Showing papers in "Journal of Advanced Nursing in 2000"

Research guidelines for the Delphi survey technique.

Abstract: Consensus methods such as the Delphi survey technique are being employed to help enhance effective decision-making in health and social care. The Delphi survey is a group facilitation technique, which is an iterative multistage process, designed to transform opinion into group consensus. It is a flexible approach, that is used commonly within the health and social sciences, yet little guidance exists to help researchers undertake this method of data collection. This paper aims to provide an understanding of the preparation, action steps and difficulties that are inherent within the Delphi. Used systematically and rigorously, the Delphi can contribute significantly to broadening knowledge within the nursing profession. However, careful thought must be given before using the method; there are key issues surrounding problem identification, researcher skills and data presentation that must be addressed. The paper does not claim to be definitive; it purports to act as a guide for those researchers who wish to exploit the Delphi methodology.

A model of burnout and life satisfaction amongst nurses.

Abstract: This study, among 109 German nurses, tested a theoretically derived model of burnout and overall life satisfaction. The model discriminates between two conceptually different categories of working conditions, namely job demands and job resources. It was hypothesized that: (1) job demands, such as demanding contacts with patients and time pressure, are most predictive of exhaustion; (2) job resources, such as (poor) rewards and (lack of) participation in decision making, are most predictive of disengagement from work; and (3) job demands and job resources have an indirect impact on nurses' life satisfaction, through the experience of burnout (i.e., exhaustion and disengagement). A model including each of these relationships was tested simultaneously with structural equations modelling. Results confirm the strong effects of job demands and job resources on exhaustion and disengagement respectively, and the mediating role of burnout between the working conditions and life satisfaction. These findings contribute to existing knowledge about antecedents and consequences of occupational burnout, and provide guidelines for interventions aimed at preventing or reducing burnout among nurses.

Methodological issues in grounded theory.

Abstract: Examination of the qualitative methodological literature shows that there appear to be conflicting opinions and unresolved issues regarding the nature and process of grounded theory. Researchers proposing to utilize this method would therefore be wise to consider these conflicting opinions. This paper therefore identifies and attempts to address four key issues, namely, sampling, creativity and reflexivity, the use of literature, and precision within grounded theory. The following recommendations are made. When utilizing a grounded method researchers need to consider their research question, clarify what level of theory is likely to be induced from their study, and then decide when they intend to access and introduce the second body of literature. They should acknowledge that in the early stages of data collection, some purposeful sampling appears to occur. In their search for conceptually dense theory, grounded theory researchers may wish to free themselves from the constraints that limit their use of creativity and tacit knowledge. Furthermore, the interests of researchers might be served by attention to issues of precision including, avoiding method slurring, ensuring theoretical coding occurs, and using predominantly one method of grounded theory while explaining and describing any deviation away from this chosen method. Such mindfulness and the resulting methodological rigour is likely to increase the overall quality of the inquiry and enhance the credibility of the findings.

Hospital nurses’ job satisfaction, individual and organizational characteristics

Abstract: Hospital nurses' job satisfaction, individual and organizational characteristics Using the Ward Organizational Features Scales (WOFS), relationships between aspects of the organization of acute hospital wards, nurses' personal characteristics and nurses' job satisfaction are examined among a nationally representative sample of 834 nurses in England. The analysis contributes to a growing body of evidence demonstrating the importance of interpersonal relationships to nurses' job satisfaction. In particular, the positive contribution of the cohesiveness of ward nursing staff is highlighted, but the potential for many current NHS staffing strategies and work environments to undermine the development of cohesive working relationships is also noted. Other influential factors are nurses' relationships with medical staff, perceptions of their workload and their evaluation of the appropriateness of the system of nursing being practised. The importance of measuring nurses' subjective assessments of their work environment is emphasized. A weak association was found between grade and job satisfaction. Individual nurse characteristics were found not to be associated with job satisfaction.

Interviewing in phenomenology and grounded theory: is there a difference?

