Showing papers in "Journal of Advanced Nursing in 1993"

Reflection: a review of the literature

Abstract: This paper is a review of the literature on reflection. The purpose was to unravel and make sense of the complex literature, and to identify the skills required to engage in reflection. An analysis of the literature revealed that differences between authors' accounts of reflective processes are largely those of terminology, detail and the extent to which these processes are arranged in a hierarchy. Key stages of reflection are identified and represented by a model. Skills required to engage in reflection were found to be implicit in the literature and these are identified. Methodological issues related to empirical literature are discussed. It is suggested that reflection is an important learning tool in professional education and that the skills required for reflection need to be developed in professional courses.

Quality of life: a concept analysis

Abstract: Quality of life (QOL) is a phrase which was first used shortly after the Second World War and has, since then, been overused and infrequently defined. A concept analysis of QOL is presented to clarify the concept for further use. The process for concept analysis developed by Walker & Avant is employed. Quality of life is found to be very complex, and it is hoped that this analysis will stimulate thought and further nursing research into what QOL means in the health care context.

Action research: what is it? How has it been used and how can it be used in nursing?

Abstract: Action research has enjoyed increasing popularity across a wide variety of disciplines including nursing. Action research was designed specifically to bridge the gap between theory, research and practice and incorporates both humanistic and naturalistic scientific methods. As such, action research is a highly compelling method for nursing. However, action research does not easily lend itself to definition. A variety of approaches, definitions and uses have emerged since it was created by Kurt Lewin and have given rise to much debate within social and behavioural sciences. This confusion has carried over into nursing literature without any systematic identification of or debate about the core characteristics of action research or the multitude of approaches or uses that have come to be associated with this method. Thus this paper addresses the central characteristics, three major approaches to action research that exist today and how action research has been used and can be used in nursing.

Social support and health: a review

Abstract: This paper addresses the importance of social support to health, drawing upon relevant literature from medical, psychological and social research. Conceptual and methodological problems are addressed and two major theories ('buffer’ and ‘attachment') are evaluated for their relevance in explaining the nature, purpose and function of social support. Finally, possible directions for future research in this field are outlined.

New paradigm research in practice: the trials and tribulations of action research.

Abstract: This methodological paper reflects on the way in which nursing research has developed along similar lines to research in education. It focuses on the emergence of action research as an example of collaborative research within the practice discipline of nursing. Action research is placed in the framework of new paradigm research and questions concerning its scientific merit are addressed along with its idealistic value to nursing. Drawing on issues raised during the collection of data for a PhD study which examined a changing ward culture, I hope to share some methodological concerns about the use of action research as a means of changing practice.

Reflective practice: a critique of the work of Argyris and Schön

Abstract: The seminal work of Argyris and Schon on action theories, technical rationality and reflective practice is reviewed; it is argued that their work reflects important inconsistencies between their theorizing and the pedagogical interventions they implemented/recommended. The implications of the results of these inconsistencies, which appear mirrored in nurse-education programmes in the United Kingdom and Australia, are discussed. Tentative suggestions for the provision of a more adequate practical pedagogy are included.

Hope in the family caregiver of terminally ill people

Abstract: This longitudinal study explored the meaning of hope, the influence of specific background characteristics on hope, and identified strategies that are used to foster hope in a convenience sample of 25 family caregivers of terminally ill family members from two hospice programmes using the technique of methodological triangulation (interview, Herth Hope Index and Background Data Form). Hope was defined as a dynamic inner power that enables transcendence of the present situation and fosters a positive new awareness of being. Six hope-fostering categories and three hope-hindering categories were identified based on the interview responses. With the exception of those providing care to a family member diagnosed with AIDS and those caregivers experiencing poor personal health, a high fatigue level, severe sleep deprivation and more than two concurrent losses, overall hope levels among participants were found to remain stable across the background variables. Across time, hope levels were found to be low at interview time one, rise significantly by time two and then level off for the remainder of the time. An understanding of hope from the perspective of the family caregiver could provide a basis upon which to develop interventions that foster hope.

Effective multidisciplinary teamwork in primary health care

Abstract: The nature and development of teamwork in primary health care is discussed and some barriers to effective teamwork identified. Theories of team effectiveness are outlined and methods of applying these to primary health care teams are explored. The 'constituency approach' and the theory of team innovation are examined in more detail. Team-building interventions are described as one way of improving team effectiveness but their limitations are also acknowledged. The Health Education Authority primary health care team workshops are used as an example of a team-building intervention. Research at the MRC/ESRC Social and Applied Psychology Unit, Sheffield University, is described. This is evaluating the outcomes of the primary health care team workshops in terms of team effectiveness. The research will measure viability (the extent to which the team sufficiently sustains good relationships to continue working together) and team performance (achievement of desired outcomes) pre and post workshop. Team effectiveness will be measured through team self-assessment, patient satisfaction and family health service authority designated targets for health promotion. The overall aim is to develop a model of team effectiveness for primary health care teams, which can then be used to diagnose and guide teams in their work.

