Showing papers in "Journal of Research in Nursing in 2003"
TL;DR: In this paper, a minimalist-passive interviewing technique and reflecting teams for analyses of data are described. But the use of small sample frames to generate meaningful case studies is defended, and the post-interview reflective process is described, followed by a case being made for analytic induction as both the foundation of Grounded Theory and an alternative to it.
Abstract: The method uses a minimalist-passive interviewing technique and reflecting teams for analyses of data. Microanalysis of the 'lived life' and thematic field analysis of the 'told story' are described. The use of small sample frames to generate meaningful case studies is defended. The interview technique is expanded upon, paying attention to the concept of Gestalt. The post-interview reflective process is described, followed by a case being made for analytic induction as both the foundation of Grounded Theory and an alternative to it. The use of reflective teams is expanded upon vis a vis the author's research. Unique approaches to the data analysis, which developed in the author's use of the method, are argued as adding flexibility to the Biographic Narrative Interpretive Method. The paper concludes with a discussion of concepts of truth and veracity in storytelling and the researcher's reconstructive process in piecing together images of a whole through the imaginative subjective dramas of everyday lives.
98 citations
TL;DR: Nurses recruited from the Philippines had high expectations of earning more money, of having a higher standard of living and of gaining professionally, but that unmet expectations could lead to dissatisfaction, affect attitudes and behaviour and promote eventual resignation from the organisation.
Abstract: Many UK hospitals are recruiting nurses increasingly from overseas to alleviate acute shortages. Nurses recruited from the Philippines were chosen for this study because they form the largest group of overseas nurses recruited to the Oxford Radcliffe Hospitals NHS Trust and they are required to undertake an adaptation programme before achieving Nursing and Midwifery Council registration to practise. The study explores the expectations and experiences of nurses from the Philippines and ascertains whether their expectations match their experiencesFollowing ethical approval, 120 questionnaires were distributed. Data were collected from 45 of the questionnaires and eight semi-structured interviews. Participants were asked the reasons for their migration, their experiences of recruitment, pre-arrival expectations, their thoughts of the trust's adaptation programme, and their good and bad experiences. They were also asked to evaluate the opportunities they were given for training and career development in the t...
74 citations
TL;DR: The paper calls for systematic development and evaluation of user involvement in research, both to identify its strengths and weaknesses and to support its most effective development.
Abstract: This paper looks at the issue of user involvement in research and evaluation. It is related to current discussions about research governance and research ethics. The regressive and liberatory potential of user involvement in research is explored, together with the ideological relations of such research. Competing strands in its development and approach are identified. The assumption is challenged that user involvement in research is a monolithic idea. User-controlled research as well as user involvement in research is examined and a case is made for more equal access to funding for it. The paper calls for systematic development and evaluation of user involvement in research, both to identify its strengths and weaknesses and to support its most effective development.
66 citations
TL;DR: It is concluded from this piece of practitioner research that professional artistry is essential for genuinely evidence-based, person-centred care, and that it can be facilitated through critical companionship.
Abstract: The investigation of practice by practitioners themselves is growing in nursing. It is now expected of many nurses that they will carry out research as part of their everyday practice, for example, in the case of consultant nurses. Nurses are also expected today to provide evidence-based care for their patients and their carers. Researching one's own practice, providing care based on rigorously gained knowledge of many types and giving a professional account of that practice are challenging activities for which many nurses need support. Based on that premise, this paper explores 'critical companionship' (Titchen, 2000; RCN, 2003), which can be described as a helping relationship based on trust, high challenge and high support, in which an experienced practitioner accompanies a less experienced practitioner on a learning journey. It is a means of enabling nurses to acquire, experientially, the knowledge and skills required for patient care and its development.The concept of critical companionship is descri...
34 citations
TL;DR: Findings from a three-year study that focused on the development and evaluation of seven lead R&D nurses: Care for Older People are reported, which are likely to be of wide interest given that nurse consultants are expected to engage in this form of practice development.
