Showing papers in "Journal of Advanced Nursing in 2002"

Getting evidence into practice: the meaning of 'context'.

Abstract: Getting evidence into practice: the meaning of `context' Aim of paper. This paper presents the findings of a concept analysis of `context' in relation to the successful implementation of evidence into practice. Background. In 1998, a conceptual framework was developed that represented the interplay and interdependence of the many factors influencing the uptake of evidence into practice [Kitson A., Harvey G. & McCormack B. (1998) Quality in Health Care7, 149]. One of the key elements of the framework was `context', that is, the setting in which evidence is implemented. It was proposed that key factors in the context of health care practice had a significant impact on the implementation and uptake of evidence. As part of the on-going development and refinement of the framework, the elements within it have undergone a concept analysis in order to provide some theoretical and conceptual rigour to its content. Methods. Morse's [Morse J.M. (1995) Advances in Nursing Science17, 31; Morse J.M., Hupcey J.E. & Mitcham C. (1996) Scholarly Inquiry for Nursing Practice. An International Journal10, 253] approach to concept analysis was used as a framework to review semi-nal texts critically and the supporting research literature in order to establish the conceptual clarity and maturity of `context' in relation to its importance in the implementation of evidence-based practice. Findings: Characteristics of the concept of context in terms of organizational culture, leadership and measurement are outlined. A main finding is that context specifically means `the setting in which practice takes place', but that the term itself does little to reflect the complexity of the concept. Whilst the themes of culture and leadership are central characteristics of the concept, the theme of `measurement' is better articulated through the broader term of `evaluation'. Conclusions. There is inconsistency in the use of the term and this has an impact on claims of its importance. The concept of context lacks clarity because of the many issues that impact on the way it is characterized. Additionally, there is limited understanding of the consequences of working with different contexts. Thus, the implications of using context as a variable in research studies exploring research implementation are as yet largely unknown. The concept of context is partially developed but in need of further delineation and comparison.

Getting evidence into practice: the role and function of facilitation.

Abstract: Getting evidence into practice: the role and function of facilitation Aim of paper. This paper presents the findings of a concept analysis of facilitation in relation to successful implementation of evidence into practice. Background. In 1998, we presented a conceptual framework that represented the interplay and interdependence of the many factors influencing the uptake of evidence into practice. One of the three elements of the framework was facilitation, alongside the nature of evidence and context. It was proposed that facilitators had a key role in helping individuals and teams understand what they needed to change and how they needed to change it. As part of the on-going development and refinement of the framework, the elements within it have undergone a concept analysis in order to provide theoretical and conceptual clarity. Methods. The concept analysis approach was used as a framework to review critically the research literature and seminal texts in order to establish the conceptual clarity and maturity of facilitation in relation to its role in the implementation of evidence-based practice. Findings. The concept of facilitation is partially developed and in need of delineation and comparison. Here, the purpose, role and skills and attributes of facilitators are explored in order to try and make distinctions between this role and other change agent roles such as educational outreach workers, academic detailers and opinion leaders. Conclusions. We propose that facilitation can be represented as a set of continua, with the purpose of facilitation ranging from a discrete task-focused activity to a more holistic process of enabling individuals, teams and organizations to change. A number of defining characteristics of facilitation are proposed. However, further research to clarify and evaluate different models of facilitation is required.

Applying phenomenography in nursing research.

Abstract: Aims. This paper examines phenomenography, a research approach designed to answer certain questions about how people make sense of their experience. The research approach, developed within educational research, is a content-related approach investigating the different qualitative ways in which people make sense of the world around them. The outcomes of phenomenographic research are different content-related categories describing the differences in other people's ways of experiencing and conceiving their world. Methods. The research approach is presented by describing the underlying ontological and epistemological assumptions, describing the research method in detail and providing some examples of phenomengraphic studies in health care and nursing research. The possibilities for applying the methodology to nursing research are discussed, illustrated by research examples. Finally, the future role of the approach within nursing research is discussed. Conclusion. The emphasis on differences in the phenomenographical research approach makes it distinct from other research approaches, and accordingly, it seems to be reasonable to incorporate knowledge of this kind in the professional education of health care personnel.

