Showing papers in "Journal of Advanced Nursing in 1983"

The nursing process: from development to implementation*

Abstract: This paper summarizes the research study carried out in 1979 as part of an MSc. The study has two purposes: to analyse, in sociological terms, the nursing process development and to understand whether it can make a practical contribution to nursing. The concept of the nursing process emerged in the United States during the 1960s. Its content was shaped by the American context. It was transferred subsequently to the United Kingdom in a limited form, modified to accommodate a different context; thus, it is not just a theoretical concept but an ideology in the technical sense as well. As a method of practice, the study shows that the nursing process is not fully implemented either in the US or in the UK. However, it does represent an important step forward in nursing in that it has made real analytical gains. The findings of the study serve to identify some of the problems that must be tackled if the theory is to be turned into practice.

Abuse and neglect of the frail elderly at home: an exploration of theoretical relationships

Abstract: Using an ex post facto, correlational descriptive design, a purposive sample of 74 elderly individuals who were identified as either having a 'good relationship' or an 'abusive/neglectful relationship' with their related caregivers were interviewed in their own homes. The purpose of the study was to test two hypotheses which predicted the nature of differences between the two groups and four which predicted the magnitude and direction of theoretically deduced causal relationships. The data showed that demographic characteristics and certain theoretical variable such as anger, hostility and stress were remarkably similar between groups. The significant differences (P less than 0.05) between the two groups included lower expectations among the abused subjects for their caregivers, lower perceptions among the abused subjects of their caregiver's actual behaviour, differences between the social networks of the two groups and more depression in the 'abuse' group. Using multiple regression analysis, a total of four causal models' were tested using anger, depression, anxiety, and abuse as terminal dependent variables. The amount of explained variance ranged from 22% for anxiety to 58% for abuse. An empirical model was generated from data available in which 2 variables, perceptions of the caregiver and family members in the house available to help, explained 54% of the variance in abuse. Language: en

Adaptation in chronic illness: an eclectic model for nurses

Abstract: The growing prevalence of chronic illness is due, in large part, to the control and/or eradication of infectious diseases as well as, in North America, the increasingly aged population and overall lengthening life span. Although the trajectory of chronic illness is in a generally downward direction, the rate of progression may vary as plateaux an remissions occur. As these changes occur, the individual and his family move through a process of continual adjustment. This paper presents a conceptual model of the process of adaptation in chronic illness. The primary concept in the model is appraisal (Lazarus, 1966) and the thought that continuous appraisal/reappraisal of the individual's progress toward the goal of adaptation is required by the individual, his family, and the nurse. The focus of the model is the chronically ill individual and his family. The goal is movement toward adaptation to the illness and its ramifications. The process is caring, which facilitates movement towards the goal. The model and its interpretation are outlined in the paper. Finally, some strategies for nurses, and others, are suggested as ways in which the concepts may be applied and implemented in practice.

Nurses' attitudes towards the nursing process.

Abstract: The attitudes of qualified nursing staff towards the nursing process were studied. Three distinct nursing units received varying degrees of planning and education regarding the principles and practice of the nursing process. The attitudes of the nursing staff of these units were assessed by means of a 20-item questionnaire. Statistically significant differences (P less than 0.001) between the mean attitude scores for the three units were found, but comparison of the overall mean attitude scores for the three grades of nurses within each unit did not result in statistical significance (P greater than 0.35). Further analysis indicated that a structured educational programme was beneficial in creating a positive attitude towards the nursing process whereas a less structured approach had the opposite effect.

Need for instruction and support of the wives of patients with myocardial infarction.

Abstract: The study investigates the need for instruction and support among wives of patients with myocardial infarction, applying the ‘stress’ theory. The data were gathered by questionnaires completed by 59 wives of patients with myocardial infarction. Feelings and symptoms indicative of stress did occur among wives of the patients. They assessed instruction especially concerning home care, as being inadequate. They stated that the support they received had come largely from their own relatives; more than one third of the respondents said they had received support from a nurse; one fifth said they had not received it from anyone. The ‘instruction’ model for wives and other relatives of patients with myocardial infarction, introduced at the end of the article, emphasizes the importance of relevant information and support to the close relatives of patients with myocardial infarction.

Professional communications in cancer care: a Delphi survey of hospital nurses

Abstract: Although good communications are generally agreed to be an essential component of effective nursing care of cancer patients, little research has been done on nurses' perception of communication problems, and less on their suggestions for resolving them. A Delphi-type survey among nurses in the North of England revealed that the main areas of comment were: dealing with patients' questions and fears; the communication implications of pain control; and relationships with other professional groups both inside and outside the hospitals. Numerous suggestions were made for improving communications.