Abstract: This paper explores the differences and similarities that may exist in respect of using the interview method in phenomenological and grounded theory methodologies. Baker et al. set out to differentiate between method in grounded theory and phenomenology and concluded that it was essential to ensure that the method matches the research question being asked. However, the paper, whilst clear in intent to differentiate between the methodologies of phenomenology and grounded theory, does little to help the researcher in the differences that may exist in carrying out such research using the same method, that is, interviewing. Interviewing has become synonymous with qualitative research and may become the accepted method of data collection irrespective of methodology. We postulate that the interview as a method of data collection may be inconsistent with the underlying principles of the methodology (phenomenology or grounded theory). Should this be the case then the interview as a means of collecting data may be viewed as generic and lack a clear connection to the methodological framework. Such a position could be consistent with a critique of qualitative nursing research on the grounds of rigour.

Effort–reward imbalance and burnout among nurses

Abstract: This study among a sample of 204 German nurses tested the hypothesis that an imbalance of high extrinsic efforts spent (i.e. job demands) and low extrinsic rewards obtained (e.g. poor promotion prospects) are associated with the burnout syndrome: the depletion of nurses' emotional resources. The results of a series of analyses of variances confirmed this hypothesis, by showing that those nurses who experienced an effort-reward imbalance (ERI) reported higher levels on two of the three core dimensions of burnout (i.e. emotional exhaustion and depersonalization) than those who did not experience such an imbalance. Moreover - as additionally hypothesized - significant interaction effects indicated that burnout (i.e. emotional exhaustion and reduced personal accomplishment) was particularly prevalent among those nurses who experienced ERI and put relatively high intrinsic effort into their jobs, as reflected by their strong tendency to be personally in control over job conditions.

Barriers to using research evidence in nursing practice

Abstract: Barriers to using research evidence in nursing practice The nursing profession has long recognized the importance of research as an essential basis for its development. More recently, the movement supporting evidence-based practice has brought this point into focus. However, relatively little research has been conducted to identify factors that interfere with the ability of nurses to base their practice on research evidence. Using factor analysis procedures, barriers to the use of research evidence in practice which were perceived to be present by 400 registered nurses working in an Australian hospital, were grouped under four main factors. These were accessibility of research findings, anticipated outcomes of using research, organizational support to use research and support from others to use research. The most important factor was perceived to be organizational support, particularly in relation to providing time to use and conduct research.

Nursing stress : the effects of coping strategies and job satisfaction in a sample of Australian nurses

Abstract: Nursing stress: the effects of coping strategies and job satisfaction in a sample of Australian nurses The study reported in this paper examined relationships between nursing work-related stressors and coping strategies, and their impact upon nurses' levels of job satisfaction and mood disturbance. It was proposed that higher levels of perceived work stress and use of avoidance coping would increase mood disturbance, while problem-focused coping would be associated with less mood disturbance. The study also aimed to explore the possible 'buffering effects' of using humour in coping with stress, and the effect of job satisfaction on the stress-mood relationship. The sample consisted of 129 qualified Australian nurses who volunteered to complete standardized questionnaires, including the Nursing Stress Scale, Ways of Coping Questionnaire, the Coping Humour Scale, Job Satisfaction Scale of the Nurse Stress Index, and the shortened version of the Profile of Mood States. Results revealed a significant positive relationship between nursing stress and mood disturbance, and a significant negative relationship between nursing stress and job satisfaction. The use of avoidance coping and the perception of work overload were found to be significant predictors of mood disturbance. No evidence was found to indicate that the use of humour had a moderating effect on the stress-mood relationship but there was support for the influence of job satisfaction upon this relationship. These results provided some support for a transactional model of stress since situational factors were found to influence the nurses' coping and perceptions of stress.