The application of vignettes in social and nursing research

Abstract: The application of vignettes in social and nursing research Aim. The aim of this paper is to review the potential for, and the limitations of, the use of vignettes in research that seeks an understanding of people's attitudes, perceptions and beliefs, particularly with regard to sensitive subjects such as health care. Background. Vignettes, in the form of text or pictures presented to research participants to prompt responses to interview questions, are widely used throughout the social sciences although their use in nursing research is less developed. Review focus. This review paper begins by addressing the differences between vignettes and real life processes. The following sections explore some of the practical advantages and pitfalls of using vignettes in social and nursing research. Conclusion. The paper demonstrates how vignettes can be very useful research tools yielding valuable data when studying people's attitudes, perceptions and beliefs in social and nursing research.

Towards clarification of the meaning of spirituality.

Abstract: Background. Rhetoric about spirituality and nursing has greatly increased, as scientific-based approaches are not fully able to address many human problems, such as persistent pain. Despite the renewed interest and growing literature on spirituality, there is no consensus on a definition of this concept. There is also ambiguity on how this concept is incorporated into nursing practice, research, and education. Aim. This paper aims to contribute toward clarification of the meaning of spirituality in relevance to health and nursing today through a conceptual analysis process. Methods. Information was obtained through dictionary definitions and electronic database searches of literature on spirituality spanning the past 30 years. The criteria for selection included scholarly articles and books with a definition of spirituality, and research studies that investigated the meaning of spirituality to individuals' health. A total of 76 articles and 19 books were retrieved for this analysis. Findings. Spirituality is an inherent component of being human, and is subjective, intangible, and multidimensional. Spirituality and religion are often used interchangeably, but the two concepts are different. Spirituality involves humans' search for meaning in life, while religion involves an organized entity with rituals and practices about a higher power or God. Spirituality may be related to religion for certain individuals, but for others, such as an atheist, it may not be. Conclusion. In order to provide clarity and enhance understanding of this concept, this analysis delineates antecedents, attributes, constructed case examples, empirical referents, and consequences of spirituality. A proposed definition of spirituality emerged from this process, which may be applied broadly. Implications for nursing practice, education, and research are discussed.

Clinical competence assessment in nursing: a systematic review of the literature

Abstract: Background. The assessment of clinical competence has returned to centre stage of nurse education. However, there is little evidence to support the use of clinical competence and a wide variety of methods for its use. Research question. The present study was designed to investigate the evidence for the use of clinical competence assessment in nursing. Design. A review using systematic methods of literature pertaining to clinical competence in nursing was conducted using defined dates, databases and search terms. Results. There is still considerable confusion about the definition of clinical competence and most of the methods in use to define or measure competence have not been developed systematically and issues of reliability and validity have barely been addressed. Conclusion. The assessment of clinical competence remains almost universally accepted in the nurse education literature as a laudable pursuit yet there are aspects of it that remain at odds with the higher education of nurses.

Phenomenology as a method to investigate the experience lived: a perspective from Husserl and Merleau Ponty's thought

Abstract: Phenomenology as a method to investigate the experience lived: a perspective from Husserl and Merleau Ponty's thought Aim. By taking nursing as a human relationships activity, in spite of its strong technical – scientific features, this article reflects on the phenomenological method as one of the ways to develop an investigation and acquire knowledge of the topic. Rationale. Based on Husserl's phenomenology, which is opposed to the way of doing science based on the laws that regulate the physics and mathematics, the article introduces Merleau Ponty's existential phenomenology as the theoretical foundation for the method it proposes. My existential conceptions – people as historic beings inserted in a world over which they act but which, in its turn, determines them; the human perception as reference for our way of being in the world; the space-time structure of perception – these are the key concepts that have led to the elaboration of an approach to phenomenological research. Proposal of a methodology. Steps are proposed for such an approach, namely phenomenological description, reduction and analysis. These lead to the building up of ideographic and nomothetic analyses, thus unveiling and describing general truths about the phenomenon studied. Finally, the possibilities for applying the methodology to nursing research are discussed, illustrated by my research into student nurses' perspectives on working on an isolation ward.