Critique of the health-belief model.

Abstract: Health-related behaviour is an important issue for providers for health care. Understanding and being able to predict and influence health behaviour are all essential if client co-operation and participation is to be obtained. Since nurses spend more time with patients than any other health care professional, they are in a position to influence health behaviour. Optimal interaction with patients and potential patients is the result of careful application of theory. The health-belief model offers an approach to understanding health-related behaviour. A clear understanding of the cause of behaviour is necessary in order to predict change. A clear understanding of cause is also necessary for determining methods to influence health behaviour. As a new model and one developed for the healthy, the model needs development and testing for applicability in understanding health and other behaviour. Nurses can make a significant contribution in this development by testing aspects of the model. This paper summarizes the model and assesses the model using specific criteria for a theory.

Ritual and rational action in hospitals

Abstract: Menzies argues that nursing hierarchies and ritual practices protect nurses from the anxieties provoked by encountering human suffering. This proposition is examined with particular reference to ritual practices in nursing. It is argued that Menzies studied nurses in isolation from the societal and subcultural norms and values which direct hospital activity. Her psychodynamic model is contrasted with a sociological model of human conduct and action. The characteristics of ritual and rational action, and the difference between non-rational and irrational rituals, is explored. The findings of three 5-month periods of participant observation are presented as illustrative case material to support the authors view, that ritual procedures are not only defence mechanisms against anxiety, but social acts which generate and convey meaning. Ritual practices described in this analysis include rituals surrounding birth, death, status and power. It is concluded that if nurses wish to change or alter ritual nursing practices in hospital it is necessary to understand their social as well as their psychological meaning.

Factors related to the problems of long-term catheterization.

Abstract: A survey of 97 elderly catheterized patients revealed the catheter-related problems of leaking, blocking, need for irrigation, odour and irritation. Details were taken of factors thought to be related to the problems and the data were analysed by using stepwise forward multiple regression. Hospital and community patients were found to have different problems. Females in both groups had more problems than males. For hospital patients, larger catheters were found to be associated with most problems, particularly leaking and blocking. For community patients, immobility and daily changing of drainage bags were major problem causers. The common nursing practice of changing to wider-diameter catheters in an attempt to prevent bypassing is wrong.

The task of nursing and risk of smoking

Abstract: A survey of hospital nurses was conducted to determine whether certain aspects of nurses' working and living conditions could explain their smoking practices. Nurses (246) of all grades answered a questionnaire about their smoking practices, job characteristics, job satisfaction, life satisfaction and anxieties. The prevalence of regular smoking was low among first and second year student nurses but reached 22% among final year students and 27% among staff nurses. Those nurses who reported stress at work, high and low overall job satisfaction, low lifestyle satisfaction and high anxiety about patients were more likely to smoke. The importance of these factors was especially marked among final year students. It seems that the changes in the life and work routine of nurses during their final year of training appear to increase their risk of regular smoking.

Stresses of hospitalization in the elderly: nurses' and patients' perceptions.

Abstract: A study of stress in hospital is reported. Twenty-five patients (aged 70-93 years) and their nurses were interviewed about the patient's perceived stresses during the first and third weeks of hospitalization. The ward was modern in design and a 'patient allocation' system of nursing care was in operation in which one nurse had primary responsibility for each patient. Patients differed significantly from nurses in their use of a 16-item stress scale, using low scale values rather than high (stressful) values. Although as groups, patients and nurses showed significant correlations between stress ratings over the items, this was interpreted as their sharing common stereotypes about the hospital situation. There was no significant relation between nurses' and patients' ratings of the overall stress being experienced by the patients. An analysis of stress items showed there to be significant differences between type of stress. There was least discrepancy between nurses and patients concerning aspects of physical illness and most on the stressful impact of the hospital environment and routine. While patients rated items within this group (e.g. toiletting) to increase in stress during their stay in hospital, nurses rated the stress value as decreasing.

Understanding mental illness: the experience of families of psychiatric patients.

