bluuebunny/crossref_metadata_2025_split huggingface dataset:
An integrated approach to ethical decision‐making in the health team
Authors: Botes Annatjie 
Published: March 2003

An integrated approach to ethical decision‐making in the health team When making ethical decisions there are different perspectives that health care professionals may use. This may lead to conflict and insufficient co‐operation between the members of the health team. Two of these perspectives are the ethics of justice and the ethics of care. In a bid to gain a better understanding of the nature of ethical decision‐making in the health team, a comparison was drawn between the ethics of justice and the ethics of care. The investigation into and comparison between the ethics of justice and the ethics of care revealed that the deficiencies in each of the two perspectives in isolation, in fact, necessitate the application of a combination of both perspectives. The aim of the article is to describe how the members of the health team can, in an integrated manner, apply both the ethics of justice and the ethics of care in their ethical decision‐making. The central argument of the article is based on the following premises: (1) the inadequacy of the ethics of justice and the ethics of care in isolation necessitates that both these perspectives be applied; (2) the application of both these perspectives again requires an extended rationality and discourse and (3) discourse, in its turn, requires that the emphasis falls on a specific telos and that the participants in the discourse be endowed with certain virtues in order to abide by the rules of discourse.
Concept analysis: chronic fatigue
Authors: Trendall Judith 
Published: March 2003

Concept analysis: chronic fatigue This concept analysis attempts to clarify and analyse the concept ‘chronic fatigue’ and does so by utilizing the framework outlined by Walker and Avant (1995). The aim is to use this work to underpin future research into the care of patients suffering from chronic obstructive pulmonary disease (COPD). The literature revealed no universal definition of fatigue and a confusion exists between fatigue and chronic fatigue. Three concept analyses are considered to assist clarification. Everyday meanings are sought as well as meanings revealed in poetry. A continuum from tired to exhausted is identified and definitions offered. Defining attributes are decided upon which will be used as an operational definition in later research. Constructed cases are created; antecedents and consequences are devised from the literature; scales, tests and descriptions of general appearance which appear within the literature are considered as empirical referents. However, whilst assisting with the understanding of the concept and future research, the complexity of this subject is still evident.
Nursing home placement: an exploration of the experiences of family carers
Authors: Ryan Assumpta Ann , Scullion Hugh F. 
Published: March 2003

Nursing home placement: an exploration of the experiences of family carers This study examines some of the factors leading family carers to place their older relatives in a nursing home. It also explores their thoughts and feelings about their relatives’ admission to a nursing home. Analysis of in‐depth interviews with relatives (n=10) found that the decision to place an older relative in a nursing home was a difficult one for families. The interviewed carers stated that admission to a nursing home was held off as long as possible but the deteriorating health of the older relative and in some cases their own health meant that there was no other option. Admission to institutional care usually followed a period of prolonged home care and occurred at a time of crisis. Family carers complained that they were given inadequate support from health care professionals and often had no choice in the decision‐making process. This was particularly evident in the case of carers whose relative was transferred directly from hospital to a nursing home setting. The majority of carers in this study experienced ambiguous feelings about placing their elderly relative in a nursing home. Feelings of relief that the burden of care had been lifted, contrasted sharply with feelings of guilt that they could not continue with their ‘duty of care’. Families also felt a need to justify their decision by emphasizing how friends and other family members agreed that they could not continue with home care in the interests of both their own and the older relative’s health. The findings suggest that while many carers are relieved of the physical exhaustion surrounding home care, the emotional turmoil continues long after admission to a nursing home.
Heart health‐associated health beliefs and behaviours of adolescents of African and African Caribbean descent in two cities in the United Kingdom
Authors: Higginbottom Gina Marie Awoko 
Published: March 2003

Heart health‐associated health beliefs and behaviours of adolescents of African and African Caribbean descent in two cities in the United Kingdom The following paper presents the findings of an exploratory ethnography, the purpose of which was to identify and describe heart health associated beliefs and behaviours of year seven (Y7) and year 10 (Y10) secondary school young people of African and African Caribbean descent in two UK cities. Data were collected by the data collection technique of focus groups. However, eight focus groups were conducted involving 47 Y7 young people and 29 Y10 pupils, 76 pupils in total. The data were analysed utilizing ATLAS/ti qualitative data analysis software. This software is informed by grounded theory. Data from the study formed six themes. The findings informed the development of an interactive health promotion website which can be found at http://www.shef.ac.uk/web/uni/projects/mshhp. The paper argues that in order to provide meaningful programmes of health promotion to be developed by health care providers including school nurses and health visitors, it is essential that interventions are informed by an understanding of the health beliefs and behaviours of African and African Caribbean young people.
Nurse‐sensitive outcomes of advanced practice
Authors: Ingersoll Gail L. , McIntosh Elaine , Williams Mamie 
Published: March 2003

