bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fears and worries associated with hypoglycaemia and diabetes complications: perceptions and experience of Hong Kong Chinese clients
Authors: Tak‐Ying Shiu Ann , Yee‐Man Wong Rebecca 
Published: March 2003

Aim.  This paper reports the second phase of a study that explored the perceptions and experience of Hong Kong Chinese insulin‐treated clients who demonstrated fear of hypoglycaemia and worry about diabetes complications. Background.

The first phase of the study, a descriptive survey (
n  = 120), identified 15% of respondents as simultaneously sustaining fears and worries associated with hypoglycaemia and diabetes complications. Although a small percentage, given the increasing number of clients using insulin treatment, this finding suggests a pocket of clients suffering from undesirable emotional health. However, a search of the literature identified few studies exploring Chinese clients' perceptions and experience in this area. Design.  The second phase of the study employed a purposive sampling method and semi‐structured interviews to collect data from 13 participants experiencing these fears and worries. Findings.  Two researchers independently used content analysis to code and categorize data. Six categories identified were: the influence of perceptions of glycaemic control on emotion, hypo‐ and hyperglycaemia as a constant threat, keeping optimal glycaemic control or maintaining a working life, financial and psychological burden of blood glucose self‐monitoring, being alone with the threat and finally distancing as the coping method. An overriding issue, a sense of losing control, emerged from the findings that described participants' perceptions and experience. This issue and two major health needs, developing self‐efficacy and emotional support from nurses, were drawn from the findings for discussion. It is suggested that self‐efficacy theory can be adopted as a conceptual framework to guide nursing practice for enhancing clients' capacity to exercise control over diabetes self‐management. Conclusions.  Findings obtained from the second phase of the study illuminated those from the first phase. Implications for nursing practice were identified, including facilitating both technical and psychosocial self‐efficacy, assessing clients' total life situation, strengthening competence in counselling skills and forming alliances with clients.
Family stress, perceived social support and coping following the diagnosis of a child's congenital heart disease
Authors: Tak Young Ran , McCubbin Marilyn 
Published: March 2003

Family stress, perceived social support and coping following the diagnosis of a child's congenital heart disease Background.  Congenital heart disease (CHD) is now estimated to be the second most prevalent chronic illness. A child's chronic illness may have effects that have pervasive consequences for family life. Recently, attention has focused on resiliency variables, especially social support and coping strategy, regulating the impact of stress. In the resiliency model of family stress, adjustment and adaptation, social support is viewed as one of the primary moderators or mediators between stress and well‐being. Aims.  The purpose of this study was to explore the relationships of family stress, perceived social support, and coping and determine the resiliency factor associated with coping by families who have a child with chronic illness. Design.  In a secondary analysis of a large longitudinal study, the sample consisted of 92 families who had a child under age 12 who was newly diagnosed with CHD within the last 3–4 months. Findings.  Results from regression analysis revealed that perceived social support operated as a resiliency factor between family stress and both parental and family coping. Child and family characteristics appeared to be the important predictors of perceived social support and parental coping. Although perceived social support appeared to be an important predictor of parental and family coping, neither the moderating nor mediating model was supported in full but partial causal relations were confirmed. Conclusions.  Findings provided evidence for the theoretical and empirical significance of perceived social support as a predictor of family coping. Further, these findings suggest that perceived social support is a factor influencing the resiliency of relatively high‐risk groups of families who have a child with chronic illness.
Poor communication and knowledge deficits: obstacles to effective management of children's postoperative pain
Authors: Simons Joan , Roberson Elaine 
Published: March 2003

Aim of the study. To explore the perceptions of nurses and parents of the management of postoperative pain in children. This paper focuses on issues of knowledge and communication.Background. Nurses are the key health care professionals with responsibility for managing children's pain, however, nurses are not well supported educationally to manage the level of responsibility.Results. Using matched interviews between 20 parents and 20 nurses many issues arose relating to the nurse/parent communication process. It was also clear that despite nurses' knowledge of pain management being deficient, they had expectations that required parents to have a level of knowledge they did not possess.Conclusions. The findings suggest that nurses' poor communication with parents and nurses' knowledge deficits in relation to children's pain management create obstacles to effective pain management. These obstacles need to be addressed in order to improve the management of children's pain through better education of nurses and two way communication with parents.
Empowering practitioners: an unrealistic expectation of nurse education?
Authors: Leyshon Stephen 
Published: March 2003

