Showing papers in "Journal of Advanced Nursing in 1988"

Reciprocal trust in health care relationships

Abstract: This paper examines the phenomenon of trust in health care relationships from a new perspective, that of the recipients of care for chronic illness. The authors argue that reciprocal trust is a necessary component of satisfying, effective health care relationships when the illness is of an ongoing nature. From the patient's perspective, reciprocal trust has a significant impact on the experience of being a receiver of health care and on the development of competency with illness management. Because of this, the authors claim that it is imperative for health care professionals to alter their traditional beliefs with regard to sick role and trust. With a new perspective, they may then develop the specific skills necessary to enact the caring aspect of the service they offer. The authors offer a number of suggestions for actualizing this reciprocal trust in clinical practice.

Nurses and shift work: effects on job performance and job‐related stress

Abstract: The purpose of this research was to examine the influence of day, afternoon, night and rotating shift schedules on the job performance and job-related stress of nurses. Registered nurses from five hospitals (n = 463) were surveyed using a structured questionnaire which measured both job performance and job-related stress. Analysis of data indicated that both the nurses' job performance and their job-related stress were related to the type of shift they worked. Overall job performance was highest for the nurses on the day shift, followed by the night, afternoon, and rotating shifts. Rotating shift nurses experienced the most job-related stress, followed in turn by the afternoon, day, and night shift nurses. The findings are interpreted within a conceptual framework which examines the social organization of work in the hospital by shift and the effects of shift work on biological rhythm synchronization.

Clinical reasoning in nursing

Abstract: This paper traces the development of the concept of nursing diagnosis and the various approaches being used to explain the cognitive processes used by practitioners in diagnosing patient problems. Three main types of explanation are compared; hypothesis generation/testing, decision analysis, and the information processing model. The recent development of the latter approach within the field of artificial intelligence is described and expert system research introduced. Finally, the potential benefits of the advent of expert systems into nursing are discussed.

Using the OSCE to measure clinical skills performance in nursing

Abstract: The measurement of clinical skills performance continues to pose a challenge for nurse educators. This paper will report on the use of the objective structured clinical examination (OSCE) to measure the psychomotor learning outcomes of a programme designed to assist students to learn to conduct a nursing neurological examination. The OSCE has a tradition in medicine, having been developed by Ronald Harden in Scotland and first reported in the British Medical Journal in 1975, The University of Ottawa has the longest North American experience with this type of evaluation procedure and there is an increasingly rich medical literature referring to the OSCE, Although the OSCE appears to be a promising method for evaluating competence in the performance of clinical skills, there are no studies in the nursing literature examining the use ofthe OSCE as a method for evaluating the performance of clinical skills by nurses. Our experience suggests that the OSCE may be a powerful tool in the evaluation of clinical competence in nursing and that it may also be an effective facilitator for learning to perform clinical skills in nursing.

The process of parenting a child with a disability: normalization through accommodations.

Abstract: Professionals commonly advise parents of disabled children to raise their children as they would children who were not disabled. The purpose of this study was to describe the management styles used by the parents of 15 children and adolescents with osteogenesis imperfecta. In particular, the behavioural strategies related to providing a normalized existence for the child and the family are discussed. Sources of threats, validation, and support for the process are also described. The convenience sample of parents was selected from the appointment calendar of a specialty clinic in a midwestern philanthropic, paediatric-orthopaedic referral hospital. Qualitative interview data were gathered using a semi-structured guide. During interviews parents described behavioural strategies they used to normalize their child's and family life. Data were analysed using a previously developed framework of normalization. This work of normalization was described as a constant process of active accommodation to the changing physical and emotional needs of the child or adolescent. It was initiated out of practical necessity at birth as a conscious solution to problems with activities of daily living, relating to the child, and engaging in family activities. Certain events constituted ‘threats’ to normalization and served as an impetus for parents to alter behavioural strategies. Implications for clinical practice and research are explicated.

Improving recovery following cardiac surgery: a randomized clinical trial.

