Showing papers in "International Journal of Nursing Practice in 2007"

Professional Socialization-The Key to Survival as a Newly Qualified Nurse

Abstract: The impact and prevalence of professional socialization in nursing has been written about extensively. Despite the many positive developments that have taken place in nursing within the past decade, the role of professional socialization remains heavily weighted and is of particular significance to those nurses who are newly qualified. The account given by newly registered nurses in this study demonstrates that their ability and willingness to become professionally socialized determines their ease of survival at clinical level. Twelve newly qualified Irish nurses, from two separate cohorts, were interviewed to ascertain their perceptions of becoming newly qualified nurses. A grounded theory approach was used and data were analysed using thematic analysis. A category that emerged was linked very strongly with professional socialization. The respondents did not refer to professional socialization per se, but through the coding process this emerged as the linchpin of the discussion.

Hearing what older consumers say about participation in their care.

Abstract: A study exploring older people's participation in their care in acute hospital settings reveals both consumers' and nurses' views of participation. Using a critical ethnographic design, data were collected through participant observation and interviews from consumers in acute care settings who were over 70 years old and nurses who were caring from them. Thematic analysis identified that older people equated participation with being independent. Importantly, consumers highlighted the complexity of the notion of participation when describing situations where they were unable to participate in their own care. The difficulties in communicating with health professionals and an inability to administer their own medications in inpatient settings were identified as barriers to participation. Understanding what consumers believe participation means provides a starting point for developing meaningful partnerships between health professionals and people receiving care.

Nurses' attitudes to and perceptions of knowledge and skills regarding evidence-based practice

Abstract: The study evaluated the effect of an evidence-based practice (EBP) educational programme on attitudes and perceptions of knowledge and skills, of registered nurses, towards EBP. The study was conducted using a quasiexperimental interrupted time series design. Participants were clinical nurses in educational and leadership roles within a Health Service District in south-east Queensland. The data were collected using a self-administered questionnaire at three points. Nurses' belief in the value of EBP for practice was high prior to the programme and did not change subsequently. There was an improvement following the intervention in nurses' attitudes to organizational support for EBP and their perceptions of their knowledge and skills in locating and evaluating research reports. Providing educational courses in a clinical setting is useful in improving clinicians' attitudes to and perceptions of knowledge and skills related to EBP.

Satisfaction with caring and living conditions in nursing homes: views of elderly persons, next of kin and staff members.

Abstract: The aim was to describe satisfaction with the caring and living conditions of elderly persons in nursing homes, expressed by the elderly persons, next of kin and staff members. Elderly persons were interviewed about their caring and living conditions. Next of kin and staff members completed a questionnaire about satisfaction with caring and living conditions of elderly persons. The main results showed significantly low levels of satisfaction regarding: altered health, influence on care, rehabilitation and meaningful occupation, as expressed by the elderly persons. Next of kin stated low satisfaction with staff contacts, influence on care, rehabilitation from staff and meaningful occupation for their elderly relatives. Staff members expressed low satisfaction with influence on care and meaningful occupation. The results present important evidence to guide the heads of nursing homes and those responsible for elderly care, which will help to improve the caring and living conditions of elderly persons.

Patients' preferences for nurses' gender in Jordan

Abstract: The purpose of the study was to examine patients' preferences for nurses' gender in Jordan. The public, private and university hospitals are represented by selecting one major hospital from each health sector. The sample size was 919 participants. Data were collected by a questionnaire through standardized individual interviews with patients. The findings of the study indicate that gender preferences are stronger among female patients than among male patients. Furthermore, two-thirds of female patients preferred female nurses, whereas only 3.4% preferred male nurses to care for them. In contrast, one-third of male patients' preferred male nurses, and only 10% preferred female nurses. The authors recommend that the high percentage of male nursing students need to be reconsidered by health policy-makers in Jordan.

