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Purposive Sample (purposive + sample)
Selected AbstractsSelf-esteem and student nurses: A cross-cultural study of nursing students in Thailand and the UKNURSING & HEALTH SCIENCES, Issue 1-2 2002Siriphan Sasat PhD Abstract Self-esteem is a key feature in a person's perception of their own worth. This report is of a study of the reported self-esteem levels of two groups of student nurses: one in Thailand and one in the UK. Purposive samples of 120 Thai students and 101 UK undergraduate nursing students were given the Culture-Free Self-Esteem Inventory (CFSEI-2). The CFSEI-2 is a self-reported inventory, which measures an individual's perception of self. The findings of the study indicate that the perceptions of own self-esteem in undergraduate student nurses in the UK and in Thailand were comparable to the normal ranges of self-esteem as assessed by the instrument. An independent sample t -test revealed that there were no significant differences in mean overall and subscale self-esteem scores between UK and Thai nursing students. There were no indications of differences in levels of self-esteem for UK and Thai nursing students experiencing different parts of their training. [source] Constructions of competence within dietetics: Trust, professionalism and communications with individual clientsNUTRITION & DIETETICS, Issue 2 2009Robyn CANT Abstract Aim:, Issues of trust are important factors that affect communication in professional,client relationships. This paper aims to explore trust in communication from the viewpoint of both clients (the truster) and dietitians. Methods:, The qualitative research techniques were based on grounded theory. Purposive samples of 46 dietitians and 34 of their adult outpatients were drawn from health services (hospitals, community services and private clinics) in one state of Australia. Clients from eight centres were aged from 21 to 80+ years. Audio-recorded in-depth interviews and focus groups were used to gather data. Transcribed narratives were open-coded and examined for deviant cases. Themes identified in dietitian and client data sets describing clients' trust were compared. Results:, The themes identified confirmed a typology of trust (from the perspective of the truster) present in the health care literature. Clients' trust was derived from institutional context or reputation. Interpersonal trust perceived in verbal and non-verbal communications with a dietitian were in evidence. Dietitians' value attributes of integrity and respect were identified as traits that help build trust and demonstrate dietitians' professionalism. The findings were built into a concept model of trust. Conclusions:, Behaviours shown that convey a sense of acceptance, understanding and individual management may lead to positive communication, and hence help build a client's trust in a professional. The link between trust, performance and dietetics clients' outcomes should be investigated further. [source] Near patient testing for glycated haemoglobin in people with Type 2 diabetes mellitus managed in primary care: acceptability and satisfactionDIABETIC MEDICINE, Issue 7 2007M. A. Stone Abstract Aims To assess the acceptability of and satisfaction with near patient testing for glycated haemoglobin in primary care in patients and health professionals. Methods A questionnaire survey and qualitative study were nested within a randomized controlled trial conducted in eight general practices in Leicester-shire, UK. Satisfaction with diabetes care was compared in the intervention group (near patient test) and in the control subjects (usual laboratory test), using the Diabetes Clinic Satisfaction Questionnaire. Semistructured interviews were conducted with a purposive sample of patients and healthcare professionals and analysed using thematic coding and framework charting. Results Questionnaire data for 344 patients were analysed and interviews were conducted with 15 patients and 11 health professionals. Interviews indicated that the near patient test was highly acceptable to patients and staff and confirmed that there may be potential benefits such as time saving, reduced anxiety and impact on patient management and job satisfaction. However, both the survey and the interviews identified high pre-existing levels of satisfaction with diabetes care in both intervention and control group patients and survey results failed to confirm increased patient satisfaction as a result of rapid testing. Limited patient understanding of glycated haemoglobin testing was noted. Conclusions We were unable to confirm actual rather than potential advantages of the near patient test. Widespread adoption in primary care cannot be recommended without further evidence of benefit. [source] Towards an understanding of the high death rate among young people with diabetes in UkraineDIABETIC MEDICINE, Issue 1 2001M. Telishevka SUMMARY Aims Published rates of deaths attributed to diabetes mellitus among those aged under 50 have risen substantially in several former Soviet republics since the late 1980s. The reasons for this increase, and the situation facing patients with diabetes in these countries are poorly understood. The aim of this study was to describe the circumstances leading up to the death of individuals dying under the age of 50 years with mention of diabetes on their death certificate. Methods Interviews with surviving relatives or neighbours, combining elements of verbal autopsy and confidential enquiry. For those who had lived in the city of Lviv a random sample was taken. For those in rural areas a purposive sample was used to ensure coverage of more and less remote areas. Results Key informants were identified and agreed to be interviewed for 64 individuals out of a possible 79 with insulin-treated diabetes identified from their death certificates. The main immediate causes of death were renal failure (69%), ischaemic heart disease (9%), ketoacidosis (6%) and hypoglycaemia (3%). Over a third of men, but no women, were reported to have been heavy drinkers. Informants described many difficulties in obtaining regular supplies of insulin and related supplies since 1990. Although insulin is officially available free of charge, most had retained supplies for use in an emergency. More than half had, at some time, purchased supplies. The large number of deaths from renal failure reflects the effective absence of renal replacement therapy for patients with diabetes. Conclusions Individuals with diabetes in Ukraine face profound challenges involving access to necessary care. Their needs require significantly more attention from policy makers. [source] Areca nut dependence among chewers in a South Indian community who do not also use tobaccoADDICTION, Issue 7 2010Shrihari J. S. Bhat ABSTRACT Aims Previously reported research suggests a dependence syndrome for areca nut use, though well-designed studies are virtually non-existent. The goal of this study was to examine evidence of areca dependence in a sample of areca-only (i.e. no tobacco) chewers using modified measurement scales. Design A purposive sample of chewers, identified