Intuition as a function of the expert nurse: a critique of Benner's novice to expert model

Abstract: Benner's model of skill acquisition is currently receiving considerable interest from nurse educationalists, and promises to form the basis for some curricula offered by colleagues of nurse education. This paper debates the 'novice to expert' model and seeks to explain exactly what an 'expert' is. The Benner model proposes that one component of expertise is working from an intuitive base. This claim is disputed and the definition of intuition is contested. Alternative explanations to account for the intuitive responses of Benner's subjects are suggested.

Postpartum depression: women's help‐seeking behaviour and perceptions of cause

Abstract: Research on postnatal depression has largely concentrated on investigating its possible causes. There have been few attempts to examine women's own perceptions and experiences of the condition or to explore the implications which these might have for help seeking and professional intervention. This paper reports on the experiences of depression of a sample of 60 first-time mothers. For the purposes of the study, depression was defined as the experience of depressed mood for a period of at least 2 weeks at some stage during the first 9 months postpartum. On this definition, depression was reported by a high proportion of the mothers (63%) and was found to be of early onset and lengthy duration. The majority of depressed mothers did not seek help from any source and only a quarter of them consulted a health professional. These low rates of consultation are explained in terms of mothers' perceptions of the cause of their depression, their ideas about appropriate solutions and their reluctance to admit to experiencing emotional difficulties. The implications of the study for intervention by health professionals are discussed.

The development of a measure of job satisfaction for use in monitoring the morale of community nurses in four trusts

Abstract: The development of the Measure of Job Satisfaction (MJS) for use in a longitudinal study of the morale of community nurses in four trusts is described. The review of previous studies focuses on the use of principal component analysis or factor analysis in the development of measures. The MJS was developed from a bank of items culled from the literature and from discussions with key informants. It was mailed to a one in three sample of 723 members of the community nursing forums of the Royal College of Nursing. A 72% response rate was obtained from those eligible for inclusion. Principal component analysis with varimax rotation led to the identification of five dimensions of job satisfaction; Personal Satisfaction, Satisfaction with Workload, Satisfaction with Professional Support, Satisfaction with Pay and Prospects and Satisfaction with Training. These factors form the basis of five subscales of satisfaction which summate to give an Overall Job Satisfaction score. Internal consistency, test-retest reliability, concurrent and discriminatory validity were assessed and were found to be satisfactory. The factor structure was replicated using data obtained from the first three of the community trusts involved in the main study. The limitations of the study and issues which require further exploration are identified and discussed.

Occupational stress in psychiatric nursing.

Abstract: Psychiatric nursing is invariably assumed to be a stressful area of nursing practice. Empirical evidence to support this proposition is limited, however, due to the lack of research in this field. The purpose of this project was to examine occupational stress in a specified area of psychiatric nursing. The research was exploratory and therefore the concern was discovery and description rather than the testing of clear hypotheses and the development of causal relationships. The study has four main objectives. First, to describe the various stressors present in the work of the psychiatric nurse in the acute admission wards of two district health authorities. Secondly, to measure the effects of stress using a recognized and well-validated instrument for recording levels of burnout. Thirdly, through the use of a particular theoretical framework to identify the types of coping strategy used by the participants in the study. Fourthly, to note any clear associations between the stressors, the effects of stress and the ways of coping identified in the study. The conceptual basis for the project was Lazarus's cognitive theory of stress and coping and Maslach's model of burnout.

To understand and alleviate suffering in a caring culture

Abstract: The purpose of this study is to help understand what suffering is, i.e. how patients and nurses describe suffering, and how suffering can be alleviated. The study has a descriptive-explorative design and its approach is phenomenological-hermeneutical. The informant (research group) are 11 nurses (nurses, doctors, hospital theologians) and five patients in a social-psychiatric nursing unit, based on Christian ideology. The results of the study show that the 'what' of suffering is unclear. The nurses tend to describe more the 'why' of suffering, i.e. the reason for suffering. The what of suffering is pain, fear, despair, lack of strength. It is a form of lack of freedom and non-motion. It is a struggle between wanting and knowing, between guilt and responsibility. The form of suffering tends to mould the caring relation. To be touched in some way by another in a meeting can alleviate the deepest suffering. Compassion will always alleviate suffering.