Feminist‐informed participatory action research: A methodology of choice for examining critical nursing issues

Abstract: Identifying a methodology to guide a study that aims to enhance service delivery can be challenging. Participatory action research offers a solution to this challenge as it both informs and is informed by critical social theory. In addition, using a feminist lens helps acquiesce this approach as a suitable methodology for changing practice. This methodology embraces empowerment self-determination and the facilitation of agreed change as central tenets that guide the research process. Encouraged by the work of Foucault, Friere, Habermas, and Maguire, this paper explicates the philosophical assumptions underpinning critical social theory and outlines how feminist influences are complimentary in exploring the processes and applications of nursing research that seeks to embrace change.

Sense or no-sense: the nurse as embodied ethnographer.

Abstract: Researching in familiar environments brings about challenges as nurses are learned to tune out their senses to give expert nursing care, and contemporary nursing research using observations has been criticized for being disembodied--not often using senses other than sight. This article draws on experiences from a fieldwork study of palliative and aged care environments to show how a deliberate use of the senses can enhance the richness of nursing research and open up new avenues for investigation. Examples from a reflexive fieldwork journal are presented to demonstrate how sensate experiences was used in a reflexive process that led into areas that otherwise might have remained unexplored. The authors argue that the interplay between sensate experiences and analytical logic can bring the background to the foreground and provide new ways of making the familiar unfamiliar. In making sense of what residing in health care environments might mean, an embodied research activity is fruitful.

Reflective practice in nursing care: embedded assumptions in qualitative studies.

Abstract: Qualitative nursing researchers have long recognized that reflective practice (RP) seems to be a valuable tool in nursing care. The aim of the present meta-study was to analyse current qualitative research on RP in nursing care, in order to create and synthesize the knowledge and the understanding of registered nurses' RP. Using a meta-study synthesis approach, embedded assumptions were identified in qualitative studies that have influenced the way researchers have interpreted and made sense of RP in nursing care. Despite empirical focus in research on RP in nursing care, it was found that assumptions about RP were predominantly based on theory. The reflective movement within the practice of nursing care has mainly a constructivist epistemology, based on learning from experience. The individual nurse's RP capability is essential in providing and improving ethical and holistic nursing care.

Families' needs when a child is long-term ill: A literature review with reference to nursing research.

Abstract: This article reports a literature review which draws together findings targeting families' needs when a child is long-term ill. The databases PubMed and CINHAL were searched from 1999 to 2003 during February 2004. The search terms were child health care, family caregivers, and needs and combinations of these. The search was limited to articles published in English and the Scandinavian languages. The analysis entailed a series of comparisons across articles focusing on major areas of inquiry and patterns of results. Various levels of needs are described, based on individual, family and social needs.

Caring relationship in a context: Fieldwork in a medical ward

Abstract: The aim of this study was to investigate how the caring relationship is formed in a medical context. The data were collected using participant observation with field notes and analysed by an interpretive phenomenological method. The context circumstances in a medical milieu demanded exacting efficiency and risks to oppress the caring relationship, subsequently causing demands in nursing practice. Three themes of the caring relationship were identified as respect for each other and for themselves, responsibility to reach out to each other and engagement. Patients' and nurses' awareness in encounters drove the forming of a caring relationship that went beyond the individual nurse and patient. This study implicates the importance of an understanding of how context circumstances create the foundation of the caring relationship.

Cooperation with school nurses described by Finnish sixth graders.

Abstract: This paper deals with research on cooperation with the school nurse described by sixth graders. The data were collected via six focus group interviews in 2003-2004. Twenty-two sixth graders (aged 11-12 years) participated in the research. The data were analysed by the constant comparison method based on grounded theory. The analysis yielded a number of concepts that describe the basis of the cooperation: the trusted expertise of the school nurse, informative interaction with the family and knowing the family situation. The cooperation consisted of supporting the pupil's growth and development, need for individual counselling and supporting coping at school. The cooperation was characterized by an open atmosphere and friendliness, a low level of reciprocity, the school nurse's stereotyped activities and respect for the pupil's privacy. Pupils' experiences and perspectives can be used to develop more holistic strategies for the school health service.

Effect of computer game intervention on the attention capacity of mentally retarded children.

