bluuebunny/crossref_metadata_2025_split huggingface dataset:
Focus on community: directions for nursing knowledge development
Authors: Kulbok Pamela A. , Gates Marie F. , Vicenzi Angela E. , Schultz Phyllis R. 
Published: March 2003

Focus on community: directions for nursing knowledge developmentNurses are challenged to advance the theoretical foundations of community practice. This paper offers ideas on what has been done and what needs to be done to meet this challenge. Within a community health nursing perspective, the paper defines community, proposes an integrated knowledge development framework that focuses on community, analyses contemporary theoretical and philosophical foundations of community in nursing, considers three world‐views in which nursing can be framed, and examines parameters for knowledge development for the future.
Mental health nursing policy — an exploratory qualitative study of managers’ opinions
Authors: Shears Malcolm , Coleman Mick 
Published: March 2003

Mental health nursing policy — an exploratory qualitative study of managers’ opinions During the 1990s, much of the legislation and policy that pertains to mental health services has sought to direct them towards a virtually exclusive concern with the seriously mentally ill, typified by the following recommendation from a recent Department of Health review of mental health nursing that stated: ‘The essential focus for the work of mental health nurses lies in working with people with serious or enduring mental illness’. On the other hand, pressure from the primary health care sector suggests the need for services to be provided for the less seriously mentally ill, particularly through the auspices of general practice fundholders. Following a review of the literature, a small‐scale, exploratory study was initiated to seek answers to the following research question: How is the policy focus urging reorientation to the severely mentally ill viewed by nurse managers who have a responsibility through Mental Health Resource Centres and Community Mental Health Teams, to provide mental health services? The study was based within a Welsh National Health Service (NHS) Trust that employed six nurse managers of Community Mental Health Teams (CMHTs). Four of the managers additionally had responsibility for Community Mental Health Resource Centres (CMHRCs). Of the population of six managers, four composed the sample for the investigation. A qualitative research approach was employed, utilizing semistructured interviews as the data collection tool. Analysis of the data revealed that managers were finding creative solutions in order to meet the conflicting demands placed upon them. The research findings also indicated that many of the obstacles to providing a needs‐led service were structural in origin, and could be resolved by central strategic intervention.
Self‐transformation as a factor in the self‐esteem and well‐being of breast cancer survivors
Authors: Carpenter Janet S. , Brockopp Dorothy Y. , Andrykowski Michael A. 
Published: March 2003

Self‐transformation as a factor in the self‐esteem and well‐being of breast cancer survivorsDiagnosis with a life‐threatening illness can lead to many changes in one’s self. These changes, called self‐transformation, are not well understood. The present study used triangulation of methods and measures to (i) describe individual differences in self‐transformation among breast cancer survivors, (ii) examine factors associated with self‐transformation in breast cancer survivors, and (iii) examine the relationships between self‐transformation and self‐esteem and well‐being in breast cancer survivors and age‐matched comparison women without cancer. Cancer survivors (n = 60) participated in structured interviews and both survivors and comparison women (n = 60) completed a set of questionnaires. Narrative analysis revealed three categories of transformation among breast cancer survivors: positive transformation, minimal transformation and feeling stuck. These groups differed by age, marital status and income, but not by disease or treatment variables. Breast cancer survivors in the positive transformation group had significantly higher self‐esteem and well‐being in comparison with (i) survivors grouped as feeling stuck and (ii) age‐matched counterparts without cancer. Cancer survivors who reported feeling stuck had significantly lower self‐esteem and well‐being than the other groups of survivors and lower well‐being in comparison with healthy women of the same age. Findings provide support for the concept of self‐transformation and a new understanding of disease, demographic and treatment factors associated with the concept. Findings also suggest that self‐transformation may be a factor in the self‐esteem and well‐being of breast cancer survivors.
The cost and value of pre‐registration clinical placements for Project 2000 students
Authors: Jones Myfanwy Lloyd , Akehurst Ron 
Published: March 2003

