Showing papers in "Journal of Advanced Nursing in 1991"

A concept analysis of empowerment

Abstract: In this paper, an objective concept analysis was undertaken to examine the attributes, characteristics and uses of the concept of empowerment. A review of the literature and selected empirical referents indicated that empowerment is a complex and multi-dimensional concept. Within a nursing context, empowerment can be conceptualized as a composite of (a) attributes that relate to the client, (b) attributes that relate to the nurse, and (c) attributes that belong to both the client and the nurse. In a broad sense, empowerment is a process of helping people to assert control over the factors which affect their lives. This process encompasses both the individual responsibility in health care and the broader institutional, organizational or societal responsibilities in enabling people to assume responsibility for their own health. Antecedents to and consequences of empowerment, from a nursing perspective, are presented. To adopt truly an empowerment model in nursing, a radical paradigm shift is needed. The final conclusion is that this concept has great utility for nursing practice, education, administration and research.

Factors which influence how nurses communicate with cancer patients.

Abstract: Communication is one of the most important aspects of cancer nursing. Evidence suggests nurses experience communication difficulties and frequently block patients from divulging their worries or concerns. This paper focuses on a study which aimed to determine: (a) the extent to which nurses facilitate or block patients and awareness of their verbal behaviours; (b) whether there is a relationship between nurses' verbal behaviours and levels of anxiety, social support, work support and attitude to death; and (c) nurses' difficulties in caring for cancer patients. The study was conducted in a specialist and non-specialist hospital. Fifty-four registered nurses completed three audio-taped histories (one with a new cancer patient, a patient with a recurrence and a patient for pallative care), a self-administered questionnaire and a semi-structured audio-taped interview. The data were analysed using SPSSX. The findings indicate an overall poor level of facilitative communication, with a patient's recurrence causing most difficulties. There is evidence to suggest the way nurses communicate may depend on the environment created by the ward sister, the nurses' religious beliefs and attitude to death rather than specific education in communication skills.

Negotiating commitment and involvement in the nurse-patient relationship

Abstract: The relationship that is established between the nurse and the patient is the result of interplay or covert negotiations until a mutually satisfying relationship is reached. Depending on the duration of the contact between the nurse and the patient, the needs of the patient, the commitment of the nurse and the patient's willingness to trust the nurse, one of four types of mutual relationship will emerge: a clinical relationship, a therapeutic relationship, a connected relationship or an over-involved relationship. If the nurse is unwilling or unable to be committed to the patient, a unilateral relationship will develop, with the patient continuing to use manipulative or coercive behaviours, attempting to increase the nursing involvement in the relationship. If the patient is unwilling to trust the nurse and accept his or her illness situation, she or he will manifest 'difficult' behaviours, be withdrawn or elope. The changing nature of the relationship, and the conditions and consequences of each type of relationship are discussed.

An analysis of the concept of comfort

Abstract: Comfort is a term that has a significant historical and contemporary association with nursing. Since the time of Nightingale, it is cited as designating a desirable outcome of nursing care. Comfort is found in nursing science, for example in diagnostic taxonomies, and in references to the art of nursing, as when practice is described. Roy, Orlando, Watson, Paterson and others use comfort in major nursing theories. The term can signify both physical and mental phenomena and it can be used as a verb and a noun. However, because comfort has many different meanings, the reader has had the burden of deciding if the term is meant in one of its ordinary language senses or if its context reveals some special nursing sense. The purpose of this paper is to analyse the semantics and extension of the term 'comfort' in order to clarify its use in nursing practice, theory and research. The semantic analysis begins with ordinary language because the common meanings of the term are the primary ones used in nursing practice and are the origin of technical nursing usages. Comfort is discussed as the term is found in nursing, including texts, standards of care, diagnoses and theory. An account of patient needs assessment is used to cull three technical senses of the term from its ordinary language meanings. After contrasting these senses in order to justify their separateness, they are shown to reflect differing aspects of therapeutic contexts. Defining attributes of the three senses are then explicated and presented in table format. The last section of the paper addresses some of the ways that the extensions of the senses can be measured.

The concept of hope revisited for nursing.