Background.  Empowerment has become an increasingly popular theme in nurse education. This is evident from the growing number of courses that claim to enable nurses to become empowered. However, this is taking place in an environment with little critical debate about the assumptions and implications for educators and students. Consequently there is a risk of creating hegemony and regimes of truth. Aim.  This paper sets out to review critically existing discourses on empowerment and to suggest a more reflexive and realistic view. Themes.  The origins of empowerment are established, together with its relationship to professional education. There is a review of the nature of power and autonomy, followed by an examination of the effects of expectations of empowering practice on educators and students. The lack of reflexivity in notions of empowerment is discussed. Consideration is given to the possibility of rehabilitating empowerment by offering an alternative conception that is realistic and reflexive. Conclusions.  Conclusions are drawn to suggest that although much of the writing on empowerment in education is insufficiently self‐critical and consequently is open to censure, ideas of empowerment should not be rejected completely: they may serve to stimulate educators (and their students as future practitioners) to connect with and challenge society.
Coping with menstruation: understanding the needs of women with Parkinson's disease
Authors: Tolson Debbie , Fleming Valerie , Schartau Elgin 
Published: March 2003

Aims. To understand how women with Parkinson's disease (PD) experience and cope with menstruation and associated gynaecological problems, and adjustments to womanhood. This paper focuses on menstruation.Rationale. Unique hormonal fluctuations are known to affect women with idiopathic PD, however, our understanding of the impact of these changes on daily lives and opportunities for nursing support are limited.Methods. Descriptive multiple case study design was adopted, and data collection involved a variety of approaches. Including semi‐structured interviews, conversational interviews, group interview, reflective diaries and creative writing. A flexible approach was encouraged whereby consenting women chose how and when they wanted to participate.Findings. A total of 19 women participated, 17 were experiencing naturally occurring periods. The majority had been diagnosed around the age of 39 years, and at the time of study participants ages ranged from 34 to 56 years. Three of the women reported no change in the experience of their periods following diagnosis, 15 reported worsening problems which in two extreme situations led to hysterectomy. During the monthly cycle PD symptoms were often exaggerated, medication effectiveness reduced and ‘off times’ increased. The period itself involved high levels of pain, fatigue and sometimes humiliating experiences when self‐care was impossible.Conclusions. This study offers a unique contribution to our understanding of the needs of young women with PD, and suggests that health professionals need to look beyond the mask of a disease associated with old age. The nursing profession has a responsibility to develop models of best practice to enable women of any age to be themselves and to adapt to the rhythm of their hormones as they live and grow older with PD.
Journeying from the philosophical contemplation of constructivism to the methodological pragmatics of health services research
Authors: Appleton Jane V. , King Lindy 
Published: March 2003

Aim.  This paper presents our journey through a contemplation of the philosophical origins of constructivism to consider its role as an active methodology in qualitative research. Method.  The first part of the paper summarizes the philosophical background of constructivism and the five principles underpinning this paradigm as described through the works of Guba and Lincoln. The philosophical roots of constructivism are then compared with postpositivism, critical realism and participatory inquiry. The paper moves on to consider their common methodological steps, before examining how the constructivist research strategy is being adopted and adapted within the pragmatics of health service research. Recent studies will be drawn upon to illustrate the use of constructivist methodology. Conclusion.  Questions are raised about the role of philosophy and the extent to which it should or does underpin or influence qualitative research strategies. We believe that if researchers gain an understanding of both philosophy and methodology a richer and more robust study is likely to result.
Evaluating Emergency Nurse Practitioner services: a randomized controlled trial
Authors: Cooper Mark A. , Lindsay Grace M. , Kinn Sue , Swann Ian J. 
Published: March 2003