Stigma of visible and invisible chronic conditions

Abstract: Nurses deliver care to people with various forms of chronic illnesses and conditions. Some chronic conditions, such as paraplegia, are visible while others, such as diabetes, are invisible. Still others, such as multiple sclerosis, are both visible and invisible. Having a chronic illness or condition and being different from the general population subjects a person to possible stigmatization by those who do not have the illness. Coping with stigma involves a variety of strategies including the decision about whether to disclose the condition and suffer further stigma, or attempt to conceal the condition or aspects of the condition and pass for normal. We present a beginning framework that describes the relationship between the elements of stigma and the decision to disclose or hide a chronic condition based on its visibility or invisibility. The specific aims were to combine the results from a meta-study on qualitative research with a review of the quantitative literature, then develop a theoretical framework. Although an understanding of how patients cope with stigmatizing conditions is essential for nurses who aim to deliver comprehensive individualized patient care, there is little current literature on this subject. The relationship between visibility and invisibility and disclosure and non-disclosure remains poorly understood. A framework to facilitate a deeper understanding of the dynamics of chronic illnesses and conditions may prove useful for practice.

Aggression and violence in health care professions

Abstract: Although violence is increasing in most workplaces, it has become a significant problem in health care professions. Not only has the number of incidents increased but also the severity of the impact has caused profound traumatic effects on the primary, secondary and tertiary victims. More health care professionals than ever are suffering from symptoms of post-traumatic stress disorder. Addressing the problem of violence in the workplace has been exacerbated by a lack of a clear definition of what constitutes aggression and violence. As a result, some administrators have been slow to commit resources to prevent further incidents and mitigate the impact. This article describes the magnitude of the problem from both an academic research and an operational perspective. A definition is presented as an initial step towards standardizing the research, and establishing an appropriate baseline upon which intervention policies and procedures can be created. This benchmark will also help to encourage empirical research into aggression and violence in health care professions and other professions. Further research needs to be conducted to create a comprehensive instrument that can more accurately measure the range of incidents and the severity of the impact.

Who cares? Offering emotion work as a 'gift' in the nursing labour process.

Abstract: Who cares? Offering emotion work as a 'gift' in the nursing labour process The emotional elements of the nursing labour process are being recognized increasingly. Many commentators stress that nurses' 'emotional labour' is hard and productive work and should be valued in the same way as physical or technical labour. However, the term 'emotional labour' fails to conceptualize the many occasions when nurses not only work hard on their emotions in order to present the detached face of a professional carer, but also to offer authentic caring behaviour to patients in their care. Using qualitative data collected from a group of gynaecology nurses in an English National Health Service (NHS) Trust hospital, this paper argues that nursing work is emotionally complex and may be better understood by utilizing a combination of Hochschild's concepts: emotion work as a 'gift' in addition to 'emotional labour'. The gynaecology nurses in this study describe their work as 'emotionful' and therefore it could be said that this particular group of nurses represent a distinct example. Nevertheless, though it is impossible to generalize from limited data, the research presented in this paper does highlight the emotional complexity of the nursing labour process, expands the current conceptual analysis, and offers a path for future research. The examination further emphasizes the need to understand and value the motivations behind nurses' emotion work and their wish to maintain caring as a central value in professional nursing.

Barriers to, and facilitators of, research utilization among nurses in Northern Ireland.

Abstract: It is clear from the nursing literature that there are a number of factors which can impede or facilitate the use of research in practice. It is important that these are identified and addressed, both at local and national levels, if evidence-based practice is to become a reality. This study surveyed nurses' perceptions of barriers to, and facilitators of, research utilization. The Barriers Scale was administered to a convenience sample of 2600 nurses in 23 hospitals in Northern Ireland. The number of completed questionnaires was 1368 (52.6%). The results show that the top barrier was 'The nurse does not feel she/he has enough authority to change patient procedures' followed by 'statistical analyses are not understandable'. Seven out of the top 10 barriers were related to 'setting'. The implications of these and other findings are discussed.

Power and empowerment in nursing: three theoretical approaches.