Abstract: This qualitative study was designed to elicit the family's perspective of their experience of the first hospitalization of a relative. A major focus of the study was the process by which families developed an understanding of mental illness and its treatment. During unstructured interviews, seven families explained how they interpreted unfamiliar events and surroundings. They identified their needs and concerns related to their interpretation of 'mental illness', and they described their efforts to understand the patient from this perspective. The study identified processes by which families attached meaning to events: they reviewed past experiences and beliefs to make sense of the present experience; they examined their own behaviour as a contributor to the development of the illness; they observed and evaluated the hospitalization as treatment; and they asked questions about the future. The direction for nursing practice was identified in terms of providing support and information to families, as well as being aware of the emotional responses of families at all stages of the patient's illness.

The consumer's voice: nursing implications*

Abstract: Winifred Raphael pioneered survey research into nursing problems. In particular she was interested in what patients thought about their care. Her sympathetic approach and her trust in the motivation of nurses resulted in ready acceptance of her findings and an eargemess of nurses to use these findings as a basis for improving their performance. This article discusses the paradox of patients wanting to talk, but staff being reluctant to listen, especially where emotionally charged topics are concerned. Recognition that it may be therapeutic for patients to discuss painful expyeriences and an increasing willingness by nurses to listen to patients may call for a system of providing support for the nurses themselves. Unaided, nurses may find the strain excessive and therefore, in spite of the best intention, may feel obliged to cut the patient off. There is evidence that a change has occurred in recent years in nurses' attitudes to researchers. Whereas early reports reveal a defensiveness and a rejection of critical comments by researchers, recent studies show that patients are less critical of nursing care than the nurses are themselves, and that nurses welcome investigations into their work. Lack of communication with patients is most frequently criticized by patients and by nurses. Because of this nurses increasingly believe that patients may need help to make their views known and increasingly incorporate patient-advocacy in their role.

An analysis of the factors which impinge on a nurse's decision to enter, stay in, leave or re-enter the nursing profession.

Abstract: As part of a wider study concerned with the changing nurse employment patterns a detailed questionnaire was completed by a total of 2325 qualified female nurses, 841 of whom were working fulltime in nursing, 634 were inactive, 678 were offering their services on a part-time basis and 172 were working in some other occupation. In a previous article the results of the analysis conducted on the responses to the attitude questions were presented. In this paper the replies to those questions aimed at soliciting the reasons felt to have impacted on the respondent's decision to take up nursing, to stay or to leave the profession and to re-enter the profession are analysed. As the questionnaires were distributed in the course of two projects separated by 4 years, what is of particular interest is the similarity of the two sets of results. These indicate that there is still a very high level of job satisfaction as evidenced by the extent to which nursing would be recommended to a friend or relative. The primary obvious reason for inactivity is the existence of a young child but when further intentions are explored it is clear that there is a large pool of qualified nurses keen to resume a career the main obstacle being the lack of sufficient flexibility of hours of working.

An ethnography: four public health nurses' perspectives of nursing.

Abstract: This paper examines one study of nursing practice that utilized ethnography as a research approach. The general overview of the ethnographic method and the symbolic interaction framework used are described. An overview of the specific approach is included. The findings of the study are presented. The strengths and problems of the approach for nursing research are then reviewed. Some potential uses of an ethnographic approach for clinical nursing research are outlined.

A personal construct theory approach to the socialization of nursing trainees in two British general hospitals

Abstract: Student and pupil nurses (64), from an initial sample of 117, completed repertory grids questionnaires and interviews on the first day of training, at 4 and 18 months. Measures of identification attraction and ideal/actual congruence were derived from the grids. Trainees were found to become more identified with and attracted to medical roles during training and less identified with and attracted to lower-status non-medical roles such as factory worker. Ideal/ actual congruence with medical roles other than trainee also increased. Some measures derived from the grids related to trainee 'wastage' and to satisfaction with the hospital.

Compliance with therapeutic regimens: a follow-up study for patients with affective disorders

Abstract: The purpose of this study was to assess the impact of patient education on patient compliance to psychotropic medication after discharge from the hospital. A sample of 36 patients discharged from an in-patient care facility and receiving an oral form of psychotropic drug were the subjects of this study. All subjects were patients of affective disorders. Subjects were randomly assigned to two groups: a control group; and a directive patient-education group. The subjects were followed up after discharge for a 6-month period. In analyzing the data, results indicated that the difference in percentage of compliance between the two groups was statistically significant. Findings imply that patient education did have an effect on patient compliance to medication. The findings of the study support a technique that can be incorporated in both in-patient and out-patient programmes in psychiatric-mental health nursing. It would increase patient compliance to medication and hence decrease chances of rehospitalization.

Patient-centred nursing care in a multi-racial society: the relevance of ethnographic perspectives in nursing curricula.