Background. Emergency Nurse Practitioners (ENP) are increasingly managing minor injuries in Accident and Emergency departments across the United Kingdom. This study aimed to develop methods and tools that could be used to measure the quality of ENP‐led care. These tools were then tested in a randomized controlled trial.Methods. A convenience sample of 199 eligible patients, over 16 years old, and with specific minor injuries was randomized either to ENP‐led care (n = 99) or Senior House Officer (SHO)‐led care (n = 100) and were diagnosed, treated, referred or discharged by this lead clinician. Following treatment, patients were asked to complete a patient satisfaction questionnaire related to the consultation. Clinical documentation was assessed using a ‘Documentation Audit Tool’. A follow‐up questionnaire was sent to all patients at 1 month. Return visits to the department and missed injuries were monitored.Results. Patients were satisfied with the level of care from both ENPs and SHOs. However, they reported that ENPs were easier to talk to (P = 0·009); gave them information on accident and illness prevention (P = 0·001); and gave them enough information on their injury (P = 0·007). Overall they were more satisfied with the treatment provided by ENPs than with that from SHOs (P < 0·001). ENPs' clinical documentation was of higher quality than SHOs (P < 0·001). No differences were found in recovery times, level of symptoms, time off work or unplanned follow‐up between groups. Missed injuries were the same for both groups (n = 1 in each group).Conclusion. The study was sufficiently large to demonstrate higher levels of patient satisfaction and clinical documentation quality with ENP‐led than SHO‐led care. A larger study involving 769 patients in each arm would be required to detect a 2% difference in missed injury rates. The methods and tools used in this trial could be used in Accident and Emergency departments to measure the quality of ENP‐led care.
A study to evaluate the pain knowledge of two sub‐populations of final year nursing students: Australia and Philippines
Authors: Chiu Lee Huang , Trinca Jane , Lim Lee Meng , Tuazon Josefina A. 
Published: March 2003

Background.  Pain management is an essential and important aspect of nursing care. Deficits in pain knowledge and attitudes continue to be reported despite a growth of educational programmes. A lack of basic knowledge of pain at an undergraduate level may limit nurses from effectively developing their knowledge after graduation. Aim of the study.  To assess the type and level of knowledge of basic aspects of pain mechanisms and treatment principles in complete classes of final year nurses, at three nursing schools. Method.  Data were collected in 1999, from 150 students (81 Australian and 69 Philippine) via a 23‐item pain knowledge test questionnaire, previously used to assess undergraduate health professionals including nurses. Results.  The mean score of concordant answers for all students was 38·6%, scores ranged from 0% to 70%, 95% Confidence Interval of the mean was 36–41%. There were few significant differences between the groups for individual questions and no significant difference in overall mean scores. Common questions answered poorly included those related to complex regional pain syndrome, pharmacology and central sensitization.Most students perceived their undergraduate pain education to be minimal. Thirty‐six per cent of Australian students compared with 50% Filipino students perceived their pain knowledge was adequate for their clinical needs. Additionally, most students believed that graduating doctors should be able to answer the test questions correctly. Conclusion.  The results demonstrate consistently low levels of knowledge and also knowledge gaps about basic pain mechanisms, terms and treatment amongst these three final year nursing classes. Such information is useful to define levels of basic knowledge about this topic, and can be explored further as to whether some or all of these facts are deemed necessary for inclusion in nursing curriculum by reference to documents such as the International Association for the Study of Pain curriculum.
Cancer patients' decision‐making regarding treatment and nursing care
Authors: Sainio Carita , Lauri Sirkka 
Published: March 2003

Background.  Patient participation in decision‐making has produced many debates among health care professionals. The research evidence concerning patient participation in decision‐making is not clear, and shows conflicting results. Aims.  To identify to what extent cancer patients participate in decision‐making and to what extent background characteristics, information obtained and relationships with staff explain cancer patients' participation in decision‐making. Design/Method.
A structured questionnaire based on earlier research and qualitative interviews was designed. The questionnaire was completed by 273 cancer patients who were inpatients or outpatients in haematology, oncology clinics and other clinics at two university hospitals in Finland. The questionnaire consisted of five areas: (1) demographic data; (2) mood; (3) information obtained; (4) relationships with staff; and (5) decision‐making. The scale used was ordinal. The data were analysed using descriptive statistics and nonparametric tests such as Mann–Whitney U‐test, Kruskall–Wallis, and Wilcoxon matched‐pairs signed‐rank tests. Results.  The majority of the respondents perceived that they had participated in making treatment decisions at least to some extent, together with the physician. In decision‐making about nursing care, respondents felt that they had participated most in decisions about personal hygiene, rest and sleep. Respondents' physical condition, marital status, age and time since diagnosis, as well as information obtained and relationships with staff, were associated with participation in decision‐making. Conclusion.  This study provided evidence that some cancer patients participated in decision‐making and felt participation to be important. Staff played a crucial role in patient participation in decision‐making. In future, staff should work to improve cancer patients' opportunities to participate in decision‐making in order that those who wish to be involved can do so.
Putting the pieces together: teaching undergraduate research from a theoretical perspective
Authors: Dobratz Marjorie C. 
Published: March 2003