Abstract: Power and empowerment in nursing: three theoretical approaches Definitions and uses of the concept of empowerment are wide-ranging: the term has been used to describe the essence of human existence and development, but also aspects of organizational effectiveness and quality. The empowerment ideology is rooted in social action where empowerment was associated with community interests and with attempts to increase the power and influence of oppressed groups (such as workers, women and ethnic minorities). Later, there was also growing recognition of the importance of the individual’s characteristics and actions. Based on a review of the literature, this paper explores the uses of the empowerment concept as a framework for nurses’ professional growth and development. Given the complexity of the concept, it is vital to understand the underlying philosophy before moving on to define its substance. The articles reviewed were classified into three groups on the basis of their theoretical orientation: critical social theory, organization theory and social psychological theory. Empowerment seems likely to provide for an umbrella concept of professional development in nursing.

Still fumbling along? A comparative study of the newly qualified nurse’s perception of the transition from student to qualified nurse

Abstract: An earlier study conducted in the United Kingdom, examining the newly qualified nurse's perception of the transition from student to qualified nurse, highlighted the limitations of pre-registration nurse education in respect of failing to provide adequate preparation for the qualified nurse's role. In the intervening years, major reforms in pre-registration nurse education and continuing professional education have occurred. Concomitant with these reforms have been major policy changes in health care delivery that have impacted upon the role of the nurse. Questions now arise as to whether the education reforms have served to equip newly qualified nurses more appropriately with the necessary knowledge, skills and confidence to function in contemporary health care settings. This paper presents the findings of a follow-up study that entailed a secondary analysis of exiting data obtained from in-depth interviews with 10 newly qualified nurses in 1985 and collecting additional data from 25 newly qualified nurses in 1998 in order to ascertain their perceptions of the transition from student to qualified nurse. Interview transcripts from both sources of data were coded and thematically analysed and comparisons made between the two sets of data. The paper focuses on one theme emanating from the original study. Entitled 'fumbling along', it described the haphazard manner whereby the nurses learned to perform their role in the light of what they perceived to be inadequate preparation and lack of support. Similarities and differences in the experiences and perceptions of the two cohorts of nurses are examined in respect of stressful aspects of the role, pre-registration preparation and post-registration development. Data from the follow-up study suggest that although newly qualified nurses still feel inadequately prepared for their role, they have developed a more active style of learning and when supported through a preceptorship scheme appear to find the transition less stressful than nurses in 1985. However, further attention needs to be paid to the development of clinical, organizational and management skills in pre-registration courses and the bridging period between the latter part of the course and the first 6 months post-qualification, in order to enable the neophyte nurse to acclimatize gradually to becoming an accountable practitioner.

The qualities of an effective mentor from the student nurse’s perspective: findings from a longitudinal qualitative study

Abstract: Parker and Carlisle (Journal of Advanced Nursing 24, 771-778) argue that there is a scarcity of empirical research focusing on issues such as supernumerary status and mentorship in Project 2000 courses from the students' perspective. This paper presents the findings of a longitudinal cohort study using Grounded Theory to discover the effect(s) of mentorship on student nurses following the introduction of the 1992 programme of education leading to a Diploma of Higher Education in Nursing and registration with the United Kingdom Central Council (UKCC). The cohort consisted of 10 students from a large Scottish College of Nursing & Midwifery who were interviewed on five occasions during the three years of their course. Students also kept a diary to record their thoughts and experiences regarding mentorship during their practice placements. In addition, a further seven students volunteered to participate by diary only. Data were analysed with the aid of NUD.IST and subjected to the constant comparative method of analysis. Findings indicate that Diploma students quickly lose their idealistic view of their mentor and over time develop an insight into the qualities they perceive are required of an effective mentor. Students quickly become aware of the importance of choosing good role models and learning their own mentor's likes and dislikes as they realize this impinges on the outcome of their assessment. As students move into their Branch programme, a gradual distancing from their mentor is evident. This coincides with a development in their confidence, skills and a holistic perspective of care.

