Showing papers in "Journal of Research in Nursing in 1997"
TL;DR: The system offers a set of guiding principles, based on the fact that, because knowledge and practice change continually when caring for patients, clinical records should be flexible and dynamic to accommodate these changes.
Abstract: Integrated care pathways (ICPs) offer a system of multidisciplinary care planning based around the principle of clinical audit and on the knowledge and practice of local clinical staff. The system offers a set of guiding principles, based on the fact that, because knowledge and practice change continually when caring for patients, clinical records should be flexible and dynamic to accommodate these changes. Benefits to be gained from implementing ICPs include improvements in communication between all disciplines involved, as well as between patients and carers. Optimal levels of free text are ensured through the pre-printed record having an outcomes-based focus and through incorporating the idea of exception-based recording. Issues to be considered include individuality and confidentiality. Benefits to be gained include increased patient satisfaction, a reduction in documentation and inappropriate lengths of stay.
453 citations
TL;DR: In this article, the authors used the initial stages of a study investigating the effects of the National Health Service and Community Care Act1 on the role of the district nurse and discussed the disadvantages of undertaking a pre-study literature review.
Abstract: Unlike most approaches to research, grounded theory requires that literature is not reviewed before commencing a research study because to do so could lead the researcher into making misconceived assumptions about what issues warrant further investigation. Using the initial stages of a study investigating the effects of the National Health Service and Community Care Act1 on the role of the district nurse, this paper discusses the disadvantages of undertaking a pre-study literature review. There is, however, a dearth of information outlining how literature can be used in grounded theory studies. Potential themes from the study are drawn on to illustrate how literature can be used in a grounded theory study to help clarify a research problem.
49 citations
TL;DR: A national initiative to establish a co-ordinated and systematic method for identifying priorities for research and development is described, jointly set up by the Royal College of Nursing and the Centre for Policy in Nursing Research.
Abstract: This paper describes a national initiative to establish a co-ordinated and systematic method for identifying priorities for research and development, jointly set up by the Royal College of Nursing and the Centre for Policy in Nursing Research. It uses an explicit policy-making model described by Lomas1 to outline the stages of the project. This model is also used to consider how nursing is influencing the current national clinical effectiveness and research and development agendas. Consideration is given as to whether the priority- setting exercise could make a difference to this wider policy agenda.
39 citations
TL;DR: In this article, the authors examined the relationship between self-esteem and stress, coping and burnout in mental health nurses (n=568) and found that selfesteem is one of the most important moderating variables in...
Abstract: This paper examines the relationship between self-esteem and stress, coping and burnout in mental health nurses (n=568). Self-esteem is said to be one of the most important moderating variables in ...
32 citations
TL;DR: A cautious and pragmatic approach to the use of action research is advocated which is based on rigorous, systematic and visible methods of data collection, analysis and verification of findings.
Abstract: This paper begins by defining what is meant by action research and locates it as a form of a new paradigm of research. Next it describes some present-day concerns about its use in health-care pract...
29 citations
TL;DR: The principles that guided the methodological choice of a multiple case study design to investigate the phenomenon of advanced nursing practice are presented and the key characteristics of designing and conducting multiple case studies are discussed and explained in the context of an on-going study.
Abstract: Deciding upon the most appropriate methodological approach to adopt when designing a research study is an important consideration for a researcher. When reviewing published research it may appear t...
29 citations
TL;DR: A contemporary national census of community mental health nurses is used as a case example to illustrate the notions, prevention and cure of non-response to postal questionnaires.
Abstract: A contemporary national census of community mental health nurses is used as a case example to illustrate the notions, prevention and cure of non-response to postal questionnaires. An argument for large-scale survey methodology is made and briefly explored in relation to other methodological approaches, which also have both their utility and limitations acknowledged.
25 citations
TL;DR: This paper provides an overview of the study and findings from Phases 1-3, and it was important for clinical leaders to be clinically credible, to have authority and to be free from day-to-day care provision and management.
Abstract: The aims of this study, which is still in progress, are to assess the value that nursing development units add to nursing and health care and to describe the essence of an NDU. The areas investigated cover: resources and costs, research and audit activities, networking activities, staff morale, staff development and supervision, and clinical leadership. The research took a staged approach with four phases: consultation, profiling the NDUs, comparing NDUs with units without NDU status and case studies of five high-performing NDUs. This paper provides an overview of the study and findings from Phases 1-3. It was important for clinical leaders to be clinically credible, to have authority and to be free from day-to-day care provision and management. Quantitative differences between NDUs and comparison units emerged for research and dissemination activity (NDUs were more active), and sickness absence (more long-term sickness in NDUs) but not for audit and staff development activity, nor for the financial conte...