Abstract: The development of nursing knowledge and interventions involve understanding human responses and needs. The human response of hope was identified as a concept in need of further clarification. The purpose of this paper was to review definitions and contextual usage of the word 'hope' from the literature and answer the conceptual question 'What is hope?' Literature from theology, philosophy, psychology and nursing was reviewed for contextual usage of the word 'hope'. In the literature, hope was viewed as part of human development, a process, a theory and a source of meaning in life. In addition, antecedents, attributes and outcomes of hope were identified from the literature that contributed to a clearer understanding of the concept.

Myocardial infarction survivors : age and gender differences in physical health, psychosocial state and regimen adherence

Abstract: Little is known about women's and older adults’experiences after myocardial infarction (MI) The purpose of this study was to determine if gender and age differences exist in psychosocial condition, health state and therapeutic regimen adherence among MI survivors Adults aged 40 to 88 years (n= 197) were interviewed 1 to 2 years after their first MI The Profile of Mood States was used to measure anxiety and depression, the Personal Resources Questionnaire was used to measure social support, the Rosenberg Self-Esteem scale was used to measure self-esteem, the Perceived Quality of Life scale was used to measure quality of life, and the Health Behaviour Scale was used to assess therapeutic regimen adherence Cardiac rehabilitation participation was recorded from rehabilitation centre records Subjective health appraisals were assessed using investigator-developed questions Increased age was associated with higher depression scores, lower quality of life, less social support, less participation in formal cardiac rehabilitation, less therapeutic exercise and poorer general health Women reported poorer health than men Findings indicated older males may be at risk for lower social support and continued smoking after infarction These findings suggest that the often-reported experience of middle-aged males post-MI cannot be generalized to all adults experiencing infarction

A participant observation study of power relations between nurses and doctors in a general hospital

Abstract: The problem addressed in this paper is how nurse-doctor power relations are manifested in a hospital setting. A review of the literature identified four major ideal types of interaction between nurses and doctors in decision-making processes. These were unproblematic subordination, informal covert decision making, informal overt decision making and formal overt decision making on the part of nurses. Each of these types was tested against empirical data gained from participant observation of interactions between the nurses and doctors working in an intensive care unit and a general medical ward. It was concluded that while both the unproblematic subordination and the informal covert decision-making types of interaction appeared superficially to be used frequently, closer examination revealed that, with the exception of nurse-consultant interactions, nurses were less dependent on these subordinate modes of interaction than much of the literature suggested. Formal overt decision making, despite official encouragement, was also infrequently utilized. However, it was noticed that senior nurses especially used informal overt strategies to involve themselves in decision-making sequences. Use of such strategies had the effect of reducing though not eliminating the power differential between doctors and nurses.

Personality hardiness, ways of coping, social support and burnout in critical care nurses.

Abstract: Hardiness, ways of coping, social support and burnout in 103 critical care nurses were addressed in this study Work-related and nonwork-related social support and hardiness were negatively related to burnout Use of emotion-focused coping was positively correlated with burnout while hardiness was negatively related to the use of emotion-focused coping and positively related to both types of social support After controlling for working nights, social support, hardiness, emotion-focused coping and problem-focused coping accounted for 44% of the variance in burnout scores

A study of role negotiation between nurses and the parents of hospitalized children.

Abstract: The role of the parent of a hospitalized child has changed considerably over the past 30 years. Where parents were previously expected to had responsibility for care over to their child's nurses, there is now an expectation that parents will be extensively involved in the care of their hospitalized children. The negotiation of roles between nurses and parents has been advocated by workers concerned about conflicts between nurses and parents. However, it is not known whether such negotiation takes place between nurses and parents. It is clear that power is not evenly distributed between nurses and parents: issues of territory, stress, anxiety, uncertainty, control and conflicts arising from parental competence all place the parent in a weaker position. It is argued that the nurse holds the initiative in the decision about whether negotiation takes place. A small study is described in which nurses were invited to describes their response to their perception that a parent wanted to increase or decrease her or his involvement in her or his child's care. The critical incident technique (Flanagan 1954) was used to collect data. Nurses' responses were categorized into categories of 'encouragement', 'explanation/advice' and 'negotiation'. Responses were then placed in more specific subcategories. The inter-rater reliability of the categorization was measured. Owing to the limitations of the study, the results can only be regarded as suggestive. Nevertheless, significant association was found between the category of response and the grade of staff, with a stratified pattern of category of response demonstrated. The implications of the study for future research are discussed.