The crescent and Islam: healing, nursing and the spiritual dimension. Some considerations towards an understanding of the Islamic perspectives on caring

Abstract: Caring from Islamic perspectives is not well versed in Eurocentric nursing literature. There is widespread misunderstanding of the concept and practice of Islam within the context of health care and nursing practice. The areas of contention, in the context of health care systems, are whether the western paradigm to nursing care and management are applicable to Muslims and non-Muslims in both Islamic and non-Islamic countries. What is lacking in some of the conceptual frameworks and models of care is not only the fundamental spiritual dimension of care, but also the significance of spiritual development of the individual towards healing. The focus of this paper is to provide an awareness of Islamic health practices, health behaviours, code of ethics and the framework of Islamic perspectives of caring and spirituality. A brief overview of the Muslim world, the historical development in caring and health and the pillars of the Islamic faith provide the context of the paper. The development of a model of care based on the Islamic perspective is suggested.

Situated learning in the practice placement.

Abstract: Nurses who had just completed their training in Scotland were interviewed with regard to their experiences on placements. The nurses had either completed a traditional training course or came from the first cohort of the Project 2000 diploma level course. The interviews focused on the way in which the student nurses had learned in their practice placements. The results suggest that the placement is a complex social and cognitive experience in which there are elements of situated learning. Acceptance into the community of practice is important but this can be separated, conceptually at least, into a social acceptance which might be extended to any student and a professional acceptance which relies on the display of appropriate competence. The nurses described the way in which their mentors had interacted with them in terms which suggested that cognitive apprenticeship strategies had been used to further their learning in practice. It is concluded that, in view of the central importance of the placement for training nurses, explicit use of mentoring techniques derived from situated learning and cognitive apprenticeship might be beneficial.

Living with stroke: a phenomenological study.

Abstract: Living with stroke: a phenomenological study Understanding how stroke sufferers experience their stroke and recovery is essential if the development of rehabilitation services is to be effective and appropriate. Previous research in this area has tended to be either cross-sectional or with a limited amount of informant follow-up, and consequently has limited utility. This paper describes a study underpinned by a phenomenological approach, which tracked the experiences of six patients admitted to a rehabilitation unit in the north-west of England. Informants were followed for at least 12 months after stroke, and a total of 73 interviews were undertaken during the study. The data demonstrate that recovery from stroke involved restructuring and adaptation in physical, social and emotional aspects of an individual’s life. Two important features of recovery were highlighted. First, whilst aspects of pre-stroke life may be used to describe individual progress, no end-point to recovery was identified as informants described and anticipated life with stroke. Second, informants focused on the social context of recovery where engagement in the social world was emphasized over discrete physical function. Although no common path of recovery was found, it is recommended that stroke services are structured to take account of the long-term needs of stroke patients and their families in their home environment.

Combining methodological approaches in research: ethnography and interpretive phenomenology

Abstract: This paper provides a detailed account of two methodological approaches commonly used in qualitative research: ethnography and interpretive phenomenology. It traces both methodologies through the various stages of a research study--data collection, analysis and validation, before considering the most appropriate methods of reconstructing the participant experience for the given audience. The author puts forward a case for the combination of methodological approaches through the triangulation of data, suggesting that this can enhance our understanding of nursing. In the case of ethnographic and phenomenological data, triangulation may enable the researcher to highlight their interpretation of the phenomenon under review, whilst at the same time considering that phenomenon in terms of the participant group, their cultural background and day-to-day experiences.

The information needs and source preferences of women with breast cancer and their family members: a review of the literature published between 1988 and 1998.

Abstract: A comprehensive and critical literature review was conducted to examine the information needs and source preferences of women with breast cancer and their family members. Relevant papers published between 1988 and 1998 were reviewed and despite their having several methodological weaknesses, a number of conclusions can still be drawn. First, women with breast cancer have distinct needs for information throughout their breast cancer journeys, indicating that information needs change with time since diagnosis and with treatment-related events. Second, family members of women with breast cancer also have substantial needs for information. Third, women with breast cancer and their family members often prefer verbal forms of information from health care professionals (HCPs), particularly around the time of diagnosis. Women with breast cancer, however, are often dissatisfied with the information they receive from HCPs. Further, the family members of women with breast cancer often perceive their information needs to be ignored by HCPs. Finally, few studies have focused specifically on the information needs and source preferences of family members of women with breast cancer. These findings have a number of implications for nursing, both for clinical practice and nursing research, and these are discussed in the review.