24 citations
TL;DR: This paper considers two 'mapping' exercises designed to survey research activity within nursing, midwifery and health visiting as a means of ascertaining current strengths and weaknesses in the research capacity.
Abstract: This paper considers two 'mapping' exercises designed to survey research activity within nursing, midwifery and health visiting as a means of ascertaining current strengths and weaknesses in the research capacity. Interviews with key opinion leaders and stakeholders of research have been and are being conducted. Two vignettes are included here for the range of views they express about research in terms of its strengths, weaknesses and opportunities for building capacity for research. One of the themes to emerge is the dominance of medicine as a reference point for analysis and the extent to which the problems of, and prospects for, nursing are shared with other groups. But an argument that follows from this is that fixing the 'gaze' upon medicine distracts researchers of nursing from looking to other disciplines for support and opportunities for coalition building. Prospects for research in nursing may have more in common with other groups who perceive themselves as being perched on the periphery of the d...
22 citations
TL;DR: This paper seeks to highlight some aspects of the debate which surrounds the subject of the participation and effectiveness of nurses, midwives and health visitors in research and development of health care, to consider organizational and inter-professional issues.
Abstract: This paper seeks to highlight some aspects of the debate which surrounds the subject of the participation and effectiveness of nurses, midwives and health visitors in research and development of health care. It aims to widen the debate from the topic of research and its implementation, to consider organizational and inter-professional issues. Assumptions about the engagement of the profession are discussed, together with reflection on the nature of professional involvement. The purpose is to stimulate debate and to generate questions. Members of the profession are invited to respond and become engaged in the dialogue from which to broaden understanding of the subject. The product of debate will be used to inform a project being undertaken for the NHS Executive Nursing Directorate. The outcome of the project will be to determine the nature of a strategic framework to enable nurses to become increasingly proactive in directing the future shape of health-care services.
22 citations
TL;DR: In this article, the authors discuss how using self-awareness as a researcher during data collection in an assisted-conception unit led them to reconsider an assumption about the methodology underpinning feminist research approaches and questioned the aims of women-centred research in a field in which men are participants as doctor.
Abstract: This paper comments on feminist research and in particular the use of reflexivity in feminist ethnography. Reflexivity in ethnography is the use of self as an instrument of the data collection and the researcher's own awareness of reactions to the research data.Ethnography requires that the researchers immerse themselves in the field and act reflexively while collecting data. I will discuss how using myself reflexively as a researcher during data collection in an assisted-conception unit led me to reconsider an assumption about the methodology underpinning feminist research approaches. It has been argued that feminist research approaches are women-centred and that debates on reproductive technologies are based on the premise that males control assisted conception.My experience of undertaking a feminist ethnography has challenged these two assumptions. Reflection during and after the data collection has led me to question the aims of women-centred research in a field in which men are participants as doctor...
TL;DR: It is shown that, although there is still a way to go, nursing research has, in recent years, produced useful information, and that this refutes the idea that it is completely undeveloped.
Abstract: There have been many complaints in recent years that nursing research has not developed as fully as it should have, together with a suggested explanation that this is largely due to a lack of success in obtaining funding This lack of success has been attributed to a domination of funding bodies by doctors, who, it is claimed, do not understand or value nursing research We have examined such claims in two ways First, a brief historical overview shows that, although there is still a way to go, nursing research has, in recent years, produced useful information, and that this refutes the idea that it is completely undeveloped Second, a report on a case study on the progress of 217 grant applications to a regional R&D office in the UK challenges the suggested explanation The limited number of funded proposals from nurses was not due to medical prejudice Rather it was due to very few nurses putting forward proposals and to many of those proposals being withdrawn voluntarily, usually after the receipt of i
TL;DR: It is suggested that the profession needs to take account of the complex and heterogeneous nature of primary care nursing to develop regulatory frameworks which address the problems faced by primary care nurses at the grassroots.
Abstract: Health service reforms emphasise the central place of the general practitioner in a primary care-led NHS, as at the same time aspects of primary care have been deregulated. Simultaneously, there is emphasis within nursing on individual accountability and professional judgement to allow responsiveness to demands for nurses to extend and develop their roles. This paper reviews the range and complexity of primary care nursing, to suggest that the profession needs to take account of the complex and heterogeneous nature of primary care nursing to develop regulatory frameworks which address the problems faced by primary care nurses at the grassroots.