The effectiveness of music as an intervention for hospital patients: a systematic review

Abstract: The effectiveness of music as an intervention for hospital patients: a systematic review Introduction. Over the past few decades there has been a growing interest in the use of music, which has seen it used to achieve a diverse range of outcomes. While music as an intervention for hospital patients has subject to considerable evaluation, many of these studies are small and findings are therefore often contradictory. This systematic review was conducted to investigate the effectiveness of music as an intervention for hospital patients. Method. A comprehensive search was undertaken involving all major health care databases. For studies to be included in the review they must have investigated the effect of music, involved adult hospital patients and used a randomized controlled trial design. These studies must also have used outcome measures such as anxiety, satisfaction, pain, mood and vital signs. Identified studies were critically appraised, and then categorized according to whether music was evaluated during normal care delivery or during invasive and unpleasant procedures. When appropriate, studies were combined in a meta-analysis. Results. A total of 29 studies were identified that fulfilled the inclusion criteria, of which 10 were subsequently excluded following critical appraisal. Music played via headphones reduces anxiety of patients during normal care deliver, but it has no impact on the anxiety of patients undergoing procedures such as bronchoscopy, sigmoidoscopy or surgery with a spinal anaesthetic. Music produces a small reduction in respiratory rate during normal care delivery, but appears to have little effect on other vital sign parameters. It has no impact on the vital signs of patients undergoing procedures. Although the evidence is limited, music also appears improve the mood and tolerance of patients. Conclusion. This review demonstrates the effectiveness of music for the reduction of anxiety during normal care deliver. Given the inexpensive nature of this intervention, and the lack of adverse events, it is recommended as an adjunct to normal care practices. This review also highlights the need for further research into many aspect of this intervention.

The value of combining qualitative and quantitative approaches in nursing research by means of method triangulation.

Abstract: Aim. The article contributes to the theoretical discussion of the epistemological grounds of triangulation in nursing research. Background. In nursing research, the combination of qualitative and quantitative methods is being used increasingly. The attempt to relate different kinds of data through triangulation of different methods is a challenging task as data derived through different methodologies are viewed as incommensurable. Content. Epistemological questions become a vital issue in triangulation of different methods, as qualitative and quantitative methods are built on philosophical differences in the structure and confirmation of knowledge. The epistemology of nursing is manifold, complex and multifarious in character. Contemporary nursing research should be developed on the bases of an epistemology that reflects this multiplicity. The benefits and problems of triangulation are discussed on basis of an epistemological position that acknowledges the need for various types of knowledge and that does not attempt to rank them in a hierarchical order or place different values on them. Conclusion. We conclude that the complexity and diversity of reality provides the ontological basis for an alternative epistemological position. The various methods used should be recognized as springing from different epistemological traditions which, when combined, add new perspectives to the phenomenon under investigation. The different types of knowledge should not be seen as ranked, but as equally valid and necessary to obtain a richer and more comprehensive picture of the issue under investigation.

A longitudinal study of perceived level of stress, coping and self-esteem of undergraduate nursing students: an Australian case study.

Abstract: Aim. The aim of this study was to investigate the perception and sources of stress, coping mechanisms used, and self-esteem in nursing students during 3 years of their undergraduate nursing programme. Methods. The sample consisted of a cohort of nursing students going through 3 years of a nursing programme. The method was a descriptive corelational design. The questionnaire consisted of demographic data, the General Health Questionnaire (GHQ-12), Self-esteem Scale, and the modified Ways of Coping Scale. Data were analysed using frequency distributions, content analysis, and measures of correlation. Results. Results indicated that students in year 1 experienced significantly less transient stress as compared with year 2; students in year 3 had more positive self-esteem than year 2 students. There were no significant differences with regard to chronic stress, avoidance and proactive coping, and negative self-esteem. Chronic and transient stress, as measured by GHQ, were significantly correlated ( P < 0·01) with avoidance coping behaviours, and negative self-esteem. Positive self-esteem was significantly correlated ( P < 0·01) with proactive coping behaviours. The four main stressors in the last three years for this cohort of students, in descending order are nursing studies, finance, family and health. They coped by using both problem-focused and emotion-focused coping skills. There is a need to review the nursing curriculum and evaluate what impacts on students' stress levels, and also introduce strategies to reduce the stress levels of nursing students.

Acute care nurses' perceptions of barriers to using research information in clinical decision‐making

