Showing papers in "Journal of Advanced Nursing in 1995"

Interpretive approaches in nursing research: the influence of Husserl and Heidegger

Abstract: This paper aims to throw some light on Husserlian phenomenology and Heideggerian hermeneutics, and to discuss their influences and applicability to the nursing research agenda. There are definite distinctions between Husserlian transcendental phenomenology and Heideggerian hermeneutic phenomenology and these distinctions have implications for the methodology employed. These traditions are discussed with respect to some fundamental research issues: the philosophical perspectives of the traditions and the notion that data that result from the inquiry are created by the interaction between researcher and researched. The central recommendation in this paper is that nurse researchers appraise the philosophical underpinnings of the methodologies they pursue.

Collaboration: a concept analysis

Abstract: Collaboration is a complex phenomenon, yet one that is of significance to nursing. This concept analysis presents definitions and defining characteristics of collaboration so that the concept may be used in the creation of operational definitions, or to develop and evaluate tools for measuring collaboration. Antecedents, consequences and empirical referents of collaboration are explored. Model, contrary and related cases are presented to clarify this concept further.

Definitions of quality of life: a taxonomy

Abstract: Quality of life is of central concern in evaluative research, improved quality of life is probably the most desirable outcome of all health care policies However, definitions of quality of life are as numerous and inconsistent as the methods of assessing it Stemming from a larger piece of work looking at the definition and measurement of quality of life, this paper highlights the lack of a consensus definition of quality of life by means of a taxonomy of definitions that emerge from the literature The paper describes and gives examples of four main types of definition which make up the taxonomy global (type I), component (type II), focused (type III), and combination definitions (type IV) In addition, an outline of factors influencing the definition of quality of life is given, and an alternative strategy for both defining and measuring the concept (the use of lay definitions) is suggested

Framing learning through reflection within Carper's fundamental ways of knowing in nursing

Abstract: Carper's fundamental ways of knowing have been utilized as a framework for the practitioner to consider what he or she has learnt through reflection on experience. The purpose of this paper is to consider, through an interpretation of Carper's writings and through analysing one practitioner's experience shared in a supervision milieu, whether this use of Carper's work can be reasonably justified on a theoretical and practical level.

Assessing the level of student reflection from reflective journals

Abstract: The concept of reflective learning has been widely adopted in many of the nursing curricula today. Reflective learning is of particular relevance to the education of professionals, as it encourages students to integrate theory with practice, appreciate the world on their own behalf, and turn every experience into a new potential learning experience. While nurse educators have widely accepted the educational benefits of reflection, research into reflective learning is hampered by the lack of reliable and widely accepted methods for assessing whether reflection takes place and the level of any reflection. This study attempted to develop and test coding systems for written reflective journals based on two well-known models of reflective thinking. The reflective journals submitted by the students were subjected to content analysis at two levels. The findings of this study suggest that student writing can be used as evidence for the presence or absence of reflective thinking. The process of allocating students to three categories of non-reflector, reflector and critical reflector was straightforward and reliable. Identifying textual elements within journals and allocating them to the finer levels of reflection within a more complex model of reflective thinking was, however, more problematic and considerably less reliable.

Interviews in qualitative nursing research: differing approaches for ethnographic and phenomenological studies

Abstract: Interviews form an essential part of data collection for many qualitative nursing studies. Information about how to individualize interview formats to meet the purpose and style of specific qualitative research approaches, however, is not readily accessible to the researcher. This paper offers an overview of use of the interviewer as an instrument in qualitative research, as well as ways in which the differing purposes and styles of ethnographic and phenomenological research approaches affect the format for the interview.

Satisfying solutions? A review of some unresolved issues in the measurement of patient satisfaction

Abstract: The measurement of patient satisfaction has been encouraged by a growing consumer orientation in health care, especially since it yields information about consumers' views in a form which can be used for comparison and monitoring. However, drawing on literature from a variety of sources, this paper suggests that there remain several unresolved issues relating to the measurement of satisfaction, and some serious questions about the validity of the concept. It is argued that current approaches to measuring satisfaction may not be grounded in the values and experiences of patients; therefore satisfaction surveys could be denying patients the opportunity to have their opinions included in the planning and evaluation of health care services.