Critical thinking: impact on nursing education.

Abstract: Critical thinking is considered an essential component of nursing science. As a concept in nursing education, however, critical thinking is not clearly understood nor systematically applied. A survey of deans and directors of baccalaureate and higher-degree schools of nursing accredited by the National League for Nursing examined perceptions of critical thinking as it is currently characterized in nursing education. Results indicated that critical thinking was conceptualized as a variant of the scientific method. It was explicated as a rational-linear problem-solving activity which reflected the nursing process. The findings demonstrated the respondents' lack of clarity about the fullest expression of the mechanisms and operations of critical thinking process and applications.

In search of more complete answers to research questions. Quantitative versus qualitative research methods: is there a way forward?

Abstract: This paper presents an overview of research methods utilized in nursing to date and traces the origins of the schism in nursing research which has led to the development of the quantitative-qualitative research-methods dichotomy. The philosophical and technical characteristics which distinguish these apparently opposing methodologies are described and critically discussed. The use of triangulation of different methods and types of data is suggested as an alternative research strategy. A study which used triangulation as a research approach which examined newly registered nurses' attitudes and educational preparation to care for patients with cancer, and developed and evaluated an educational intervention for nurses on cancer care, is described. This illustrates how the use of different research methods within a single study can provide a richer and deeper understanding of the area under investigation than would otherwise be possible. This paper also discusses the notion that nursing research has arrived at a watershed in which competing methodologies serve to divide and separate nurse researchers on the grounds of philosophical approach, a division which a neophyte discipline such as nursing can ill afford. Nurse researchers need to gain skills and understanding of different approaches to capitalize on the strengths and benefits of each in order to develop a more complete understanding of nursing practice in all its complexity.

Factors which contribute to fatigue associated with rheumatoid arthritis.

Abstract: The purpose of this research was to identify the factors which people with rheumatoid arthritis (RA) believed contributed to their fatigue. A second purpose was to examine the relationships among identified factors and the sensation of fatigue. One hundred people with RA were asked to identify verbally factors which they believed contributed to their fatigue. The three most frequently identified factors included RA disease activity, disturbed sleep and increased physical effort. These factors were operationalized and measured as joint pain using the Modified McGill Pain Inventory, fragmented sleep through overnight electroencephalographic (EEG) sleep studies, and reduced physical ability using walking time and grip strength measures. Fifteen of the original subjects with RA and 12 age and gender matched control subjects completed the second phase of the research. Five of the RA subjects were experiencing a disease flare while the remaining 10 were either in remission or their disease was midly active. Those subjects in flare had significantly (P less than 0.01) more joint pain, significantly (P less than 0.05) more fragmented sleep, and significantly reduced functional capacity as measured through walking time (P less than 0.05) and grip strength (P less than 0.05) when compared to non-flare and control subjects. Fatigue levels of the subjects in flare were positively correlated with joint pain (r = 0.62), fragmented sleep (r = 0.42) and grip strength of the right hand (r = 0.52) and left hand (r = 0.88). Fatigue levels of non-flare and control subjects were negatively correlated with the majority of measured variables.(ABSTRACT TRUNCATED AT 250 WORDS)

Patient and staff perceptions of caring: review and replication.

Abstract: The present study identified patient (n = 86) and nursing staff (n = 73) perceptions of most and least important caring behaviours. Using a Swedish version of the CARE-Q instrument or a free rating scale, patients ranked items concerned with giving honest and clear information and competent clinical expertise as most important. The nursing staff ranked expressive/affective behaviours as most important. There were significant differences between the two groups in the ranking of 14-30 out of 50 specific behaviours and in 3-5 out of 6 subscales. Patient and staff ratings did not differ appreciably between the methods used, with the exception that staff gave much higher ratings to most items in the free response format. Patients were more discriminating in the importance they assigned to the various items.