Nurse‐sensitive outcomes of advanced practice Advanced practice nurses (APNs) in the USA are registered nurses who hold masters or doctoral degrees in a specialized area of nursing. They provide advanced clinical care to clients, manage health care systems and influence health care decision‐making through expert clinical reasoning and research and theory‐based action. APN impact on health care outcomes is supported by studies using physician‐focused indicators, although a few studies have identified several that are sensitive to or reflective of advanced practice nursing. A modified Delphi survey was conducted during May 1997–December 1998 to determine the outcome indicators APNs recommend for use in measuring their effect on care delivery outcomes. A convenience sample of 66 APNs attending a statewide outcomes conference identified 27 potential outcome indicators. These indicators were included in a mailed survey sent to APNs working in Tennessee. Respondents were asked to rate each indicator for validity, sensitivity, feasibility, utility and cost. In the second round of the survey, they were asked whether or not they agreed with the rank ordering of indicators, which was determined by the means calculated from responses in the first round. The 10 highest ranked indicators were satisfaction with care delivery, symptom resolution/reduction, perception of being well cared for, compliance/adherence with treatment plan, knowledge of patients and families, trust of care provider, collaboration among care providers, frequency and type of procedures ordered and quality of life. APNs identified both direct and indirect measures of effect on care delivery outcomes. Some of these are currently used as indicators of advanced practice, but many are not. Additional research is needed to determine whether the indicators proposed are valid and sensitive to advanced practice care by nurses.
Factors affecting influenza vaccination rates in older people admitted to hospital with acute medical problems
Authors: Gosney Margot 
Published: March 2003

Factors affecting influenza vaccination rates in older people admitted to hospital with acute medical problems Influenza is a major problem both in the community and hospital and elderly people who are at particular risk should be included in vaccination programmes. In August 1998 the Chief Medical Officer for England extended the current influenza immunization policy to include all those aged 75 years or over. However, prior to this date only those patients with co‐existing cardiac or respiratory diseases at increased risk of influenza were vaccinated routinely. In order to determine whether such patients had been immunized, we approached all patients admitted to Care of the Elderly wards during an 8‐week period in January and February. The study additionally identified factors that may have influenced patients’ participation in this immunization programme. Six hundred and forty‐nine patients on Care of the Elderly wards with acute medical illness were questioned with regard to vaccination against influenza during the previous year. Of the 649 patients 279 were suitable for entry into the study. Of these 39% had been vaccinated against influenza. When considering the 171 who were not vaccinated, 25% (44 patients) had actually been offered and declined vaccination, in 46% of these cases due to previous side‐effects, or fear of anticipated side‐effects. In those unvaccinated three‐quarters considered that the influenza vaccine was not efficacious. Unfortunately, patients with co‐existing cardiac, respiratory or endocrine diseases were no more likely to have been vaccinated than were those without these diseases. Many older patients admitted with acute medical problems had not been vaccinated against influenza and the reasons for this included not being offered vaccination, a belief that influenza vaccination was not efficacious and concerns about possible side‐effects. The role of community doctors and nurses in facilitating the vaccination of such an at‐risk group is evident and should be incorporated into resource planning.
The qualities of an effective mentor from the student nurse’s perspective: findings from a longitudinal qualitative study
Authors: Gray Morag A. , Smith Lorraine N. 
Published: March 2003

The qualities of an effective mentor from the student nurse’s perspective: findings from a longitudinal qualitative study Parker and Carlisle (Journal of Advanced Nursing24, 771–778) argue that there is a scarcity of empirical research focusing on issues such as supernumerary status and mentorship in Project 2000 courses from the students’ perspective. This paper presents the findings of a longitudinal cohort study using Grounded Theory to discover the effect(s) of mentorship on student nurses following the introduction of the 1992 programme of education leading to a Diploma of Higher Education in Nursing and registration with the United Kingdom Central Council (UKCC). The cohort consisted of 10 students from a large Scottish College of Nursing & Midwifery who were interviewed on five occasions during the three years of their course. Students also kept a diary to record their thoughts and experiences regarding mentorship during their practice placements. In addition, a further seven students volunteered to participate by diary only. Data were analysed with the aid of NUD.IST and subjected to the constant comparative method of analysis. Findings indicate that Diploma students quickly lose their idealistic view of their mentor and over time develop an insight into the qualities they perceive are required of an effective mentor. Students quickly become aware of the importance of choosing good role models and learning their own mentor’s likes and dislikes as they realize this impinges on the outcome of their assessment. As students move into their Branch programme, a gradual distancing from their mentor is evident. This coincides with a development in their confidence, skills and a holistic perspective of care.
Using focus groups to develop a culturally sensitive videotape intervention for HIV‐positive women
Authors: Murdaugh Carolyn , Russell Rebecca Baker , Sowell Richard 
Published: March 2003