The process of empowerment in mothers of chronically ill children

Abstract: As a result of advances in scientific knowledge and technology, the number of children living with chronic illness is ever increasing. The burden of responsibility for the care of these children falls increasingly on the involved parents and, particularly, on mothers. In spite of the challenges that chronic childhood illness presents, many families are able to adapt to their situation and develop a sense of control over their lives. A sense of control has been associated with the notion of empowerment. Following a theoretical analysis, empowerment was conceptualized as a social process of recognizing, promoting and enhancing people's abilities to meet their own needs, solve their own problems, and mobilize the necessary resources in order to feel in control of their own lives. To understand the concept of empowerment from an empirical perspective, a fieldwork study was undertaken to describe the process of empowerment as it pertains to mothers of chronically ill children. This paper presents the process of empowerment that occurred in these mothers. Four components of the process of empowerment emerged: discovering reality, critical reflection, taking charge, and holding on. As a result of the study, empowerment was reconceptualized as largely a personal process in which individuals developed and employed the necessary knowledge, competence and confidence for making their voices heard. Participatory competence--the ability to be heard by those in power--was the outcome of this process. Although the unique finding in this study suggests that the process of empowerment was largely intrapersonal, there was a relational element in the process. Clearly, the intrapersonal and interpersonal processes of empowerment are intertwined.

Sensing an improvement: an experimental study to evaluate the use of aromatherapy, massage and periods of rest in an intensive care unit

Abstract: There is widespread belief that the use of aromatherapy and massage in an intensive care environment offers a means of increasing the quality of sensory input that patients receive, as well as reducing levels of stress and anxiety. Despite a wealth of anecdotal evidence in support of these claims, there have been few objective studies to evaluate the effects of these therapies. In this experimental study 122 patients admitted to a general intensive care unit were randomly allocated to receive either massage, aromatherapy using essential oil of lavender, or a period of rest. Both pre- and post-therapy assessments included physiological stress indicators and patients' evaluation of their anxiety levels, mood and ability to cope with their intensive care experience. Ninety-three patients (77%) were able to complete subjective assessments. There were no statistically significant differences in the physiological stress indicators or observed or reported behaviour of patients' ability to cope following any of the three interventions. However, those patients who received aromatherapy reported significantly greater improvement in their mood and perceived levels of anxiety. They also felt less anxious and more positive immediately following the therapy, although this effect was not sustained or cumulative.

Nurses' power in interactions with patients

Abstract: Power in interactions between nurses and patients, as mediated through language, is examined in this paper The findings from an observational study confirm much previous research in that the majority of nurse-patient interactions were superficial, routinized and related to tasks It was found that nurses exert a lot of control over interactions and the linguistic devices used to achieve this are explored Links are established between macro-level factors, such as the institution, and the micro-level of nurse—patient encounters, to demonstrate how wider forces affect and are reflected in interactions Examination of the interactions also reveals issues of conflict arising from the caring and controlling functions that nurses perform It is suggested that the power dimension inherent in the relationship constitutes a barrier to open and meaningful communication between nurses and patients

Drug administration errors: a study into the factors underlying the occurrence and reporting of drug errors in a district general hospital

Abstract: Drug administration is one of the highest risk areas of nursing practice and a matter of considerable concern for both managers and practitioners. The aim of this study, carried out in a district general hospital, was to identify any common themes that underlie the occurrence and reporting of drug administration errors. Data were collected from a variety of sources: drug error reports, questionnaires to nurses and nurse managers, and interviews with nurses who had been involved in drug errors. Several areas of particular concern emerged, including: the nurses' confusion regarding the definition of drug errors and the appropriate actions to take when they occurred; their fear of disciplinary action; their loss of clinical confidence; the variation in managerial response; and a possible lack of nurses' mathematical skills. The results from the study demonstrated that it was likely that many drug errors were not reported, for a variety of reasons. It is recommended that all of these issues are addressed as a matter of urgency, for the sake of both patients and nurse practitioners.