TL;DR: The stigma associated with drug-use, prostitution and mental and physical illness is not just an experience, it is an active and dynamic process which is often perpetrated by professional responses as mentioned in this paper.
Abstract: The stigma associated with drug-use, prostitution and mental and physical illness is not just an experience, it is an active and dynamic process which is often perpetrated by professional responses...
TL;DR: While information obtained from use of the MACL could not be used in the way originally intended, by adopting a flexible approach it was possible to use these data as a means of triangulating in a broader sense and thus to shed light from a different source on the caring experience.
Abstract: Triangulation of data collection is often seen as a way of enhancing rigour in research. In a study of the experiences of informal carers of terminally ill cancer patients, a qualitative approach was employed, relying on unstructured interviews. However, it was planned to utilise a triangulation strategy by administering a mood adjective checklist (MACL) to informants. Justification for the choice of MACL is given, followed by discussion of the difficulties encountered when carrying out the research plan. Four reasons for these difficulties are identified: reliability of the instrument, duty of care, control, and mixing qualitative and quantitative research strategies. Some of these difficulties might apply generally to research studies but some were peculiar to the particular research situation. This highlights both the necessity to be sensitive to the special needs of different research populations and the advantage of adopting a flexible approach to triangulation in data collection. While information o...
TL;DR: In attempting to gain access to and to understand the lived experience of learning in clinical practice, interview conversations were supplemented by visits to the participants' clinical placements for periods of observation while they were undertaking care, either with their mentor or independently.
Abstract: This paper investigates the use of observation in clinical practice. The study uses a longitudinal, naturalistic-phenomenological design to investigate the development of professional knowledge in ...
TL;DR: The authors conclude that while CRM undoubtedly raises standards of patient care, the future implementation and direction of the strategy may be governed by both patient expectations and the changing nature of the'new NHS'.
Abstract: This paper outlines the concept of clinical risk management (CRM), a vital component in health service providers' total quality strategies. It is argued that, owing to the nature of health-care pro...
TL;DR: Key areas of family care which warrant further investigation are identified and highlight a potential focus of education and practice initiatives within hospitals.
Abstract: It has been suggested that an important difference between hospital and hospice care is that the latter is more geared to the attainment of family goals. Nurses are the one group of health-care professionals who work with families during all phases of an illness. Using the Delphi technique, this study aimed to identify some supportive nursing behaviours and some factors which went against effective provision of family care in a hospital. Twenty-two qualified nurses drawn from seven wards participated in the study. Supportive nursing behaviours were identified and priority was given to issues concerning symptom control, privacy, time and honest communication. Factors hindering the effective provision of family care focused mainly on the problems of balancing priorities, issues of disclosure, providing privacy and managing family conflict. The findings identified key areas of family care which warrant further investigation and highlight a potential focus of education and practice initiatives within hospitals.
TL;DR: In this article, the authors investigated the potential for self-learning of psychomotor skills in nursing and found that students who received a demonstration appeared to pay more attention to the principles of asepsis and communication; however, these students were also more likely to pick up bad habits from the lecturer.
Abstract: The learning of nursing psychomotor skills has traditionally been associated with lecturer demonstrations. In recent years there has been an increased emphasis on the development of independent learning within nurse education, and this study aims to investigate the potential for self-learning of psychomotor skills in nursing. Students were sampled from a number of different nurse education facilities in Northern Ireland, and a true experiment was carried out. Results indicate that students can learn a psychomotor skill both with and without a demonstration. Students who received a demonstration appeared to pay more attention to the principles of asepsis and communication; however these students were also more likely to pick up bad habits from the lecturer. This study adds to the existing research base for the learning and teaching of psychomotor skills in nursing.
TL;DR: This paper reviews the current rhetoric on changing professional role boundaries and mixing skills in general practice, particularly in relation to the general practice nurse and provides conceptual matrices which place the key issues of general practice nursing in contingent relation.
Abstract: This paper reviews the current rhetoric on changing professional role boundaries and mixing skills in general practice, particularly in relation to the general practice nurse. The issues relating to the effectiveness and efficiency of the general practice nurse role and to the professional development of general practice nurses, can be placed in a matrix, represented by parameters which relate to teamworking and to the 'doctoring/nursing relationship'. The question is asked: 'How can the reality of current nursing roles within general practice meet the rhetoric of the current NHS (Primary Care) Bill?' By providing conceptual matrices which place the key issues of general practice nursing in contingent relation, questions which relate to, for example, changing professional roles and the appropriateness of a general medical services infrastructure for primary health care can be explored — a process of contingent quality improvement.