The meaning of incontinence: a qualitative study of non‐geriatric urinary incontinence sufferers

Abstract: The meaning of the problem for incontinence suffers is known to be a very significant influence on coping. The present study was based on in-depth qualitative interviews with 28 young or middle-aged women who suffered urinary incontinence. Analysis, aimed at discovering the meaning of their condition for the sufferers themselves, led to the following conclusions. Incontinence is taboo, meaning not only that it is a socially unacceptable topic of conversation (inhibiting the approach of suffers to health professionals), but also that it is difficult for suffers themselves to focus on and think about clearly. Sufferers can react with apathy, or may perpetually teeter on the edge of taking ameliorative action: rational ways of tackling the problem are often not followed. The problem is seen as one of personal control: incontinence is lack of a grip on bodily propriety. Sufferers may feel horribly unique, and also worry that the incontinence is their own fault. They fear a guilty association with despised groups. It is noteworthy that the maintenance of 'normality'--allowing the sufferer to claim that there is no problem and that she is not incontinent--may involve a great deal of work. Although there are indications of defensive denial in sufferers' reactions to the problem, an additional interpretation is that they are fighting to subordinate the problem in favour of other priorities. Implications for practice of each of these features of the meaning of incontinence are drawn out.

Psychophysiological effects of back massage on elderly institutionalized patients

Abstract: An experimental design was used to measure the effects of back massage on anxiety levels of elderly residents in a long-term care institution. Twenty-one residents, 17 females and four males, participated in the study. Subjects were randomly assigned to three groups which received ‘back massage with normal conversation',‘conversation only’ and ‘no intervention’ respectively. The dependent variable, anxiety, was measured prior to back massage, immediately following, and 10 minutes later, on four consecutive evenings. The Spielberger Self-Evaluation Questionnaire (STAI), electromyographic recordings, systolic blood pressure, diastolic blood pressure (DBP) and heart rate were used as measures of anxiety. Analysis of variance was used to examine differences in group mean scores over the pre-test to post-test, post-test to delayed time interval, and pre-test to delayed time intervals, Scheffe comparisons being made where indicated. With the exception of mean DBP which showed no change from pre-test to post-test and HR which increased from post-test to delayed time interval, there was a statistically insignificant decrease in mean scores on all variables in the back massage group from pre-test to post-test and from post-test to delayed time interval. There was a statistically significant difference in the mean anxiety (STAI) score between the back massage group and the no intervention group. The difference between the back massage group and the conversation only group approached statistical significance. Verbal reports from subjects indicated that they perceived back massage as relaxing. Back massage may be an effective, non-invasive technique for promoting relaxation and improving communication with patients. It was recommended that touch be encouraged in caring for the elderly and that further investigation of the effects of such therapies as back massage are indicated.

Common adaptive tasks facing parents of children with chronic conditions

Abstract: Parents of chronically ill or disabled children face a number of common tasks in adapting to their child's condition These tasks are delineated from the literature on theory, research and clinical issues and are discussed in relation to their documented importance to family adaptation, the difficulties parents have in managing the tasks and effective coping strategies parents can use to accomplish the tasks The implications of utilizing adaptive tasks as an organizing framework for assessing and intervening with parents of children with chronic conditions are discussed

Feminist research: definitions, methodology, methods and evaluation.

Abstract: The literature relating to feminist research both within and beyond nursing is reviewed in this paper. Feminist research is located within a post-positivist paradigm, and various definitions are considered. The distinctive methodological approach of feminist research is discussed, and interviewing and ethnography are evaluated as suitable methods for use in feminist research. Oakley's (1981) paper on interviewing women is subjected to criticism. A final section examines attempts by three sets of writers to propose evaluation criteria for feminist research. The review concludes that a number of paradoxes and dilemmas in feminist research have yet to be resolved.