The development of a clinical learning environment scale

Abstract: Within nursing, there is a strong demand for high-quality, cost-effective clinical education experiences that facilitate student learning in the clinical setting. The clinical learning environment (CLE) is the interactive network of forces within the clinical setting that influence the students' clinical learning outcomes. The identification of factors that characterize CLE could lead to strategies that foster the factors most predictive of desirable student learning outcomes and ameliorate those which may have a negative impact on student outcomes. The CLE scale is a 23-item instrument with five subscales: staff-student relationships, nurse manager commitment, patient relationships, interpersonal relationships, and student satisfaction. These factors have strong substantive face validity and construct validity, as determined by confirmatory factor analysis. Reliability coefficients range from high (0.85) to marginal (0.63). The CLE scale provides the educator with a valid and reliable instrument to evaluate affectively relevant factors in the CLE, direct resources to areas where improvement may be required, and nurture those areas functioning well. It will assist in the application of resources in a cost-effective, efficient, productive manner, and will ensure that the clinical learning experience offers the nursing student the best possible learning outcomes.

The phenomenological movement: implications for nursing research

Abstract: This paper presents a comparison of the phenomenologies of Edmund Husserl and Martin Heidegger with the aim of highlighting some of the critical distinctions between these two 'schools' of phenomenology concerning the methodological implications of each approach for nursing research. Specifically, the paper examines: the implications of epistemology versus ontology; issues relating to validity; the involvement of the researcher, and aspects relating to interpretation.

The information needs of women newly diagnosed with breast cancer.

Abstract: Nurses can play a key role in patient education, including providing patients with useful and appropriate information. Rather than focusing on the process of education or information giving by nurses, this study places emphasis on the content of that information by taking the patients' perspective and asking the patients themselves what particular types of information are perceived as important at a specific point in time. The aim of the study was to explore what particular types of information were important to women newly diagnosed with breast cancer; to enable nurses and other health care professionals to utilize their time as effectively as possible and provide a high-quality service to individuals in their care. Women with breast cancer (a mean of 2.5 weeks from diagnosis) were interviewed and asked to compare items of information. The items of information were presented in pairs and the women stated a preference for one item in that pair. Thirty-six pairs were presented in total. The analysis involved the use of a Thurstone scaling model, which allowed rank orderings, or profiles of information needs, to be developed, reflecting the perceived importance of each item. Information about the likelihood of cure, the spread of the disease and treatment options were perceived as the most important items of information at the time of diagnosis. Other information needs, in order of descending priority, included information about the risk to family, side-effects of treatments, impact on family, self-care, effect on social life and sexual attractiveness. Profiles of information needs were produced to take account of differences in age, level of education and social class.(ABSTRACT TRUNCATED AT 250 WORDS)

Reflection-on-practice: enhancing student learning

Abstract: The writing of a reflective diary is viewed as an effective tool for promoting reflection and learning in students, and for self-assessment and evaluation of a clinical learning experience. This work is a study of 30 undergraduate nurses and their use of reflective diaries during a period of community health care practice. The theoretical basis of the study is based on Schon's work on reflection-in-action. The research tool, developed for the study of nursing practice by Powell, is based on Mezirow's levels of reflectivity. The findings are that, in the sample used, students do reflect on their practice according to Mezirow's levels of reflectivity, but that the highest number of reflections occur at the lower levels of reflectivity (94% of the total number of scores). However, although only 6% of the total number of scores were found at the higher levels of reflectivity, some 22 of the samples of 30 students did attain conceptual and theoretical reflectivity, the highest levels of reflectivity.

Preceptors' perceptions of benefits, rewards, supports and commitment to the preceptor role

Abstract: The purpose of this descriptive correlational study was to examine the relationships among preceptors' perceptions of benefits, rewards, supports and commitment to the preceptor role A convenience sample of 59 nurse preceptors in a 400-bed urban teaching hospital participated by completing a four-part questionnaire the Preceptor's Perception of Benefits and Rewards Scale, the Preceptor's Perception of Support Scale, the Commitment to the Preceptor Role Scale, and a demographic questionnaire Kanter's (1977) model 'Structural Determinants of Behaviour in Organizations' provided the conceptual framework for the study Three study correlations reached statistical significance, suggesting that commitment to the preceptor role is positively associated with (a) preceptors' perception of benefits and rewards, (b) preceptors' perception of support, and (c) the number of preceptor experiences The results have implications for nursing administrators and nursing educators to ensure that adequate benefits, rewards and supports are available to preceptors Recommendations for developing more effective preceptor programmes are proposed

The nurse-doctor relationship: a selective literature review.

