Showing papers in "Journal of Clinical Nursing in 2006"

Family centred care: a review of qualitative studies.

Abstract: Aim. To review systematically qualitative studies, which were found during a literature search for a Cochrane systematic review of the use of family centred care in children's hospitals. Background. Family centred care has become a cornerstone of paediatric practice, however, its effectiveness is not known. No single definition exists, rather a list of elements that constitute family centred care. However, it is recognized to involve the parents in care planning for a child in health services. A new definition is presented here. Methods. The papers were found in wide range of databases, by hand searching and by contacting the authors where necessary, using terms given in detail in the protocol in the Cochrane Library, in 2004. Qualitative studies could not be used for statistical analysis, but are still important to the review and so are described separately in this paper. Results. Negotiation between staff and families, perceptions held by both parents and staff roles influenced the delivery of family centred care. A sub-theme of cost of family centred care to families and staffs was discovered and this included both financial and emotional costs. Conclusion. Further research is needed to generate evidence about family centred care in situations arising from modern models of care in which family centred care is thought to be an inherent part, but which leave families with the care of sick children with little or no support. Relevance to clinical practice. Family centred care is said to be used widely in practice. More research is needed to ensure that is it being implemented correctly.

Consultation with children in hospital: children, parents' and nurses' perspectives.

Abstract: Aims and objectives. To explore children's, parents’ and nurses’ views on participation in care in the healthcare setting. Background. Children have a right to be consulted and involved in their care. Design. The grounded theory method was used and data were collected through in-depth interviews, questionnaires and observation. Sample consisted of 11 children, 10 parents and 12 nurses from four paediatric wards in two hospitals in England. Results. Parents felt that children should be involved in the decision-making process thereby enhancing and promoting children's self-esteem and positive self-regard, which would consequently enhance their overall welfare. Likewise, children expressed the need for consultation and information so that they could understand their illness; be involved in their care, and prepare themselves for procedures. However, children's own opinions and views were underused and they had varying experiences of being consulted about their care and treatment. Nurses appeared to hold varying and discrepant views on the involvement of children in decisions and for some nurses, the child's involvement seemed to be dependent on the child's cognitive maturity and being defined as a rational subject. Conclusion. Health professionals’ communication behaviour may reflect recognition of children's cognitive abilities rather than their competence to understand. The fact that children's nurses appeared to make decisions about involving children in decision making in the absence of a reliable framework was a significant finding and highlights a real problem in the current climate. Relevance to clinical practice. Nurses faced with workforce pressures may encounter considerable challenges to facilitating children's involvement in decisions about their care. Hence it is imperative that nurses’ examine the basis of their decisions and use more explicit criteria for determining children's involvement.

Life satisfaction among older people (65+) with reduced self-care capacity: the relationship to social, health and financial aspects.

Abstract: AIMS AND OBJECTIVES: This study aimed at investigating life satisfaction and its relation to living conditions, overall health, self-care capacity, feeling lonely, physical activities and financial ...

Spiritual care in nursing: an overview of the research to date.

Abstract: Aims. The paper gives an overview of nursing research papers published on spiritual care between 1983 and October 2005. It also provides pointers for the future direction of research in this emerging field. Background. Spiritual care of patients/clients is expected of nurses and is reflected in nursing codes of ethics, nurse education guidelines, policy documents and nursing guidance. Recent years have seen a proliferation in nursing research in this area, particularly in the UK and North America, and now in other European countries. It seemed timely, therefore, to review this published research. Method. Included in the review were 47 original published nursing research papers identified from a CINAHL search and from a collection held by the author since 1983. Papers were sorted into five categories, a template to aid reviewing was produced and a short summary and critique of each paper was written. Conclusions. Research on spirituality and health needs to move forward in a systematic and co-ordinated way. Relevance to clinical practice. Hopefully, the research summarized in this paper will be useful to clinicians and nurse educators as they strive to incorporate spiritual care within their practice. In turn patients/clients and their families should benefit from care which is more holistic and addresses their deepest concerns and needs.

Nursing competencies for spiritual care.

Abstract: Aim and objectives. The aim of this paper is to reveal the main nursing competencies for spiritual care, which emerged from data collecting from qualified nurses in Malta. Background. For nurses to deliver spiritual care, they must be competent to provide care on a physical, mental, social and spiritual level. As spiritual care may be influenced by culture, this study explored the competencies for spiritual care from the Maltese nurses’ perspective. Methods. A descriptive exploratory study investigated nurses’ competencies in the delivery of spiritual care to patients with myocardial infarction. Data were collected by means of an open-ended questionnaire on qualified nurses (n = 77) followed by an in-depth interview on a stratified random sample (n = 14) of nurses from the same respondents. Results. The four main nursing competencies identified were associated with the role of the nurse as a professional and as an individual person; delivery of spiritual care by the nursing process; nurses’ communication with patients, inter-disciplinary team and clinical/educational organizations and safeguarding ethical issues in care. Conclusion. This study demonstrated the complexity of spiritual care, which requires nurses to increase their awareness of the uniqueness of each individual patient with regard to the connection between mind, body and spirit; the assessment of the spiritual status of patients during illness and the implementation of holistic care as recommended by the Nursing Code of Ethics. Relevance to clinical practice. These findings will enable nurses to consider the importance of spiritual care, which may allow them to help empower patients find meaning and purpose during times of illness. More emphasis should be put on spiritual care in the pre- and postregistration education. Further research to translate these main competencies into specific competencies will guide spiritual care.