Abstract: Aim: To examine the barriers that nurses feel prevent them from using research in the decisions they make. Background: A sizeable research literature focusing on research utilization in nursing has developed over the past 20 years. However, this literature is characterized by a number of weaknesses: self-reported utilization behaviour; poor response rates and small, nonrandom sampling strategies. Design: Cross-case analysis involving anonymised qualitative interviews, observation, documentary audit and Q methodological modelling of shared subjectivities amongst nurses. The case sites were three large acute hospitals in the north of England. One hundred and eight nurses were interviewed, 61 of whom were also observed for a total of 180 h, and 122 nurses were involved in the Q modelling exercise (response rate of 64%). Results: Four perspectives were isolated that encompassed the characteristics associated with barriers to research use. These related to the individual, organization, nature of research information itself and environment. Nurses clustered around four main perspectives on the barriers to research use: (1) Problems in interpreting and using research products, which were seen as too complex, 'academic' and overly statistical; (2) Nurses who felt confident with research-based information perceived a lack of organizational support as a significant block; (3) Many nurses felt that researchers and research products lack clinical credibility and that they fail to offer the desired level of clinical direction; (4) Some nurses lacked the skills and, to a lesser degree, the motivation to use research themselves. These individuals liked research messages passed on to them by a third party and sought to foster others' involvement in research-based practice, rather than becoming directly involved themselves. Conclusions: Rejection of research knowledge is not a barrier to its application. Rather, the presentation and management of research knowledge in the workplace represent significant challenges for clinicians, policy-makers and the research community

Family stress, perceived social support and coping following the diagnosis of a child's congenital heart disease.

Abstract: Family stress, perceived social support and coping following the diagnosis of a child's congenital heart disease Background. Congenital heart disease (CHD) is now estimated to be the second most prevalent chronic illness. A child's chronic illness may have effects that have pervasive consequences for family life. Recently, attention has focused on resiliency variables, especially social support and coping strategy, regulating the impact of stress. In the resiliency model of family stress, adjustment and adaptation, social support is viewed as one of the primary moderators or mediators between stress and well-being. Aims. The purpose of this study was to explore the relationships of family stress, perceived social support, and coping and determine the resiliency factor associated with coping by families who have a child with chronic illness. Design. In a secondary analysis of a large longitudinal study, the sample consisted of 92 families who had a child under age 12 who was newly diagnosed with CHD within the last 3–4 months. Findings. Results from regression analysis revealed that perceived social support operated as a resiliency factor between family stress and both parental and family coping. Child and family characteristics appeared to be the important predictors of perceived social support and parental coping. Although perceived social support appeared to be an important predictor of parental and family coping, neither the moderating nor mediating model was supported in full but partial causal relations were confirmed. Conclusions. Findings provided evidence for the theoretical and empirical significance of perceived social support as a predictor of family coping. Further, these findings suggest that perceived social support is a factor influencing the resiliency of relatively high-risk groups of families who have a child with chronic illness.

Nurses' attitudes towards clients who self-harm

Abstract: Background. Deliberate self-harm is frequently encountered by emergency department (ED) nurses. However, clients are often dissatisfied with the care provided and clinicians feel ambivalent, helpless or frustrated when working with clients who self-harm. Aim. The aim of the study was to develop and test a scale to identify relevant dimensions of ED nurses' attitudes to clients who present with self-injury. Methods. Items on Attitudes Towards Deliberate Self-Harm Questionnaire (ADSHQ) were drawn from a literature review and focus group discussions with ED nurses. The tool was piloted with 20 ED nurses not working in the target agencies. A survey of nurses working within 23 major public and 14 major private EDs in Queensland, Australia ( n = 1008) was then undertaken. Results. A total of 352 questionnaires were returned (35% response). Analysis revealed four factors that reflected nurses' attitudes toward these clients. The factors related to nurses' perceived confidence in their assessment and referral skills; ability to deal effectively with clients, empathic approach; and ability to cope effectively with legal and hospital regulations that guide practice. There was a generally negative attitude towards clients who self-harm. Correlations were found between years of ED experience and total score on the ADSHQ, and years of ED experience and an empathic approach towards clients who deliberately self-harm. Conclusion. There is a need for continuing professional development activities to address negative attitudes and provide practical strategies to inform practice and clinical protocols.

The quest for ordinariness: transition experienced by midlife women living with chronic illness.

Abstract: Aims. This paper reports the findings of research that aimed to elucidate the meaning of midlife women's experiences of living with chronic illness. Background. A lack of awareness by health professionals of the context in which women must live with chronic illness often results in women feeling overwhelmed, alienated and without voice within the delivery of health care. This inquiry privileged women's voices. Design. The construct of ‘transition’ in chronic illness experience evolved from this collaborative and participatory research with midlife women living with adult onset chronic illness. Over a 1-year timeframe, 81 women were asked to tell their stories of living with a chronic illness. These correspondence data were thematically analysed to provide storied accounts. Guided by feminist principles, women were empowered through research processes and have actively participated in the development of the transition construct. Findings. The research revealed that when women are first confronted with a chronic illness they appear to move through a complex trajectory that involves an ‘extraordinary’ phase of turmoil and distress; however, they may then make the transition toward an ‘ordinary’ phase that involves incorporating chronic illness into their lives. Transitions in chronic illness experience involve movement from extraordinariness to ordinariness and sometimes back again and were found to be processes that are nonlinear, sometimes cyclical and potentially recurring throughout a woman's life. Four major constructs emerged from women's narratives: How quickly life changes; extraordinariness: confronting life with illness; The illness experience as transforming and ordinariness: reconstructing life with illness. Conclusion. Nurses are in a position where they may make a difference to women who live with chronic illness. Understanding illness transitions offers a framework that will enable nurses to move beyond the bio-medically orientated concepts of nursing practice, towards a holistic approach to the provision of nursing care.