The importance of 'knowing the patient': community nurses' constructions of quality in providing palliative care.

Abstract: This paper reports findings from a study conducted in one community health care trust where 62 members of the district nursing team (grades B-H) were interviewed. An adaptation of the critical incident technique was used to determine factors which contributed or detracted from high quality care for a number of key areas including palliative care. The centrality of knowing the patient and his/her family emerged as an essential antecedent to the provision of high quality palliative care. Factors enabling the formation of positive relationships were given prominence in descriptions of ideal care. Strategies used to achieve this included establishing early contact with the patient and family, ensuring continuity of care, spending time with the patient and providing more than the physical aspects of care. The characteristics described by the community nurses are similar to those advocated in 'new nursing' which identifies the uniqueness of patient needs, and where the nurse-patient relationship is objectified as the vehicle through which therapeutic nursing can be delivered. The link with 'new nursing' emerges at an interesting time for community nurses. The past decade has seen many changes in the way that community nursing services are configured. The work of the district nursing service has been redefined, making the ideals of new nursing, for example holism, less achievable than they were a decade ago. This study reiterates the view that palliative care is one aspect of district nursing work that is universally valued as it lends itself to being an exemplar of excellence in terms of the potential for realizing the ideals of nursing practice. This is of increasing importance in the context of changes that militate against this ideal.

Hermeneutic‐phenomenology: providing living knowledge for nursing practice

Abstract: The phenomenological approach has gained popularity among nurse researchers as an alternative investigative method to those used in the natural sciences. As more nurse scholars and nurse researchers utilize phenomenology as a research approach, it becomes critical to examine the implications this may have for nursing knowledge development and for the utilization of that knowledge in practice. In this paper, an examination of the results of phenomenological inquiry is presented and compared with the types of knowledge considered important for nursing by Carper and White. It is clear that phenomenology contributes to empirical, moral, aesthetic, personal, and socio-political knowledge development. Its contribution is not in developing predictive and prescriptive theory, but in revealing the nature of human experience. Although interpretive inquiry, such as hermeneutic phenomenology, does not prescribe action for use in clinical practice, it does influence a thoughtful reflective attentive practice by its revealing of the meanings of human experience.

The critical incident technique and nursing care quality research.

Abstract: The critical incident technique, is a highly flexible qualitative research method used in solving practical problems. Although this research method has been extensively used in the service industry to evaluate consumers' expectations and perceptions, applications to the study of health care quality are just beginning. This article describes critical incident methodology, reviews previous applications of the technique to the study of health care quality and provides illustrations from research. This practical research methodology offers the following important advantages to those interested in designing studies of care quality: identifying patients' experiences in health care settings, exploring dimensions of nurse-patient interactions and identifying patients' responses to illness and health care treatment.

Quality of life in old age described as a sense of well‐being, meaning and value

Abstract: The purpose of the study was to present a model of quality of life and related factors, to study quality of life in a group of elderly subjects, and to do preliminary testing of the model. Quality of life was defined as a sense of well-being, meaning and value. The model includes health, functional capacity, and coping mechanisms as intra-individual conditions for quality of life, while factors in the biophysical and sociocultural environment are described as external conditions. The study sample consisted of 300 subjects, aged 75 or older and living in Finland. Data were gathered by means of structured personal interviews. The participants' quality of life was generally quite good. The correlations among the variables related to quality of life were significant, but the results of the regression analyses showed that the individual aspects of quality of life did not have identical explanatory models. The internal consistency of the instruments was good. The results give preliminary support to the model, but in future studies more attention must be paid to the conceptual and theoretical validity. In order to achieve results that can be applied in gerontological nursing practice, different groups and contexts must be investigated.