The cost and value of pre‐registration clinical placements for Project 2000 students The research outlined in this article was commissioned by the Sheffield and North Trent College of Nursing and Midwifery to explore the cost implications of pre‐registration clinical placements in the context of Project 2000. The authors outline the methodology and findings of an exercise designed to collect relevant cost information which was not readily available. On the basis of these findings, they suggest that: at 1995/1996 pay and prices, clinical placements cost the education provider approximately £890 per student per annum; in terms of real resources, the value to service providers of the service contribution made by second‐ and third‐year nursing and midwifery students on ward‐based placements outweighs the value of the time spent by qualified staff on their supervision and education. Once the funding assumptions underlying the introduction of Project 2000 have been taken into account, second‐ and third‐year nursing and midwifery students benefit the service provider by on average £3·46 for every hour they spend in an unrostered ward‐based placement. The service contribution made by students in community‐based clinical placements cannot free staff time in the same way as on the wards and, because qualified staff in these areas are generally more highly graded, the value of the time they spend on the supervision and education of students on placement is higher than in ward‐based placements. Second‐ and third‐year students therefore appear to cost the service provider on average £0·48 for each hour they spend in a community‐based placement. It was not possible to determine whether this cost translates into a reduction in patient contacts.
Synergy: working together with volunteers in community well woman clinics
Authors: Merrell Joy , Williams Anne 
Published: March 2003

Synergy: working together with volunteers in community well woman clinics Despite promotion of the participation of volunteers in community and primary care services, there are few British studies which have explored the benefits and challenges of collaborative working between volunteer and paid workers, and in particular, women’s experiences of volunteering within the National Health Service (NHS). The study presented here seeks to add to the limited, existing knowledge in this area. The experiences of volunteer and paid workers working together in two community well woman clinics are discussed, focusing on the benefits of working together for volunteers, paid workers and clients. Discussion is based on data collected over an 18‐month period of participant observation in two community well woman clinics, interviews with 26 volunteer and paid workers and a review of the clinics’ operational policy documents. Drawing on the concept of synergy, relationships between volunteer and paid workers are illuminated. In this paper it is argued that working together renders the opportunity for volunteer and paid workers to share insights, perspectives and approaches which enhance clients’ health assessments. It provides an added value dimension to client care and yields benefits for the service provider. The implications of the study for practice and policy are considered.
Nurses’ and physicians’ narratives about long‐term non‐malignant pain among men
Authors: Paulson Margareta , Danielson Ella , Norberg Astrid 
Published: March 2003

Nurses’ and physicians’ narratives about long‐term non‐malignant pain among menThe aim of this study was to illuminate the meaning of skilled nurses’ and physicians’ lived experiences in their encounters with men suffering from long‐term, non‐malignant pain of at least 6 months duration. Seventeen nurses and four physicians participated in the study. A phenomenological‐hermeneutic method was used. In the analysis three themes, ‘needing to be manly’, ‘struggling for relief from pain’ and ‘needing human support’ emerged. The phenomenon ‘confirmation’ was especially important in all three themes. This study indicates that confirmation of the theme ‘needing to be manly’ means that nurses’ and physicians’ must have such a relationship with these men that they really feel respected. Confirmation of the theme ‘struggling for relief from pain’ means that the care givers must convince these men that they really believe each unique individual’s narratives. Confirmation of the theme ‘needing human support’ means that nurses and physicians have to behave in such a way that these men are convinced that the caregivers really care about them. When the men felt confirmation they dared to disclose their pain experiences more honestly. This is a preliminary prerequisite for nurses’ and physicians’ potential to help these men.
Evaluation of reflective learning in a psychodynamic group of nurses caring for terminally ill patients
Authors: Von Klitzing Waltraut 
Published: March 2003

Evaluation of reflective learning in a psychodynamic group of nurses caring for terminally ill patients The development of a psychodynamic group comprising seven female nurses was studied for 1 year (31 sessions). The group was part of a 1‐year postgraduate training in patient‐centred nursing. The members of the group all worked on the same unit; none of them left the unit or the group during the study. As the nurse–patient relationship is considered to be crucial for patient‐centred nursing, the group sessions focused on the problems which the nurses experienced in their relationships with the patients. The objective of the group‐work was to improve the nurses’ ability to reflect on these relationships. The purpose of the study was to evaluate the group sessions, concentrating on the characteristics of patients selected for discussions, group process over time, and impact of specific patient characteristics on the group‐work. Transcriptions of the tape‐recorded group sessions were made for systematic analysis. A category system was developed and validated to rate reflection about the patient, the nurses themselves and the nurse–patient relationship. The results showed that the nurses over‐proportionally selected terminally ill patients, as well as patients who were female and within a similar age range as themselves. These results could be due to an identification with these patients, causing increased psychological stress on the nurses. Throughout the year, the nurses’ verbal activity and their reflections about their patients increased, whereas their reflections about themselves decreased. The need to withdraw and protect oneself by focusing more on the patient than on oneself might have been a strategy the nurses used to cope with growing stress.
Empathy has not been measured in clients’ terms or effectively taught: a review of the literature
Authors: Reynolds William J. , Scott Brian , Jessiman Wendy C. 
Published: March 2003