Spirituality and health: towards a framework for exploring the relationship between spirituality and health.

Abstract: Spirituality and health: towards a framework for exploring the relationship between spirituality and health Background. A growing body of evidence has found that spirituality enhances health. However, spirituality is an elusive concept that defies clear definition. This inevitably presents difficulties when comparing the findings of studies. Therefore conceptual clarification is essential if practitioners are to better understand the relationship between spirituality and health. Aims. The aim of this paper is to develop a conceptual framework, which can be used to explore the relationship between spirituality and health. Methods. The concept-indicator model was used to analyse spirituality in the literature. The literature was searched for empirical indicators or what are taken as essential attributes of spirituality. Similarities and differences between approaches were identified and these formed the basis of a framework. Findings. The analysis identified three approaches (a trichotomy) to spirituality in the literature. These were termed the transcendent, the value guidance and the structuralist–behaviourist approaches. The paper shows how by clarifying the different conceptualizations of spirituality and the interrelationship between them researchers can also clarify their respective contributions to health. Thus a contribution is made towards making more explicit the ways in which key aspects of spirituality such as transcendence, meaning and purpose, connectedness, hope, and faith, work to produce health benefits in terms of prevention, recovery from illness, or coping with illness. Conclusions. The framework (or trichotomy) will enable practitioners to understand better the connection between spirituality and health. In particular, it will show that to appreciate the benefits that patients might experience from their value or belief systems, practitioners must actively explore the content of those systems in a respectful way.

Cautious caregivers: gender stereotypes and the sexualization of men nurses' touch

Abstract: Aim. The aim of this research was to explore the experience of men nurses and the ways in which gender relations structure different work experiences for women and men in the same profession. Background. Men are now entering the nursing profession in record numbers and challenging the notion that men are inappropriate in caregiver roles or incapable of providing compassionate and sensitive care. A limitation of the current state of knowledge regarding caring and men nurses is that it is primarily focused on men nursing students, not practising nurses. Little is known about men nurses' practices of caring and how such practices reflect the gendered nature of nursing and nurses' caring work. Methods. The theme of men nurses as cautious caregivers emerged from data that were collected in two rounds of semi-structured interviews with eight men nurses practising in Nova Scotia, Canada. Thematic analysis, informed by feminist theory and masculinity theory, was used as the method for analysing the data. Findings. For men nurses, the stereotype of men as sexual aggressors is compounded by the stereotype that men nurses are gay. These stereotypes sexualize men nurses' touch and create complex and contradictory situations of acceptance, rejection and suspicion of men as nurturers and caregivers. They also situate men nurses in highly stigmatized roles in which they are subject to accusations of inappropriate behaviour. For men nurses, this situation is lived as a heightened sense of vulnerability and the continual need to be cautious while touching and caring for patients. Ultimately, this situation impacts on the ability of men nurses to do the caring work they came into nursing to do.

A qualitative study of shift handover practice and function from a socio-technical perspective.

Abstract: A qualitative study of shift handover practice and function from a socio-technical perspective Background. Shift handover plays a pivotal role in the continuity of patient care in 24-hour nursing contexts. The critical nature of this communication system is recognized within the literature and by the nursing profession; however, there are few in-depth studies. The rationale for this study is to gain a better understanding of handover practices and functions and their implications for effectiveness. Method. Handover systems on two very different paediatric wards were selected as case studies. In each case, 20 handovers were observed and audio-taped and 12 individual and two-group interviews with nursing staff about handover were also conducted. Analysis involved categorizing the data and characterizing handover practices and functions using an inductive approach to generate qualitative themes. The ethics committees of the hospital and the university approved the research. All involved were fully informed about the study, with confidentiality maintained throughout. Results. Handover practices are distributed over time, socially among the staff and technologically through a range of artifacts, while the system also accomplishes informational, social and educational functions. Handover effectiveness is characterized by flexibility in managing competing demands and tensions, such as maintaining confidentiality while practising family centred care. There are limitations in how far the findings can be generalized to other nursing contexts, and the possible effects of the researcher’s presence are also recognized. Conclusions. Handover is a complex system based on several sound socio-technical principles and the value of this nurse-to-nurse communication should be acknowledged. The multiple functions highlight the knowledge and expertise currently hidden within handover, which could be promoted in terms of nursing professionalism.