Relatives in end‐of‐life care – part 1: a systematic review of the literature the five last years, January 1999–February 2004

Abstract: AIM: To review systematically research conducted during the past five years focusing on the relatives' situation and needs in end-of-life care. BACKGROUND AND AIM: That relatives make a large contr ...

Clinical supervision and burnout: the influence of clinical supervision for community mental health nurses

Abstract: AIMS: The aim of this study was to establish the degree to which clinical supervision might influence levels of reported burnout in community mental health nurses in Wales, UK. METHODS: The research instruments used were the Maslach Burnout Inventory and the Manchester Clinical Supervision Scale. At the time of the survey 817 community mental health nurses were reported to work within Wales. Two hundred and sixty (32%) community mental heath nurses working in 11 NHS Trusts responded to the survey. RESULTS: One hundred and eighty-nine (73%) community mental heath nurses had experience of clinical supervision in their present posts and 105 (40%) in their previous posts. The findings from the Maslach Burnout Inventory indicated high levels of emotional exhaustion for 36%, high levels of depersonalization for 12% and low levels of personal accomplishment for 10% of the community mental heath nurses surveyed. Univariate analysis showed that those community mental heath nurses who were younger, male and who had not experienced six or more sessions of clinical supervision were more likely to report cold negative attitudes towards their clients as indicated by higher scores on the depersonalization subscale of the Maslach Burnout Inventory. One hundred and sixty-six community mental heath nurses had experienced six or more sessions of clinical supervision and had completed the Maslach Burnout Inventory. Higher scores on the Manchester Clinical Supervision Scale were also associated with lower levels of measured burnout, with significant negative correlations between the total Manchester Clinical Supervision Scale score and the emotional exhaustion subscale (r = -0.148, P = 0.050) and the depersonalization subscale (r = -0.220, P = 0.003) of the Maslach Burnout Inventory. These findings suggest that if clinical supervision is effective then community mental heath nurses are likely to report lower levels of emotional exhaustion and depersonalization. CONCLUSIONS: The findings from this study suggest that if clinical supervision is effective then community mental heath nurses report lower levels of burnout. Further research is required to determine the long-term benefits of implementing clinical supervision and to determine which other factors have an influence on levels of burnout for this group of nurses. Health service organizations have a responsibility for ensuring that all individual practitioners have access to effective clinical supervision and the Nursing and Midwifery Council could extend the registered nurses personal accountability to include - to seek clinical supervision as and when necessary.

Patients' perceptions of quality of care at an emergency department and identification of areas for quality improvement.

Abstract: Aims. This paper reports a study to identify patient's perceptions of quality of care at an emergency department and areas for quality improvement. Background. Patients are not always satisfied wit ...

Negotiation of parental roles within family‐centred care: a review of the research

Abstract: Aims and objectives. To review research published in the past 15 years about how children's nurses’ negotiate with parents in relation to family-centred care. Background. Family-centred care is a basic tenet of children's nursing and requires a process of negotiation between health professionals and the family, which results in shared decision-making about what the child's care will be and who will provide this. The literature highlights inconsistencies in the degree to which nurses are willing to negotiate with parents and allow them to participate in decisions regarding care of their child. There is need to explore further the extent to which nurses communicate and negotiate shared care with children and their parents. Conclusions. Three themes emerged from this review of the literature relating to whether role negotiation occurred in practice, parental expectations of participation in their child's care and issues relating to power and control. Parents wanted to be involved in their child's care but found that nurses’ lack of communication and limited negotiation meant that this did not always occur. Nurses appeared to have clear ideas about what nursing care parents could be involved with and did not routinely negotiate with parents in this context. Relevance to clinical practice. For family-centred care to be a reality nurses need to negotiate and communicate with children and their families effectively. Parents need to be able to negotiate with health staff what this participation will involve and to negotiate new roles for themselves in sharing care of their sick child. Parents should be involved in the decision-making process. However, research suggests that a lack of effective communication, professional expectations and issues of power and control often inhibit open and mutual negotiation between families and nurses.

The gap between saying and doing in postoperative pain management

Abstract: Aim. To understand how nurses contribute to postoperative pain management in a surgical setting and to identify barriers to achieving optimal postoperative pain alleviation. Background. Postoperative pain is inadequately managed. Nurses play an important role in assessment, treatment and evaluation of postoperative pain in surgical wards, but combined observational and interview studies about how they approach these activities have rarely been undertaken. Design and methods. The study design is descriptive. Observations and in-depth interviews were conducted with nine nurses on three surgical wards at two hospitals. Each nurse was observed during five shifts, day and night, and interviewed after the final observation. The collection and analysis of data followed principles of qualitative research. Findings. One main theme emerged about the nurses’ approach to postoperative pain management: a discrepancy between what the nurses said they did and what they actually did. Conclusion. The study revealed a gap between what nurses said and did in postoperative pain management, and this gap was smaller when the nurses took an active approach. An active approach towards patients about postoperative pain seemed to enhance pain alleviation. Relevance to clinical practice. Nursing education and practice both need to promote knowledge of pain and pain management, as well as empathy and empathic communication in relation to pain. They need to collaborate in guiding nurses to act in accord with theoretical knowledge and so enhance competence in nursing actions related to postoperative pain management.

