now recognized as an issue of concern for nurses; however, the essentially dynamic character of policy requires that consideration of its nature and consequences is continuous. This paper addresses the parallel development of the New Public Management (NPM) and the New Nursing as a means of demonstrating the perceived disjunction between events in nursing and the wider policy arena. The nature of policy is discussed and the relationship between the NPM and the New Nursing is explored. An examination of the unintended consequences of policy implementation and the role of rhetoric in the development of the NPM and the New Nursing demonstrates that these contrasting ideologies have emerged from a similar set of circumstances and have developed along a broadly similar timescale. The final effects of this process, however, are not yet clear. It is suggested that although the processes of policy formation and implementation are inherently complex there is an opportunity for nurses to exert some influence over them. Finally it is argued that if nurses become skilled in the art of rhetoric and combine this with a thorough understanding of the policy process they may be able to shape policy directly when and where it is implemented.
Menorrhagia: women’s perceptions of this condition and its treatment
Authors: Chapple Alison 
Published: March 2003

Menorrhagia: women’s perceptions of this condition and its treatment This paper reports a qualitative study of women’s perceptions and experience of menorrhagia. Having obtained ethics committee approval, and informed written consent, interviews were conducted with 30 women who reported that they were suffering from menorrhagia. The sample included 13 women of South Asian descent. Some of those interviewed did not want medical treatment for menorrhagia. Other women were quite satisfied with the treatment they received when they consulted their doctors. However, it appears that some general practitioners failed to recognize women’s need for treatment and were slow to comply with requests for referral to a gynaecologist. Although in the past there has been justifiable concern about women who undergo unnecessary treatment for perceived menorrhagia, this study suggests that health care professionals should be aware that some women may experience menorrhagia for long periods of time without receiving effective health care. It is possible that those who volunteered for the study were those most likely to have experienced problems with their treatment. However, the results of this study have implications for nurses, who may be in a position to give help and advice to women who want information about possible alternative treatments and sources of help for menorrhagia.
The moral metaphors of nursing
Authors: Wurzbach Mary Ellen 
Published: March 2003

The moral metaphors of nursingThe essence of metaphor is understanding and experiencing one thing in terms of another. Metaphorical concepts structure and reflect what we perceive, how we act, and how we relate to other people. In nursing ethics, several metaphors have emerged which have had a great impact on nursing practice. These metaphors include the military metaphor which exemplified nursing during the 1800s, the advocacy and academic metaphors which became a philosophical basis for nursing during the 1960s, and the individualist and community as caring metaphors which have emerged more recently. Although beneficial in some ways, these metaphors may be obscuring the complex moral reality of nursing practice. This article defines a moral metaphor, critiques nursing’s moral metaphors, and provides an historical overview of their development with examples of how they have and do affect nursing practice.
Passivity vs. militancy: a Q methodological study of nurses’ industrial relations on Merseyside (England)
Authors: McKeown Mick , Stowell‐Smith Mark , Foley Bernard 
Published: March 2003

Passivity versus militancy: a Q methodological study of nurses’ industrial relations on Merseyside (England) This paper describes a Q methodological study of accounts of nurses’ industrial relations expressed by a sample of nurses (n = 60) drawn from the geographical area of Merseyside, United Kingdom (UK). The participants completed a 65‐item Q sort made up of statements which could be ranked in terms of their relevance to an understanding of their industrial relations situation. Of interest was the importance of the narrative accounts which nurses draw upon in making sense of their employment relations, having the potential to underpin or delimit their actions. The notion of industrial action was an important focus of this research. Q methodology was chosen to allow the meaningful investigation of such subjectivity, with interesting tensions between differing notions of professionalism and militancy apparent from the analysis. Six accounts of industrial relations, which are available to be drawn on by nurses, are described and interpreted within a social constructionist framework. Some implications for the conduct of nurses’ industrial relations in the UK are contemplated.
Meal procedures in institutions for elderly people: a theoretical interpretation
Authors: Sidenvall Birgitta 
Published: March 2003