A descriptive study of registered nurses' experiences with web‐based learning

Abstract: Aims. To describe the experiences of registered nurses (RNs) who enrolled in a web-based course from either their home or the workplace. Rationale. In order to maintain competency in rapidly changing health care systems, and meet the challenge of overcoming traditional barriers to continuing education, RNs need access to innovative educational delivery methods. As yet, little is known about the web-based learners' experience, particularly when courses are accessed from the nursing practice setting. Methods. The article focuses on the results from questionnaires conducted with 57 RNs enrolled in a web-based, postdiploma course. These findings emanate from a larger study using survey method and focus group interviews. Nurses' experiences were measured using the Online Learner Support Instrument which was developed and tested for use in the study. Results. Most nurses found the course highly satisfactory. Not all experiences were positive however, and a number of challenges were faced. Access to the course from home was reported as very satisfactory for the majority, while work users encountered a number of serious barriers such as insufficient time and limited computer access. The RNs made significant gains in their learning with e-mail, Internet, keyboarding and word processing skills during the 16-week course. Lack of computer skills, erroneous perceptions of course workload and inadequate preparation for web learning were largely responsible for the majority of withdrawals. Conclusion. Web-based learning can be an effective mode of delivery for nursing education. Advance preparation by educational institutions, employers and prospective students is essential. Teachers, peers, technology, course design and the learning environment are key variables that influence the learners' experience and success.

A review of older people’s experiences with residential care placement

Abstract: A review of older people’s experiences with residential care placement Background. Transition to the care and environment of a residential home has been identified in the literature as the most significant relocation affecting older people. However, little effort has been made systematically to review and synthesize the body of knowledge relating to older people’s experiences with such placement. This has led to lack of concerted effort in the development of strategies to help elders adjust to such placement with dignity and success. Aim. This paper presents a critical review of the literature related to older people’s experiences with residential care placement, with an attempt to identify how knowledge in this area could be moved forward. Conclusions. It is concluded that, while understanding of older people’s pre and postplacement experiences was abundant, there was a dearth of literature on the actual experiences involved as older people made their day to day adjustment after placement. There is a need for future research to identify the dynamic processes of how older people come to terms with residential living. Future research should also focus on developing an accurate understanding of the adjustment experiences of elders with different ethnic background.

Partnership: an analysis of the concept within the nurse-client relationship.

Abstract: Background/Rationale. Current nursing literature that describes the nurse–client relationship as a partnership provides little clarity about the elements and processes of this partnership. This is hardly surprising as conceptual definitions of partnership differ in scope and vary according to the context of the partnership and types of partners. Aims of the paper. This paper examines the concept of partnership using Rodgers's (2000) evolutionary approach to concept analysis. The paper describes the antecedents, attributes and consequences of partnership as well as changing socio-political and economic contexts that illuminate how and why nurse–client partnership emerged. Temporal changes in the concept of partnership are also examined. Findings. The nurse–client relationship as partnership evolved from a growth in democratic thinking and progress in clarifying how to honour basic human rights in health care relationships. The attributes of partnership include structural and process phenomena. The structure of partnership includes the phases of the relationship, focus and aims of each phase, and roles and responsibilities of the partners. The process of partnership embodies power sharing and negotiation. The main consequence of partnership is client empowerment, which is understood to be the improved ability of the client to act on his/her own behalf. Conclusions. The paper concludes with suggestions for further development of the concept of partnership through empirical research.