Abstract: To enhance individual and family health during recovery from heart surgery, this study employed nursing interventions based on self-efficacy and family stress theory during the hospitalization period and for 3 months thereafter. The effectiveness of the interventions were assessed through a randomized trial in which 67 prospective bypass and valve surgery patients, aged 30-77 years, and their spouses, were allocated either the experimental interventions or usual care and followed for 6 months. At 3 months post-surgery, the only statistically significant differences between the experimentals and controls were on perceived self-efficacy for lifting and tolerating emotional distress. At 6 months no significant differences were found on individual or family measures. Analyses revealed that age, gender and preoperative cardiac status significantly affected individual recovery. The study is continuing with a larger sample in order to explicate the recovery process and to better determine whether a low intensity nursing intervention can effect changes in individual and family recovery.

Spiritual care: an element in nursing care planning

Abstract: Nursing has recognized spirituality as an aspect of holistic patient care but little has been written on the understanding of this concept within the holistic approach. In a discussion of the issue, three basic questions are addressed. These questions include 'What is spirituality?', 'How do patients express their spirituality?', and 'How can spiritual care be incorporated into a plan of care?' Drawing upon nursing and health-related literature, an outline of the concept of spirituality is drawn and five broad areas of expression are described. The nursing process is used to demonstrate how spirituality can be incorporated into the patient's plan of care.

Patient education: a literature review

Abstract: The literature review has been carried out to examine the role of nurses as patient teachers. It attempts to determine why patient education is necessary and why it should be part of the nurse's role. Included is an account of the abilities required by the nurse in order to function in that role. It is generally agreed that it is part of the nurse's role to educate patients but this is often not carried out in reality. Where it is done it is mostly unplanned and haphazard in manner and the effectiveness uncertain. There are many reasons cited why this is the case and many of these reasons relate to the inadequate education and training of nurses for this role. Registered nurses are responsible for the nursing care of patients which should include their education. In order to be able to provide the necessary education nurses must have the opportunity to be taught to develop the appropriate skills during basic training. As a result, a study is now underway to attempt to determine the extent to which student nurses are being prepared for their role as patient educators during basic training.

A comparison of sources of nursing stress and job satisfaction among mental handicap and hospice nursing staff

Abstract: This study compares sources of nursing stress and job satisfaction among 181 mental handicap and 24 hospice nurses. It was hypothesized that nursing stress varies as a consequence of nursing specialty. Analysis of variance revealed differing features of nursing stress between the two specialties. Hospice nurses reported stress as primarily associated with death and dying and inadequate preparation to meet the emotional needs of patients and their families, while mental handicap nurses reported stress related to workload, conflict with other nurses and nursing environment. The results suggest that two additional factors that did not differ between specialties require further examination, namely patient behaviour and purposelessness of nursing care. Job satisfaction also differed between specialties with hospice nurses reporting higher satisfaction with supervision, co-workers, and pay, and lower satisfaction with promotion in comparison to mental handicap nurses. Within the mental handicap groups nursing stress correlated with job satisfaction, state-trait anxiety and non-psychotic psychiatric disturbance in predicted directions. Analysis of the above variables with respect to mental handicap nursing grade was also undertaken. Overall results indicate the importance of nursing specialty as a major factor influencing nursing stress.

Support of wives of myocardial infarction patients

Abstract: Seventy-six wives of patients suffering a first myocardial infarction were studied by questionnaire 6 weeks after their husbands went home. Despite the routine provision of support and information to spouses during their husband's stay in hospital, a high proportion reported physical and emotional symptoms of stress. The majority of wives felt they were poorly informed about myocardial infarction, had not had enough opportunity to ask the experts questions, and had received most support from relatives. The reasons for these findings are discussed and suggestions for early and systematic nursing intervention are made in an attempt to reduce stress and prevent the development of unhealthy patterns of behaviour.

A comparison of nurse-related behaviour, philosophy of care and job satisfaction in team and primary nursing.

Abstract: The study compares team and primary nursing modes of organization of nursing care on three related variables, namely: nurse-related behaviour and quality of care, philosophy of care and job satisfaction for nurses. The historical dimension and evolution of modes of care, quality of care, philosophy of care and theories of job satisfaction are discussed within the context of the study. The literature and previous research studies conducted on team and primary nursing are reviewed and comparisons of the two are made. Analysis of data collected yielded results which are compared for differences and benefits between team and primary nursing. The results of the study suggest that when compared to team nursing mode of organization of care, primary nursing affords increased quality of care, a more coherent philosophy of nursing and increased job satisfaction for nurses. Methodological problems are examined and implications for policy explored.