TL;DR: This paper analyses the features of 50 proposals made by the Nursing Section to funding bodies since 1994 and concludes that research was no more likely to be funded if a medical colleague was named as a collaborator, a statistician or health economist was involved in the bid, or the bid came from more than one university.
Abstract: The Nursing Section at SCHARR was established in 1994 as one of six groups that constituted the Sheffield Centre for Health and Related Research (SCHARR). Based at the University of Sheffield, SCHARR was established as a response to the imperatives outlined in NHS Research and Development Strategy documentation for multidisciplinary health services research (HSR). The Nursing Section at SCHARR has always been fully supportive of such principles and over the past three years has worked with many different health-care researchers to maximise the nursing contribution to health services research. This paper analyses the features of 50 proposals made by the Nursing Section to funding bodies since 1994. Approximately half (52%, n=26) of all bids were successful and led to a total of nurse-related research grants worth 2.7 million pounds. Projects were significantly more likely to be funded if the method proposed was qualitative (or a combination of methods) or the lead researcher was a nurse. However, research ...
TL;DR: Recommendations for coordinating nursing research within the trust are made, including the role of the university and suggestions for further research.
Abstract: This paper focuses on a study to identify and evaluate nursing research activity between 1990 and 1996 within a large acute hospital trust. One of the first steps in this process involved establishing a database of nursing research. On the surface, the task appeared to be relatively straightforward. In reality, it proved to be far more complex and time-consuming than originally anticipated. The data collection process is reviewed and the key features of the database described. Issues concerning the coordination and dissemination of nursing research activity within the trust are highlighted. Finally, recommendations for coordinating nursing research within the trust are made, including the role of the university and suggestions for further research.
TL;DR: This paper shows how one NHS trust, in partnership with a university, has formulated and developed a strategy for developing research in nursing practice, which aims to support nurses and midwives in understanding research and applying it, where appropriate, to their practice.
Abstract: The problems of utilising research findings in practice and the need for evidence-based practice are being increasingly recognised. This paper shows how one NHS trust, in partnership with a university, has formulated and developed a strategy for developing research in nursing practice. The strategy aims to support nurses and midwives in understanding research and applying it, where appropriate, to their practice, and also to promote a culture of evidence-based care.
TL;DR: The project highlighted training needs both for service-users and mental health workers regarding service-user self-advocacy and underlined the importance of providing service- users with information.
Abstract: Self-advocacy involves individuals speaking out for themselves rather than others speaking for them. Using an action research methodology, the study aimed to explore the views of individuals experiencing mental ill-health regarding self-advocacy. Focus groups were set up as an exploratory method to obtain information for the design of an interview schedule. Interviews were conducted with 35 service-users to determine what encouraged and prevented them from speaking out. Focus groups were also used to obtain the views of mental health workers regarding service-user self-advocacy. Findings from the project emphasised the importance of one-to-one relationships between service-users and staff and underlined the importance of providing service- users with information. The project highlighted training needs both for service-users and mental health workers.
TL;DR: Focus group participants acknowledged that the Project 2000 course provided a greater emphasis on health than traditional courses and that students appear to gain a broader understanding of health within the community at large than students on traditional courses.
Abstract: The emphasis on health as opposed to disease in the Project 2000 curriculum is consistent with the concept of the nurse of the future working across both institutional and non-institutional setting...
TL;DR: General points concerned with the use of the RCT, particularly when a practice is perceived to do good, when patients have preference about their treatment or there is a new unproven treatment needing evaluation are covered.
Abstract: The need for nurses to debate issues concerned with randomised controlled trials (RCTs) has its origins in several areas of professional concern. These include the need to design and implement rese...
TL;DR: The findings from the study support the validity of the research tools and support the need for a main study in the field of adolescent cancer patients' health-care needs.
Abstract: This paper reports on an exploratory study of the perceived health-care needs of hospitalised adolescent cancer patients. Data were collected using a Q sort board game, specifically designed for this study, and by semi-structured interview based on a rigorous search of the literature. Factor analysis was employed to examine the data. The findings from the study are related primarily to the validity of the research tools and support the need for a main study in the field of adolescent cancer patients' health-care needs.
TL;DR: The authors are optimistic that by establishing a framework for nurses to review care in a professional and sound manner they will feel more confident and comfortable with the concept of EBR.
Abstract: This study describes how one trust addressed the issue of assessing and implementing evidence-based nursing and midwifery practice through the setting up of a Nursing/Midwifery Research and Practic...