via local informants and advertisements, was surveyed from January to March of 2005. Setting Six villages in Dakshina Kannada District, Karnataka State, India. Participants Fifty-nine daily areca chewers who do not also currently use any form of tobacco. Measurements Questionnaires included modified versions of the Fagerström Tolerance Questionnaire, Cigarette Dependence Scale (CDS-5) and the Smokeless Tobacco Dependence Scale (STDS). Additional questions assessed demographic characteristics and patterns of use. Findings Approximately half of respondents reported 1,3 chews/day (mean = 1.9; SD = 0.98). The average number of chewing episodes/day was 4.4 (SD = 3.4) and the average number of nuts/day was 1.2 (SD = 1.1). Users' typical chew lasts up to 20 minutes and includes spitting out the juices and rinsing the mouth with water. Overall, the levels of reported dependence symptoms were quite low, but approximately 44% of chewers endorsed at least one of the following items: continued use despite illness or mouth wounds, difficulty refraining from chewing in forbidden places, or craving during periods of abstinence. Approximately 15.4% of chewers reported at least one intentional quit attempt and a subset had summary scores indicative of dependence (13.6% had scores >16 on the CDS-5 and 5.3% had scores >11 on the STDS). Dependence scores were positively correlated with frequency of chews/day. Conclusions The symptoms of dependence observed in a subset of areca-only chewers warrant further investigation. Next steps should include well-controlled laboratory evaluation of dependence features. [source] Assessing the impact of late treatment effects in cervical cancer: an exploratory study of women's sexualityEUROPEAN JOURNAL OF CANCER CARE, Issue 4 2007M. BURNS rn, m.phil, professional development nurse Cancer survivorship has become a major issue due to people living longer with the effects of cancer treatment. A key issue in this area are the ,iatrogenic effects' of cancer treatments and their adverse impact on the quality of long-term patient survival. This paper considers the late physical effects of treatment for cervical cancer, in particular psychosocial problems associated with sexuality. The aim of this paper was to explore women's sexuality following treatment for cervical cancer. A qualitative phenomenological design was used to explore the lived experiences of a purposive sample of 13 women 2,3 years after treatment, using in-depth interviewing. The findings demonstrate that cancer treatment can result in a number of late physical effects, including bladder and bowel dysfunction. Moreover, the physical problems led to sexual difficulties experienced several years after treatment. Concerns were expressed by patients about perceived psychosexual difficulties encountered as a result of treatment. In conclusion, the study raises issues associated with the management of late treatment effects and its impact on sexuality. The findings underline the need for effective communication of possible iatrogenic effects of treatment during follow-up care and a need for research to consider the advice and information that women require about long-term treatment effects. [source] Envisioning Fatherhood: A Social Psychological Perspective on Young Men without Kids,FAMILY RELATIONS, Issue 2 2000William Marsiglio Using in-depth interviews and a purposive sample of 32 men ages 16,30 who have not yet fathered a child, our grounded theory study examined how men envision aspects of fatherhood. Informed by symbolic interactionist and life course perspectives, our interpretive data analyses yielded two interrelated substantive dimensions: fatherhood readiness and fathering visions. We introduce five interrelated theoretical themes to sharpen our understanding of these dimensions, and discuss how these dimensions and themes inform interventions aimed at heightening young men's procreative responsibility. [source] Developing indicators for measuring Research Capacity Development in primary care organizations: a consensus approach using a nominal group techniqueHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 3 2009Gill Sarre LCST Abstract Research Capacity Development (RCD) in the National Health Service supports the production of evidence for decision-making in policy and practice. This study aimed to establish a level of consensus on a range of indicators to measure research capacity in primary care organizations. Indicators were developed in a two-stage process using workshops and modified nominal group technique. In 2005, workshops were used to generate possible indicators from a wide range of research active and research-interested people. A theoretical framework of six principles of RCD was used to explore and identify indicators. Data were thematically coded, and a 129-item, 9-point Likert scale questionnaire was developed. A purposive sample of nine experts in developing research capacity in primary care agreed to take part in a nominal group in April 2006. The questionnaire was circulated prior to the meeting, and analysis of the responses formed the basis for structured discussion. Participants were then asked to rescore the questionnaire. Only seven participants were able to take part in the discussion and rescore stages. Data were analysed in two ways: level of relevance attributed to each indicator as a measure of organizational RCD, represented by median responses (medians of 7,9 defined strong support, 4,6 indicated moderate support and 1,3 indicated weak support), and level of consensus reached by the group. Consensus was reached if 85% of the group rated an indicator within the same band. Eighty-nine (68%) indicators were ranked as strongly relevant, and for seventy-three of these indicators, a consensus was reached. The study was successful in generating a set of agreed indicators considered relevant for measuring RCD in primary care organizations. These will form the basis of a pilot tool kit to assist primary care organizations to develop research capacity. Further work will explore the applicability of the indicators in practice. [source] The impact of managed competition on diversity, innovation and creativity in the delivery of home-care servicesHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2008Glen E. Randall PhDArticle first published online: 28 JUN 200 Abstract Reforming publicly funded healthcare systems by introducing elements of competition, often by allowing for-profit providers to compete with not-for-profit providers, is a strategy that has become commonplace in Western democracies. It is widely thought that the competitive forces of the marketplace will lead to greater efficiency, diversity and even innovation in the delivery of services. Between 1997 and 2000, a model of ,managed competition' was introduced as a major reform to the delivery of home-care services in Ontario, Canada. It was expected that by allowing greater competition within the home-care sector, this model would constrain costs and encourage provider agencies to become more innovative and creative in meeting service delivery needs. The purpose of this case study is to explore