Strain among nurses and their emotional reactions during 1 year of systematic clinical supervision combined with the implementation of individualized care in dementia nursing

Abstract: This study aimed at exploring nurses' views of the characteristics of severely demented patients, the difficulties these characteristics produced and the emotional reactions they evoked during the provision of care. Also, it aimed at exploring any changes in these aspects during a year of regular systematic clinical supervision combined with the implementation of individualized care at an experimental ward (EW) (n = 19) and at a control ward (CW) (n = 19). Data were collected by means of the Strain in Nursing Care scale, assessing the presence of certain characteristics in the patients, and how difficult each characteristic can be to handle. The Emotional Reactions in Nursing Care scale was also used, assessing 18 pairs of emotions. The analysis showed that agitation, not being responsive and unruly behaviour were the most common features while emptiness and agony turned out to be the most difficult problems to handle in the provision of care. Feelings of defeat and dissociation were reported to be almost as common as feelings of control and association. The EW nurses saw the patients as significantly more responsive, and victims of nihilation to a lesser degree and also patients' willfulness and emptiness was significantly easier to handle during the year of intervention. There were no significant changes on the CW. The mean values improved significantly in several aspects on the EW in comparison to the CW; patients seen as victims of nihilation, easier to handle agony, obediency, willfulness, evaluation and improved feelings of devotion and beneficence in the nurses. Thus the intervention seemed to improve the nurse-patient relationship and to decrease the experience of strain in the nurses.

Nurses' experiences of caring for ethnic-minority clients.

Abstract: This paper describes a research study designed to explore the experiences of nurses caring for ethnic-minority clients and to identify any specific problems nurses encounter when caring for these clients. Data were collected through a process of in-depth interviews with 18 trained nurses. The findings of the study suggest that nurses caring for ethnic-minority clients share many common experiences, problems and challenges. Difficulties in communication with clients and a lack of knowledge about cultural differences were highlighted by all respondents. The lack of holistic care and the inability to develop a therapeutic relationship were identified as major areas of frustration and stress. The study demonstrates that there is an urgent need to develop cultural knowledge in nurse education programmes and that nurses need help and support with communication difficulties. Interpreting services and dietary facilities available for ethnic-minority clients were also found to be inadequate and it is suggested that there is a need to review these facilities within hospitals.

The use of focus groups in a study of attitudes to student nurse assessment.

Abstract: This paper describes the use of focus groups in the first phase of a study to investigate the attitudes of teachers and clinical assessors to the assessment of student nurses It offers a description of the methodology, with an analysis of its strengths and weaknesses

Determinants of a health‐promoting lifestyle: an integrative review

Abstract: This paper reports on an integrative review of the research literature published between 1983 and 1991 that focused on identifying the determinants of a health-promoting lifestyle. Twenty-three studies were reviewed, six of which were concerned with children and adolescents and the remaining 17 with adults. A meta-analysis of correlations for each study determinant was conducted using the Pandora System. Results indicated that self-efficacy was the strongest predictor of a health-promoting lifestyle, followed by social support, perceived benefits, self-concept, perceived barriers and health definition. The most frequently studied determinants were not the best predictors of a health-promoting lifestyle.

Focus groups in distance nursing education

Abstract: This paper describes an educator's experience using focus groups with post-RN nursing students in a course offered by audio teleconferencing. The purposes of implementing focus groups included: to increase involvement of students located in the distance education settings, to implement principles of adult learning, to increase opportunities for drawing on the experience of the students, and to improve the quality of learning experience offered by distance education. An example is given to demonstrate how the process was used to integrate the focus group experience into the distance education classroom.

Nursing research conventions : objectivity or obfuscation ?

Abstract: This paper is a critique of naive realism, the philosophy which animates much nursing research, and which leads researchers to assume that the attainment of objective knowledge is possible The nature of naive realism, and its relationship to objectivity, is discussed Central to this outlook is the belief that the values and interests of the researcher can and should be divorced from the prosecution of research This is reflected in the literary convention of referring to the researcher in the third person Contrary to this position, I argue that the interpretations, values and interests of the researcher are central to the research process Moreover, nursing research may be affected by the interests of managers, educationalists, and those who wish to see nursing attain professional status Nursing researchers should accept that they are part of the social situations which they study They should therefore become reflexive in their outlook This entails recognizing and attempting to understand the effects of the researcher, rather than trying to eliminate or ignore them

Care of sick children by parents: a meaningful role

Abstract: Parental involvement in their child's care in hospital has undergone great change over the last century. Studies have shown how ‘maternal deprivation’ and ‘separation anxiety’ expressed by children are detrimental to a child's recovery in hospital. Striving efforts have been made to develop family-centred care, promote normality of the family unit and continue with the normal routine of the child's life within the limitations of a hospital environment and the child's illness. Expectations of the parental role in hospital need to be identified and expressed from both the parents and staff to establish an understanding that will ultimately be best for the child. Many studies have highlighted benefits to both parent and child from parental participation in hospital. However, disadvantages have been identified from resident parents who feel captive to their new situation and role. Efforts for family-centred care are highly advocated now. Care-by-Parent units have been set up in some areas to promote this idea and, although many advantages have been identified, they are not without their problems. The success of parental involvement is dependent on both parents’ and staff's attitudes, enthusiasm and willingness to work together.