Ageist attitudes among young adults: implications for a caring profession.

Abstract: It is frequently suggested that younger adults are negative in their attitudes toward elderly people. There are also claims that such attitudes develop as a result of the socially constructed phenomenon of ageism. This paper briefly addresses the concept as it is presented in the literature and goes on to describe an attitudinal study which supports the existence of ageism. An Attitudes Toward the Elderly inventory was administered to secondary school pupils during their final 2 years of schooling, to student nurses at the very beginning of their training and to qualified nurses. It was found that the subjects did demonstrate negative attitudes and that there appeared to be a definite gender socialization influence, with females demonstrating less negative attitudes than males. Contrary to expectations, entry into nursing did not lead to more positive attitudes but had the converse effect. The influence of ageism and more specific professional socialization processes are suggested as explanations for these patterns. Implications for nursing and other occupational groups involved in caring for the elderly are discussed.

The theory-practice gap in nurse education: its causes and possible solutions. Findings from an action research study.

Abstract: Kurt Lewin, the orignator of action research, proposed that it was valuable not only for innovating change, but also the process of change could lead to new insights into the nature of the problem that was being tackled This action research project developed and evaluated a teaching model that aimed to help RGN (registered general nurse) students to bridge the theory-practice gap During the course of this work, the possible reasons for a theory-practice gap started to become clear This paper provides a discussion of these factors The viewpoint for this discussion is that of the student nurse The student is assumed to‘own’the problem and it is from her perspective that the theory-practice gap is analysed The paper includes a critical examination of books, lectures, the school curriculum and ward nursing practice Finally, possible solutions to the theory-practice problem are discussed and it is hoped that these will provide a rational basis for tackling the problem

Issues in measuring outcomes of nursing.

Abstract: The upsurge in interest in measuring patient outcomes of nursing, it is argued, has been occasioned firstly by management changes and secondly by the professionalizing thrust of the nursing profession. Within this overall context, however, the objectives of individual patient outcome studies vary considerably. The current status of outcome measurement in nursing is outlined through a description of the use of different outcome measures to suit different purposes. Ascertaining whether nursing care makes a difference by using outcome measures raises methodological as well as professional issues, for example that of separating nursing from the inputs of other professional groups and incorporating individual patients' perspectives. While these challenges are complex and measuring the effectiveness of nursing in terms of patient outcomes is in its infancy, it is argued that, in this, nursing is no different from other professional groups. The paper goes on to suggest ways of moving forward in the measurement of outcomes of nursing for patients.

Patient perspectives of diabetes care and education

Abstract: Educating and supporting patients in managing their daily life with diabetes mellitus are important goals of diabetes care today. These goals demand not only good medical knowledge but also good communication skills in the members of the diabetes care team and in the patients. Continuity and accessibility are naturally factors influencing the communication between the patients and the care team. This study, based on 55 interviews with well-experienced insulin-dependent diabetic patients, shows further that the contacts between the diabetes care system and the patient are often only superficial and in practice mainly related to the patient's metabolic control. Patients with good or acceptable metabolic control experience positive feed-back from the care team, while those with unsatisfactory or unacceptable metabolic control do not receive positive response and support to the same degree. The patients want to be permitted to be responsible for themselves and need support from the care team in order to accomplish this. From the patient's perspective, the diabetes education consists of an overwhelming amount of new information which often is presented on only one occasion. The patients want the education to be on an acceptable but minimum level and to be a continuous process that is applicable in practice.

Attitudes toward nurses discussing sexual concerns with patients

Abstract: Attitudes toward nurses discussing sexual concerns with clients were examined in 73 healthy subjects using Section A of the Sexual Adjustment Questionnaire The variables of age, sex, race, occupation, educational level, marital status, importance of sexual activity, frequency of discussing sexual relationship with partner, and number of others with whom sexual concerns are discussed were examined to determine influence on subject's attitudes Ninety-two per cent of subjects thought that nurses should discuss sexual concerns with clients Weighted least squares analysis showed that only two variables (number of others with whom sexual concerns are discussed and race) were significant predictors of attitudes

Chronic sorrow: analysis of the concept.