International nursing research in social support: theoretical and methodological issues

Abstract: Social support has been widely studied within cultures as a variable that is protective of health and mental health, either directly or as a buffer against life stress. When research is conducted across cultures, several conceptual and methodological issues emerge. The purpose of this paper is to discuss the conceptual basis for assuming that social support is a universal phenomenon, to suggest areas in which manifestations of social support may be culture-specific, and to present methodological issues that need to be addressed in conducting valid international research on social support.

Patient teaching or patient counselling

Abstract: Careless or confused use of terms such as information giving, teaching and counselling may lead to inadequate understanding and practice. In view of the progress made in this area, designed to help patients cope with illness and treatment, this paper aims to clarify and identify similarities and differences between these activities and discuss their relevance for those in most need of these types of care. Having recognised the complexity and persistence of such needs, patients, their relatives and nurses should perhaps decide their respective roles and work towards improving the quality of and opportunities for such interventions.

Evaluation of a gerontological nursing continuing education programme: effect on nurses' knowledge and attitudes and on patients' perceptions and satisfaction

Abstract: The purpose of this study was to evaluate the effects of a four-session (8-hour) gerontological nursing continuing education (CE) programme on nurses' knowlege of and attitudes towards the elderly. The study also sought to ascertain the effects of the CE programme on patient satisfaction with and perceptions of nursing care. Seventy-six nurses completed the Miller-Dodder Revision of the Palmore Facts on Ageing Quiz and the Kogan Attitudes Towards Old People Scale before and after participating in the CE programme. Post-test scores on both measures were slightly but significantly higher than pretest scores. Thirty hospitalized elderly patients were interviewed before and 33 were interviewed after the CE programme was offered to the nurses on their hospital units, using the LaMonica-Oberst Patient Satisfaction Scale and the Harrison-Novak Patient Perception Scale. Post-test measures of patient satisfaction and perception were not significantly different from pretest scores. Patients were generally satisfied with their nursing care, but perceived that nurses did not focus on health promotion activities. In addition, 59% of the patients indicated that they were unable to distinguish nurses from other health care providers. The article identifies implications of the study for nursing education, practice and research.

Nursing care as a moral, practical, communicative and creative activity

Abstract: In this paper nursing care is studied by philosophical inquiry. According to the outlined philosophical theory, nursing can be conceived as a moral, practical, communicative and creative activity. This means that nursing care is viewed as a manifestation of a conception of the good life, that it is related to some kind of changes or non-changes with respect to the patient, that it is oriented towards reaching understanding and that something new, unpredictable and meaningful is created in the nursing interaction. The theory is defended by scientific, moral and practical arguments. Habermas' theory of communicative action plays a central part in the outlined theory of nursing care.

Verbal communication and behaviour during meals in five institutionalized patients with Alzheimer-type dementia.

Abstract: Five institutionalized patients with Alzheimer-type dementia were observed (video-recorded) during meals. The aim was to assess their meal behaviour and social interaction. The results showed that ...

Preceptorship: a viable alternative clinical teaching strategy?

Abstract: The difficulty experienced by many baccalaureate student nurses in making the role transition from student to graduate nurse continues to pose problems for nursing education and nursing service personnel alike. A variety of instructional strategies described in the literature which claim to enhance the effectiveness of student learning in the clinical setting and promote role adjustment immediately upon graduation have been used by nursing faculty and nursing service personnel. Preceptorship is one such strategy. The author reviews the evolution of preceptorship within the nursing profession and explores factors which are provoking current interest in this concept. Available empirical data regarding the effect of preceptorship on student and graduate nurse performance in the clinical setting are presented and implications for nursing education discussed.

Professionalization—or struggle for survivalquest; A consideration of current proposals for the reform of nursing in the United Kingdom

Abstract: Should the current proposals to reorganize nursing work and training in the United Kingdom be understood as part of a strategy of professionalization? Traditional sociology and traditional nursing historiography tend to regard professional status as a natural occupational goal, and the widespread use of the rhetoric of professionalism in nurses' own writings and speeches would seem to endorse this. However, more recent work which uses empirical studies rather than secondary accounts and adopts different starting points is offering new perspectives. The documents proposing reform should perhaps be viewed more fruitfully as a struggle for survival through the evolution of a new occupational model, rather than as a covert quest for traditional professional status.

Individual learning styles of student nurses, their teachers and ward sisters.