Clinical role modelling: uncovering hidden knowledge

Abstract: Those responsible for the education of nurses are well aware of the need to reconcile the art and science of nursing so that future practitioners can be prepared to offer a humanistic and professional service to society One way to assist students in this integration is to provide them with opportunities for role modelling as a means of discovering the knowledge embedded in clinical practice A study of first-year undergraduate students undertaking a course which provides such opportunities in a number of practice settings was earned out to determine whether the observation of clinical role models does lead to knowledge discovery The study, which used a grounded theory approach, indicated that the major aspect of nursing uncovered by the students through observation of clinical role models was that of provision of direct care They articulated their values in relation to ‘good’ and ‘bad’ care and identified those attributes of nurses which they considered contributed to these care positions In addition, they were able to recognize creativity and flexibility in practitioners and to relate these attributes to the ability to provide individualized, context-specific care There was some uncovering of aspects of the nurse's role in maintaining their own professional competence, socializing neophytes into the profession and collaborating with the members of the multi-disciplinary health care team

Quality of care in nursing homes: from the resident's perspective

Abstract: This paper derives from a study conducted by the Deakin Institute of Nursing Research between 1988 and 1990, whose major objective was to determine the impact of staffing mix on nursing resident's quality of care and life. Resident satisfaction with life in the nursing home is a key element in determining the quality of care and quality of life provided. Both the literature review and the study objectives supported the view that resident outcome can be collected through assessing the quality of care and the quality of life, through assessment by informed observers using instruments derived from explicitly stated standards, and through eliciting the perceptions of residents themselves. A schedule designed to measure satisfaction with care was developed and resident interviews were undertaken using this measure and the Life Satisfaction Index (A). The majority of responses to the resident satisfaction schedule were positive. The high percentage of positive responses did not correlate with the observations of the research assistants and there was some concern that while residents were able to assess care they were reluctant to criticize the staff or their behaviour.

Towards a better understanding of patients with irritable bowel syndrome.

Abstract: This study was undertaken by sending a questionnaire to 148 people suffering from irritable bowel syndrome (IBS) The respondents all were members of the IBS Network, a national independent organization formed to help alleviate the suffering and distress of people diagnosed as having irritable bowel They were asked about their symptoms, the medical tests they had undergone, how they felt about the treatment they received, and how IBS affected their lives The study found that IBS affected all aspects of their lives work, leisure, travel and relationships Sufferers indicated that they felt they would have coped better if they had been provided with more information about IBS, its possible causes and treatment, and greater sensitivity from members of the medical profession in dealing with them

Intensive care: situations of ethical difficulty

Abstract: Twenty enrolled nurses (ENs), 20 registered nurses (RNs) and 20 physicians working in intensive care in northern Sweden narrated 255 stories about their experience of being in ethically difficult care situations. The ENs' stories mainly concerned problems relating to relationship ethics, the stories narrated by the physicians mainly concerned problems relating to action ethics, while the RNs' stories gave equal attention to both kinds of problems. The most common theme of both the RNs' and the physicians' stories was that of too much treatment. An obvious similarity between the ENs, RNs and physicians was that they saw themselves as equally lacking in influence in ethically difficult care situations. The only apparent difference between the three groups, however, was that the ENs brought up relationship problems more often than the others. Thus, the differences between the RNs and the physicians were fewer than usually reported in the literature. This might be related to the specialization of intensive care.

An ethnographic study of nursing culture as an exploration for determining the existence of a system of ritual

Abstract: The idea that much of nursing is ‘ritualized’ activity which is harmful to patient care assumes that ‘ritual’ itself is unacceptable behaviour or practice At a time when market forces are clearly influencing the delivery of care and, in turn, changes in nursing practice, it has become important both to clarify what ‘ritual’ is and to determine its existence and ‘form’ within nursing This study explored nursing culture for ‘ritual’ in a ward setting and used ethnography as both method and description Rituals were found to exist in the working day of the nurses studied, but was not an indication that ‘ritualized behaviour’ is harmful to individualized patient care There is a clear need, however, to determine specifically the difference between ‘unsafe outdated practices’ and ritual in a cultural ‘sense’ This would ensure that what had to be relinquished would in no way jeopardize the future existence of nursing and nurses as socially cohesive groups with their own culture