Abstract: The disciplines of nursing and medicine are expected to work in unusually close proximity to one another, not just practising side by side but interacting with one another to achieve a common good: the health and well-being of patients. This selective review of literature addresses some of the issues arising from the frequently controversial subject of the nurse-doctor relationship and seeks to draw out the principal themes emerging from the application of sociological theory to the nurse-doctor relationship and research into its operation in clinical settings. Particular attention is paid to the 'doctor-nurse game', a stereotypical pattern of interaction, first described in the 1960s, in which (female) nurses learn to show initiative and offer advice, while appearing to defer passively to the doctor's authority. This pattern of interaction seems less common in clinical practice today but the problem remains of each profession having ideal expectations of one another which inevitably fall short as a result of differing views of qualities of doctors and nurses to be valued.

The Claybury community psychiatric nurse stress study: is it more stressful to work in hospital or the community?

Abstract: The Claybury community psychiatric nurse (CPN) stress study collected data on stress levels in 250 CPNs and 323 ward-based psychiatric nurses (WBPN) in the North East Thames region. Four out of 10 CPNs were found to be experiencing high levels of psychological distress on GHQ scores. Whilst both CPNs and WBPNs scored highly on scores of occupational burnout, especially on emotional exhaustion scores, WBPNs scored worse on emotional detachment from their patients and were achieving less personal fulfilment from their work. Both groups of nurses were more satisfied with direct patient clinical work than with their employment conditions, particularly their working environments and, for CPNs, their relationships with their managers. The different patterns of coping skills are explored and discussed for both groups of nurses, especially the use of social support, time management and organization of tasks. The study concludes that whilst major changes are occurring in the psychiatric arena for both groups of nurses, stress is reaping its toll on mental health nurses, in terms of higher absence rates, lower self-esteem and personal unfulfilment. This could not only affect the quality of patient care but also future career prospects for nurses. The study invites serious consideration of introducing stress-reducing measures in the work-place as well as further research into specific stressors for different groups of nurses.

Academic rigour in the lived experience of researchers using phenomenological methods in nursing.

Abstract: In its quest for knowledge, nursing has relied heavily on the positivist approach to scientific enquiry. Phenomenological enquiry identifies the essence of a phenomenon and accurately describes it through the lived experience. Through consistency in the use of the methodology, and avoidance of method slurring, academic rigour can be maintained. It is advocated that the phenomenological method is congruent with nursing ideals where humanistic knowledge is valued. Nurses and phenomenologists share skills in observation, interviewing, interaction and interpersonal relationships in the appreciation of the individual's perception of an experience. Through the development of professional practice, nurses thus gain the tools to assist them in phenomenological research. It is suggested that, given appropriate attention to rigour, phenomenological methodology could become the basic instrument in the reform of nursing research as it moves from the positivist to the humanist paradigm.

A sociological analysis of the extent and influence of professional socialization on the development of a nursing identity among nursing students at two universities in Brisbane, Australia

Abstract: Professions make extraordinary demands on its practitioners. Professionals are required to master substantive theory and technical skills. They also develop their own unique subcultures, demanding specific normative standards from their members, which are symbolized by professional ethical codes. In the health professions, ethical codes include strong altruistic elements. Professional normative standards are learnt on a formal level (for example, at a university) and informal level (during the process of professional socialization and contact with the peer group, as well as informal sanctions). The transformation process of a novice to a professional is essentially an acculturation process during which the values, norms and symbols of the profession are internalized. Acculturation can be so strong that it may cause personality transformation, which the French refer to as 'deformation professionelle', usually displayed by stereotypes, which are almost always exemplified by members of professions as ideal professionals, those who have internalized the profession's culture completely. The question is, what is the extent of normative standards and professional characteristics that nursing students are exposed to during professional socialization, and to what extent are these standards and characteristics internalized so that a nursing 'deformation professionelle' develops? A reliable Likert-type measurement scale was developed to measure this phenomenon. One of the most important findings of this study was that students at both universities are highly professionally socialized.