Abstract: Emotionally close relationships can be disrupted at any time in the life cycle. When a relationship of attachment is disrupted following an event that renders a loved one forever changed from the hoped-for child or from the known person, recurrent sadness, or chronic sorrow, is a frequently encountered response. The genesis of sadness is one's recognition of a negative disparity between the person who was known prior to the onset of disability (or the imagined, hoped-for child) and the now-disabled person. Though each episode of sadness resolves somewhat over time, renewed recognition of a negative disparity in the disabled loved one triggers sadness again. Besides being recurrent, the sadness of chronic sorrow is also permanent, variable in intensity between situations and persons, and interwoven with periods of neutrality, satisfaction and happiness. The concept is analysed and contrasted with the prevalent model of linear, time-bound grief.

The experiences of new fathers during the first 3 weeks of life.

Abstract: Research has consistently demonstrated that the transition to parenthood is a stressful event. As well, the literature recognizes that the role of the father in North American society is in the process of change. The purpose of this qualitative study was to clarify our understanding of the experience of new fathers during the first 3 weeks postpartum. Twenty-two fathers were interviewed in their homes using a semi-structured interview format. Findings suggest that new fathers go through a predictable three-stage process during the transition to fatherhood. In addition, factors were identified which affect the transition. Nursing interventions were suggested to facilitate this process and implications for future study included.

Caring versus empowerment: considerations for nursing practice

Abstract: The authors argue that there is a tension between the concepts of caring and empowerment. This tension appears in political and managerial debates over how best to run a health service, and it reappears in the clinical situation in nursing dilemmas over the presentation of information to patients. The authors review the major contributions to theory from health care literature, and use case studies to explore some of the clinical implications of these theories for nursing practice.

A study of the teaching and learning of the biological sciences in nurse education.

Abstract: The study was designed to explore the teaching and learning of the biological sciences in nurse education in an attempt to identify why some students are failing to support their practice with theory. Questionnaires were sent to third-year nurse students (n = 140) and nurse teachers (n = 43) in three schools of nursing. Several findings emerged from the study: (a) the balance between the behavioural and biological sciences in nurse education was perceived by the students as being too much in favour of the behavioural sciences; (b) the level of knowledge from the biological science taught was perceived by the students as being inappropriate for RGN training; (c) teachers felt inadequately prepared to teach the biological sciences and, similarly, nurse students felt inadequately prepared in these sciences; and (d) self-directed methods of teaching and learning, although used most frequently, were perceived by the students as being the most ineffective.

The nursing process: raising the profile of emotional care in nurse training

Abstract: This paper reports on the results of a previous investigation into the ward learning environment for student nurses and its relationship to quality of nursing. The emotional aspects of caring associated with the nursing process emerged as an important component of their relationship. The nursing process, introduced during the 1970s, is described as both a philosophy and work method. As a philosophy, it promotes a people-centred rather than task-centred approach to patients and raises the profile of emotional care. Hochschild's definition and analysis of emotional labour in the workplace is used as a conceptual means to understanding the content of nurses' emotional work. It is also used to assess the extent to which the predominant ideologies of nursing, articulated through the nursing process, were applied in the selection and training of nurses to be emotional labourers. It is concluded that the nursing process is more successful as an ideology and less in providing a knowledge base with which to inform training and support for managing complex feelings.

Power: a concept analysis.

Abstract: This paper follows the Walker & Avant approach to concept analysis of the concept of power. For the purposes of the paper, power was defined as the actual or potential ability or capacity to achieve objectives through an interpersonal process in which the goals and means to achieve the goals are mutually established and worked toward. The distinction between the views of power as 'power to' versus 'power over' are addressed in the literature review. King's conceptual framework was used as a guide. Defining attributes, antecedents and consequences of power, demonstration cases, and assumptions are presented. A theorem and testable hypothesis are proposed. The final product is a conceptual map which illustrates the contents of the concept analysis.