Spiritual care: implications for nurses' professional responsibility

Abstract: Aim. This paper aimed to gain insight into the spiritual aspects of nursing care within the context of health care in the Netherlands and to provide recommendations for the development of care in this area and the promotion of the professional expertise of nurses. Background. International nursing literature suggests that caregivers are expected to pay attention to spiritual aspects of patient care. In Dutch nursing literature, the spiritual dimension is increasingly becoming a focus of attention. Despite this, there is a lack of empirical data from professional practice in the Netherlands. Method. Data were collected by means of focus group interviews. The sample was made up of the specialist fields of cardiology, oncology and neurology and divided into groups of patients, nurses and hospital chaplains. The interviews took place between May and December 2004. Data were qualitatively analysed using the computer programme Kwalitan. Results. Different spiritual themes emerged from the interviews. There were different expectations of the nurse's role with regard to spiritual aspects. The main themes derived from this research can be recognized as aspects of nursing competencies that are reported in the literature. However, the attention to spiritual aspects in the nursing process is not clear cut. It seems to be highly dependent on personal expression and personal commitment. Conclusions. The study raises questions about the nurse's professional role in spiritual care. The study shows that different factors (personal, cultural and educational) play a role in the fact that spiritual care is not structurally embedded in nursing care. Further research on the impact of that variable is recommended. Relevance to clinical practice. Nursing care implies care for the spiritual needs of patients. To provide this care, nurses need to be knowledgeable regarding the content of spiritual care and the personal, professional, cultural and political factors influencing it. They also need to be able to participate in policy and decision-making discussions of spiritual care in clinical nursing practice.

Putting a puzzle together: making spirituality meaningful for nursing using an evolving theoretical framework

Abstract: Aims and objectives. This paper addresses the need for a practical understanding of spirituality in nursing by means of a generic definition of spirituality, an emerging theoretical framework, and some general practice guidelines. Background. Spirituality is being addressed more frequently in nursing literature, but there is still lacking a professional understanding of the phenomenon that is useful as a basis for practice and research. Conclusion. The history of spirituality in nursing is recognized, and then its role in peoples’ and patients’ lives, health and healing is examined. Spirituality is clarified through its various definitions in the literature, and identification of component concepts: connectedness, meaning, transcendence, values and beliefs, energy and emotion. A working definition and the concepts are brought together into a framework. Guidelines for how to incorporate spirituality into practice are presented. Relevance to clinical practice. With this understanding of spirituality by means of a clarifying definition, a theoretical framework and six general guidelines, nurses may be better equipped to incorporate spirituality into their practice. This will fulfil professional and accrediting mandates and, more importantly, provide more holistic, ethical and balanced care for patients.

Patient participation in clinical decision-making in nursing: A comparative study of nurses' and patients' perceptions.

Abstract: AIM AND OBJECTIVES: The aim of this study was to compare the degree of concordance between patients and Registered Nurses' perceptions of the patients' preferences for participation in clinical dec ...

Using clinical skills laboratories to promote theory–practice integration during first practice placement: an Irish perspective

Abstract: Aims and objectives. This aim of this study was designed to investigate how a select cohort of nursing students experienced their first practice placement in a large Irish teaching hospital. The objectives of this study were to investigate whom do students learn from, what skills they learnt during their first practice placement and to identify if the use of clinical skills laboratories before their first practice placement helped students relate theory to practice during their first practice placement. The aim of this paper is to discuss if the sessions taught in the clinical skills laboratory prior to the first placement helped students integrate theory to practice during their first practice placement. Background. The debate regarding theory–practice integration has been ongoing in nursing for decades. Many studies across Europe have consistently demonstrated that the use of clinical skills laboratories have helped students integrate theory to practice during practice placements. Others have identified the difficulty students have relating theory to practice. However, as there appears to be a gap in current literature, from an Irish perspective, it is essential to highlight if Irish students can integrate theory to practice during their first practice placement. Design. A qualitative method incorporating the Heideggarian approach of phenomenology was utilized. Methods. A purposeful sampling technique was used to select six participants from all first year students. Interviews were conducted using a semi-structured interview schedule. Data were analysed using the Giorgi method of analysing phenomenological data. Results. The participants identified that sessions taught in the clinical skills laboratory before the first practice placement, which they identified as ‘basic nursing skills such as taking and recording vital signs and hygiene needs of patients were useful and helped them to integrate theory to practice during their first practice placement. These results are relevant to this paper as they identify the use of teaching sessions in the clinical skills laboratories, enabling students to link theory to practice during practice placements. Conclusions. Nursing students must be adequately prepared to carry out clinical skills competently and efficiently. Educators and practitioners must display the knowledge and skills required to promote theory–practice integration, to enhance nursing students education, which in turn will optimize high standards of patient care. Relevance to clinical practice. Clinical skills laboratories are essential to help students develop the collaborative skills required for a profession like nursing. It is essential that students are adequately prepared to carry out clinical skills during their first practice placement, and have the ability to link theory to practice.