Empathy has not been measured in clients’ terms or effectively taught: a review of the literatureEmpathy, the ability to communicate an understanding of a client’s world, is said to be a crucial component of all helping relationships. The first part of this paper focuses on the failure of measures of empathy to reflect clients’ views about the ability to offer empathy. It is argued that, if clients are able to perceive the amount of empathy in helping relationships, they are able to advise professionals about how to offer empathy. The second part of this paper examines the inconclusive research evidence that existing courses have enabled professionals to offer empathy, and the disagreement about how empathy is best taught. The literature reviewed in this paper substantiates these observations.
Placing empowerment research within an action research typology
Authors: Sturt Jackie 
Published: March 2003

Placing empowerment research within an action research typology The focus of this paper is to use three action research typologies to consider retrospectively, and understand, the processes of an empirical study. The typologies are used to plot the changing emphasis of collaborative action research with a primary health care team that addressed their health promotion practice. The study implemented self‐efficacy theory into the health promotion practice of a primary health care team and developed a self‐efficacy framework for smoking cessation. The framework had some success in aiding practitioners in their work despite the patients’ disinterest in smoking cessation. Two action research types can be identified within the study, a technical/experimental approach which surrounded the use of a researcher‐led theoretical agenda, whereas the research facilitation was informed by critical theory and was classified as an enhancement/empowering action research type. This paper demonstrates the conflicting natures of these types which, in this study, resulted in positive outcomes associated with the experimental/technical approach but only at the expense of professional empowerment. The findings of this study imply that theoretically‐led empowering action research was an incompatible combination in this instance and this potential conflict needs to be addressed by researchers engaging in collaborative research relationships with practitioners.
The Childbirth Self‐Efficacy Inventory: a replication study
Authors: Sinclair Marlene , O’Boyle Colm 
Published: March 2003

The Childbirth Self‐Efficacy Inventory: a replication study In 1993 Lowe developed the Childbirth Self‐Efficacy Inventory (CBSEI). This is a self‐administered, 62‐item, Likert tool which measures women’s confidence in their ability to cope with labour. The tool is valid and reliable for use in American culture but had not been tested in Northern Ireland, therefore a replication study was deemed necessary. The research study set out to replicate Lowe’s study and to test the potential application of this tool in clinical midwifery practice. A convenience sample comprising a cohort of 126 women attending an urban maternity unit in Northern Ireland formed the study population and a response rate of 64% was achieved. The tool was administered antenatally, intranatally and postnatally. The predictive validity of the instrument was tested to determine actual coping behaviours in labour (Pearson’s r=0·3963, P < 0·00 for active labour; r=0·5149, P < 0·00 for second stage labour). This work confirms the CBSEI as a measurement of confidence in women’s ability to cope in labour. The authors recommend the utility of the CBSEI in midwifery practice as a tool for the identification of women who will require extra support in labour and pregnancy.
An evaluation of patients’ quality of life before, 6 weeks and 6 months after total hip replacement surgery
Authors: Knutsson Susanne , Engberg Ingegerd Bergbom 
Published: March 2003

An evaluation of patients’ quality of life before, 6 weeks and 6 months after total hip replacement surgery Annually, throughout the world, more than 800 000 primary total hip replacement surgery procedures are performed on patients suffering from hip joint arthrosis. Since 1991, ≈11 000 of these procedures are performed annually in Sweden. This study aimed to investigate any changes in the patients’ life quality 6 weeks and 6 months after their total hip replacement surgery had been performed, compared to that immediately prior to the operation. It also aimed to examine the reason for surgery, the types of prostheses used, postoperative pain, complications and the actual usage of ambulation support. The Sickness Impact Profile self‐appraisal instrument, together with personal patient interviews have been used as the basis of the research. A total of 51 patients responded to the quality of life instrument prior to their operation, 47 of these participated 6 weeks after the operation, and 40 patients 6 months after the operation. Significant differences in patients’ total, physical and psychosocial quality of life 6 months postoperatively compared to the situation prior to the operation were found, but not between the situation before and 6 weeks after the total hip replacement surgery. The majority of patients were of the opinion that it was more important that the pain had disappeared or decreased, than any overall increase in the quality of life. Postoperative complications occurred within 6 weeks, and even after 6 months some patients still suffered from these.
An evaluation of the safety and effectiveness of telephone triage as a method of patient prioritization in an ophthalmic accident and emergency service
Authors: Marsden Janet 
Published: March 2003