Abstract: The low rate of understanding and the limited domain of attention are two important and distinctive characteristics of mental retardation. One of the important strategies to provide effective education for these subjects is to lessen the backgrounds and impacts of these affective factors. The aim of this research was to find the effect of computer games program on the amount of mentally retarded persons' attention. Sixty educable male mentally retarded subjects were selected from two 24-h care centres in Tehran. The Toulouse-Pieron Scale was used to determinate the subjects' attention at pre-post test. Members of the experimental group were subjected to 35 sets of computer games. After use of the sets of computer games, the attention scores of the subjects were assessed immediately after the intervention and 5 weeks later. The results showed that exactly after the intervention the average attention scores of the experimental group were significantly higher than those of the control group. But, 5 weeks after the intervention, there was actually no significant difference.

Witnessing tragedy: Nurses' perceptions of caring for patients with cancer

Abstract: This paper details one of the findings of a large phenomenological study into the effects of nurse-patient encounters on clinical learning and practice. Every nurse faces the challenge of caring for a patient with cancer at some point in his or her nursing career. The participants, 392 nurses, were asked to discuss a care episode from their practice and the impact this encounter had on clinical learning and practice. The data collection method was by way of a written narrative/clinical exemplar. Meaning units and themes were identified using the Nvivo computer program. The procedural method of Giorgi was followed in all phases of analysis. The participants provided a detached description of the patients' diagnoses but tended to become emotive when discussing the cancer treatment experience. Nurses detailed care episodes with insight and understanding of the consequences of cancer for the patient. Nurses used powerful language to illustrate the enormity of the cancer experience for the patient and family. Although the nurses recognized the emotional impact themselves, they attempted to understate it. Participants spoke of their frustration and their sadness when describing the nurse-patient encounters. The life-threatening potential of cancer for the patient and the perception of potential or actual suffering do impact on nurses, their learning and their clinical practice. This is particularly evident when the cancer experience for the patient is not predictable. Participants clearly felt the influence of patients' cancer experience, personally and professionally. Participants detailed learning from the encounters and reflected with great insight on themselves and their practice. Identifying the learning potential of nurse-patient encounters can contribute to change in clinical practice.

Capacity building: a concept analysis of the term applied to research.

Abstract: Recent policy developments in Ireland have led to a focus on research capacity building as a means of consolidating nurse and midwifery education in the Irish academic setting. This follows similar initiatives in the United Kingdom and Australia. However, sparse literature and a lack of clarity of the term ‘research capacity building’ leads to some confusion. A concept analysis using Rodgers' framework was conducted. The literature examined included ‘grey’ literature, policy documents and indexed papers across a range of disciplines, derived from CINAHL/PubMed searches. The concept of research capacity building was deemed to imply a funded, dynamic intervention operationalized through a range of foci and levels to augment ability to achieve objectives in the research field over the long-term, with aspects of social change as an ultimate outcome. This is presented as an interim statement because of the evolutionary nature of the concept and the limitations of the exercise. [ABSTRACT FROM AUTHOR]; Copyright of International Journal of Nursing Practice is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A Framework Guiding Critical Thinking Through Reflective Journal Documentation: A Middle Eastern Experience

Abstract: The purpose of this paper is to present a framework to guide critical thinking through reflective journaling, and describe how a group of 20 Middle Eastern nurses used reflective journaling to enhance their practice. Journal documentation was used during clinical practicum to foster the development of critical thinking in order to assist nurses when analysing and evaluating their clinical experiences. The findings from this study demonstrated that nurses accepted the framework for journal documentation because it provided structure for reflection, speculation, synthesis and metacognition of events experienced during clinical practice. Journaling gave nurses the opportunity to transfer thoughts onto paper and write down subjective and objective data, and created dialogue between the nurse educators and nurses. They were engaged in productive and positive activity to enhance their nursing practice. Nurses also commented that writing helped to develop their confidence in writing English.

Children's perceptions on the implementation of methods for their postoperative pain alleviation: an interview study.