Abstract: This paper presents a brief description of an experiential learning theory, which provides a model of learning and adaptation processes consistent with the structure of human cognition and the stages of human growth and development. It conceptualizes the learning process in such a way that differences in individual learning styles and corresponding learning environments can be identified. Sixty-two student nurses, 10 nurse teachers and 15 ward sisters completed a learning style inventory. No significant differences were detected. Learning style differences are discussed.

Assessment of sleep in hospital patients: a review of methods.

Abstract: Since sleep and healing appear to be associated, achieving the optimum quality of sleep among hospital patients should be a priority for both clinical nurses and researchers. This paper discusses various methods of sleep assessment which may be used by those intending to conduct research in this field.

Indwelling catheterization and related nursing practice

Abstract: A survey of patients with an indwelling urethral catheter was conducted over a 14-day period in five randomly selected district general hospitals in England. The demographic characteristics of the patients and the types of catheter and urinary drainage bags used were recorded. Observational techniques were used to describe nursing care during meatal cleansing and bag emptying Over the 14-day study period 294 patients were catheterized giving an overall daily incidence of catherization of 11.2 per 1000 of the average daily population. Nurses inserted over 50% of catheters and subsequently maintained all closed urinary drainage systems. The closed system was broken for 42% of patients and only 48% of drainage bags were always observed in the correct position. Techniques aimed at preventing infection were observed more frequently when meatal cleansing was performed separately from daily hygiene. The frequency of hand washing, both before and after meatal cleansing and bag emptying, was low. It is concluded that the procedures and practices involved in the care of the urinary drainage system require re-evaluation and re-emphasis.

Strategies and conditions for teaching theoretical nursing: an international perspective

Abstract: How, when, and why to teach nursing theory are still central questions for nurse educators. The questions are restated and generalized to the whys, and hows, and the whens to incorporate theoretical nursing rather than nursing theory in nursing education. Process and strategies for teaching theoretical nursing are compared and contrasted with those related to research. We propose the use of similar strategies and add several essential conditions related to theoretical nursing. In teaching theoretical nursing, educators are expected to develop an environment that values theory and ways by which a theoretical identity is facilitated and fostered in students. Critical and reflective thinking as well as the role modelling of local models of excellence are central ingredients in the development of nurses who are committed to using and developing theories. One approach in incorporating theory in curricula is to identify central components and goals such as historical analyses, domain boundaries, theory utilization, process and strategies for theory development and testing. Once components are identified, faculty can make a decision about where to incorporate them. We have proposed several approaches that incorporate theoretical nursing in undergraduate and graduate programmes.

Health promotion in the family: current findings and directives for nursing research.

Abstract: This paper reviews the current nursing research findings on health promotion within the family and provides directives for future research. The concept of health promotion-the overall enhancement of well being--is contrasted with primary or disease prevention, the specific protection from a health threat. The conceptual parameters of health promotion were used to search the nursing research journals for studies of health promotion in the family. The four major nursing research journals were reviewed and yielded five articles in 105 issues which addressed this phenomenon. The findings from these studies as well as other research literature are used to develop future directives. The directives are presented for both the internal environment of the family and its external environment. Areas for study related to the internal environment include definitions of health and health promotion, descriptions of current health promotion behaviours and those practised over time, decision making, fathering, and methods of intervention. Research of the external environment includes the societal norms, societal interventions, and the effects of societal institutions. This discussion of health promotion in the family describes an agenda for nursing research which is necessary to support nursing practice with families if 'health for all' is to be reached by the year 2000.

Food refusal amongst nursing home patients as conceptualized by nurses' aids and enrolled nurses: an interview study.

Abstract: One hundred and forty-three nurses' aids and 48 enrolled nurses at nursing homes in Sweden were interviewed about food refusal among patients. It became evident that their concepts of 'food refusal' and 'forced feeding' were very vague. This could partly be explained by the lack of knowledge among staff of how to interpret the frequent ambiguous eating behaviours among demented patients. It has been suggested that concept clarification and ethical analysis might reduce anxiety among staff caring for patients with severe eating problems.

The nursing prevention of pressure sores in hospital and community patients.