the impact of the managed competition reform on the for-profit and the not-for-profit organisations that provided rehabilitation home-care services, and, more specifically, to assess the extent to which the goal of greater diversity, innovation and creativity was achieved following implementation of the reform. A purposive sample of 49 key informants were selected for in-depth interviews, and a survey of the 36 organisations that provided rehabilitation home-care services and the 43 community care access centres that purchased services from these provider agencies was conducted. Data were collected between November 2002 and May 2003. Findings demonstrate that a combination of coercive, mimetic and normative isomorphic pressures have constrained diversity, innovation and creativity within the home-care sector. The implication is that the features that have traditionally distinguished for-profit and not-for-profit provider agencies from each other are rapidly disappearing, and a new hybrid organisational structure is evolving. [source] Lesbian, gay, bisexual and transgender young people's experiences of distress: resilience, ambivalence and self-destructive behaviourHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 3 2008Jonathan Scourfield BA MA DipSW PhD Abstract The research presented in this paper set out to explore the cultural context of youth suicide and more specifically any connections between sexual identity and self-destructive behaviour, in the light of international evidence about the disproportionate risk of suicidal thoughts and suicide attempts in lesbian, gay, bisexual and transgender (LGBT) young people. The empirical basis for the paper is qualitative research that was carried out in the North West of England and South Wales. Focus groups and interviews were conducted with a total of 69 young people, with a purposive sample to reflect diversity of sexual identity, social class and regional and rural-urban location. The paper presents a thematic analysis of the data specifically relating to the experiences of LGBT young people. A range of strategies that LGBT young people employ in the face of distress are described. These are categorised as resilience, ambivalence and self-destructive behaviour (including self-harm and suicide). The potential implications for health and social care of these strategies include the need for ecological approaches and for sexual cultural competence in practitioners, as well as prioritisation of LGBT risk within suicide prevention policies. [source] The interface of mental and emotional health and pregnancy in urban indigenous women: Research in progress,INFANT MENTAL HEALTH JOURNAL, Issue 3 2010Barbara A. Hayes Research among indigenous women in Australia has shown that a number of lifestyle factors are associated with poor obstetric outcomes; however, little evidence appears in the literature about the role of social stressors and mental health among indigenous women. The not-for-profit organization beyondblue established a "Depression Initiative" in Australia. As part of this they provided funding to the Townsville Aboriginal and Torres Strait Islander Health Service in the "Mums and Babies" clinic. The aim of this was to establish a project to (a) describe the mental health and level of social stressors among antenatal indigenous women and (b) assess the impact of social stressors and mental health on perinatal outcome. A purposive sample of 92 indigenous women was carried out. Culturally appropriate research instruments were developed through consultations with indigenous women's reference groups. The participants reported a range of psychosocial stressors during the pregnancy or within the last 12 months. Significant, positive correlations emerged between the participants' Edinburgh Postnatal Depression Scale (EPDS; J. Cox, J. Holden, & R. Sagovsky, 1987) score and the mothers' history of child abuse and a history of exposure to domestic violence. A more conservative cutoff point for the EPDS (>9 vs. >12) led to 28 versus 17% of women being identified as "at risk" for depression. Maternal depression and stress during pregnancy and early parenthood are now recognized as having multiple negative sequelae for the fetus and infant, especially in early brain development and self-regulation of stress and emotions. Because of the cumulative cultural losses experienced by Australian indigenous women, there is a reduced buffer to psychosocial stressors during pregnancy; thus, it is important for health professionals to monitor the women's emotional and mental well-being. [source] Ease of reading of mandatory information on Canadian food product labelsINTERNATIONAL JOURNAL OF CONSUMER STUDIES, Issue 4 2009Mary Alton Mackey Abstract Food product labels present individual product information, safety, nutrition, electronic inventory, container and environmental information, in various formats, languages and images. Some information is mandatory; much is promotional. The food label is an essential tool for regulators of safe food handling, nutrition policy and fair competition. Mandatory information on food labels in Canada is required to be presented in both English and French, readily discernable, prominently displayed and legible. This study examines the ease of finding and reading of mandatory label components on selected Canadian food products. A validated typographical scoring system assessed the lists of ingredients on a purposive sample of 100 food labels representing foods in all groups in Canada's Food Guide. Seven percent of the ingredient lists were easy to read; 26% were difficult to read and 67% were very difficult to read. Well-educated resourceful readers in consumer focus groups examined food labels for key elements that influence ease of finding and reading information. Focus groups and typographical scoring identified: colour contrast, case, print style, print size, space between the lines, reverse print, organization, justification, type of surface, hyphenation and print reproduction as factors that affect ease of reading. Print that curves around a container, lack of paragraphing or point form organization make reading difficult; text blocks at right angles to each other make comparisons difficult; separation of the nutrition facts table from the list of ingredients makes decision making tedious. Inadequate spacing between lines of print creates problems for readers of English and exacerbates problems for readers of French. Words placed over illustrations, busy backgrounds or watermarks increase reading difficulty. Hazard statements, instructions and storage information imbedded in other information without added space or appropriate heading is difficult to find and read. Canadian consumers echo consumers in 28 European countries who find label information difficult to find and to read and want clear guidelines/regulations on the placement and the typography of mandatory food label components [source] NANDA and NIC: Mediators to Describe Irish Intellectual Disability NursingINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2003Fintan Sheerin PURPOSE To identify the foci of interest specific