Abstract: The purpose of this study was to reveal the 8-12-year-old children's perceptions on the use of methods for pediatric postoperative pain alleviation by themselves, their parents and nurses. Face-to-face structured interviews were conducted with 59 subjects who had undergone surgical procedures in three provincial hospitals in Fujian Province, China in 2004. Content analysis and descriptive statistics were used to analyse the data. According to the children's perceptions, they commonly used rest/sleeping, a physical method (positioning) and a strategy of emotional support (requiring presence of their parents); their parents frequently used helping with daily activities and all strategies of emotional support; the nurses mostly used a strategy of emotional support (comforting) and a physical method (positioning). Children's suggestions mainly concerned the application of non-pharmacological methods, especially presence of caregivers. In conclusion, pain-relieving methods were not sufficiently used although children suffered from intense postoperative pain, which calls for health-care providers' future attention.

Muslims in Australian hospitals: the clash of cultures.

Abstract: The objective of this paper is to review the multicultural nature of Australian society, with a specific focus on the Islamic culture. Islamic principles will be presented and the impact this has on the health-care provision of Muslim people will be explored. This paper highlights issues that Muslim patients face when hospitalized in Australia. Australia has seen a major shift in its society, from English-speaking European to one that boasts enormous cultural diversity. However, this cultural diversity poses a number of challenges for a Western-based health-care service based on differing needs and expectations. This challenge is perhaps most evident during times of illness, when the Muslim patient must attempt to adhere to the principles of their faith in the non-Islamic environment of the Australian hospital. The differences discussed in this paper serve to highlight the importance of having strategies that identify the needs and expectations of culturally diverse consumers of the hospital system.

The importance of the patient-clinician relationship in adherence to antiretroviral medication

Abstract: The aim of the study was to assess dimensions of the patient-clinician relationship in relation to adherence with antiretroviral medication in a sample of HIV patients. This was a correlational evaluation, using a cross-sectional design. Thirty-eight HIV patients in two UK HIV units provided complete data. Analysis suggested that the elements of the patient-clinician relationship contributing to adherence with medication were the patient perception of being valued and respected by the clinician, the patients' ability to initiate discussions about the treatment, empowerment and level of trust placed in the nurse. The latter, and the time since starting antiretroviral treatment, were the only two variables that could predict adherence in a regression model, explaining 41% of the variance in adherence. Building trusted relationships with the patients and investing in educational and communication techniques to improve the therapeutic relationship could strongly contribute to HIV patients to maintaining high adherence rates

Enhancing nurses' capacity to facilitate learning in nursing students: effective dissemination and uptake of best practice guidelines.

Abstract: The preparation of nursing students for the real world of practice is a significant contemporary issue for health care and education institutions globally. Positive learning experiences are enabled through positive role models and attitudes which impact on ward culture. Although these best practices have been described, they have not been assimilated into the health-care system as the uptake of evidence is fraught with difficulties. Using the problem-solving approach of fitting evidence into practice––Read, Think, Do, this paper describes practical activities throughout the process to assimilate evidence. In particular, it details effective strategies that take into account the clinical context, such as displaying posters, demonstration of problem resolution in small group sessions and role modelling, and a presence in the clinical area. All of these contribute to the uptake of the guidelines to improve student experiences within the clinical setting.

A 22 month study of patient complaints at a National Health Service hospital

Abstract: Patient complaints are an important source of information for service improvements. We audited patient complaints made about medical care in a National Health Service District general hospital over a 22 month period. Complaints were about medical care, nursing care, attitudes of staff, poor communication, clinical delay (9%) and hospital environment. The complaints department closed 66% complaints within 20 days. The majority of the complaints were directly related to clinical care, poor communication, attitudes of staff and nursing care. However, 99% of patients were satisfied with an explanation and an apology indicating that almost all have been due to a lack of good communication than due to real deficiencies in the clinical care. The hospital management has investigated the majority of cases within 20 days and has made several policy changes after the investigations.

Nurses' attitudes to single checking medications: before and after its use.

