Showing papers in "Journal of Research in Nursing in 2004"
TL;DR: In this paper, a personal account of the nurse-nurse researcher role conflict encountered while conducting a qualitative research study is described. But the authors do not consider the impact of the self on the research process.
Abstract: This paper is a personal account of the nurse-nurse researcher role conflict encountered while conducting a qualitative research study. Difficulties in the transition from a clinical post to a nurse researcher role are described and the experiences of other authors dealing with such a role change are used to illustrate potential resolutions. An understanding of the concept of reflexivity is offered and a description of how this can be applied to consider the impact of ‘the self’ on the research. The paper suggests a solution to the well-known role conflict encountered by nurse researchers: including the nurse in the process of research, and being confident about taking a personal investigative approach. It is argued that drawing on the interactive skills of the nurse can benefit and not detract from the research process.
67 citations
TL;DR: Role remits are examined in an attempt to show that not only do CRNs possess many of the skills that are highly regarded and respected in specialised clinical nursing but also that they may be well placed within the profession to assist in building the evidence base for practice as nursing continues to develop.
Abstract: Increasing numbers of nurses are moving from their direct clinical base to take up posts as clinical research nurses. However, although there are published guidelines about their role responsibilities, little is written about the reality of the role. This paper offers an experiential account into the variety of responsibilities undertaken by CRNs, highlighting the extended role that experienced CRNs may undertake, the transferable skills exhibited and the extent to which traditional boundaries between professionals can continue to be challenged. Role remits are examined in an attempt to show that not only do CRNs possess many of the skills that are highly regarded and respected in specialised clinical nursing but also that they may be well placed within the profession to assist in building the evidence base for practice as nursing continues to develop.
34 citations
TL;DR: It is argued that nursing research is losing its way and how, in comparison to the search for knowledge in the wider world, the health professions are making research more difficult to execute than it needs to be.
Abstract: In this paper I argue that nursing research is losing its way. There are a number of ways in which this is happening; for example, people are spending much more time writing about methodology than getting on with the research itself and the reporting of discovery. Here, I address the extent to which we are debilitating the research enterprise through what passes as ‘ethics’ and
‘governance’.
I will refer to examples from nursing and related research to illustrate the gradual development of greater concern for the well-being of research participants and the prevention of harm. I will go on to illustrate how, in
comparison to the search for knowledge in the wider world, the health professions (and in the UK nurses in particular) are making research more difficult to execute than it needs to be. In the development of defensive rules
and procedures we have somehow forgotten exactly from what harms we are protecting our patients, students and staff.
For those looking for a theoretical background to my views, they are, in essence, consequential, and I hope to show that with a harms and benefits approach we could bring much common sense to the critical appraisal of
previous research and the approval and conduct of nursing research now and in the future.
26 citations
TL;DR: It is concluded that the answers to some dilemmas and challenges are not always found in the literature and that decisions taken often depend on the researcher's morality and pure common sense.
Abstract: Undertaking a piece of research in the clinical setting is often far more difficult than it appears from descriptions in textbooks. This paper describes some of the challenges faced in the course of completing a non-participant observational study that examined how health promotion practice was carried out by hospital-based nurses in an acute setting. The challenges included deciding which observational role to adopt, whether to use structured or unstructured observations, which observational position to adopt, how long observation sessions should be and how to deal with ethical issues when the researcher is also a nurse. It is concluded that the answers to some dilemmas and challenges are not always found in the literature and that decisions taken often depend on the researcher's morality and pure common sense.
23 citations
TL;DR: The findings suggest that clinical supervision using a psychodynamically informed approach helps nurses acknowledge their feelings and see their work from a different perspective; builds confidence; provides support through a crisis and reduces their isolation in their role.
Abstract: This paper reports the findings from the development of psychodynamically informed group supervision for 52 clinical leaders in nursing at a general NHS hospital over four years. The initiative was evaluated through a variety of methods, underpinned by action research. This paper is based on the findings generated by semi-structured interviews (n=24) and descriptive statistics of staff sickness and turnover.The findings suggest that clinical supervision using a psychodynamically informed approach helps nurses acknowledge their feelings and see their work from a different perspective; builds confidence; provides support through a crisis and reduces their isolation in their role. Other findings suggest that, while having no impact on staff turnover, clinical supervision might reduce staff sickness. However, not all staff were comfortable with the experiential nature of clinical supervision and there was fragmented attendance at sessions. Embedding supervision into nursing practice remains a challenge; this ...