Caring for patients of Islamic denomination: critical care nurses’ experiences in Saudi Arabia

Abstract: Aim. To describe the critical care nurses’ experiences in caring for patients of Muslim denomination in Saudi Arabia. Background. Caring is known to be the essence of nursing but many health-care settings have become more culturally diverse. Caring has been examined mainly in the context of Western cultures. Muslims form one of the largest ethnic minority communities in Britain but to date, empirical studies relating to caring from an Islamic perspective is not well documented. Research conducted within the home of Islam would provide essential truths about the reality of caring for Muslim patients. Design. Phenomenological descriptive. Methods. Six critical care nurses were interviewed from a hospital in Saudi Arabia. The narratives were analysed using Colaizzi's framework. Results. The meaning of the nurses’ experiences emerged as three themes: family and kinship ties, cultural and religious influences and nurse–patient relationship. The results indicated the importance of the role of the family and religion in providing care. In the process of caring, the participants felt stressed and frustrated and they all experienced emotional labour. Communicating with the patients and the families was a constant battle and this acted as a further stressor in meeting the needs of their patients. Conclusions. The concept of the family and the importance and meaning of religion and culture were central in the provision of caring. The beliefs and practices of patients who follow Islam, as perceived by expatriate nurses, may have an effect on the patient's health care in ways that are not apparent to many health-care professionals and policy makers internationally. Relevance to clinical practice. Readers should be prompted to reflect on their clinical practice and to understand the impact of religious and cultural differences in their encounters with patients of Islam denomination. Policy and all actions, decisions and judgments should be culturally derived.

Patients' perceptions of the concept of the quality of care in the psychiatric setting: a phenomenographic study.

Abstract: Aim. The aim was to describe how patients perceived the concept of quality of care in psychiatric care. Background. It is important to include patients’ experiences in defining quality of care and in the development of instruments measuring quality of psychiatric care, as patients have unique information. But only a limited number of studies have directly involved patients. Design. It was a qualitative interview study with 20 adult in and outpatients from psychiatric care. Method. A phenomenographic approach was used for the analysis of the interviews. Results. The results showed that quality of care was perceived as a positive concept, namely as ‘good’ quality of care. The normative component was striking. Five descriptive categories emerged: The patient's dignity is respected; The patient's sense of security with regard to care; The patient's participation in the care; The patient's recovery; and The patient's care environment. Two conceptions emerged that had not emerged explicitly in earlier studies of quality of care: Being helped to reduce the shame and Being looked upon as like anyone else. Conclusions. The findings emphasize the importance of the interpersonal relationship between patients and staff. There is a need for further exploration of central aspects of quality in psychiatric care. Relevance to clinical practice. It is important that the knowledge about how patients perceived the quality of care in psychiatric care is included in the planning and evaluation of care. The guidelines should designate quality of care from the patient perspective as the goal of interventions.

Cultural attribution of mental health suffering in Chinese societies: the views of Chinese patients with mental illness and their caregivers.

Abstract: Aims and objectives. This study examined the cultural attribution of distress in the Chinese, the special role of the family in distress and the specific emotional reactions within distress dictated by culture. Methods. This phenomenological study illustrated the narrative representation of the experiences of suffering by the Chinese patients with mental illness. Twenty-eight Chinese–Australian patients and their caregivers were interviewed together in their homes. They were invited to talk about the stories of the patients’ experiences of suffering from mental illness. The interviews were recorded and transcribed to be further analysed according to the principles of narrative analysis. Results. The results of case narration indicated that (1) because of the influence of Confucian ideals, interpersonal harmony was the key element of maintaining the Chinese patients’ mental health, (2) Chinese patients’ failure to fulfil cultural expectations of appropriate behaviours as family members contributed to disturbance of interpersonal relationships and (3) Chinese patients’ failure to fulfil their familial obligations contributes to their diminished self-worth and increased sense of guilt and shame. Conclusion. The findings of the present study suggest that Chinese people's well-being is significantly determined by a harmonious relationship with others in the social and cultural context. Psychotherapy emphasizing an individual's growth and autonomy may ignore the importance of maintaining interpersonal harmony in Chinese culture. Relevance to clinical practice. The results of this study contribute to the essential knowledge about culturally sensitive nursing practices. An understanding of patient suffering that is shaped by traditional cultural values helps nurses communicate empathy in a culturally sensitive manner to facilitate the therapeutic relationship and clinical outcomes.

An exploration of factors which constrain nurses from research participation.