Abstract: We report nurses' attitudes towards the single checking of medications before and after the implementation of this procedure in an acute health-care setting. Data from a pre-implementation survey confirmed that some nurses held strong views against single checking. Following this survey, the hospital's medication administration policy was revised, a single checking resource manual was developed, 1-2 h nurse education sessions were held, the competencies of nurses to single check and to administer medications were assessed, and single checking was successfully piloted before hospital-wide implementation. Data from a survey conducted 18 months after the implementation indicated that nurses welcomed the single checking medication procedure, felt more confident using single checking and perceived that it made them more accountable for administering medications. The findings provide evidence that nurses' attitudes to single checking change remarkably in favour of its use with education and experience using this procedure.

Getting on with life: Accepting the permanency of an Implantable Cardioverter Defibrillator

Abstract: Increasing numbers of people with cardiovascular disease are requiring the insertion of Implantable Cardioverter Defibrillators (ICDs). Although these devices are an effective life-saving treatment, psychological distress sometimes accompanies their insertion. A qualitative approach was used to explore the experiences, concerns and needs of recipients of the device in Western Australia. Twenty-two tape-recorded interviews were carried out and transcribed verbatim. This paper focuses on the physical and psychological adjustments following the insertion of the device. A central theme of 'getting on with it' used to cope with the permanency of the device was identified. This was an approach to life in which the presence of the device was accepted and then put aside while life was continued and optimized. This study provides directions for the identification of persons who might be experiencing difficulties adjusting, or who are taking extended amounts of time to accept the permanency of the device.

Taming the rescuer: The therapeutic nature of qualitative research interviews

Abstract: Interviewing in qualitative research allows, indeed encourages, participants to tell their story. Although the researcher might want to hear a certain part of the story, it is not unusual for participants from vulnerable populations to tell the researcher their entire story. This paper explores the dilemmas faced by a researcher when interviewing in a non-sensitive area and explicates the ethical decision-making that occurred during the interviews to prevent blurring of boundaries.

Jordanian women's postpartum beliefs: An exploratory study

Abstract: This study was aimed to determine the beliefs among Jordanian women regarding 10 selected postpartum behaviours. Following Human Subjects approval, a descriptive quantitative questionnaire was administered to 40 postpartum women, 20 from two rural communities and 20 from two urban communities. The majority believed, incorrectly, in prolonged bed rest, that the baby's exhalation on the mother's breast can lead to infection, that kofaleyas (tightly secured wraps around the baby) do not harm newborns, that observation by others while nursing might 'steal' the mother's milk, and that a belt around the mother's abdomen will tighten muscles. The majority correctly believed that dieting affects breast-feeding. Most postpartum women could benefit from increased education about postpartum practices. Educational programmes can help women differentiate between helpful postpartum practices and those which might have adverse effects on the health of a mother and her newborn.

A randomized controlled trial for maintaining peripheral intravenous lock in children.

Abstract: The most effective and safe method of maintaining peripheral intravenous lock in children is an important clinical question that has been identified by the researchers. The results of recent studies comparing saline versus 10 units/ml of heparin saline flush using a 24-gauge catheter in neonatal and pediatric populations are conflicting and inconclusive. The objectives of this study were to evaluate the effectiveness and safety of three flush solutions: normal saline, 1 unit/ml of heparin saline and 10 units/ml of heparin saline for maintaining peripheral intravenous locks in children, and to establish a research-based practice in the study hospital. In a prospective, randomized controlled, double-blind trial, one hundred and twenty-three subjects ranging in age from 1-10 years with 123 intravenous locks were randomly chosen to receive 1 unit/ml of heparin saline, 10 units/ml of heparin saline and normal saline to evaluate length of catheter use, survival rate and incidence of intravenous complications. The study found no statistically significant differences in length of catheter use, estimated catheter survival and the incidence of intravenous complications among the three groups. The group that received 1 unit/ml of heparin saline demonstrated the highest rate of survival. The mean length of catheter use of the group that received 1 unit/ml of heparin saline (49.8 hours) was 17 hours longer than the group that received normal saline (32.5 hours). There are no significant differences among the three types of flushing solution in terms of the catheter longevity and incidence of intravenous complications.

Prevention and health promotion and evidence-based fields of nursing - a literature review.