20 citations
TL;DR: E evaluation highlighted important features of the secondment process contributing to its success and indicated pitfalls attached to introducing such schemes, and it is recommended that evaluation should be extended to explore how the new staff nurses prepared by this novel scheme continue to develop their career trajectories.
Abstract: Traditionally in the United Kingdom, reliance has been placed on unqualified support workers, such as student nurses, to deliver a high proportion of patient care. However, the move of nurse education into higher education and the accompanying supernumerary status of student nurses in the 1980s resulted in a shortfall of staff to deliver that care. The government has made a number of suggestions for increasing recruitment. One possible solution regarded as very promising is to encourage health care assistants (HCAs) with at least 12 months' experience in the National Health Service to enrol on existing pre-registration programmes, providing them with financial incentives to do so. Very little literature directly concerned with training opportunities for HCAs could be traced, but it was evident that financial constraints and family commitments had, in the past, operated as disincentives to training, although some HCAs would otherwise be keen to register.
In 1999 one of the workforce development confederations in London responded to government policy by seconding HCAs onto a pre-registration programme operated by the local university. Plans for evaluation were made at the outset. Interviews were conducted with two consecutive intakes of secondees at three time intervals: after three months; after 12 months and during the final placement of the 36-month course. Interviews with other stakeholders were conducted just before the course ended. A qualitative approach was taken and the data were analysed employing the sequence recommended by Miles and Huberman (1994).
Evaluation highlighted important features of the secondment process contributing to its success and indicated pitfalls attached to introducing such schemes. It is recommended that evaluation should be extended to explore how the new staff nurses prepared by this novel scheme continue to develop their career trajectories. Given the emphasis now being placed on the 'skills escalator' model of staff development in the NHS, such approaches will assume even greater importance in future, and more extensive evaluations will be needed.
14 citations
TL;DR: The SWOT analysis demonstrates that there is a clear need to increase the number of nurses participating in research and development activities in both settings, a fundamental requirement if evidence based nursing practice is to be a reality.
Abstract: This paper seeks to outline how clinical and academic colleagues can work together to promote nursing research and development in order to enhance care delivery. The literature shows that problems concerning capacity and capability continue to impede progress in developing further the contribution that nursing research can make to patient care. The settings which are the focus of this collaboration are a large acute teaching hospital NHS Trust and a post-1992 university. In order to develop firm foundations that a collaborative nursing research strategy could rest on, a SWOT analysis was undertaken. The SWOT analysis demonstrates that there is a clear need to increase the number of nurses participating in research and development activities in both settings. This is a fundamental requirement if evidence based nursing practice is to be a reality.
12 citations
TL;DR: There is a lack of coherent policy and procedure in safety and security measures across psychiatric acute admission wards in the Republic of Ireland and it may be concluded that there is an escalation in violent episodes and assaultive behaviour in psychiatric services in recent years.
Abstract: Violence and assaultive behaviour is a serious and growing problem in psychiatric services across the world. Despite many concerns about violence and assault in healthcare, there is an alarming lack of clarity on matters of procedure and policy pertaining to safety and security in psychiatric hospitals.This paper describes the safety and security measures in psychiatric acute admission wards in the Republic of Ireland and may be considered to be representative of acute psychiatric settings in other jurisdictions. A population study was undertaken, which included all psychiatric acute admission wards in the Republic. A descriptive survey research design was adopted, with the use of a questionnaire for data collection. The questionnaire was analysed using SPSS (version 11) and descriptive statistics were used to present the results.There was wide variation in safety and security practices across the wards. Measures aimed at ensuring staff security were also lacking, with no overall acceptable minimal standa...
12 citations
TL;DR: The study aimed to discover the extent to which participants agreed about what the key features of a future career pathway should represent, and suggested that these statements will aid and inform stakeholders and decision-makers as to the future direction that career pathways in nursing and midwifery could take.
Abstract: There is growing interest, both nationally and internationally and within healthcare research, regarding future career pathways for nurses and midwives and what these pathways should represent. Thi...