Abstract: Lack of funding for research capacity-building in nursing and allied health research has been a long-standing issue (Rafferty et al., 2002; Scott, 2002). More recently, limited moneys have been made available in the form of doctoral and post-doctoral awards from the Health Foundation and the Department of Health, largely to prepare nurses and allied health professionals for a career in research. However, little attention has been given to the capacity-building required for practitioners who may now have research as a core component of their work: nurse consultants and research and development nurses working in NHS and primary care trusts, for example. These practitioner researchers tend not to have previously benefited from the luxury of full-time funding and have learnt their research skills through higher education courses — Master's or part-time PhDs — or 'on the job' experience.This paper reports findings of a three-year study, the CELEC [Central and East London Education Consortium (now the North Eas...
23 citations
TL;DR: It will be argued that if the authors are serious about creating 'research cultures' in practice settings, the most feasible way of doing so is through practitioner research, as this approach integrates knowledge-generation with knowledge-utilisation.
Abstract: Clinical outcomes, effective decision-making and the use of evidence in practice have been part of the nursing agenda for many years and a key focus of knowledge generation and utilisation activities in nursing research. However, while this focus prevails, the ability of our organizational systems to support nursing research in practice is still limited. There continues to be a divide between the 'knowledge generators' and the 'knowledge users', and while considerable progress has been made in the use of research in practice, less progress has been made in formally connecting academic and practice communities.This paper argues for such a connection through a focus on practitioner research — a focus that can enable the sharing of academic and practice agendas at a variety of levels. It will be argued that if we are serious about creating 'research cultures' in practice settings, the most feasible way of doing so is through practitioner research, as this approach integrates knowledge-generation with knowled...
22 citations
TL;DR: The major themes that emerged from the data concerned problems in professional nursing doctorates, such as the inherent high volume of work; lack of opportunity to use skills in practice; for some students, the uni-disciplinary nature of the courses.
Abstract: This study explored the views of course leaders and students taking doctorates in nursing science. Semi-structured telephone interviews were undertaken with a purposive sample of course leaders and students (n=8) from three UK courses running at the time of the study. One course had been established for six years, the other two were in the first year of delivery.The theme we have labelled 'new knowledge for improvement' describes what emerged from the data as the underlying mission and philosophy guiding the doctorates.Students were found to value the following course features: supportive systems; peer group support; being embedded in an academic department; exposure to multiple research methods; and preparation for clinically focused research. Some nurses were not attracted to what they perceived as a long and lonely route to a PhD, favouring instead the new-style doctorates because of the supportive networks these offer. While the focus of this paper is nursing, there is a long history of professional d...
21 citations
TL;DR: The findings show that there appears to be substantial systematic variation between hospitals in the grade mix of nursing staff and that there is little difference in the types of task undertaken by different grades of staff.
Abstract: This paper describes key findings and implications from analyses of activity and workload of nurses of different grades and support workers based on data collected using Nursing Information Systems for Change Management (NISCM). 'Activity' refers to the amount of time on a shift spent on different tasks, and 'workload' refers to the number of patients in a variety of wards by demand/dependency group. The activity evidence is based on data from 5,208 staff recording their activity in 535 shift blocks in 19 hospitals and the workload evidence is based on data from 38,585 shifts across 90 wards in 17 hospitals.Four of the seven main findings have been selected for presentation here: variations, division of labour, skill-mix issues and flexibility. The findings show that there appears to be substantial systematic variation between hospitals in the grade mix of nursing staff and that there is little difference in the types of task undertaken by different grades of staff. As overall staffing increases, there is...
21 citations
TL;DR: Qualitative methods were used to gather data from postoperative adult Hispanic patients in both an urban and rural setting regarding their perspective and response to the pain experience, and several themes defined each category were used in a larger study to develop a Spanish language instrument to measure pain outcomes.