Abstract: This paper summarizes the evidence constituting the foundation for preventive and health promotive work performed by nurses in primary care. This is a systematic literature review in six scientific databases. Forty original articles and 16 literature reviews met the inclusion criteria. After both authors independently read the articles, 25 were excluded and 15 included. One article was judged to be of high quality, five of medium quality and 10 of low quality. The articles of high and medium quality focused on alcohol counselling, coronary heart disease and diabetes. Of the 16 literature reviews from the Cochrane Library, 10 were found to be relevant and presented evidence. The subjects included smoking cessation, breast-feeding, prevention of falls among the elderly, asthma in children, diabetes and cardiovascular disease. Few studies in the area of prevention and health promotion are of adequate scientific quality, resulting in limited evidence for the effects of interventions.

Day-case surgery patients' health-related quality of life.

Abstract: This study describes the health-related quality of life (HRQoL) of day-surgery patients and aims to identify factors associated with HRQoL. The cross-sectional questionnaire survey data were collected from day-surgery patients being discharged from hospitals in one Finnish hospital district in 2001 using the Nottingham Health Profile (NHP). The analysis was based on statistical methods. Day-case surgical patients had the best HRQoL in the social dimension and mobility. The NHP scores showed moderate distress in sleep and energy, and demonstrated pain. Older age and vocational education were associated with higher scores as measured with the NHP, indicating more problems in the measured variables. The patients who have been operated as day cases recovered satisfactorily and the operation did not weaken their perceived HRQoL. More emphasis should be put on evaluating day-case surgery patients' pain. Patient's age should be taken into account in planning type of surgery. The NHP is also a useful tool for the purposes of studying the HRQoL of day-case surgery patients.

The role of significant others in the care of women with breast cancer

Abstract: This study seeks to gain knowledge of how significant others experience the nursing care of women with breast cancer and what their own caring needs might be. The overall research design is a clinical application research within the hermeneutic tradition. Thirty-seven significant others have contributed their own narratives about the care on the basis of open, structured questions. The narratives have been submitted to an analysis of contents. The result shows that significant others have no given place in nursing care. Their place in nursing care is to look on, be present or be ignored. No matter what their place is, the significant others feel a need for caring conversations and information in an ethical manner. The faith and trust of significant others, the sharing, sense of communion and the information about woman's illness strengthen the significant others' own vitality. Their inmost desire concerns the sensitiveness of caregivers with regard to the woman's as well as the significant others' personal needs. If space is allowed and this desire meets with response, significant others can constitute a source of strength in the care of the woman suffering from breast cancer.

Contributing to a culture of learning: a mentor development and support project for Australian rural nurses.

Abstract: Mentoring in rural and remote nursing receives little attention in the literature, even though it is emerging in Australia as a popular strategy to improve the retention of staff. The Association for Australian Rural Nurses established a 2-year Mentor Development and Support Project in 2003 with the aim of promoting mentoring among rural and remote nurses. During the life of the project, 101 such nurses attended Mentor Development Workshops. This project demonstrated that training is an important prerequisite for rural and remote nurses who are planning to enter a mentoring relationship. Participant evaluation showed an increase in mentoring knowledge and skills and a subsequent rise in confidence about undertaking the role. Participants also believed that their increased capacity to mentor was reflected in their workplaces, contributing to a positive culture of learning.

Identifying measures for evaluating new models of nursing care: A survey of NSW nurse practitioners

Abstract: Health-care reforms in Australia and worldwide have seen the creation of the position of nurse practitioner (NP). To date, no protocol has been developed in Australia to guide the evaluation of this new role. All NSW authorized NPs were invited to participate in a self-administered questionnaire. Generic process and outcome measures of NP services were taken from a review of the literature. NPs were asked to determine how ‘essential’ each of these measures would be to describe their clinical practice. Of the 36 eligible authorized NPs in NSW, 30 returned completed questionnaires (83% response rate). The following measures were rated ‘essential’ by all (100%) NPs: presenting issue as stated by patient; current medications; patient satisfaction with education, quality of care received, and provider knowledge and skill. Our results provide a unique set of indicators with which to evaluate process and outcome measures of NP services. Standard outcome measures will enable NPs to evaluate their service efficiently and to benchmark against other NPs.