Abstract: An exploration of factors which constrain nurses from research participation Aim. The aim of this study was to explore practising nurses' views on factors which they perceived constrained them from research participation. Background. Many studies reviewed in the literature have taken a quantitative approach and have concentrated on why nurses do not use research findings in their practice. Of these studies a few included constraints to research use. However, with the development of national research strategies for nursing and the drive for the profession to develop its own research base, there is a need to understand what constrains clinically practising nurses from taking up opportunities to either develop their own research or participate in research studies. Design and method. Data were collected during June and July 2004 by means of two focus groups (n = 7) followed by single interviews (n = 7). Analysis was undertaken using a thematic approach aided by N-Vivo 2.0. Results and discussion. In this study, findings revealed six key themes perceived by nurses to constrain from research participation: 'Level of support nurses require to be research active', 'Nurses' attitudes to undertaking/participating in research', 'The extent of nurses knowledge about research', 'Skills to undertake research' and 'Level of educational preparation relating to undertaking/participating in research'. Conclusions. In this study, nurses were generally receptive to participating in research. However, they felt constrained because of lack of time, lack of peer support and limited knowledge and skills of the research process. Relevance to clinical practice. What is already known on this topic: studies into nurses and research have predominantly taken a quantitative approach; many studies have aimed to elicit the extent of nurses' use of research findings. What this study adds: this study adds a qualitative perspective; although findings are not generalizable, they support quantitative study findings into this subject; identifies constraints that require to be overcome for practising nurses to actively get involved in research studies.

Nurses as providers of support for mothers of premature infants

Abstract: Aim. The study aims to explore the supportive behaviour of nurses as experienced by mothers of premature infants in Hong Kong. Background. The sudden, unexpected delivery of a premature infant is an extreme shock to parents. Studies have confirmed the importance of nursing support to the relief of stress of parents. Design. A descriptive study design. Methods. A convenience sampling of 37 mothers in a neonatal Intensive Care Unit were recruited from a regional hospital to complete the ‘Nurses Parent Support Tool’ (NPST) which consists of four aspects: communication information support, emotional support, parental esteem support and quality care-giving support. Six mothers were interviewed after the completion of the tool to give examples of supportive and non-supportive behaviour. Results. The results showed that all of the mothers rated all nursing support items as important. However, there was a significant mean difference between perceived and received nursing support. These findings demonstrated that parents desired more nursing support than they received, particularly in the area of supportive communication and the giving of information. Comparatively, emotional support was rated less important as well as having been less often received than the other three domains of support. Interviews with six mothers further gave examples and described the types, attributes and the phases of support in the Chinese setting. Conclusion. The findings indicate that Chinese parents are desirous of more nursing support than they received. Relevance to clinical practice. Nurses should be aware of the importance of tailoring nursing support to meet the needs of parents of premature infants.

The qualitative experience of Chinese parents with children diagnosed of cancer

Abstract: Aim. The present study aimed to describe the coping experiences of Chinese parents with children diagnosed as having cancer during the treatment stage. Background. Cancer is the second major cause of death among children in Hong Kong, it claims the lives of 60–70 children per year. Childhood cancer has tremendous impact on the family, especially the parents. It is, therefore, important to understand parents’ psychological functioning and coping experience. Methods. A phenomenological approach was used. Data were collected by qualitative interviews and analysed following Colaizzi's phenomenological methodology. A purposive sample of nine parents whose children were diagnosed of having childhood cancer was recruited from a regional hospital in Hong Kong. Results. Four themes emerged describing parents’ coping experiences: shock and denial, establishing the meaning or the situation, confronting the reality and establishing a new perspective. The initial reactions of the parents to the diagnosis were shock, denial and worry. However, they quickly accepted the reality and regarded their child's illness as their ‘fate’ that they had to accept. They were committed to the care of the sick child and seek informational and emotional support to cope with the situation. All of them were able to identify positive aspects from the illness experience and establish hope for the future. Chinese cultural beliefs might help the parents cope positively and avoid negative emotions. Conclusion. This study found some commonalities of coping experience in both Western and Chinese culture. It adds knowledge to the coping experience of Chinese parents at the treatment phase of their children's illness and highlighted the need for emotional and information support for parents. Relevance to clinical practice. Education programme and mutual support group would be helpful to parents. Nurses have to learn how different cultural groups and subcultural groups in the society cope to provide competent cultural care.

Nurse education – the role of the nurse teacher

Abstract: Aim To explore and analyse the role of the nurse teacher. Background This paper examines the issue of clinical credibility among nurse teachers which has been ongoing for over a decade. The move of nurse education from colleges of nursing to the Higher Education Institutes was seen in 1992. Since then, nurse teachers have been faced with the need to juggle the roles of teaching, administration, research and clinical support for students. Nursing students within these Higher Education Institutes require more than the traditional theoretical classroom teaching. Nurse teachers have a role beyond this in encouraging students to link theory with practice, and practice with theory. Therein lies a challenge for nurse teachers to ensure they remain credible within the clinical setting and continue to provide education and support, which is firmly grounded in both practice and theory. Method The authors have critically reviewed the evidence related to the role of the nurse teacher in an attempt to identify key concepts and ideas, assumptions, supporting examples and the implications for their role. Conclusion The role of the nurse teacher, it would appear, is a dynamic one that needs to engage actively the needs of the student. Nurses therefore need to be dynamic in their approach in order to respond to both local and global demands and ensure that students become competent, professional, knowledgeable and caring in their approach. Relevance to clinical practice This paper demonstrates the complex and ever changing role of the nurse teacher. This paper attempts to help nurse teachers understand the complex nature of their role.