to nursing interventions within residential, intellectual disability nursing through the use of the terms and meanings presented in NANDA and NIC. METHODS Data were collected using a Delphi approach involving a purposive sample of 8 individuals with relevant expertise, followed up by the conduct of three focus groups held with a total sample of 17 intellectual disability nurses working in three Irish service settings: traditional residential, community residential, and nurse education. Data were examined for contextual meaning as well as consensus of perceptions. FINDINGS Many potential interventions and diagnoses were identified for the field of residential learning disability nursing. Interventions that elicited a >50% consensus among participants across groups were examined for contextual meaning, based on the taped and noted responses, and potentially related NIC interventional labels were then applied. These led, through a reverse NIC-NANDA linkage exercise, to the identification of 8 potentially related interventions. The contextual aspect directed the analysis process to identify the nursing diagnoses associated with the interventions to be used, and 21 resultant diagnoses were identified. DISCUSSION Further analysis and study are needed to verify the relevance of these diagnoses and interventions to residential learning disability. A quick comparison of the results with those of studies carried out in other countries demonstrates that certain diagnoses have been identified by one or more authors in their studies. CONCLUSIONS This study identified a number of foci that have achieved various levels of consensus among the study participants. The ongoing study plan will further examine nurses' and managers' perceptions while also looking at these within the context of current service philosophy. [source] Students' ideals for nursing older people in practiceINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 2 2006Erica S. Alabaster MSc Aim., Drawing on research exploring nursing students' experiences of working with older people, this paper aims to demonstrate how context and culture can impact on the realization of their ideals. Background., The principles underpinning individualized and person-centred approaches to care resonate with those focal to gerontologic nursing. Restrictive contexts of care and pervasive workplace cultures render nurses unable to deliver care in accord with these. Design and method., This interpretive study was informed by phenomenological,hermeneutic theory. A purposive sample (n = 10) was recruited from a single educational institution. Data were generated in two phases using loosely structured interviews and supplementary activity. Themes explicating their experiences were identified via systematized detailed analysis and issues pertaining to nursing students' orientation towards older people cut across these. Findings and discussion., Students perceived that older people were prone to depersonalization and marginalization, so sought to show respect by coming to know individuals, form human connections with them and personalize care accordingly. Giving respect, promoting personhood, asserting reciprocal identity and maintaining dignity were prominent features of this but were often frustrated by practices and cultures encountered in mainstream settings. Conclusions., Nursing students' approaches to older people are contextual and reflect elements of person-centred ideology. Their attempts upholding their ideals are liable to be subverted by workplace norms. Preparatory education should address these, assist students to learn how to attend to personhood in restrictive environments and offer targeted placements in age-specific and non-acute services. Relevance to clinical practice., Demographic trends mean that working with older people has increased significance for nurses in most settings. Person-centredness is seen as beneficial for older people but contemporary service imperatives and enduring practices are inhibitory, preventing entrants to nursing from developing related skills. [source] Promoting breast health: older women's perceptions of an innovative intervention to enhance screeningINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 2 2006Robin Y. Wood EdD Aims and objectives., This study is a continuation of prior funded research in which we tested the use of age and ethnically sensitive video breast health kits to increase knowledge about breast cancer and enhance the screening practices of breast self-examination and mammography among older Caucasian and African-American women. Background., Breast cancer is the most frequent cancer in women worldwide and accounts for 23% of all cancers. Mammography is currently the best procedure available for mass screening of breast cancer. However, underutilization of mammography is a problem among older women in the United States. Elders are at the greatest risk for developing and dying from breast cancer but they are the least likely group to be screened routinely with mammograms or to practice breast self-examination, particularly if they are African-American. Design., Participatory qualitative evaluation focus groups were used to assess the overall impact of the video kit intervention programme and to elucidate the quantitative findings of the original study. Methods., Four focus groups were conducted in two diverse settings with a purposive sample of 23 participants (N = 23). The overall sample was predominantly African-American (87%) with mean age of 71 ± 7.9 years and mean education completed of 12 ± 3.4 years. Results., Five major themes emerged from group discussions: usability and appeal of the intervention, fear and empowerment, personal relevance and intergenerational sharing, impact on screening behaviours, and story telling. Conclusions., Analyses suggest that customized media materials constructed especially for older African-American women empowered participants in this sample to action regarding their own breast health. Relevance to clinical practice., These findings may translate to global populations where risk is increasing but screening programmes are not widely available. Given that older women are historically difficult to access and impact, further design and evaluation of innovative and sensitive educational programmes such as the one described here are recommended. [source] Seen but not heard: a systematic review of the place of the child in 21st-century dental researchINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 5 2007ZOE MARSHMAN Background., The position of children in society has changed with increasing emphasis on children's rights and child-centred services. This study aimed to describe the extent to which contemporary oral health research has been conducted with or on children. Design., A systematic review of the child dental literature from 2000,2005 was conducted. A purposive sample was used to develop categories describing the level of involvement of children in research. Four main categories were developed: children as the objects of research, proxies used on behalf of children, children as the subjects of research with some