Meal procedures in institutions for elderly people: a theoretical interpretation In a study of mealtimes in institutions for elderly people the organization of meals was found to be task‐oriented rather than patient‐oriented in ways which failed to meet the needs of patients. The aim of the current paper is to examine and explain the institutional organization of meals, drawing on Goffmans’ theory of institutionalized culture, Elias’ theory of civilization, Douglas’ theory of purity and order, and Bourdieus’ key‐concept ‘habitus’. The method entails a secondary analysis of previous research carried out in a rehabilitation and long‐term hospital. This second analysis indicates that elderly patients coming to the ward with their individual meal customs were met by caregivers with an institutionalized culture. Meals in the ward were organized in line with the organization of family meals in society, and both the elderly people and the nurses strove towards civilized manners, purity and order. The demands implicit in these cultural practices kept the elderly patients silent. By failing into line, they suffered from their loss of habitus. In contrast nurses’ habitus was accomplished by carrying out procedures automatically. Consequently, the combination of patients’ lost habitus and nurses’ working habitus resulted in defective nursing, where the purpose of nursing is the fulfilment of patients’ social, personal and material needs.
The relationship between diabetes knowledge and compliance among Chinese with non‐insulin dependent diabetes mellitus in Hong Kong
Authors: Chan  , Molassiotis  
Published: March 2003

The relationship between diabetes knowledge and compliance among Chinese with non‐insulin dependent diabetes mellitus in Hong Kong This study examines the relationship between diabetes knowledge and compliance among Chinese with non‐insulin dependent diabetes mellitus (NIDDM) in Hong Kong. A cross‐sectional design was used to collect data through structured self‐report interviews based on validated scales assessing diabetes knowledge, compliance behaviours and demographic data. The Diabetes Knowledge Scale was used to sample knowledge in the major areas of basic physiology of diabetes and general principles of diabetes care. Compliance level was assessed by using the Compliance Behaviour Questionnaire, inspection of patients’ feet and the value of HbA1c. A convenience sample of 52 Chinese with NIDDM receiving out‐patient diabetes care participated in the study on a voluntary basis. Descriptive and correlational statistical analyses were used to analyse the data. The findings indicated that there was no association between diabetes knowledge and compliance. There was a gap between what the patients were taught and what they were actually doing. Most of the patients gained higher marks on factual knowledge on diabetes but lost marks on the application of knowledge to their real life situations. Strategies are suggested to close the ‘knowledge–action gap’ and increase patients’ motivation and ability to comply with the health regimen.
Good characteristics of a clinical supervisor: a community mental health nurse perspective
Authors: Sloan Graham 
Published: March 2003

Good characteristics of a clinical supervisor: a community mental health nurse perspectiveA qualitative methodology was adopted using a questionnaire and focus group to identify characteristics of a good supervisor from a supervisee perspective (staff nurses working in a mental health setting). Findings from the questionnaire and focus group were used as a basis for the nominal group technique to establish a prioritization of those characteristics identified. Thematic content analysis of the focus group generated five major categories: who provides clinical supervision; what happens during supervision; factors affecting the choice of supervisor; characteristics of a good clinical supervisor; and limitations caused as a result of how supervision is conducted. The ability to form supportive relationships, having relevant knowledge/clinical skills, expressing a commitment to providing supervision, and having good listening skills were perceived by the staff nurses as important characteristics of their supervisor. Supervisees viewed their supervisor as a role model, someone who they felt inspired them, whom they looked up to and had a high regard for their clinical practice and knowledge base. Nonetheless, limitations to the supervisory process were identified. Having their clinical supervisor allocated to them, their supervisor also being their manager, and having supervision sessions documented and stored by this manager threatened the full utility of the clinical supervision. In this paper three categories will be discussed: what happens during clinical supervision; good qualities of a clinical supervisor; and limitations caused as a result of how clinical supervision is conducted. In light of the study’s findings, recommendations are offered to develop the provision of clinical supervision.
Health professionals’ perspectives on service delivery in two Northern Ireland communities
Authors: Mason Carolyn , Orr Jean , Harrisson Sheila , Moore Ronnie 
Published: March 2003