Effects of massage on pain and anxiety during labour: a randomized controlled trial in Taiwan

Abstract: Effects of massage on pain and anxiety during labour: a randomized controlled trial in Taiwan Aims. To investigate the effects of massage on pain reaction and anxiety during labour. Background. Labour pain is a challenging issue for nurses designing intervention protocols. Massage is an ancient technique that has been widely employed during labour, however, relatively little study has been undertaken examining the effects of massage on women in labour. Methods. A randomized controlled study was conducted between September 1999 and January 2000. Sixty primiparous women expected to have a normal childbirth at a regional hospital in southern Taiwan were randomly assigned to either the experimental (n=30) or the control (n=30) group. The experimental group received massage intervention whereas the control group did not. The nurse-rated present behavioural intensity (PBI) was used as a measure of labour pain. Anxiety was measured with the visual analogue scale for anxiety (VASA). The intensity of pain and anxiety between the two groups was compared in the latent phase (cervix dilated 3–4 cm), active phase (5–7 cm) and transitional phase (8–10 cm). Results. In both groups, there was a relatively steady increase in pain intensity and anxiety level as labour progressed. A t-test demonstrated that the experimental group had significantly lower pain reactions in the latent, active and transitional phases. Anxiety levels were only significantly different between the two groups in the latent phase. Twenty-six of the 30 (87%) experimental group subjects reported that massage was helpful, providing pain relief and psychological support during labour. Conclusions. Findings suggest that massage is a cost-effective nursing intervention that can decrease pain and anxiety during labour, and partners' participation in massage can positively influence the quality of women's birth experiences.

Predictors of job satisfaction and absenteeism in two samples of Hong Kong nurses.

Abstract: Background. Stress-related outcomes of job satisfaction and absenteeism among nurses should receive more attention in Hong Kong because absenteeism is costly. Many nurses' complaints are due to organizational change in privatization since the establishment of the Hong Kong Hospital Authority in 1991. Organizational climate is found to be an antecedent of job dissatisfaction and absenteeism in many studies in western societies. Aim. To investigate the role of organizational climate and psychological distress on job satisfaction; and the role of climate, distress and job satisfaction on absenteeism in Hong Kong nurses, while controlling for demographic variables. Methods. A self-administered questionnaire survey method was used to collect data from two samples of nurses within a 8-month period. They are, respectively, 144 (74 general nurses, 70 psychiatric nurses; 47 males, 97 females) and 114 (85 general nurses, 29 psychiatric nurses; 17 males, 97 females) nurses. Results. Multiple regression analyses revealed that occupational type (psychiatric/general), environment (the physical conditions in the work area) and psychological distress were significant predictors of job satisfaction for sample 1; and well-being (social relations, welfare and health issues) was the only significant predictor of job satisfaction for sample 2. However, age, involvement (the degree of commitment displayed towards employees by the organization), psychological distress and job satisfaction were significant predictors of absenteeism for sample 1; and occupational type, organization (the interaction between the worker and the organization), and involvement were significant predictors of absenteeism for sample 2. Conclusions. The empirical findings provide support for the climate–job satisfaction and climate– absenteeism relationships. Psychological distress could be an antecedent of job satisfaction; and job satisfaction could be an antecedent of absenteeism. Certain climate dimensions should be improved to enhance job satisfaction and reduce distress, which in turn will reduce absenteeism.

Storytelling and the interpretation of meaning in qualitative research.

Abstract: Aim. This paper reviews literature on narrative analysis and illustrates the meaning-making function of stories of chronic illness through analysis and discussion of two case studies from a study of acute episodes of chronic obstructive pulmonary disease (COPD). Background. Individuals living with COPD experience acute exacerbations characterized by extreme dyspnea, but there has been little research to provide understanding of these events from the perspectives of individuals with COPD, family caregivers, and nurses. Narrative analysis – considered in the context of the aims of qualitative research – illuminates how these people make sense of acute exacerbation events by telling stories. Design and methods. In an ethnographic study, 10 patient–family nurse units in two Canadian general hospitals participated in interviews concerning acute episodes of COPD. Narrative analysis enabled identification of several story forms and their functions. Results. Examples were found of a story told twice with different meanings, and of a patient's ‘death story’ used to communicate distrust of the nurse's ability to recognize the seriousness of distress and implications for its potential course. These examples are presented, and interpreted with respect to issues of meaning. Conclusions. The analysis indicates that stories told by patients in the context of nurse–client interactions inform understanding of the individual's acute exacerbation events beyond the biophysical.

Nursing as means of governmentality.