Abstract: As a primarily subjective phenomenon, pain expression may vary among different populations. Patients from minority populations may be more likely to have poor pain management, less analgesia prescr...
21 citations
TL;DR: The findings of an exploratory qualitative study that investigated issues having an impact on registered nurses' ability to care for older people in a publicly funded teaching hospital in Australia provide a base from which to progress further research and provide a challenge to those working in acute settings to develop systems of care that maximise the role of the registered nurse.
Abstract: The worldwide phenomenon of ageing populations in developed countries has led to an increased emphasis on how best to meet the healthcare needs of people aged 65 years and older. One area identified as requiring particular attention is the care provided to older people in acute settings. This paper reports on the findings of an exploratory qualitative study that investigated issues having an impact on registered nurses' ability to care for older people in a publicly funded teaching hospital in Australia. Issues identified pertain to the complexity of managing the healthcare needs of the older person with an acute illness; the acute care environment as being problematic for the older person, and maintaining continuity of care in an often fragmented and under-resourced healthcare system.It is clear from the study findings that registered nurses in the acute setting play a central and pivotal role in the multidisciplinary team caring for older people with regard to the management and coordination of care as ...
20 citations
TL;DR: It appeared that a considerable number of nurses would have been retained if retention strategies focusing on promotion of greater autonomy, professional development, managerial support, or improved professional practice environments had been introduced.
Abstract: It became apparent in 1998 that there was a significant shortage of nurses and midwives in the Republic of Ireland. Because of the lack of data on the reasons for this, a national study was commissioned to estimate the turnover rate among registered nurses and to identify the underlying reasons for the loss of so many trained staff to the profession. Both quantitative and qualitative methodologies were used. Participants were drawn from 128 health service agencies, and 1,921 questionnaires were completed over a one-year period by nurses and midwives leaving the service. Telephone interviews were also conducted with 140 participants. The results indicate a mean turnover rate of 12%, with considerable variations across services. Reasons for leaving included wanting to pursue other employment in nursing (35%), travel abroad (21%) and a desire to undertake further study (12%). It appeared that a considerable number of nurses would have been retained if retention strategies focusing on promotion of greater aut...
TL;DR: This paper argues for greater flexibility within the ethical review process better to respond to the needs not only of this type of research, but also to other research and development activities, such as audit and practice development.
Abstract: The operation of research ethics committees in England now follows standard procedures. However, the new ethical review process favours research where research questions and protocols can be clearl...
TL;DR: It is concluded that development of practitioner research skills needs to be supported by a career strategy enabling clinical research careers in the NHS.
Abstract: The development of research capacity is a priority in healthcare. However, little information is available on the outcomes of different approaches to capacity-building. This paper provides a description of the approach taken in a primary health care (PHC) project (Teamcare Valleys) to support the development of research skills by PHC practitioners. The 35 practitioners were all experienced nurses, midwives, health visitors, GPs, practice managers and health promotion specialists. Research capacity development was supported by colleagues with experience in a range of research approaches in PHC and social science research.A case study was designed to examine the impact of the capacity-building process on the development of research and other skills. Data were collected at the end of the three-year project and five years later to identify the development of research skills and their utilisation in subsequent posts. Evidence indicates that the practitioner researchers developed considerable skills in research...
TL;DR: A critical review of important issues in the implementation and interpretation of randomised controlled trials used to evaluate non-biomedical therapeutic interventions for pain focuses on the validity, relevance and clinical importance of outcome measures; sampling and randomization bias; blinding procedures used to control for the placebo response and therapist influences, and treatment standardisation.