Abstract: The main purpose of the study was to evaluate the amount of time which was spent in giving preventive pressure area care in both a sample of hospital patients (n = 88) and a sample of community patients (n = 30). Bedfast or chairfast patients were studied from admission to the selected hospital wards or community nursing areas for a period of a maximum of 6 weeks or until they were discharged from care, developed pressure sores, died or became mobile. Data were collected by means of a diary sheet which was designed for use by nurses in the hospital and by nurses and relatives in the community. They were asked to record pressure area care as it was given on the diary sheets. The researcher also collected data about the patients' appetite, Norton score, age, sex and diagnosis. The outcome measure used was whether or not the patient developed a pressure sore, which was defined for this study as a break in the skin due to pressure. Some descriptive analysis of the data has been carried out. Results available so far show that a higher percentage of the hospital patients developed pressure sores (29%) than among the community patients studied (20%). The study appears to show that nursing care devoted to the prevention of pressure sores in terms of time and frequency is significantly related to outcome and thus to effectiveness.

The clinical nurse specialist: from the outside looking in

Abstract: This paper considers the role of the clinical nurse specialist (CNS) as portrayed in the literature. The historical development of the role is highlighted, rationale for preparation at an advanced level presented and controversy regarding placement of the CNS in a line or staff position outlined. Also discussed are the five commonly accepted sub-roles of the CNS (practitioner, educator, consultant, researcher and change agent) as well as a new role (staff advocate) which can be seen to be emerging in the literature. The author presents some of her observations of the role of the CNS at a large urban teaching hospital and concludes that congruence between the ideal role portrayed in the literature and the actual practice of the role is possible.

Mentoring in doctoral education

Abstract: Mentoring has historically been common among men. Recently, however, mentoring has emerged as a popular concept in nursing and more and more references in the nursing literature describe the importance of a mentor to the nurse. Mentoring is also an important concept in doctoral education in nursing. This paper discusses both the development of mentoring and its use in nursing today. Furthermore, six important characteristics of the mentoring relationship which can vitally contribute to the development of the nurse leader are discussed. A mentoring relationship between a doctoral student and a more experienced professional can enable the development of leadership potential and significantly contribute to the development of competent professionals in nursing.

Assessment of nurses' attitudes towards cancer: a critical review of research methods.

Abstract: There has been increasing interest in the attitudes that the general public and health care professionals hold towards cancer, the effect these have on an individual's likelihood to present early with symptoms, and the quality of care patients with the disease receive from carers. The research appears to indicate that the attitudes of both groups are largely negative and stereotyped, and cancer is seen as being more devastating than other life threatening diseases. These attitudes have been associated with patterns of poor communication and care for cancer patients. This paper looks critically at the research into the attitudes of nurses towards cancer and calls for more innovative methods than have been used to date. There is a need to increase our understanding of this complex problem before indications for education and practice can be made.

Stress factors, emotional stress and rheumatoid arthritis disease activity.

Abstract: The purpose of this study was to determine the relationship between stress factors, emotional stress and rheumatoid arthritis (RA) disease activity. Subjects (n = 101) confirmed to have RA completed the Daily Hassles Scale (DHS) to identify daily stress factors and the State/Trait Anxiety Inventory (STAI) as well as a visual analogue (VA) to measure emotional stress levels. The investigator evaluated RA disease activity (RADA) and erythrocyte sedimentation rate (ESR). Pearson product-moment correlation was used for statistical evaluation. A statistically significant, positive correlation was found between RADA and both measures of emotional stress; STAI r2 = 0.16, VA r2 = 0.25, P less than 0.01. Utilizing a psychophysiological feedback loop model, it was hypothesized that emotional stress levels and RA disease activity each served as a driving force and a consequence, i.e. as emotional stress levels increased, RA symptoms intensified and, likewise, as RA symptoms intensified, emotional stress levels increased. Nursing interventions were identified which possibly would reduce emotional stress levels, and thus, perhaps, decrease the incidence and/or severity of RA disease activity.

Hospital and community liaison links in nursing: the role of the liaison nurse.

Abstract: Since the 1960s there has been an awareness of a 'care-gap' when patients are transferred between hospital and home. In the United Kingdom, attempts to improve continuity of care have included the development of the role of the hospital/community liaison nurse. The liaison role has evolved in different ways and no systematic evaluation has occurred. This paper reports the findings of an exploratory study into the structure and process of the liaison role. It is suggested that the role is effective in enhancing continuity of care, but that modifications accompanied by educational and organizational changes would improve current practice.