Abstract: Background. This paper conceptualizes nursing as a health profession in transformation at the beginning of the 21st century. We frame our analysis using Michel Foucault's concept of governmentality. While extensively quoted and used in other disciplines, the work of the late French philosopher has been cited infrequently in the nursing literature. Yet a closer look at his work reveals how Foucault offers a relevant entry point for revisiting nursing theory and nursing practice. Aim of paper. The aim of this paper is to reflect on nursing practice as it is inscribed within the state's modus operandi. We discuss the prevalent notion that nurses are powerless and suggest they do exercise power in many ways and that they are a powerful group. Results. In this paper we show how nursing is a means of governmentality of individuals and of the population because its practices contribute to the management of society through a vast range of power techniques. These techniques range from disciplining individuals to promoting discourses that construct desirable subjectivities. Within this perspective, the emergence of political aspects of nursing theory and nursing practice are made explicit. Conclusion. We explore the limits and potentials of the concept of governmentality to the understanding of nursing as a health profession. This concept can generate a form of critical immobilism, but also promotes a more politically complex understanding of nursing practice.

Developing culturally competent researchers.

Abstract: Background Whilst we live in multi-cultural societies most health researchers tend to take the cultural perspective of the majority ethnic group at the expense of the perspective of minority ethnic groups. Aim This paper discusses the need for the development of culturally competent health researchers in all areas of research and proposes a model for the achievement of this. Design A snapshot review of research textbooks used in nursing curricula was conducted to identify whether culturally competent research was being promoted. Results The review found that whilst a few textbooks touched on ethnicity, race and culture, none of them addressed the issue of culturally competence. Subsequently the authors adapted their existing model of culturally competent health care practice, and in this paper they propose it as a model for the development of culturally competent researchers. Discussion The model put forward by the authors consists of four concepts: cultural awareness, cultural knowledge, cultural sensitivity and cultural competence. A culturally competent researcher is one who is able to apply the related skills and knowledge in project design, data collection, analysis, report writing and dissemination. Furthermore, the authors identify two layers of cultural competence, those of culture-generic (knowledge and skills that are applicable across ethnic groups) and culture-specific competence (knowledge and skills that relate to a particular ethnic group). The relationship between these two layers is a dynamic and spiralling process as illustrated by the model. Conclusion Current health policy in many developed countries focuses on inequalities of health and managing diversity, including ethnicity. Thus the authors conclude that the development of culturally competent researchers will lead to both valid research and culturally competent practice by health care professionals.

Action research: politics, ethics and participation

Abstract: Aim. This paper contributes to an understanding of the political and ethical aspects of action research (AR). Background. Action research is growing in popularity in nursing and health care as a means of changing practice and generating new knowledge. As a methodology, AR relies on a close collaborative working relationship between researcher and participants, but this close relationship is also the source of political and ethical problems faced by researchers and participants. Content. We argue that action researchers and participants working in their own organizations should be clear about the extent to which they are engaged in a political activity, and that AR does not offer the same ethical guarantees concerning confidentiality and anonymity, informed consent, and protection from harm as other research methodologies (both quantitative and qualitative). This argument is illustrated by our experiences of participation in an AR study. Conclusion. We outline three areas where AR is implicitly political, and three areas where it is ethically problematic. We recommend that researchers and participants recognize, discuss and negotiate these problematic areas before starting their work.

The concept of self-management of type 1 diabetes in children and adolescents: an evolutionary concept analysis

Abstract: The concept of self-management of type 1 diabetes in children and adolescents: an evolutionary concept analysis Aim. An evolutionary concept analysis was undertaken to clarify the concept of self-management of type 1 diabetes in children and adolescents. Background. Several problems exist in the literature on self-management of type 1 diabetes in children and adolescents. There is no uniform terminology and there is no uniform definition of the concept. Also, there is no differentiation in the literature between self-management of diabetes in children and adults. Methods. Ninety-nine references were reviewed and analysed in the disciplines of nursing, medicine, and psychology. After separate analyses revealed no significant differences across disciplines, the analyses were combined to describe the attributes, antecedents, consequences, and surrogate and related concepts. Results. The three essential attributes of the concept were identified as process, activities, and goals. Self-management of type 1 diabetes in children and adolescents is an active and proactive process; it is daily, lifelong, and flexible, and it involves shifting and shared responsibility for diabetes care tasks and decision-making between child and parent. It is a process that involves collaboration with health care providers. Self-management of type 1 diabetes in children and adolescents also consists of varied and many activities related to giving insulin, monitoring metabolic control, regulating diet and exercise, to name just a few. The concept also involves goals, which may differ from one parent/child dyad to another. A working definition of the concept is suggested. Conclusions. It is hoped that a more uniform definition of the concept will enable researchers to continue investigating antecedents and consequences of the concept in a way that allows for aggregating results.