Using focus groups to develop a culturally sensitive videotape intervention for HIV‐positive women Research‐based interventions for women with the human immunodeficiency virus (HIV) are usually developed without input from the women who receive the intervention. An exploratory study was performed using focus group methodology to develop a culturally sensitive videotape intervention for educating HIV‐positive women about pregnancy and antiretroviral use. Women who met the study criteria were HIV‐positive and of childbearing age. These women volunteered to participate in the focus groups to provide information on decisions concerning pregnancy and antiretroviral use during pregnancy to decrease perinatal transmission. A total of five focus groups were conducted in 1998. Responses to three questions that were relevant to the video are presented in this article. Information gained from the focus groups was used successfully to develop a videotape currently being used in a multisite intervention study. Focus group methodology is a useful strategy to develop culturally and content relevant educational interventions for research and practice.
Oral health care needs of dependent older people: responsibilities of nurses and care staff
Authors: Fitzpatrick Joanne 
Published: March 2003

Oral health care needs of dependent older people: responsibilities of nurses and care staff The population of older people as well as the number of dependent older people is steadily increasing. Those unable to live independently at home are being cared for in a range of settings and varying degrees of dependency means that many are unable to attend fully to their needs, one aspect of which is oral care. The fact that the oral and dental health of the UK population is generally improving, makes more emphatic the responsibilities of nurses and care staff in this area. This review of the literature reveals that oral health of older people in continuing care settings is generally inadequate and that nurses’ and care staff’s knowledge and practice of oral care for older people is variable. Inadequate oral care is identified as multifactorial, with implications for educators, policy makers, practitioners and researchers. The need to address oral care for nurses pre‐ and post‐registration as well as adequate preparation for support workers is highlighted. Development of a robust oral assessment tool, as well as empirical investigation of the effectiveness of oral cleaning agents, equipment and techniques to inform standard setting is indicated, with monitoring of standards being imperative.
Forecasting models for human resources in health care
Authors: O’Brien‐Pallas Linda , Baumann Andrea , Donner Gail , Murphy Gail Tomblin , Lochhaas‐Gerlach Jacquelyn , Luba Marcia 
Published: March 2003

Forecasting models for human resources in health care This article is a review of the approaches published between 1996 and 1999 that have been used to forecast human resource requirements for nursing. Much of the work to date generally does not consider the complex factors that influence health human resources (HHR). They also do not consider the effect of HHR decisions on population health, provider outcomes such as stress, and the cost of a decision made. Supply and demand approaches have dominated. Forecasting is limited, too, by the availability of reliable and valid data bases for examining supply and use of nursing personnel across sectors. Three models – needs based, utilization based, and effective demand based – provide substantially different estimates of future HHR need. The methods of analysis employed for forecasting range from descriptive to predictive and are borrowed from demography, epidemiology, economics, and industrial engineering. Simulation models offer the most promise for the future. The forecasting methods described have demonstrated their accuracy and usefulness for specific situations, but none has proven accurate for long‐term forecasting or for estimating needs for large geographical areas or populations.
‘More than just money’– widening the understanding of the costs involved in cancer care
Authors: Pearce Susie , Kelly Daniel , Stevens Warren 
Published: March 2003

‘More than just money’– widening the understanding of the costs involved in cancer care Aim.  This paper examines the literature relating to the wider concept of cost in cancer care and the implications this has for the development of services particularly within the changing context of cancer care. Background.  Cancer remains a major cause of morbidity and mortality in the United Kingdom (UK), treatment is often complex and expensive; both in financial and human terms. Service patterns for cancer care are shifting away from traditional inpatient, hospital settings towards short stay/day‐care and home care models. This is in response to developments in health care policy, but it is also because of the availability of better tolerated treatments and demand for more patient‐focused health care. Review of the literature.  The databases of Cinhahl and Medline were accessed using the keywords of costs, treatment, outpatients, home care and cancer. Additional sources of literature were also accessed through hand searching key journals. The paper explores the literature in three themes. First, the cost‐effectiveness of cancer treatment; second, the often invisible indirect or ‘out of pocket’ costs incurred by patients and their families during cancer treatment and finally, the ‘human costs’ of a cancer diagnosis and cancer therapy. Conclusions.  In view of recent calls to improve the effectiveness of cancer care in the UK, we suggest that research is needed to address all the dimensions of cost. It is only by exploring total costs from this broad perspective that appropriate, effective and holistic services can be planned for the future.
Stories seldom told: paediatric nurses’ experiences of caring for hospitalized children with special needs and their families
Authors: Ford Karen , Turner DeSales 
Published: March 2003