Abstract: The aim of the paper is to demonstrate the importance of including cultural dimensions as a fundamental component of nursing curricula and to provide some indications as to how this may be achieved. The concept of ‘institutionalized racism’ is examined, with reference to the absence of the cultural dimension in nursing education, and it is suggested that nurses, as members of a ‘caring profession', should be in the forefront in promoting mutual cultural understanding. The argument for promoting cultural awareness is developed in the context of individualized nursing care and the nursing process. The needs of ethnic minority learners are considered along with their potential role, and that of tutors, in breaking down barriers to the acceptance of cultural diversity. Some possible reasons for the failure to include ethnographic perspectives in nurse education programmes are postulated, and finally suggestions as to how this curriculum deficit may be rectified are made. The paper concludes that British nurse educators should ensure that the needs fo learners and patients are better provided for in the future by directing more attention to ethnographic perspectives relating to learning and the provision of nursing care.

Role conflict and intention to leave nursing

Abstract: To test the hypothesis that one of the reasons why nurses leave their job is that they find it difficult to meet the public expectations 246 student and qualified nurses answered a questionnaire to assess this form of role conflict. It emerged that role conflict was highest among second and third year students and that particular aspects of it were strongly related to an expressed intention to leave nursing. The implications of these findings are discussed.

Nursology of mouth care: preventing, comforting and seeking activities related to mouth care

Abstract: Mouth care across age groups, whether independently carried out or with assistance from a nurse, is frequently not considered in relation to the health of the mouth before commencement. This need for assessment and a schema as a baseline should dictate the most appropriate tools and the method of intervention. With a nursing model by Roper based on a model of living, nursing interventions are indicated across three age groups.

Health: a basic concept in nursing theory

Abstract: The concept of health is evolving over time. Traditional paradigms of health, with disease being the central focus, have emerged into complex, multidimensional models centering on a positive, holistic approach towards the phenomenon of health. The subsequent emphasis on health promotion has concomitantly affected the concept of nursing. The concept of health is a basic building block for nursing theory. How health is defined dictates how nurses should be educated and how they should practice. Incorporating the self-care model of nursing practice, health is conceived of as the effective functioning of self-care resources which ensure the operation and adequacy of self-care actions.

Attitudes towards mental illness: effect of integration of mental health concepts into a postbasic nursing degree programme.

Abstract: A 2-year assessment of the effect of integrating mental health concepts into a postbasic nursing degree programme was done with two classes of students who had minimal psychiatric preparation in their diploma programme. These two groups of students were studied as they progressed from first to second year and from second to third year at the 3-year postbasic nursing degree programme at the University of Ibadan, Nigeria. A questionnaire on Opinion about Mental Illness (OMI Scale) was used to note if there was any change in the five attitudinal factors measured, as these students progressed from one class to the next. Results show changes in both groups in terms of their authoritarianism and social restrictiveness.

The American Nurses' Association's position statement on nursing and social policy: philosophical and ethical dimensions.

Abstract: This article analyses the American Nurses' Association's position statement on nursing and social policy. Specifically, its purpose is to highlight three themes suggested within the position statement: nursing as duty, nursing as moral art and nursing as autonomous profession. Questions are raised about the nature and significance of these themes as they relate to philosophical and ethical dimensions within nursing.

Nurses and cigarette smoking: a literature review

Abstract: This brief literature review covers forty-eight references from the English-speaking world and is concerned with three subject areas or questions, which are: In what way are nurses heavy smokers? What particular aspects of nursing may cause nurses to smoke? What influence does a nurse's smoking behaviour have on the effectiveness of the use of nurses in health-education campaigns specifically designed to decrease smoking? The first part of the article critically examines the assumptions underlying some of the evidence which has already been collected on the question of nurses' supposed heavy cigarette-smoking consumption. The general point which is made is that few of the social-research studies concerned with nurses' smoking behaviour seem to be correctly focused. The second part of this review is concerned with some of the issues which may need to be clarified. For example, it is proposed that a distinction should be made between the starting, continuing and stopping of cigarette smoking. Similarly, it is argued that nursing cannot account for the cigarette-smoking behaviour of nurses who begin nursing as smokers, nor (obviously) for those who never smoke. It is therefore suggested that the emphasis of research could initially be on those who become cigarette smokers while they are becoming nurses. Finally, having accepted Farrell's definition of health education as only including information-giving, and not behavioural changes, it is argued that any ideas of the use of nurses as health educators in smoking-cessation work in hospitals will need to be clarified and translated into practical and sensible options which take account of the limitations within the nurse training process, and also the heavy work load of nurses.