12 citations
TL;DR: Research governance in care homes is a complex process, due to the ambiguous status of the care home as a public and a private space as discussed by the authors, while treating the processes of informed consent as a purely individual matter may fail to safeguard individuals who may be vulnerable.
Abstract: Research governance in care homes is a complex process, due to the ambiguous status of the care home as a public and a private space. As such, public sector research governance processes may infringe individual's rights to make decisions about participation in research, while treating the processes of informed consent as a purely individual matter may fail to safeguard individuals who may be vulnerable. This paper discusses these dilemmas in the light of existing research governance frameworks, and goes on to outline protocols that the team have developed for their own use.
12 citations
TL;DR: Assessment included assessing and grading both children’s and parents’ involvement in decisions according to a five-level scale of different degrees of respect, and emphasised that both children and parents had varying abilities to become involved in the decision-making process.
Abstract: Different reasons are given as to why children and their parents should be involved in discussions and decisions regarding the child’s care. The UN Convention on the Rights of the Child formulates the needs of children and young people in terms of human rights. Ethical duties of health professionals include the obligation to enhance their patients’ competence and ability to participate. The concepts of autonomy, integrity, competence, assent and consent are complex and sometimes difficult to relate to practice. However, they are essential in paediatric care. In earlier studies we observed 24 children and 35 parents during the child’s hospitalisation, and situations including a decision-making process were identified. Analysis included assessing and grading both children’s and parents’ involvement in decisions according to a five-level scale of different degrees of respect. The results emphasised that both children and parents had varying abilities to become involved in the decision-making process. Promoting children’s rights is one of the most important roles for the children’s nurse. Having a voice in decision-making helps the child to develop a sense of him-herself as a person and gives the parents a feeling that they are part of a team giving their child optimal care during hospitalisation. (Less)
TL;DR: This paper will critique a recently published study that focused on nursing practice and was, in the authors' view, inappropriately described as ethnographic, and suggest some opportunities for a broader understanding and for learning may have been lost.
Abstract: The effects of drug errors and any consequent adverse events frequently impact on patients, their relatives and professional carers. Furthermore, the financial cost to the National Health Service i...
TL;DR: A survey of the educational preparation of nurses working in high, medium and low security mental health settings identified issues in relation to security and how procedures in parts of the system militate against therapeutic care.
Abstract: This paper describes a survey of the educational preparation of nurses working in high, medium and low security mental health settings. Data from focus groups and interviews were also content-analysed to yield a theory of nursing in secure environments comprising of statements of competency.The competences were translated into a questionnaire and distributed to nurses working in high, medium and low security mental health settings. Respondents stated whether individual competences were part of their current practice or supervisory involvement, and the degree of importance they accorded to each competency.The competence framework received widespread support from nurses at all levels of security in relation to their role description and level of importance. Results identified issues in relation to security and how procedures in parts of the system (notably in high security) militate against therapeutic care. Noticeable differences emerged between respondents working in high and medium secure environments in...
TL;DR: Evidence of a growth in plagiarism and other offences among students raises concerns about the trustworthiness of individuals who aspire to enter the NMC professional register whereupon they will be expected to act as guardians of certain values.
Abstract: Fraud is defined as deliberate intention to deceive, and is contrary to the two most valued qualities of nurses—honesty and integrity. The Nursing and Midwifery Council (2002a) states in its Code of Professional Conduct that the nurse must be trustworthy. Students on an educational programme leading to a professional qualification as a registered nurse or midwife, which gives them the right to practise those professions, are subject to particular standards of behaviour. Professionalism in nursing means that nurses profess to something that makes them guardians of certain values. Evidence of a growth in plagiarism and other offences among students raises concerns about the trustworthiness of individuals who aspire to enter the NMC professional register whereupon they will be expected to act as guardians of certain values.
TL;DR: The development and definition of the profession of nursing required the extinction of a casual nursing workforce that provided the nursing staff of the hospitals in England up to the 1860s, which was a 'moral crusade' as well as an attempt at organizational efficiency.
Abstract: The development and definition of the profession of nursing required,inter alia,the extinction of a casual nursing workforce that, in the main, provided the nursing staff of the hospitals in England up to the 1860s. That process was a 'moral crusade' as well as an attempt at organizational efficiency. As the end of the 20th century approached, the picture appeared to have turned full circle, and many more nursing staff are employed on anything but full-time contracts. There are major implications for the way the profession defines itself and for the future of nursing work.