involvement and children as active participants with their perspectives explored. Electronic databases were searched and exclusion criteria applied. Each of the resulting papers was examined and categorised. The frequency distribution in each category and the distribution of these categories according to subject were calculated. Results., The search revealed 3266 papers after application of the exclusion criteria. Of these, 87.1% were categorised as research where children were used as objects, 5.7% were found to involve proxies (parents or clinicians), 7.0% involved children to some extent and 0.3% involved children actively. Conclusion., Most oral health research is conducted on children, in future research should strive to be conducted with children, involving them as fully as possible. [source] Managing independent prescribing: the influence of primary care trusts on community nurse prescribingINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 3 2004Mr. Jason Hall Clinical teaching fellow Background Community nurses have been prescribing in the United Kingdom from the Nurse Prescribers' Formulary (NPF) since 1994. Most prescribing for the items included in the NPF is still carried out by general practitioners, although the proportion attributed to nurses is increasing. Objective To describe the methods that primary care trusts (PCTs) have used to influence the prescribing practices of community nurses and to explore the views of nurse prescribers regarding these methods. Method Semi-structured interviews with a purposive sample of 22 community nurse prescribers and five PCT prescribing leads. The transcripts were analysed using the framework method. Key findings PCTs used formularies and guidelines, education and training, individual prescriber feedback and directives to varying degrees to influence nurse prescribing. Some nurse prescribers considered formularies and guidelines to be restrictive. There were few instances of feedback or training being given to prescribers following their initial training as a prescriber, despite a majority wishing to receive both of these. Directives were used to restrict prescribing in a limited number of specific areas. Conclusion Influencing nurse prescribing did not appear to be a priority for PCTs despite this being part of the National Health Service's clinical governance agenda. PCTs will need to engage with nurse prescribers to determine ways to influence prescribing that are in the best interests of patients, nurses, doctors and the Trust. [source] Professional competence: factors described by nurses as influencing their developmentINTERNATIONAL NURSING REVIEW, Issue 1 2006R. Tabari Khomeiran bs mscn phd Aim:, To discuss the results of a study that explored factors that may influence competence development. Background:, Competence, a controversial issue in health care settings, affects many aspects of the nursing profession, including education, practice and management. Although a number of research and discussion papers have explored the issue, in particular the meaning and assessment of nursing competence, to date little research has explored factors identified by nurses themselves as influencing their development of professional competence. Methods:, A purposive sample of 27 registered nurses was recruited from two university-affiliated hospitals. Data collection was by tape-recorded semi-structured interviews. Interviews were transcribed verbatim and analysed according to the qualitative methodology of content analysis. Findings:, Six descriptive categories were identified from the data: experience, opportunities, environment, personal characteristics, motivation and theoretical knowledge. Conclusions:, The findings suggest that the factors influencing the process of developing professional competence in nursing extend across personal and extra-personal domains. An understanding of these factors may enhance the ability of nursing managers and educators to enable student and qualified nurses to pursue effective competency development pathways to prepare them to provide a high standard of care. These findings, which may have important implications for nursing practice, management and education, are being further tested in a larger study. [source] Receiving power through confirmation: the meaning of close relatives for people who have been critically illJOURNAL OF ADVANCED NURSING, Issue 6 2007Åsa Engström Abstract Title.,Receiving power through confirmation: the meaning of close relatives for people who have been critically ill Aim., This paper is a report of a study to elucidate the meaning of close relatives for people who have been critically ill and received care in an intensive care unit. Background., Falling critically ill can bring about a difficult change in life. In previous reports such events are described as frightening experiences, and close relatives are described as an important source of support in this difficult situation. Method., A purposive sample of 10 adults, eight men and two women, narrated how they experienced their close relatives during and after the time they were critically ill. The data were collected in 2004. The interview texts were transcribed and interpreted using a phenomenological hermeneutic approach influenced by the philosophy of Ricoeur. Findings., One major theme was identified, experiencing confirmation, with six sub-themes: receiving explanations; a feeling of being understood; a feeling of safety; gaining strength and will-power; having possibilities and realizing their value. Close relatives served as tools for the person who was ill, facilitating better communication and an increased ability to do various things. Simultaneously, feelings of dependence on the close relatives were expressed. There were descriptions of loneliness and fear in the absence of close relatives and, in order to feel safe, the participants wanted their close relatives to stay near them. Conclusion., Close relatives are vital, as they are the ill person's motivation to stay alive and to continue the struggle. Their presence is of great importance for the ill person and must be facilitated by staff. [source] The conceptual structure of transition to motherhood in the neonatal intensive care unitJOURNAL OF ADVANCED NURSING, Issue 1 2007Hyunjeong Shin Abstract Title. The conceptual structure of transition to motherhood in the neonatal intensive care unit Aim., This paper is a report of a concept analysis of transition to motherhood for mothers with infants in a neonatal intensive care unit. Background., Mothers with infants in a neonatal intensive care unit have more difficulty in their transition to motherhood compared with mothers of healthy infants. The concept of transition to motherhood in the neonatal intensive care unit is not well-understood in nursing, often being confused with mothers' psychological responses in the neonatal intensive care unit. Methods., The concept analysis combined Rodgers' evolutionary method with Schwartz-Barcott & Kim's Hybrid method. Thirty-eight studies were reviewed and a purposive sample of 10 Korean mothers with infants in a neonatal intensive care unit was