Goal-setting in terminal care: a method of recording treatment aims and priorities.

Abstract: Although hospices are often said to provide a higher standard of care to terminally ill patients than conventional health care facilities, little empirical investigation has been conducted to test such statements. One aspect of the care process for which hospices are often praised is the attention paid to social and emotional problems concerning the patient, as well as more directly clinical matters. Often these goals are not explicitly stated. This paper investigates a method for systematically documenting the goals set by a multidisciplinary group of staff for the patients under their care. The study was conducted in a National Health Service (NHS) terminal cancer care unit, the staff of which were interested in setting clear, explicit objectives for their patients.

Understanding the patient in all his human needs.

Abstract: The ‘patient’ whether an individual, family or group has multiple human needs. These needs vary with the characteristics of the patient, the state of health/illness and the setting in which care is delivered. Needs may be of a psychological, physical and/or social nature, with dynamic interaction between and within these areas. The patient is part of a large system, the family and society, and here also mutual impact takes place. Time and space take on new meaning in periods of stress and the nurse must be sensitive to the humans needs which grow out of these changed perceptions. Factors which may contribute to meeting patient needs are a systematic method of learning about the patient, basing care on his specific needs, knowledgeable and skilled care givers and an appropriate environment.

Learning to nurse the elderly: outcome measures.

Abstract: This study explores the impact of a planned learning experience with the elderly on BScN students' level of knowledge about aging. Data were gathered by means of Palmore's 'Facts on Aging Quiz', an instrument which has been validated as a measure of knowledge. Findings revealed that a learning experience requiring that students have contact and planned experience with essentially well older people who were living and functioning relatively independently was effective in increasing their level of knowledge about aging as well as lessening negative stereotypes associated with the aged.

Frontiers of nursing in the 21st century: development of models and theories on the concept of nursing

Abstract: In the past nursing has used a medically oriented perspective; consciously or not, nursing practice, education and research have been guided by the same conceptual frame of reference as has medicine. For nursing to justify its claim to being an independent health profession offering a particular service to society, it must adopt its own conceptual base, one that indicates those phenomena that are of concern to nursing and those health problems that nursing must try to solve. Many nurses have already chosen to base their teaching, research and nursing care on one of the existing conceptual models for nursing. The challenge for the 21st century is that all nurses adopt an explicit conceptual base. Broader than a theory, a conceptual model specifies nursing's focus of inquiry and may thus lead to the development of theories which will prove useful not only to nurses but to other health professionals as well. Since nursing exists to provide a necessary service to mankind, its conceptual base must be evaluated by using specific social criteria.

Exploratory study to evaluate staff attitudes towards geriatric psychiatry.

Abstract: This work is part of a larger study carried out at the Murray Royal and Murthly Hospitals within the Tayside Health District. The survey was concerned with staff attitudes towards geriatric psychiatry patients and shows that the nurses in these peripheral hospitals hold a positive attitude towards this area of nursing. These findings appear to contradict the popular opinion held throughout the nursing service, that the geriatric psychiatry nursing area is very unpopular with trained, untrained and learner nurses. In the study by Hooper [Nursing Times (1981) 77 37-40/43-44], anxiety levels among learners towards the geriatric nursing areas were found to be very high. This appears to correlate with Kogan [Journal of Abnormal and Social Psychology (1961) 62, 616-622], which summarized is as follows: Young subjects were imputed to have a more consistently negative view of old people.' By using a series of two precoded questionnaires that the subjects completed, an overview of staff attitudes towards the geriatric psychiatry areas was obtained. The hypothesis on which the study was based was as follows: that a negative view towards geriatric psychiatry would be found among the staff of the Murray Royal and Murthly Hospitals.' However, the findings of this study did not support the hypothesis on any counts and gave a highly positive attitude scale.

Where angels fear to tread--nursing and the concept of creativity.

Abstract: In the United Kingdom at the present time, there are radical changes taking place in the nursing profession. In order to cope with these new ideas, it has been suggested that nursing needs to attract into its ranks individuals who are not only highly intelligent but also highly creative. This paper examines the concept of creativity as it has been used in the fields of education and psychology and seeks to examine whether or not nurses with creative attributes are desirable or acceptable in current nursing practice. The ability of the nurse educator to provide for the needs of the highly divergent thinker is also questioned. The paper concludes with a suggested alternative for the use of creativity within the profession, that of the creation of innovative, original and humanistic approaches to the education of the student of nursing.