An evaluation of the safety and effectiveness of telephone triage as a method of patient prioritization in an ophthalmic accident and emergency service Service changes in the accident and emergency service at Manchester Royal Eye Hospital in England resulted in a telephone triage‐based referral service for health care professionals. It became clear that this service needed evaluation in order to assure both providers and users of the service that this referral strategy, based on experienced nurse practitioners making decisions about patient priority, was safe and effective. The evaluation was extended to encompass the other area of the service where telephone referrals tend to be directly from patients. A mixed method was used. Information gained within the telephone triage conversation was compared with a final diagnosis through retrospective analysis of secondary data; the documentation of those patients who were not given access to the service initially was followed‐up to ensure that this decision was safe and a number of nurses were questioned about telephone information gathering, using partially structured interviews. The study showed that nurse practitioners within the accident and emergency service were able to elicit accurate information from the telephone triage conversation on which to base a decision about patient access in most cases (76% over the whole service). This resulted in the appropriate prioritization of patients. No patient who needed urgent access to the service was denied it. The decisions made to deny urgent appointments to a number of patients were safe in all cases. It appears that one of the problem areas in the gathering of information for prioritization purposes is in the nurses’ telephone triage discussions with some, but by no means all, doctors. Some general practitioners seemed unwilling to discuss the patient and give accurate information to a nurse and this is an area which appears to need some further work.
How women receiving adjuvant chemotherapy for breast cancer cope with their treatment: a risk management perspective
Authors: Cowley Lorraine , Heyman Bob , Stanton Michelle , Milner Susan J. 
Published: March 2003

How women receiving adjuvant chemotherapy for breast cancer cope with their treatment: a risk management perspective Retrospective interviews were undertaken with 12 women who had received an 18‐week course of adjuvant chemotherapy for positive node breast cancer 1 year previously, and who had not experienced cancer recurrence. The nonstandardized interviews covered women’s preconceptions about adjuvant chemotherapy, their information needs, and the impact of treatment. The qualitative data analysis drew upon the theoretical ideas of patient career, trajectory projection and qualitative risk analysis. Some women regarded adjuvant chemotherapy as no more than an ‘insurance policy’. This perception may have arisen because doctors, attempting to minimize patient anxiety, did not discuss the high risk of disease recurrence which they faced. Other women equated adjuvant with curative chemotherapy, and anticipated hair loss or almost certain death. The women tried to cope with the physical and mental suffering associated with adjuvant chemotherapy through normalizing strategies, such as keeping a brave face, maintaining previous patterns of life, looking for humour and restructuring time. However, the rapid alterations in physical and mental state resulting from cycles of adjuvant chemotherapy resulted in a ‘rollercoaster’ experience for women which made normalization more difficult. Health professionals caring for women who must cope with uncertain future trajectories need to manage a risk communication dilemma. A strategy of fully informing women about the risks they face may cause anxiety or depression, and even impede recovery, given the evidence for psychological influences on health outcomes. But, if women do not understand the medical thinking on which their treatment is based, their misconceptions may be equally damaging.
Language, discourse and the chronotope: applying literary theory to the narratives in health care
Authors: Harden Jane 
Published: March 2003

Language, discourse and the chronotope: applying literary theory to the narratives in health care One of the most significant developments in nursing has been the recognition of the power of the narrative approach. Narrative knowing has evolved from both the patient and the nurse experience. In the case of the individual, it can be told through case history (clinical) and life story (theory‐building). The life story of the individual as a patient represents him or her to the nurse and is in turn responded to through appropriate care. Alternatively, the life story of the individual as research participant represents him or her to the researcher and is in turn responded to through appropriate interpretation. The value of the narrative is that the ‘otherness’ of the teller/writer can be regarded by the listener/reader. There resides a major tension, however, whether in theory building or the practice setting: meaning What this paper argues, is that the emphasis placed on the subject to provide an authentic story of their life is misguided, whether in the care setting or in interpretive research. My contention is that we need to develop a less naive understanding of the complexities of the language with which the individual speaks. This can be achieved by adopting post‐structural analyses of the spoken or written word, from both the originator’s and recipient’s experiences. By reconceptualizing such narratives as ‘autobiographies’ it is possible to borrow from the field of literary criticism a tool known as chronotopic analysis to perform this task.