Family burden in chronic mental illness: a review of research studies

Abstract: Early research has established that burden exists and has identified certain behaviours of mentally ill relatives that family members find most distressing Further research has confirmed the accuracy of the early work and has focused on the severity of mental illness Recent research has stressed the importance of social support in the study of caregiver burden This paper explores the research literature that covers the concept of caregiver burden in the area of mental illness and also presents developed instruments for the study of caregiver burden

Written patient information: a review of the literature

Abstract: In the United States during the 1940s Flesch and Gunning pioneered the movement to improve the comprehensibility of government documents. Since that time the provision of comprehensible information to the general public has become increasingly important. Indeed, most computer programs have the facility to assess what percentage of the population will understand certain forms of written information. Vast quantities of written patient information have been produced over the decades and more are being produced daily. This literature review sets out to provide an insight into the studies which have looked at the value and purpose of such literature. Considering the amount of written patient information in existence the amount of research into this interesting subject is small. Many concepts have to be considered. Is this information of any use to patients? Can they understand and recall it and does it increase compliance? Are patients satisfied with the amount, quality and detail of written information? If health professionals are to inform their patients fully, written information is an area which should be more fully researched for ethical, quality and economic reasons.

Perpetuation of ageist attitudes among present and future health care personnel: implications for elder care.

Abstract: The population of the western world is greying rapidly By the year 2025, people over the age of 65 will make up 20% of the population of the USA By the year 2000, one-half of elderly people in the United Kingdom (UK) will be over the age of 75 The increasing numbers of elderly people will be spending from 18% (males) to 27% (females) of their added years as impaired, disabled and frail individuals The purposes of this comparative descriptive study were to (a) describe and compare the attitudes of registered nurses (RNs) and health career work study students (HCS) who work with elderly people in the clinical setting, and (b) determine whether relevant demographic variables of the two groups were related to their attitudes A convenience sample of 82 RNs and 68 HGSs were asked to complete Kogan's (1961) Attitudes Toward Old People Scale (KOP) Response to the survey was 91% and 74% for the HCS and RN groups respectively There was a significant difference between the group mean scores with students holding less favourable attitudes toward elderly people on the KOP-negative scale No significant difference was found on the KOP-positive scale Point-bisenal correlations between demographic variables and attitude scores revealed that gender and ethnicity were significantly related to RNs attitudes—males and blacks and Asians expressed more unfavourable attitudes Educational level and primary area of clinical work were significantly associated with students' scores on the KOP-negative scale, while years of clinical experience was significantly related to KOP-positive scale scores While both groups held attitudes that were more favourable than unfavourable, RNs and HCSs expressed stereotypical views about old people in general Recommendations for nursing education and nursing service are proposed to prevent the negative impact on future care elderly people that the findings suggest

Are there too many alarms in the intensive care unit? An overview of the problems

Abstract: There are many reported problems with auditory warnings in critical care areas of hospitals such as the intensive care unit (ICU) and operating room. There are too many alarms; many of them are unnecessarily loud and continuous, which can be irritating and annoying for staff. The problem of excessive alarms is further complicated by the fact that there are no standards agreed between manufacturers on the auditory warnings used for medical equipment. Therefore, the same piece of equipment manufactured by different companies will have different alarms that could result in confusion. Another possibility as to why confusion could occur is because alarms are often inappropriate in terms of their 'urgency mapping'. This means there is generally no relationship between the urgency of a medical situation and the perceived urgency of the alarm that signals that condition. A further problem involves the number of false alarms that occur; that is, alarms that are not signalling a medical emergency. The following paper discusses these problems and suggests attempts to remedy some of them. There is also a brief discussion of the amount of monitoring that occurs on the ICU as the more monitors there are the greater the number of alarms there will be

Parents' perceptions of caring for an infant or toddler with diabetes.