The principal components model: a model for advancing spirituality and spiritual care within nursing and health care practice.

Abstract: Aim. The aim of this study was to generate a deeper understanding of the factors and forces that may inhibit or advance the concepts of spirituality and spiritual care within both nursing and health care. Background. This manuscript presents a model that emerged from a qualitative study using grounded theory. Implementation and use of this model may assist all health care practitioners and organizations to advance the concepts of spirituality and spiritual care within their own sphere of practice. The model has been termed the principal components model because participants identified six components as being crucial to the advancement of spiritual health care. Design. Grounded theory was used meaning that there was concurrent data collection and analysis. Theoretical sampling was used to develop the emerging theory. These processes, along with data analysis, open, axial and theoretical coding led to the identification of a core category and the construction of the principal components model. Methods. Fifty-three participants (24 men and 29 women) were recruited and all consented to be interviewed. The sample included nurses (n = 24), chaplains (n = 7), a social worker (n = 1), an occupational therapist (n = 1), physiotherapists (n = 2), patients (n = 14) and the public (n = 4). The investigation was conducted in three phases to substantiate the emerging theory and the development of the model. Results. The principal components model contained six components: individuality, inclusivity, integrated, inter/intra-disciplinary, innate and institution. Conclusion. A great deal has been written on the concepts of spirituality and spiritual care. However, rhetoric alone will not remove some of the intrinsic and extrinsic barriers that are inhibiting the advancement of the spiritual dimension in terms of theory and practice. Relevance to clinical practice. An awareness of and adherence to the principal components model may assist nurses and health care professionals to engage with and overcome some of the structural, organizational, political and social variables that are impacting upon spiritual care.

Patterns and frequency of anxiety in women undergoing gynaecological surgery.

Abstract: Aims. Within a gynaecological surgical setting to identify the patterns and frequency of anxiety pre- and postoperatively; to identify any correlation between raised anxiety levels and postoperative pain; to identify events, from the patients’ perspective, that may increase or decrease anxiety in the pre- and postoperative periods. Background. It is well documented that surgery is associated with increased anxiety, which has an adverse impact on patient outcomes. Few studies have been conducted to obtain the patient's perspective on the experience of anxiety and the events and situations that aggravate and ameliorate it. Method. The study used a mixed method approach. The sample consisted of women undergoing planned gynaecological surgery. Anxiety was assessed using the State Trait Anxiety Inventory. Trait anxiety was measured at the time of recruitment. State anxiety was then assessed at six time points during the pre- and postoperative periods. Postoperative pain was also measured using a 10 cm visual analogue scale. Taped semi-structured telephone interviews were conducted approximately a week after discharge. Results. State anxiety rose steadily from the night before surgery to the point of leaving the ward to go to theatre. Anxiety then increased sharply prior to the anaesthetic decreasing sharply afterwards. Patients with higher levels of trait anxiety were more likely to experience higher levels of anxiety throughout their admission. Elevated levels of pre- and postoperative anxiety were associated with increased levels of postoperative pain. Telephone interviews revealed a range of events/situations that patients recalled distressing them and many were related to inadequate information. Conclusion. This study found higher rates of anxiety than previously reported and anxiety levels appeared raised before admission to hospital. This has important clinical and research implications. Relevance to clinical practice. Patients with high levels of anxiety may be identified preoperatively and interventions designed to reduce anxiety could be targeted to this vulnerable group. Patient experiences can inform the delivery of services to meet their health needs better.

'The intruder': spouses' narratives about life with a chronically ill partner.

Abstract: 'The intruder': spouses' narratives about life with a chronically ill partner Aim. The aim of this study was to illuminate the meaning of middle-aged spouse's experiences of living with a chronically ill partner. A purposive sample of four female spouses was selected for interviews using a narrative approach. Background. When someone is diagnosed with a chronic illness, it is easy to understand that a considerable number of devastating consequences follow, both for the afflicted as well as for the family. Families often feel neglected and that their problems and needs are underestimated, if they do not personally draw attention to this fact. Methods. A phenomenological hermeneutic method, inspired by the philosophy of Ricoeur, was used when interpreting the interview text. Results. The experiences of spouses living with a chronically ill partner often brought a feeling of detachment from their partner's lives. The women experienced changes in their relationships because of their partners' disabilities; they had emotions of loneliness, despite living together as a couple. Through their actions, the women sought reassurance and support in order to maintain a meaningful partnership with their spouses and this is expressed in three themes: feelings of limitation, the struggle of everyday life and a striving for normalization. Conclusions. Middle-aged women living with a chronically sick partner are still of an active disposition and regard themselves as still being in mid-life. They wish to be loved as a wife and not as a care provider. Relevance to clinical practice.The findings from this study can help increase the knowledge and understanding of the problems and concerns encountered by middle-aged spouses living with chronically ill partners and can be useful in the education and supervision of nurses and in relationship with relatives.

Structured reminiscence: an intervention to decrease depression and increase self-transcendence in older women.