interviewed. Findings., Three critical attributes of transition to motherhood in the neonatal intensive care unit were identified: (1) time-dependent process, (2) psycho-emotional swirling and (3) hovering around the edge of mothering. These are caused by the antecedents (1) unexpected outcome of pregnancy, (2) awareness of the situation and (3) mother,infant separation. The consequences were: (1) delayed motherhood and (2) developing a sense of meaning concerning family and life. Additionally, five influencing factors to be alleviated were identified: (1) negative meaning attribution, (2) uncertainty, (3) social prejudice, (4) lack of opportunities to make contact with the infant and (5) the neonatal intensive care unit environment. Conclusions., This concept analysis should help nurses to understand the process of becoming a mother in a neonatal intensive care unit and plan appropriate interventions for mothers with special needs. [source] Evaluating STORM skills training for managing people at risk of suicideJOURNAL OF ADVANCED NURSING, Issue 6 2006Linda Gask MSc PhD FRCPsych Aim., This paper reports a study evaluating the Skills Training On Risk Management (STORM) training initiative in three mental health services in the North-West of England, UK. Background., Training for health workers has been widely advocated as a key route to suicide prevention. However, reports of evaluations are scarce in the literature. In previous research, we have demonstrated that the STORM intervention results in acquisition of new skills and can be disseminated in a community setting. Method., The training was delivered during a 6-month period in 2002 by three mental health nurses who were seconded part-time to the project. The quantitative evaluation, which assessed change in attitudes, confidence, acquisition of skills and satisfaction, used a pretest/post-test design, with participants acting as their own controls. Qualitative interviews were conducted with a purposive sample of 16 participants to explore the impact on clinical practice, and with the three trainers at the end of the study. Findings., Data from 458 staff members were collected during a 6-month period. Positive changes in attitudes and confidence were shown, but previous evidence of skill acquisition was not replicated. Qualitative interviews revealed important insights into changes in clinical practice, particularly for less experienced or unqualified nursing staff, but also concerns about the lack of an educational culture to foster and support such interventions in practice within the organizations. Conclusion., STORM training for the assessment and management of suicide risk is both feasible and acceptable in mental health trusts. However, we remain uncertain of its longer-term impact, given the lack of engagement of senior staff in the enterprise and the absence of linked supervision and support from the organizational management to reinforce skill acquisition and development. We consider that regular supervision that links STORM training to actual clinical experience would be the ideal. [source] Implementing bedside handover: strategies for change managementJOURNAL OF CLINICAL NURSING, Issue 17-18 2010Anne McMurray Aims and objectives., To identify factors influencing change in two hospitals that moved from taped and verbal nursing handover to bedside handover. Background., Bedside handover is based on patient-centred care, where patients participate in communicating relevant and timely information for care planning. Patient input reduces care fragmentation, miscommunication-related adverse events, readmissions, duplication of services and enhances satisfaction and continuity of care. Design., Analysing change management was a component of a study aimed at developing a standard operating protocol for bedside handover communication. The research was undertaken in two regional acute care hospitals in two different states of Australia. Method., Data collection included 532 semi-structured observations in six wards in the two hospitals and 34 in-depth interviews conducted with a purposive sample of nursing staff involved in the handovers. Observation and interview data were analysed separately then combined to generate thematic analysis of factors influencing the change process in the transition to bedside handover. Results and conclusion., Themes included embedding the change as part of the big picture, the need to link the project to standardisation initiatives, providing reassurance on safety and quality, smoothing out logistical difficulties and learning to listen. We conclude that change is more likely to be successful when it is part of a broader initiative such as a quality improvement strategy. Relevance to clinical practice., Nurses are generally supportive of quality improvement initiatives, particularly those aimed at standardising care. For successful implementation, change managers should be mindful of clinicians' attitudes, motivation and concerns and their need for reassurance when changing their practice. This is particularly important when change is dramatic, as in moving from verbal handover, conducted in the safety of the nursing office, to bedside handover where there is greater transparency and accountability for the accuracy and appropriateness of communication content and processes. [source] Perspectives on professional values among nurses in TaiwanJOURNAL OF CLINICAL NURSING, Issue 10 2009Fu-Jin Shih Aim., The purpose of this study was to identify the most important contemporary professional nursing values for nursing clinicians and educators in Taiwan. Background., Nursing values are constructed by members of political and social systems, including professional nursing organisations and educational institutions. Nurses' personal value systems shape the development of these professional values. An understanding of nurses' perceptions of professional values will enable the profession to examine consistencies with those reflected in existing and emerging educational and practice environments. Design., A qualitative descriptive study was conducted using the focus-group discussion method. Methods., A purposive sample of 300 registered nurses in Taiwan, consisting of 270 nursing clinicians and 30 faculty members, participated in 22 focus-group interviews. Data were analysed using a systematic process of content analysis. Results., Six prominent values related to professional nursing were identified: (a) caring for clients with a humanistic spirit; (b) providing professionally competent and holistic care; (c) fostering growth and discovering the meaning of life; (d) experiencing the ,give-and-take' of caring for others; (e) receiving fair compensation; and (f) raising the public's awareness of health promotion. Four background contexts framed the way participants viewed the appropriation of these values: (a) appraising nursing values through multiple perspectives; (b) acquiring nursing values through self-realisation; (c) recognising nursing values through professional competency and humanistic concerns and (d) fulfilling nursing values through coexisting self-actualisation. A conceptual framework