Abstract: This paper offers a critical review of important issues in the implementation and interpretation of randomised controlled trials (RCTs) used to evaluate non-biomedical therapeutic interventions for pain. The analysis of methodological issues focuses on the validity, relevance and clinical importance of outcome measures; sampling and randomization bias; blinding procedures used to control for the placebo response and therapist influences, and treatment standardisation. A key issue is that pain management is inextricably linked to the establishment of a therapeutic relationship. In such circumstances, it is argued that the 'gold standard' double-blind RCT is impracticable. Those relying on RCTs as sources of evidence need to be aware that an 'unblinded' RCT can enhance placebo responses to the intervention and introduce important sources of bias. The challenge faced by healthcare researchers is to identify alternative research designs able to provide valid and reliable evidence that the proposed therapeutic intervention is capable of achieving cost-effective, clinically important and personally relevant outcomes in naturalistic settings.
TL;DR: The experience of undertaking the pilot study indicated that despite NHS reforms focusing on the user perspective, some health consumers were not enthusiastic about participating in research or informing government policy, and the importance of thorough pilot work to the success of the eventual investigation is demonstrated.
Abstract: Parkinson's disease (Pd) affects over 120,000 people in the UK. Onset usually begins in people over 50 but in a significant number of people symptoms first develop at a much earlier age without affecting life expectancy. A pilot study to explore quality of life, psychological adjustment and service use for this population initially foundered because of difficulties in contacting a sample of younger people with Pd and motivating them to participate. The pilot study was then extended to determine these people's perceptions of their condition and their needs through content analysis of a magazine circulated by their user group, and a website. Information was also sought from key informants working with young people with Pd. This eventually resulted in contact with the target sample and the collection of valuable data through participation in a conference held by the user group. Reasons for reluctance to become involved in traditional research studies related to denial of having Pd; a desire to conceal it fro...
TL;DR: A case study is presented, demonstrating that the process of malignant alienation can indeed occur as a result of interaction between nurses and a patient whose behaviour they find challenging and that a more positive approach by nurses to the same patient can have therapeutic outcomes.
Abstract: This paper uses a case study approach to explore issues for mental health nurses in relating with suicidal patients. The phenomenon of 'malignant alienation' is described, whereby the suicidal tend...
TL;DR: The findings reveal that paediatric nursing in the UK currently has very limited capacity to conduct and utilise research in the care of children and is in a weak position to create a future workforce that has this capacity.
Abstract: There is general agreement that nursing-led research is under-resourced with respect to funding for academic preparation and for the conduct of clinical research. All of the previous literature, however, focuses on the nursing profession as a whole and provides little insight into the capacity and resource issues for specialty practice areas such as children's nursing. This paper provides an overview of the state of paediatric nurse-led research capability, capacity and output within the limitations of the available data. The findings reveal that paediatric nursing in the UK currently has very limited capacity to conduct and utilise research in the care of children and is in a weak position to create a future workforce that has this capacity. Nurse-led research on children's health issues is urgently needed if the UK paediatric nursing workforce is to deliver the standard of care specified in the Children's National Service Framework. However, strategies for accelerating the development of research capaci...
TL;DR: The authors argued that paying attention to the madness of those producing mental health research in the academy (or is it the asylum?) may offer insight into the researcher's own madness, arguing that behaviours which might typically be described as indicators of mental illness could be considered as reasonable protective mechanisms.
Abstract: The invention of madness led to the professional practice of mental health that has as its main aims the identification and treatment of mental illness. Traditionally, notions of madness and sanity are polarised, with sanity being linked to functionality and madness being aligned with dysfunction. While such a dichotomy is always questionable, currrent studies of mental illness reflect the social dissolution of such stark categorization. Indeed, it could be argued that this divergence is sensible, given that behaviours which might typically be described as indicators of mental illness could be considered as reasonable protective mechanisms.Contemporary approaches to researching mental health problems focus on the 'madness of the other', with little attention being paid to the madness of research itself or, indeed, to the researcher's own madness. This paper argues that paying attention to the madness of those producing mental health research in the academy (or is it the asylum?) may offer insight into the...
TL;DR: The research governance regulations provide a framework that might lead to new understandings of best practice in research, create ownership, and generate more inclusive, equitable research with greater validity in a multi-cultural society.