Abstract: Aims/objectives. The purpose of this study was to assess the effect of group reminiscing on depression and self-transcendence of older women residing in an assisted living facility in southeast Texas. There were two major objectives for this study. One objective was to determine if depression decreased in older women after structured reminiscence group sessions held twice weekly for a six-week period. A second objective was to determine if self-transcendence increased after structured reminiscence group sessions held twice weekly for a six-week period. Background. Reminiscence has been studied to determine its impact on a variety of conditions including but not limited to depression, self-esteem, fatigue, isolation, socialization, well-being, language acquisition and cognitive functioning. This review of research specifically focused on reminiscence, depression, self-transcendence and older people. Design/methods. Two groups were assessed at baseline, three and six weeks to answer the research questions. A sample of 24 women between the ages of 72 and 96 years were randomly assigned to either a reminiscence (experimental) group or the activity (control) group of the facility. Pearson's r was used to determine the magnitude of the relationship between subjects’ responses on the Geriatric Depression Scale and the Self-Transcendence Scale. A mixed design analysis of variance (anova) was used to determine if there was a difference between the experimental and control groups on scores of the Geriatric Depression Scale and the Self-Transcendence Scale at baseline, three and six weeks. Conclusions. Data revealed a non-significant decrease in depression and increase in self-transcendence in the reminiscence group at the completion of six weeks, indicating a trend toward a positive result with reminiscence group sessions. The study also revealed an inverse relationship between depression and self-transcendence. These findings underscore the importance of screening older people for depression. Relevance to clinical practice. One of the primary modalities used for the treatment of depression in elderly women is medication. Antidepressant medications lead to harmful side effects without alleviating the underlying depression. For these reasons, there is a need to research alternative therapies for treatment of depression in the older female. Reminiscence offers a possible intervention for treatment of depression in older women.

Mealtimes in hospital – who does what?

Abstract: Aim. This paper describes the findings of a descriptive study about what nurses do at mealtimes in relation to monitoring/assisting the eating practices of older patients in an acute care facility.Background. The prevalence of under nutrition is known to be high in hospitalized older patients and insufficient dietary intake is regarded as a major cause. However, most of the research tends to concentrate on the nursing home setting. Little is known about the situation in acute care facilities.Methods. Two medical wards participated in the study. Ward 1 had introduced a change of nurses' meal break time and ward 2 continued with normal practice. Convenience sampling was used. Fifty nurses and 48 patients were observed at different mealtimes during two weeks. Four nurses and four patients who were observed were also interviewed. Data were analysed using descriptive statistics and thematic analysis.Results. Kitchen staff delivered all meals and collected the majority of the meal trays. Older patients did not receive enough assistance during mealtimes. Interruptions happened frequently and social interaction was neglected. About one-third of patients observed left more than two-third of their meals.Conclusion. Nutrition issues appeared to receive less priority in the ward than other nursing care activities and nurses' assistance was generally insufficient and not provided in a timely manner.Relevance to clinical practice. Findings highlight the deficiency in practice that should suggest to nurses that they examine their practice and put into place strategies to ensure older patients are properly/adequately hydrated and receive sufficient nutrient intake.

Health-related quality of life among haemodialysis patients--relationship with clinical indicators, morbidity and mortality.

Abstract: Aim. To verify the association between quality of life and morbidity, mortality and clinical indicators in haemodialysis patients. Background. While a number of therapies have been reported to increase quality of life in end-stage renal disease, patients report that they remain substantially burdened by limited physical functioning and by dialysis-related symptoms. Indeed, quality of life may be the most critical outcome for those undergoing haemodialysis. Furthermore, quality of life has been associated with clinical indicators, morbidity and survival in haemodialysis patients. Design. Descriptive cohort study of patients undergoing haemodialysis at the Nephrology Hemodialysis Unit of the Hospital de Clinicas in Porto Alegre, Brazil. Methods. Forty haemodialysis patients were followed for 12 months and evaluated for demographics, time on dialysis, diabetes mellitus, clinical indicators (dose of dialysis – Kt/V, haematocrit and serum albumin) and comorbidities. The comorbidities were evaluated with the end-stage renal disease severity index and health-related quality of life with The Medical Outcomes Study 36 (SF-36). Results. Men present higher health-related quality of life scores in the energy and fatigue component (P = 0·04). Patients treated for over one year at the beginning of follow up and patients with less schooling had better results in General Health Perception (P < 0·05). The health-related quality of life evaluation of patients who later died showed that they already had a worse perception of physical functioning as compared to the survivors (P = 0·05). Patients with diagnosed diabetes perceived their physical functioning more negatively compared with those with other etiologies of end-stage renal disease (P = 0·045). We found a correlation between physical functioning and serum albumin (r = 0·341, P < 0·05) and between physical functioning and haematocrit (r = 0·317, P < 0·05). The end-stage renal disease severity index was more strongly related to physical functioning (r = −0·538, P < 0·001). Comparing the patients’ results to the indicators above and below the established targets, we observed a trend to worse health-related quality of life in patients with Kt/V above target. However, in the case of albumin, patients with results above target tended to have better results. Conclusion. A close relationship was observed between quality of life and morbidity and mortality. Among the clinical indicators, albumin and haematocrit have the greatest influence on quality of life. Relevance to clinical practice. Haemodialysis patients experience various problems that may adversely influence their quality of life. Special care must be given to those who have diabetes mellitus, high morbidity scores, low serum albumin and low haematocrits.