was developed to represent this phenomenon. Conclusion., The most important professional nursing values according to the perspectives of nurses in Taiwan were identified. These values reflect benefits to society, to nurses themselves and to the interdisciplinary team. Relevance to clinical practice., Nurses' awareness of their own values and of how these values influence their behaviour is an essential component of humanistic nursing care. Nursing educators need to develop better strategies for reflection and integration of both personal and professional philosophies and values. [source] Managing infant feeding practices: the competing needs of bulimic mothers and their childrenJOURNAL OF CLINICAL NURSING, Issue 6 2009Helen Stapleton Aim., This paper seeks to explain how bulimic mothers accommodated infant feeding demands in conjunction with managing their disordered eating practices. Background., Eating disorders are chronic and disabling illnesses primarily affecting women. There are few qualitative studies describing bulimia in the context of motherhood. Design., The study employed an inductive qualitative approach. Methods., A purposive sample of childbearing women (n = 16), who self-defined as living with an eating disorder, were recruited. Data were generated from one-to-one interviews; a thematic analysis identified key issues. Results., Participants were primarily responsible for ensuring child/ren's socialisation processes, including modelling appropriate dietary behaviours and these demands often conflicted with their personal needs for food restraint. Pressures to participate in social activities with children were widely experienced as stressful especially when these events focused on food. Participants viewed early and repeated exposure to ,healthy' eating as protective against their children acquiring an eating disorder and in this respect commercial child-care facilities provided alternative environments for children to explore food-related activities. Conclusions., Participants employed a variety of strategies to ensure children's exposure to normalising influences and socialising processes. Concerns about personal competencies with respect to food preparation and storage were articulated by all participants. Relevance to clinical practice., Professionals involved with providing care to mothers and their infants are well placed to support bulimic clients and to foster confidence in their mothering skills. Early and appropriate intervention is key to effecting positive changes in bulimic patterns, with potential benefits to women's future health and well-being and that of their children. [source] A study of a training scheme for Macmillan nurses in Northern IrelandJOURNAL OF CLINICAL NURSING, Issue 2 2008BSocSc, Cert Ed., DipDN, Johnston Gail PhD Aim., To evaluate a one year training scheme for Macmillan Nurses. Background., The role of the clinical nurse specialist has evolved and expanded greatly over the past few years so that it now encompasses components far beyond the traditional nursing remit of direct clinical practice. While several studies have looked at the barriers and facilitators to this process for clinical nurse specialists in particular, none has looked at the benefits of a structured training scheme which involves both a theoretical and clinical component. Methods., Tape recorded, semi-structured interviews were undertaken with a purposive sample of trainees who undertook the scheme, their practice-based facilitators and another person(s) involved in the trainee's support Analysis., Tapes were transcribed verbatim and each transcript anonymized to prevent identification of participants. Data were analysed thematically using the main headings of expectations, experience and impact and the structured prompts from the aide-memoir within these headings. Results., Results showed that the majority of respondents felt the scheme had been successful with one of the main achievements being that trainees were perceived to be adequately prepared to take on the role of a CNS on completion of the scheme. While the Role Development Programme was thought to provide a good academic structure for the scheme some participants thought that more theory on symptom control and communication skills and a placement in a specialist palliative care centre should also be included. Conclusion., The Macmillan Trainee Scheme has succeeded in its objectives to facilitate the transition from generalist to specialist nursing. It should be extended to include an induction and consolidation period and more theoretical input on communication skills and symptom control. Relevance to clinical practice., With these improvements, the scheme could be used as a standard model for training specialist practitioners and a means to address the current issues of workforce planning. [source] The challenges for nurses communicating with and gaining valid consent from adults with intellectual disabilities within the accident and emergency care serviceJOURNAL OF CLINICAL NURSING, Issue 9 2007Margaret Sowney MSc Aim., This paper reports the challenges experienced by nurses within accident and emergency departments in communicating with and gaining valid consent from adults with intellectual disabilities. Background., Consent is both a legal requirement and an ethical principle required to be obtained by health-care professionals, prior to the start of any examination, treatment and/or care. Central to the process of seeking consent is effective communication. However, evidence shows that people with intellectual disabilities are not viewed by professionals within acute general hospitals as a vital source of information, neither are they often communicated with directly, nor involved in discussions or decisions about their health care and are frequently not directly asked for their consent. Method., A purposive sample of nurses working within the accident and emergency departments of five general hospitals was recruited to participate in this qualitative study. Data were collected from five focus groups. Findings., Effective communication was identified as the most challenging aspect in caring for adults with intellectual disabilities within this environment, having an impact on the assessment of needs, informing patients of their health status and seeking valid consent. Conclusions., Fundamental to the provision of quality care are the concepts communication, choice and control. However, these issues are perceived to be more challenging in the provision of health care to people with intellectual disabilities. Communication and consent, therefore, require further consideration within the educational and clinical areas to strengthen nurses' competence in caring for people with intellectual disabilities, with an emphasis and understanding that choice and control are key principles for all people, being central aspects to the provision of an inclusive service for people with intellectual disabilities. Relevance to clinical practice., All nurses need to have a greater awareness of learning disability, how to increase opportunities for effective communication and be very familiar with