TL;DR: It is demonstrated that not only is it possible to undertake research in the vegetative state but also that there needs to be more of it so that greater numbers of patients and their families will benefit.
Abstract: It is now generally accepted that all patient groups should benefit from the potential advances in knowledge and understanding that result from clinical research. Despite this principle, patients in the vegetative state remain a group that has been chronically under-researched by neuroscientists because complex ethical questions and logistical dilemmas are raised by such research.The vegetative state is one of the best known but least understood of neurological conditions. It affects a small but significant number of people who make a poor recovery after sustaining a brain injury and has been brought to public attention through high profile cases in the UK and the USA. This paper defines the vegetative state and explores four important issues that should be considered when planning clinical research in this field. It is demonstrated that not only is it possible to undertake such research but also that there needs to be more of it so that greater numbers of patients and their families will benefit.
TL;DR: A questionnaire-based survey of rheumatology nurses was undertaken to investigate the use, and perceptions, of the effectiveness of complementary and alternative medicines (CAM) in the management of patients with rheumatic diseases (RD).
Abstract: A questionnaire-based survey of rheumatology nurses was undertaken to investigate the use, and perceptions, of the effectiveness of complementary and alternative medicines (CAM) in the management of patients with rheumatic diseases (RD). A total of 192 rheumatology nurses (response rate 76.2%) completed the questionnaire, which included sections on qualifications and clinical experience, perceptions of, training in, and use of CAM in the management of RD patients. CAM was provided by 8.3% of respondents, principally aromatherapy, massage and reflexology. Furthermore, over half of respondents (51.6%) provided advice to patients about CAM, primarily to patients with rheumatoid arthritis (RA). Perceptions of the benefits of CAM are overwhelmingly positive: 89.8% of respondents considered it to have a role in the NHS. Current barriers to wider use of CAM include budgetary constraints in the health service, limited availability of published evidence, and the current lack of a clear and adequate regulatory fram...
TL;DR: The study showed that district nurses were able to administer the annual review satisfactorily but that they found execution of the protocol time-consuming, and a great deal of variation was found among respondents, which pointed to different sub-groups of frailty in the older population of people with diabetes.
Abstract: A study was undertaken to explore the potential of district nurses assessing older frail people with type 2 diabetes using an explicit schedule in the form of an annual review. A pilot study follow...
TL;DR: An analysis of the process of a project scoping the staff development needs of nursing and midwifery academics to meet the National Health Service Modernisation Agenda in the United Kingdom highlights some of the difficulties of working as a multi-site virtual team.
Abstract: Background: Collaborative multi-site research is gaining recognition. In particular, across stakeholders in the health and social care professions, there has been an increase in the documentation of such approaches, with the majority acknowledging the strengths and few identifying the pitfalls. Four universities in the south west of England collaborated on the design, analysis and implementation of a project scoping the staff development needs of nursing and midwifery academics to meet the National Health Service Modernisation Agenda in the United Kingdom.Aim: This paper highlights the challenges and the lessons learned from each stage of the process of this large multi-site collaborative study. Consideration has been given to addressing the site-specific differences as well as the politics of the processes and power relations across the research team.Discussion: From an analytical reflection across the team, there were a number of lessons learned from the process of collaboration. Initially, the main cha...
TL;DR: Interest in the topic was considerable and the results can be used to stimulate discussion and emphasise the importance of controlling health-related infection.
Abstract: Healthcare-associated infection has become a topic of interest to the general public in the United Kingdom, kindled by media accounts of poor hygiene and the risks of cross-infection. In the spring...
TL;DR: This paper argues against launching, at this stage, a major initiative to conduct clinical trials to test the effectiveness of various therapies; instead, an approach using qualitative methods and drawing on biographical narrative research is advocated.