Caring in nursing: investigating the meaning of caring from the perspective of cancer patients in Beijing, China.

Abstract: Aims. The aims of the study were to develop an understanding of caring in nursing from the perspective of cancer patients and attempt to identify the concept of caring in the Chinese cultural context. Background. Caring as a concept remains elusive, the acceptable definitions of the term care have not been reached. The expressions, processes and patterns of caring vary among cultures, but there is a lack of Chinese culture-based study about caring in nursing. Methods. A qualitative research design was used and 20 cancer patients were interviewed using a semi-structured interview guide. A qualitative content analysis was used to identify themes in the data. Results. Three themes emerged from the data, which suggested that caring is delivering care in an holistic way: nurses’ caring attitudes and their professional responsibility for providing emotional support, nurses’ professional knowledge and their professional responsibility for providing informational support and nurses’ professional skills and their professional responsibility for providing practical support. The caring behaviour of nurses as perceived by cancer patients involved the provision of emotional, informational, and practical support and help based on patients’ needs. A model of caring in nursing was formulated. Conclusions. Caring in nursing as perceived by cancer patients involves nurses having qualified professional knowledge, attitudes and skills in oncology and providing the informational, emotional and practical supports and help required by cancer patients. Relevance to clinical practice. Caring is manifested in nursing actions through nurse–patient communication process. Patients have their inner expectation for nurses’ caring behaviour and attitudes and nurses’ performance of caring or uncaring behaviour has a direct influence on the feelings of patients. It is necessary for all nurses to continue improving their oncology professional knowledge, attitudes and skills as well as their abilities of offering informational, emotional and practical support and help for their cancer patients.

The impact of empirical studies of spirituality and culture on nurse education.

Abstract: Journal of Clinical Nursing 15, 840–851The impact of empirical studies of spirituality and culture on nurse educationAims and objectives. The aim of this paper is to share reflectively how my empiricalstudies on spirituality and culture have had an impact upon nurse education.Background. Spirituality and cultural dimensions of care are considered to beintegral to holistic care. The healing potentials of spiritual and cultural care are welldocumented. The commitment to the research programme came due to the concernwithin early literature on nursing that the provision of spiritual care for patients isinadequate.Methods. The research programme used action research comprising largely qualit-ative approaches. As the holistic and multiperspective nature of spirituality andculture requires a multidisciplinary approach and flexibility of methodology, variousresearch techniques were used.Results. The findings from the research programme led to the development of the-ories, models and conceptual literature on spiritual and cultural care. In particular,two models evolved from the studies: the ASSET for spiritual cares education andtraining and the ACCESS for transcultural care practice. The critical incident studiesprovide insights into nurses’ roles in spiritual care interventions. The phenomeno-logical study highlights that chronically ill patients use spiritual strategies in copingwith their illness.Conclusion. Overall, the paper offers a body of evidence that has an impact uponcurriculum development in nurse education and nursing practice.Relevance to clinical practice. The ASSET model offers a framework for spiritualcare education. The ACCESS model offers a framework for transcultural carepractice. The critical incident studies map out nurses’ roles in spiritual and culturalcare with scope for development of care intervention models for the future. Thecoping mechanisms study highlights how patients use spiritual coping strategiessuch as prayer and other resources to cope with their chronic illnesses.Key words: culture, models of intervention, nurses, nursing, spiritual andtranscultural care, spirituality

The culture of a trauma team in relation to human factors.

Abstract: Aim. The aim of this ethnographic study was to explore the culture of a trauma team in relation to human factors. Background. Traumatic injury is the leading cause of death in the first four decades of life in the western world. Evidence suggests that the initial assessment and resuscitation of trauma victims is most successfully carried out by an organized trauma team. Most trauma teams use Advanced Trauma Life Support principles which focus on rapid assessment and management of the patient's injuries. Similarly, most trauma education focuses on Advanced Trauma Life Support principles, concentrating firmly on the patient's physical status. Nevertheless, contemporary literature about emergency teams suggests that human factors, such as communication and interprofessional relationships, can affect the team's performance regardless of how clinically skilled the team members are. Method. Focused ethnography was used to explore the culture of a trauma team in one teaching hospital. Six periods of observation were undertaken followed by 11 semi-structured interviews with purposively chosen key personnel. Data from transcripts of the observation field notes and interviews were analysed using open coding, followed by formation of categories resulting in the emergence of six central categories. Results. Findings suggest that leadership, role competence, conflict, communication, the environment and the status of the patient all influence the culture of the trauma team. Interpretation of these categories suggests that trauma team education should include human factor considerations such as leadership skills, team management, interprofessional teamwork, conflict resolution and communication strategies. Relevance for clinical practice. The findings suggest that support systems for role development of junior team leaders should be formalized. The proven airline industry techniques of Crew Resource Management, focusing on teamwork and effective communication, could be implemented into continuing professional development for trauma teams to engender collaboration and interprofessional practice.