Health professionals’ perspectives on service delivery in two Northern Ireland communities This research builds on the findings of an ethnographic study of health inequalities in two small, rural communities in Northern Ireland. Through further analysis of existing data, this second study aimed to explore health professionals’ perspectives on issues of service delivery relevant to government policy on primary care. Anthropological fieldwork was conducted for two consecutive 4‐month periods during 1995 and 1996 in one predominantly Catholic and one predominantly Protestant town. To preserve confidentiality, the locations have been given the pseudonyms, respectively, of Ballymacross and Hunterstown. Research tools included fieldwork journals and a fieldwork diary, meetings with key informants, tape‐recorded interviews, group discussions, participant observation and use of secondary material such as census data, local newspapers and community health profiles. Interviews with 15 health workers revealed that there was not a coherent approach to achieving health gain, little collaborative enterprise and minimal interaction between the different professional groups. The National Health Service (NHS)‐employed primary care professionals, more than local community workers, appeared to be demoralized, exhausted and suspicious of the business‐orientated health service. In this respect, the primary care‐led NHS appeared not to be working. It is concluded that a shared health agenda should be developed by NHS‐employed primary care professionals and local community workers to create a health‐inducing environment at community level. This needs to be complemented by the establishment of formal mechanisms for inter‐agency working at local, professional and government levels.
Measurement of communication skills in cancer care: myth or reality?
Authors: Booth Katie , Maguire Peter , Hillier Valerie F. 
Published: March 2003

Measurement of communication skills in cancer care: myth or reality? Despite wide agreement about the importance of effective communication in cancer care there is continuing evidence of the need for nurses, doctors and colleagues to be helped to improve their communication skills. Consequently, there has been a growing demand for effective methods for evaluation of communication training programmes. This paper discusses theoretical perspectives in this field and describes the rationale underpinning the development of a detailed objective method of assessing interviews between health professionals and cancer patients. The method enables an utterance by utterance rating of transcribed interviews to be made which can be used to construct profiles of interviewer and patient behaviours and interactions. All categories were developed from interviews drawn from a large sample of participants (n=206) at counselling skills workshops. Six domains have been identified and these are: grammatical style; the purpose of each technique; what is being discussed, the degree of feeling expressed; explicit avoidance; and the use made of patients’ cues. Each domain contains a mutually exclusive set of categories. In addition the method enables the sequence of events to be plotted. Using these methods, examples from published studies will be given to show how the processes of interaction within a health care interview can be better understood, thus enabling the most effective techniques to be taught, the effectiveness of different teaching methods to be assessed and how changes brought about by training have the potential to make a significant clinical difference to patients.
Natural science and nursing science: where do the horizons fuse?
Authors: Whittemore Robin 
Published: March 2003

Natural science and nursing science: where do the horizons fuse?The natural sciences have an influential effect on society, contemporary world‐views, and other scientific disciplines. A brief history of the major advances in the natural sciences and the associated philosophies provides a platform for scholarly discourse regarding the subsequent influence on nursing epistemology. The concepts of knowledge and understanding are differentiated and a cautionary word is expressed not to cast aside the natural sciences and their corollary philosophies as nursing embarks upon its epistemological journey into the 21stcentury. Aesthetics is presented as a possible fusion of horizons of nursing and natural science.
Can a standardized needs assessment be used to improve the care of people with severe mental disorders? A pilot study of ‘needs feedback’
Authors: Lockwood Austin , Marshall Max 
Published: March 2003

Can a standardized needs assessment be used to improve the care of people with severe mental disorders? A pilot study of ‘needs feedback’ The care programme approach (CPA) was introduced in the United Kingdom in 1991 to ensure that the needs of people with mental health problems are met appropriately. Many community psychiatric nurses (CPNs) act as ‘key workers’ under the CPA. Recent evidence suggests that the CPA is not particularly effective at meeting the needs of this vulnerable group, but it might be possible to enhance the CPA by introducing a more ‘needs‐led’ approach to the planning of nursing care. ‘Needs feedback’ is a technique for enhancing the CPA. Needs feedback begins with a standardized assessment of patients’ psychiatric and social needs by a nurse specialist. The patient’s CPN is then provided with information on: (a) the needs identified; (b) why these needs have been identified; (c) the interventions required to meet the identified needs; and (d) how these interventions may be obtained. In the pilot study reported in this paper, 20 patients with severe mental disorder were evaluated before and after their CPN received needs feedback. All patients were living in the community and being managed by CPNs under the CPA. Outcome was assessed 6 months after the feedback in terms of: mental state, social behaviour and number of ‘unmet’ needs. Needs feedback was found to be compatible with the CPA in that it proved acceptable to CPNs and patients. Significant improvements were seen in the number of ‘unmet’ needs and the level of anxious/depressive symptoms. Improvements approaching significance were seen for social functioning and negative psychiatric symptoms, but not for positive psychiatric symptoms. This pilot study suggests that needs feedback may improve the quality of nursing assessment and care planning within the CPA. Further controlled investigations of needs feedback are justified.