Abstract: Complementary and alternative medicine are widely used by people with cancer, yet little information exists as to how such therapies are used or people's motivations for using them, and few studies have been conducted to assess the efficacy and safety of these in the context of cancer and its treatment. Therapies may be used in parallel to conventional cancer treatment in the belief that they may help cure the cancer, prevent its recurring, help manage the symptoms or simply enhance well-being. Little data exist for patients to help guide choices over whether or not to use complementary medicine. There is also a lack of information available to inform patients as to how to use therapies for their best effect; many patients manage complementary treatments themselves as there is little else to guide them. Pressure is increasing to fill in the large evidence gaps surrounding the efficacy and safety of complementary medicine through conducting large-scale clinical trials. This paper argues against launching, at this stage, a major initiative to conduct clinical trials to test the effectiveness of various therapies; instead, an approach using qualitative methods and drawing on biographical narrative research is advocated. We are in the process of collecting information about how people with cancer use complementary therapies in a longitudinal study of cancer patients who have declared that they are users or non-users of complementary medicine, funded by the NHS R&D Programme. Using a biographic narrative method, detailed maps of the ways in which patients' use complementary medicine and the intersection of this with individual cancer journeys and personal biographies are being acquired. Arguments for this novel methodological approach are presented.
TL;DR: The progress of a qualitative research study that aims to examine the benefits of aromatherapy massage in the management of chronic pain in patients diagnosed with MS, and points to the preliminary findings.
Abstract: The pain experienced by patients who have multiple sclerosis (MS), remains a poorly understood phenomenon, although it is becoming more clearly defined. It is often the case that the pain patients with MS experience does not easily respond to traditional therapeutic treatments, and may therefore remain unrelieved. Patients may be reluctant to take additional medication to that they are taking for their MS-related symptoms, which means that many choose complementary therapies to help them manage their pain. However, like the pain experience, the nature of complementary therapies and their effectiveness in treating illness and alleviating symptoms is also poorly understood. Thus, while many patients choose treatments such as aromatherapy, there is little research evidence to support its application in a systematic and rigorous way. This paper reports the progress of a qualitative research study that aims to examine the benefits of aromatherapy massage in the management of chronic pain in patients diagnosed ...
TL;DR: In this article, the authors report on the progress of an action research project to develop, implement and evaluate a Joint Research and Development Strategy between North East Wales NHS Trust and North English Wales Institute of Higher Education.
Abstract: The Research Governance Framework (DoH, 2001) requires health and social care organisations to promote a research culture in their organisation and ensure that staff are supported in, and held accountable for, the professional conduct of research. In Wales, recent policy documents also necessitate the building of research capacity in health and social care in order to develop a high-quality workforce (WAG, 2002: 31) and deal with recruitment and retention problems by supporting initiatives and developments (NAfW, 2001). A literature search revealed that, although such strategies exist, none were reported to use an action research framework.This paper, therefore, reports on the progress of an action research project to develop, implement and evaluate a Joint Research and Development Strategy between North East Wales NHS Trust and North East Wales Institute of Higher Education. The strategy reported on in this paper used action research as a means of empowering stakeholders to become involved in research, w...
TL;DR: The case for improving systems of statutory and voluntary self-regulation in the complementary sector is outlined and the progress and current developments in a number of therapies towards that end are charts.
Abstract: In any healthcare profession, orthodox or complementary, quality of care, treatment and patient safety must be given the highest priority. The establishment of effective systems of professional regulation is seen by many as essential in order for this to happen. This paper outlines the case for improving systems of statutory and voluntary self-regulation in the complementary sector and charts the progress and current developments in a number of therapies towards that end. The impact of an independent, non-governmental organisation, The Prince of Wales's Foundation for Integrated Health, in driving forward this process, is discussed. Nurses, as part of any modern multidisciplinary healthcare team, need to be aware of the advances and current issues emerging in this sector and the increasing need for their profession to be involved in shaping future developments.
TL;DR: Criteria for excellence in nursing and midwifery research is differentiating this from ‘cutting edge’ and ‘international’ descriptors, and the creation of research teams within the current financial strictures is examined.
Abstract: This paper builds on Tierney’s 1998 address to the annual RCN International Nursing Research Conference. It explores criteria for excellence in nursing and midwifery research, differentiating this from ‘cutting edge’ and ‘international’ descriptors. Members of an expert panel were asked to give ideas on how to create excellence and to provide examples of such work, and on how to develop leaders in research. Their inspiration is presented here. The last section of the paper examines the creation of research teams within the current financial strictures.