Abstract: Although the incidence rate of diabetes in children under the age of 3 years is increasing dramatically, no previous studies provide information about the day-to-day experience of caring for these infants and toddlers. Because a young child with diabetes is dependent on the parent for his/her very existence, the purpose of this phenomenological study was to gain knowledge and understanding of the parents' experiences so that appropriate interventions could be developed and implemented to support parental care for this unique population. Findings revealed three distinct phases in the parents' experiences: the diagnosis and child's hospitalization; adjusting to care at home; and long-term adaptation. Within these phases, parents described inordinate amounts of stress exacerbated by the child's young age and the complex, intrusive nature of diabetes management. On the basis of these findings, implications for practice are discussed.

Critical thinking and intuitive nursing practice.

Abstract: In this paper, we analyse how critical thinking and intuitive practice are related to expertise in nursing. We examine how intuitive practice, when performed automatically without care, vigilance, and criticism, can result in prejudice and patterns of practice which are misinformed. We will show that the student nurse develops intuitive, skillful performance in nursing by reasoning about nursing knowledge and applying reflective, critical thought in practice situations, thereby gaining increasing expertise in reasoning as a reliable professional ensuring quality client care. The elements of thought necessary for sound reasoning in clinical practice will be explored. Finally, we suggest educational strategies and tactics which promote the development of the intellectual capacities of student nurses as independent critical thinkers.

A selective review of the literature on nurse‐patient communication: has the patient's contribution been neglected'

Abstract: The literature on nurse-patient communication is selectively reviewed. Previous research has been critical of the quality and quantity of nurse-patient communication, describing it as brief and superficial. Nurses are depicted as controlling and restricting the course and topics of conversations with patients. Communication skills training for nurses has been advocated as a solution for this apparent deficit. In this paper it is argued that research has over-emphasized nurses' roles in nurse-patient communication, particularly their communication skills. The patients' contribution to the content and organization skills. The patients' contribution to the content and organization of nurse-patient communication has been largely ignored. Assumptions have been made about nurses' and patients' intentions and motives during nurse-patient conversations, but the participants, particularly patients, are rarely asked for their views. There has been a tendency to view nurse-patient communication in terms of isolated excerpts of conversation. When environmental and organizational factors are included, it is their effect on nurses' communication capability, not the patients', that are the interest. It is suggested that future research consider both patients' and nurses' contributions to nurse-patient communication.

'Spirituality as integrative energy’: a philosophical analysis as requisite precursor to holistic nursing practice

Abstract: Spirituality is a universal human phenomenon, yet conceptual confusion, ambiguity and scientific scepticism have prevented adequate investigation into its potential healing effects. A recent resurgence of interest in non-medical sources of healing and holistic medical practices is causing increased speculation regarding the nature of spirituality. The lack of conceptual clarity, and absence of a precise theoretical definition, prevent recognition of spiritual distress and, hence, appropriate nursing intervention. In this paper, current usage and definitions of spirituality are discussed and a philosophical definition of 'spirituality as integrative energy' is proposed. The metaphysical nature of this phenomenon makes it the proper concern of philosophy; consequently, a philosophical analysis of the aforestated proposition was completed using the five predicables of logic theory: species, genus, differentia, logical property and logical accident. Implications of this definition for providing holistic nursing care are also presented.

Registered nurses' experiences of mentoring undergraduate nursing students

Abstract: This paper describes a research study undertaken by the first author, which explored and analysed registered nurses' experiences of mentoring undergraduate nursing students within a single health authority in England The study design was qualitative and data were collected through semi-structured interviews with 12 mentors The findings of the study indicate that mentoring undergraduate nursing students is a complex and skilled activity, requiring educational preparation, support and recognition The potential for mentoring to further the personal and professional development of mentors is highlighted

Busy doing nothing: activity and interaction levels amongst differing populations of elderly patients.

Abstract: This paper considers the activity and interaction levels amongst three differing populations of elderly patients (long-stay, short-stay and respite). It begins with a consideration of the literature on staff-patient interactions in care environments for elderly patients, highlighting the virtual absence of preplanned, purposeful activity. Data are then presented which suggest that, despite the emphasis nurses place on communicating with their patients, many patients continue to spend most of their time inactive. It is suggested that if the quality of care elderly patients receive is to improve, nursing staff must see the provision of activity as an integral part of their role and function.