Stories seldom told: paediatric nurses’ experiences of caring for hospitalized children with special needs and their families Aims of the study.  This study explored paediatric nurses’ experiences of caring for children with special needs and their families in an acute care setting. The aim of the study was to increase understanding of nurses’ experiences of caring for these children and their families. The study was designed to reveal the caring practices embedded within these relationships through exploring nurses’ stories. Study design/methods.  Gadamerian hermeneutic phenomenology and feminist research principles were the approaches used to guide the study. Interviews were held with experienced paediatric nurses and interpretation of interview transcripts using a Gadamerian hermeneutic phenomenological approach resulted in the identification of four themes. Findings.  The four themes revealed were: Special Relationships; Multiple Dimensions of Who is Expert; Development of Trust Between Nurses and Families; and Feelings of Frustration and Guilt. Conclusions.  The study emphasized the context‐specific nature of relationships between nurses and children and their families. The nurses spoke about the difficulties they encountered in their practice and some of the ways that they dealt with these problems. They discussed the things that they valued and those that made them feel guilty and frustrated. In doing so, they revealed their warmth, strength, humanity and caring.
Patients’ and relatives’ experiences and perspectives of ‘Good’ and ‘Not so Good’ quality care
Authors: Attree Moira 
Published: March 2003

Patients’ and relatives’ experiences and perspectives of ‘Good’ and ‘Not so Good’ quality care Aims. To explore patients’ and relatives’ perceptions of care and identify key criteria used to evaluate quality care, via descriptions of actual care experiences. Method. A qualitative approach using Grounded Theory was adopted; data collected by semistructured interviews, from a purposive sample of 34 acute medical patients and 7 relatives, was subjected to question and thematic analysis. Findings. The nature of the care provided and interpersonal aspects of caring emerged as key quality issues for patients. Good Quality Care was characterized as individualized, patient focused and related to need; it was provided humanistically, through the presence of a caring relationship by staff who demonstrated involvement, commitment and concern. Care described as ‘Not so Good’ was routine, unrelated to need and delivered in an impersonal manner, by distant staff who did not know or involve patients. Conclusions. Empirical evidence was found which support these findings, which are in opposition of the received view that patients place greater emphasis on the technical aspects of care tasks. The quality issues identified as important by patients and relatives in this study are not always evaluated in care audits. Those responsible for evaluating health care quality might consider combining traditional (professional/technical) audit criteria with those used by health care users to achieve a more comprehensive evaluation.
A critical incident study of nurses’ responses to the spiritual needs of their patients
Authors: Narayanasamy Aru , Owens Jan 
Published: March 2003

A critical incident study of nurses’ responses to the spiritual needs of their patients Aims of study. The aims of the study were to carry out a critical incident study to: (1) Describe what nurses consider to be spiritual needs; (2) Explore how nurses respond to the spiritual needs of their patients; (3) Typify nurses’ involvement in spiritual dimensions of care; (4) Describe the effect of nurses’ intervention related to spiritual care. Background. In the caring professions a focus on individuals as bio‐psychological‐spiritual beings is gaining recognition and this notion is based on the premise that there should be a balance of mind, body and spirit for the maintenance of health in a person (Stoll 1979). Emerging research highlights the importance of spiritual care in nursing and suggests that there is scope for improving this dimension of care in order to improve the quality of life for many patients. However, there is very little evidence about how nurses respond to the spiritual needs of their patients. Therefore the purpose of this study was to map by critical incident techniques how nurses construct and respond to patients’ spiritual needs in a variety of clinical settings. Methods. Critical incidents were obtained from 115 nurses. The data from these incidents were subjected to content analysis and categories were developed and described. The emerging categories were subjected to peer reviews to ensure reliability and validity of findings. Findings. The findings suggest that there is confusion over the notion of spirituality and the nurse’s role related to spiritual care. A variety of approaches to spiritual care emerged in this study from the critical incidents derived from nurse respondents. These were categorized as ‘personal’, ‘procedural’, ‘culturalisit’ or ‘evangelical’. There was an overwhelming consensus that patients’ faith and trust in nurses produces a positive effect on patients and families, and nurses themselves derived satisfaction from the experience of giving spiritual care. In this respect, spiritual care interventions promote a sense of well‐being in nurses as well as being a valuable part of total patient care. Conclusion. The study concluded that there is scope for developing an ideal model of spiritual care using the critical incident data from this study.