the issue and guidelines relating to consent, to ensure that people with learning disabilities have choice, control and are more active in decision making regarding their health. [source] Experience of Hong Kong patients awaiting kidney transplantation in mainland ChinaJOURNAL OF CLINICAL NURSING, Issue 11c 2007Sylvie SH Leung MN Aim., This paper describes the experience of Hong Kong Chinese patients awaiting kidney transplantation in mainland China. Background., While travelling to mainland China for kidney transplantation is a controversial issue, there is an increasing trend of Hong Kong Chinese patients with chronic kidney disease seeking this treatment choice, which outnumbers that performed in Hong Kong. Although these patients seek pre- and post-transplantation care from Hong Kong public healthcare system, little is known about their experience during the waiting period. Methods., This experience is examined in an exploratory qualitative study. In-depth interviews were used to collect data from a purposive sample of 12 kidney recipients. Results., Three major findings are identified: (i) transplant waiting patients may travel to mainland China for transplantation in search of normal life, (ii) they need informational support from their continuing healthcare providers in Hong Kong to make the informed decision and (iii) they perceive a variation of attitudes of nurses and doctors in Hong Kong towards transplantation in mainland China. Conclusions., This study contributes to the literature by researching patients' perspective. The findings highlight the importance and controversy of addressing these patients' informational needs. While the authors have no inclination for or against travelling to mainland China for transplantation, the findings reveal a tenacious clinical dilemma, which deserves debate in international transplant community and further research to inform the debate. Nurse and doctors in Hong Kong may contribute to the debate by articulating their experience of caring for these patients. Relevance to clinical practice., Health information that is readily available for patients scheduled for kidney transplantation in Hong Kong should be made accessible to the whole community of patients with chronic kidney disease. To address the complexity of patients travelling to elsewhere for transplantation and the needs of these patients, provider reticence may be counterproductive. [source] Lecturer practitioners in six professions: combining culturesJOURNAL OF CLINICAL NURSING, Issue 5 2004Pat Fairbrother BA Background., Whilst research has been undertaken in relation to the lecturer practitioner role in nursing, there have been no cross-professional studies. There is an explicit political agenda in the United Kingdom on interprofessional education and enhancing the status of those who provide practice-based teaching. Aim., This paper reports a study to investigate the commonalities and differences between lecturer practitioners across professions and to generate hypotheses about the role, which follows different models of practice in the different professions. Methods., An exploratory research design was adopted, using semi-structured interviews with a purposive sample of lecturer practitioners from six professions (architecture, clinical psychology, law, medicine, nursing and social work). A grounded theory approach was used. Findings., All lecturer practitioners perceived a clear dichotomy between their professional practice role and their university role. All used similar strategies to adapt to and deal with combining two very differently perceived cultures. There were striking similarities in response to the consequences of serving ,two masters' in the areas of time management and role identity/definition. Conclusions., The role not only bridges theory and practice, but has to operate within very different organizational cultures. Further research is needed to test the generalizability of the findings. Relevance to clinical practice., This investigation aims to inform higher education and health service policy on lecturer practitioners, and also provide support for those undertaking this challenging role. The study poses challenging questions for policymakers in the current climate of interprofessional learning, which need to be addressed if future initiatives in this area are to be successful. [source] Elders' needs and experiences of receiving formal and informal care for their activities of daily livingJOURNAL OF CLINICAL NURSING, Issue 3 2001Brenda Roe PhD, FRSH ,,Older people living in the community or institutional settings are more likely to require help with their activities of daily living, with women more likely than men to need some help. ,,The interviews in this qualitative study were conducted with a convenience and purposive sample of 20 elders living in Southeast Washington, USA, at home or in institutional settings, receiving informal or formal health care. ,,Findings related to personal and instrumental activities of daily living are reported and include elders' experiences and views relating to the help and assistance they receive. ,,The majority of elders needed help with their instrumental activities of daily living, provided by informal networks, whether living at home or in institutional settings. This help constituted social care. Formal health care with personal activities of daily living was required only by a minority of elders and constituted those with the greatest disability and dependency. [source] Patients' experiences of the impact of periodontal diseaseJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 4 2010Louise K. O'Dowd O'Dowd LK, Durham J, McCracken GI, Preshaw PM. Patients' experiences of the impact of periodontal disease. J Clin Periodontol 2010; 37: 334,339. doi: 10.1111/j.1600-051X.2010.01545.x. Abstract Aim: To examine critically patients' experiences of the impact of periodontal disease on their daily lives. Material and Methods: Semi-structured interviews of a purposive sample of patients with periodontal conditions were conducted using a flexible evolving topic guide. Data collection and analysis were an inductive, iterative process that occurred concurrently. The data were organized in a framework and recurrent themes identified. Interviews occurred until it was felt that no new themes or ideas were being expressed by respondents (n=14). Results: Effects of periodontal disease on patients' daily lives included impairment, functional limitation, discomfort and disability (including physical, psychosocial and social disability). A large number of the emergent themes from the analysis were relevant to the domains of Locker's conceptual model of oral health. The domain within Locker's model that had no data relevant to it in the context of periodontal disease was death. Two additional themes emerged that appeared unrelated to Locker's model, these were stigma and retrospective regret. Conclusion: Periodontal disease reportedly affects patients' lives in a negative manner in a variety of ways. This is of relevance in the management of patients with periodontitis. [source] | ||||||||||||||||||||||||||||