Abstract: The NHS and its clinical workforce are committed to evidence-based practice, which requires quality evidence to assist and justify change. Such evidence can be used to inform best practice and to c...
TL;DR: The need for nursing to develop a genuine culture of research that can enable the profession to deliver research-oriented practice is highlighted, highlighting the need to develop careers in nursing in order to provide evidence-based practice and appropriate care to patients.
Abstract: This paper aims to review and provide a brief critique of the modern health service in the UK, highlighting the need for nursing to develop a genuine culture of research that can enable the profession to deliver research-oriented practice. The need to develop careers in nursing in order to provide evidence-based practice and appropriate care to patients is discussed within the context of current policy drives and professional aspirations. It is argued that not only will this raise the overall standard of care, but also will develop the level of professional knowledge, credibility and accountability of practitioners. Links between research, clinical governance and evidence-based practice are made, and the wider implications for the position of nursing within healthcare services are discussed.
TL;DR: The paper considers some of the challenges of undertaking a randomised controlled trial for a topic within what Nancy Woolf (2000) describes as a 'socially complex service context' and suggests some ways that sources of confound be minimised.
Abstract: Nurse prescribing is gradually being implemented across a range of areas in healthcare. This paper examines the context of prescribing for mental health problems and discusses the issues relating to nursing and some of the broader matters such as the effectiveness of medication for mental health problems, the economics of mental illness and more general workforce issues. Mental health nurse prescribing obviously presents some significant research opportunities that should be seen within the settings of the Medical Research Council's framework for assessing complex health interventions (Campbell et al., 2000). The paper also considers some of the challenges of undertaking a randomised controlled trial for a topic within what Nancy Woolf (2000) describes as a 'socially complex service context'. Such a context requires the research team to consider a number of potential confounds. The paper concludes by suggesting some ways that such sources of confound be minimised.
TL;DR: It is important that nurses know how fraud may be perpetuated so that they do not risk unknowingly abetting or committing fraud themselves, and need to be advocates for quality research.
Abstract: As treatment and care given to patients should be evidence-based, nurses are becoming more involved in the conduct of research. However, research results based on fraudulent findings can have a serious impact on patient care. It is important, therefore, that nurses know how fraud may be perpetuated so that they do not risk unknowingly abetting or committing fraud themselves. Those who commit such acts stand to lose their academic credibility, the respect of their colleagues, and their livelihood. Mechanisms need to be developed within each institution to facilitate the conduct of quality research that can be audited. Nurses need to be advocates for quality research in the realisation that respect for the research findings will be achieved by respect for the maintenance of standards.
TL;DR: A regional survey was undertaken to identify and analyse the development needs of individuals involved in the education of nurses and midwives in the South West of England, and the need for collaborative working across HEIs and the NHS is reinforced.
Abstract: To ensure that higher education institutions (HEIs) keep abreast of the changes advocated by the NHS modernisation agenda, a regional survey was undertaken to identify and analyse the development needs of individuals involved in the education of nurses and midwives in the South West of England. A total of 760 self-administered postal questionnaires were distributed with 426 returns, giving a response rate of 56%. This paper discusses the qualitative responses from the 57-item questionnaire that reported the factors facilitating (n=79) and inhibiting (n=140) the educators' personal development, and additional responses from those wishing to make further comment (n=125). From a content analysis it was noted that the themes identified as both facilitating and inhibiting development were inter-linked. The data from the additional responses served to reinforce the issues that had already emerged. Discussion revolves around the four refined themes of the need for greater resources, for a supportive organisation, for role organisation and development and for collaborative practice. Recommendations suggest greater clarification is needed of the roles of academics in practice and that they need more resources to support them in their achievement. Finally, the study reinforces the need for collaborative working across HEIs and the NHS if the modernization agenda is to be met.
TL;DR: The study suggests that nurses are knowledgeable and supply antibiotics judiciously in terms of drug and dose, but that in Terms of clinical governance there is room for improvement in record-keeping.