The theory–practice gap in nursing: the role of the nurse teacher

Abstract: The increasingly complex requirements of today's nursing practitioners, have been accompanied by demands on nurse educators to look at new ways to facilitate learning in the clinical area (Camiah 1996). In recent years nursing education has undergone a period of major change in many countries through integrating with universities. While nurse educators are striving to respond to changes in education the dichotomy between the theoretical input taught in the classroom and what is practised or experienced on the wards remains a problem (Ashworth & Longmate 1993, Ferguson & Jinks 1994). Dale (1994) postulates that theory provides the basis for understanding the reality of nursing, it would seem reasonable, therefore, to assume that the content studied in the classroom correlates with what the student experiences on the ward. It should also follow that if a gap exists between theory and practice, efforts should be taken for its reduction (Rafferty et al. 1996). According to MacNeil (1997) many initiatives have been introduced in an effort to bridge the theory-practice gap and these have focused around the role of the nurse teacher. These changes in education are redefining the role of the nurse teacher, therefore, the part that they currently play and will play in the future needs to be carefully considered (Phillips et al. 1996b). The aim of this paper is to provide an overview of the literature on the theory-practice divide in nursing. First, some of the reasons cited for its existence will be explored. Second, suggested ways of bridging the divide will be considered focusing on the role of the nurse teacher.

Do nurses and other professional helpers normally display much empathy

Abstract: Empathy, the ability to perceive and reason, as well as the ability to communicate understanding of the other person's feelings and their attached meanings, is held to be a core characteristic of a helping relationship. This paper examines some of the observations that motivated the authors' interest in how registered nurses learn how to offer empathy to clients. First, while empathy is crucial to all helping relationships, professional helpers do not normally offer much empathy. Second, while nurses are meant to provide helping relationships, they do not tend to show much empathy to clients. The relevance of empathy to clinical nursing and the potential consequences of low-empathy nursing for clients is considered. It will be shown that, in the past, a low level of empathy has been reported among the helping professions, including nursing, indicating that many professional helpers are not as helpful as they ought to be. While most studies of empathy in professional relationships are more than a decade old, more recent studies report similar results.

Enhancing hope in people with a first recurrence of cancer.

Abstract: Enhancing hope in people with a first recurrence of cancer Researchers and clinicians have identified the need for well-defined intervention studies to test the efficacy of interventions designed to strengthen hope. This quasi-experimental study sought to determine if a specific nursing intervention program designed to enhance hope would positively influence levels of hope and quality-of-life (QOL) in a convenience sample of 115 people with a first recurrence of cancer who were randomly assigned to one of three groups: treatment group (hope), attention control group (informational), or control group (usual treatment). The Herth Hope Index (HHI) and the Cancer Rehabilitation and Evaluation Systems, Short Form (CARES-SF) were administered prior to intervention, immediately after intervention and at 3, 6, and 9-month intervals. Treatment and control groups differed significantly with regard to level of hope (P=0·02) and QOL (P=0·03). Both the level of hope and QOL were significantly increased (P=0·03) immediately after intervention and across time (3, 6 and 9 months). This study was a preliminary attempt to design, implement, and evaluate a theory-driven hope intervention program. Knowledge about the effectiveness of specific interventions designed to enhance hope is vital if nurses are to significantly influence hope in those whom are in their care.

Nurses’ experiences of making decisions to call emergency assistance to their patients

Abstract: Patient survival often depends on decisions by nurses to call emergency assistance. The experiences of nurses calling emergency assistance have not been described. This descriptive study explored the experiences of registered nurses (n=32) using unstructured interviews. The main findings were that nurses questioned whether they were doing the 'right thing' calling the emergency team, sometimes collaborated with others prior to calling and most felt nervous and anxious. They recognized patient deterioration from feelings they had that something was wrong. However, they were not able 'to put their finger on it'. Knowing the patient and past experiences were involved in the recognition of deterioration. This association indicates the importance of experience in the development of clinical decision-making skills. Further, nurses calling emergency assistance need to be provided with the opportunity to debrief after calling. Their heavy reliance on subjective data before searching for objective data as outlined in the emergency calling criteria suggests that it is essential that nurses do not devalue or ignore concerns they may have about patients.