Service needs of stroke survivors and their informal carers: a pilot study

Abstract: This pilot study prepares the way for a controlled evaluation of counselling of disabled stroke survivors and their carers. It assesses feasibility of methods and outcome measures potentially useful in the main study. The study elicited information about the psychological, physical, social and service needs, and the feelings of stroke survivors and their informal carers. Twenty patients and their carers were interviewed separately in their own homes. Results describe research tools which were refined, and demonstrate several unmet needs in the psychosocial domain. The main findings were a requirement for more information about stroke and for counselling in relation to 'care' problems arising out of the disability of stroke disease and the changes in dependency produced.

Immigrant women speak of chronic illness: the social construction of the devalued self*

Abstract: This inquiry into the existential experience of chronic illness by immigrant women begins from a phenomenological perspective, and proceeds to examine the context in which women's experiences are embedded. It is argued that multiple factors influence the ability to manage illness. Not least among them are the emotions that are an integral part of daily existence, and the sense of self that is constructed during the course of a chronic illness. These emotions, and the definitions of self embodied within the illness experience, are produced in ongoing social interactions. For the immigrant woman, the difficulties in living with a chronic illness are exacerbated by the experience of uprooting from her homeland and resettling in a new country. She must deal with her marginality, social isolation and alienation in a foreign culture. The feeling of being devalued arises not only from the chronic illness experience, but also from the definition of self that is constructed in dealing with the migration experience. The implications that this research study has for the profession of nursing are discussed.

Mind the theory/practice gap in nursing

Abstract: The theory/practice gap is a recurrent theme in the nursing literature. Numerous suggestions have been made about how this gap may be narrowed or even closed. However, there appears to have been little attempt to date to examine the ways in which research conducted into the hidden curriculum, and philosophical analysis of the concepts involved, might inform our understanding of the reasons for the existence of the theory/practice gap. This paper attempts to utilize some of the contributions from these areas of research, and as a result will argue that, while narrowing of the theory/practice gap may be a realistic goal, any attempt to close it completely will be doomed to failure.

Needs and anxiety levels in relatives of intensive care unit patients.

Abstract: The purpose of this study was to explore the perceived needs and anxiety levels of adult family members of intensive care unit (ICU) patients. The study was conducted over a 3-month period, on a convenience sample of 166 subjects selected from the total adult population of family members visiting an ICU patient in three Sudbury hospitals. Data were gathered using a self-report questionnaire, the Critical Care Family Needs Inventory (CCFNI) and Spielberger's State Trait Anxiety Inventory (STAI). Interviews were conducted in French or English according to the subject's preference. The major variables examined were: family needs; state and trait anxiety; on-site sources of worry; spiritual needs; level of knowledge of ICU from past experience or pre-surgery education; sociodemographic data. The Situational Anxiety Scale yielded a mean score of 45.24 and the Trait Anxiety Scale a mean score of 37.3. Inferential statistics demonstrated that family needs and situational anxiety were significantly related (P less than 0.0002). Furthermore, worries, trait anxiety, age and family needs explained 38% of the variation of situational anxiety. As well, spiritual needs and situational anxiety explained 33% of the variation of family needs.

Assessing patients' pain: identifying reasons for error.

Abstract: Accurate pain assessment is vital for good medical care, and yet the literature indicates that nurses often provide inaccurate and biased estimates of their patients' pain. The following paper reviews the methods used to assess nurses' accuracy, and reasons offered for the errors observed. Practical options for improving pain assessment and pain management are discussed.

The use of a teaching model to promote reflection and the experiential integration of theory and practice in first-year student nurses: an action research study.

Abstract: This study developed and evaluated an experiential teaching model which aimed to improve the integration of theory and practice for first-year RGN students. This work took a qualitative approach and used Lewin's action research methodology. Using a participant observation approach, data, in the form of diaries, interviews and spot checks, were gathered. To evaluate the teaching model, the spot checks were developed as an indicator of theory-practice integration. The analysis of these spot checks revealed that this teaching approach had value. The strengths and weaknesses of the teaching model, in relation to possible origins of the theory-practice gap, are outlined. The validity of action research is discussed, as are similar issues that are related to the methodology of this study.