Abstract: Patient group directions (PGDs) are now an integral feature of walk-in centres (WiCs), enabling nurses to supply and administer drugs to the generalised direction of a doctor rather than by means o...
TL;DR: The research evidence underpinning each of the pain standards in the National Service Framework for Children: Standard for hospital services is discussed, and aspects of children's pain management where the research evidence is particularly strong or weak are identified.
Abstract: This critical literature review discusses the research evidence underpinning each of the pain standards in the National Service Framework for Children: Standard for hospital services. Relevant evid...
TL;DR: Some aspects of managing research in healthcare practice today are explored, based largely on government guidelines in England in which a research governance framework has been developed and is now being used to monitor many aspects of research activity in the NHS.
Abstract: This paper explores some aspects of managing research in healthcare practice today. The work is based largely on government guidelines in England in which a research governance framework has been developed and is now being used to monitor many aspects of research activity in the NHS. Following a brief overview of the evolution of the research governance framework, some aspects of the strategy are outlined and considered. The challenge to nurses is to ensure that research work is developed in accordance with these guidelines, which lay specific expectations on people and organisations working in health-care research
TL;DR: The picture was one of inconsistency and widespread differences between curricula and institutions, and the lack of a greater emphasis on communication skills in Making a Difference curricula is surprising, given that it is intended to be skills-based.
Abstract: This paper reports on a survey of the teaching of communication skills on pre-registration nursing programmes in England in 2000. Questionnaires were devised for the Common Foundation Programme and the four Branch Programmes. These were sent to academic staff responsible for both Project 2000 and Making a Difference curricula. Comparisons are made between the two curricula, between matched pairs of curricula in institutions offering them both, and according to whether the institutions were designated as pilot sites for the Making a Difference curricula. The overwhelming finding was that there was no difference between any of the particular comparisons made. Lecturer-practitioners were more likely to be used to teach communication skills on Making a Difference curricula, but otherwise the picture was one of inconsistency and widespread differences between curricula and institutions. The lack of a greater emphasis on communication skills in Making a Difference curricula is surprising, given that it is inten...
TL;DR: It is argued that pain should not be regarded as a symptom in isolation but as a component of symptom clusters, and the interactions between symptoms, their synergistic effects and their impact on the patient's decisions about symptom management is needed.
Abstract: This paper argues that pain should not be regarded as a symptom in isolation but as a component of symptom clusters. Recent research on symptom clusters that involve pain is overviewed, together with data from a single case study. These sources of evidence suggest that pain is commonly associated with other symptoms, especially fatigue, and is an important but not necessarily dominant component of clusters of three or more symptoms. Much more research into the interactions between symptoms, their synergistic effects and their impact on the patient's decisions about symptom management is needed. Nurse researchers are ideally placed to play a leading role in this research agenda, given the focus of nursing practice on symptom and side-effect management.
TL;DR: In this paper, the advantages and disadvantages of insider/outsider status are discussed in order to present a "matrix of involvement" to illustrate key issues in social research, and the authors draw on the literature and provide examples from the authors' research to illustrate some key political scenarios researchers may face.
Abstract: Although reports of political issues in social research were popular in the 1960s and 1970s, more recent accounts of nursing research largely neglect this area. This paper highlights such political issues, offering guidance to help equip researchers to deal with these.Published reports of research studies necessarily present a linear account of how, and how well, the research question was answered. It is rare for research to follow so straightforward a path, because interwoven is a little discussed, but not uncommon, political arena. Standard texts offer plenty of guidance on research ethics, but there is little advice to help researchers walking a thin line between diverse political elements. This paper draws on the literature and provides examples from the authors' research to illustrate some of the key political scenarios researchers may face. The advantages and disadvantages of insider/outsider status are discussed in order to present a 'matrix of involvement' to illustrate key issues. It is suggested...