Problem/purpose. Baccalaureate graduates are expected to utilize research across a wide variety of practice settings. While the literature reports a variety of teaching approaches, few studies examine baccalaureate students' comprehension of research content. Teaching techniques that focus on a conceptual or theoretical approach may foster research comprehension. Therefore, the purpose of this paper is to evaluate teaching/learning outcomes of an undergraduate nursing research course designed from a conceptual or theoretical approach.Procedure/findings. Two classes of senior baccalaureate nursing students (n = 47) at a private institution, whose curriculum was based on the Roy adaptation model, were surveyed in 1990 and 1991 at the end of their undergraduate research course. The survey tool consisted of seven three‐point Likert scale questions, four open‐ended questions, and one unstructured comment. Findings showed that 72% strongly agreed that they would continue to read nursing articles in their practice field, 57% disagreed that they were intimidated by research language, and 55% agreed that they trusted their ability to use and utilize nursing research in practice. The most helpful learning activity was the research critique (34%) followed by group work (28%). The support of the teacher and Instructor's use of own research examples was also seen as most helpful (36%), while abstract cards (8%) were least helpful. Nonetheless, 23% requested more group activities, 13% wanted more class examples, and 11% asked for more time to comprehend definitions.Implications. Students who approached research from the perspective of a nursing conceptual framework indicated that they put the pieces of the research puzzle together by working in groups, being supported by the Instructor, and learning from a variety of teaching methods.
Impending extinctions of North American freshwater mussels (Unionoida) following the zebra mussel (Dreissena polymorpha) invasion
Authors: RICCIARDI ANTHONY , NEVES RICHARD J. , RASMUSSEN JOSEPH B. 
Published: March 2003

1.  Freshwater mussels (Order Unionoida) are the most imperiled faunal group in North America; 60% of described species are considered endangered or threatened, and 12% are presumed extinct. Widespread habitat degradation (including pollution, siltation, river channelization and impoundment) has been the primary cause of extinction during this century, but a new stress was added in the last decade by the introduction of the Eurasian zebra mussel, Dreissena polymorpha, a biofouling organism that smothers the shells of other molluscs and competes with other suspension feeders for food. Since the early 1990s, it has been spreading throughout the Mississippi River basin, which contains the largest number of endemic freshwater mussels in the world. In this report, we use an exponential decay model based on data from other invaded habitats to predict the long‐term impact of D. polymorpha on mussel species richness in the basin. 2.  In North American lakes and rivers that support high densities (>3000 m−2) of D. polymorpha, native mussel populations are extirpated within 4–8 years following invasion. Significant local declines in native mussel populations in the Illinois and Ohio rivers, concomitant with the establishment of dense populations of D. polymorpha, suggest that induced mortality is occurring in the Mississippi River basin. 3.  A comparison of species loss at various sites before and after invasion indicates that D. polymorpha has accelerated regional extinction rates of North American freshwater mussels by 10‐fold. If this trend persists, the regional extinction rate for Mississippi basin species will be 12% per decade. Over 60 endemic mussels in the Mississippi River basin are threatened with global extinction by the combined impacts of the D. polymorpha invasion and environmental degradation.
Delayed maturation in female bank voles: optimal decision or social constraint?
Authors: Prévot‐Julliard Anne‐Caroline , Henttonen Heikki , Yoccoz Nigel G. , Stenseth Nils ChR. 
Published: March 2003

1. Density, maturation and survival of female bank vole (Clethrionomys glareolus) in the northern taiga of Finnish Lapland were studied using long‐term capture–mark–recapture data from two large grids, one food‐addition grid and one control grid, in 1982–94. 2. The density on the food grid was consistently higher than the density on the control grid. 3. Females born early in the breeding season usually matured, except at very high densities. Those born later in the summer season commonly delayed maturation to the following spring. 4. Winter survival of sub‐adult (having delayed maturation) females was significantly higher than survival of adult (breeding) females. However, empirical values of sub‐adult and adult survival, as well as difference between them, were not consistent with survival values assumed in theoretical models on optimal deferred breeding. 5. There was a density‐dependent relationship between the maturation rate of young voles and the density of already established breeding females (both bank voles and all Clethrionomys together; C. rutilus and C. rufocanus occasionally occurred on the study grids). This density dependence was different for the two grids (weaker on the food‐addition grid). 6. These findings are discussed within an evolutionary context: we have, on the basis of these findings, no evidence suggesting that the observed delayed maturation represents an evolutionary optimal strategy. Rather, there is evidence suggesting that the delay is due to social constraints.