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Aim. The aim of the paper is (1) to offer an overview of different theoretical approaches to discourse analysis and (2) to review papers published in the Journal of Advanced Nursing from 1996–2004 in which discourse analysis is identified as a method of data analysis. Background. Discourse analysis offers rigorous approaches to analysing naturally occurring talk and texts. Forms of discourse analysis have developed across broad theoretical bases. Such development has created challenges for researchers wishing to adopt this methodology and readers wishing to evaluate the quality of discourse analytic work. Methods. First, key documents which describe the theoretical range of discourse analysis are used to provide (i) a comprehensive overview of the approach, (ii) the identification of categories of discourse analysis and (iii) minimum criteria for determining if an individual paper can realistically claim to be adopting discourse analysis. Secondly, an electronic search followed by hand search of the Journal of Advanced Nursing full- contents between 1996 and 2004 was undertaken. The papers were grouped into the types of approach identified in i, and evaluated to see whether they met the ‘minimum criteria’ also identified in i. Findings. The search of Journal of Advanced Nursing revealed 24 papers where the authors stated that discourse analysis was among the methods or was the sole method of data analysis. The majority of the papers cluster around critical approaches to discourse analysis. Only a few approach discourse analysis primarily as analysis of conversation. Some papers are excellent, while others offer analysis that bears little resemblance to any form of discourse analysis. Conclusions. A strategy for improvement could include more rigorous attention on the part of those practising discourse analysis to methodology and the key features that differentiate the different approaches to discourse analysis from other qualitative methods. Authors should include sufficient detail of their approach. [ABSTRACT FROM AUTHOR]

Williamson G.R. (2003) Journal of Advanced Nursing 44(3), 278–288 Misrepresenting random sampling? A systematic review of research papers in the Journal of Advanced Nursing This paper discusses the theoretical limitations of the use of random sampling and probability theory in the production of a significance level (or P-value) in nursing research. Potential alternatives, in the form of randomization tests, are proposed. Research papers in nursing, medicine and psychology frequently misrepresent their statistical findings, as the P-values reported assume random sampling. In this systematic review of studies published between January 1995 and June 2002 in the Journal of Advanced Nursing, 89 (68%) studies broke this assumption because they used convenience samples or entire populations. As a result, some of the findings may be questionable. The key ideas of random sampling and probability theory for statistical testing (for generating a P-value) are outlined. The result of a systematic review of research papers published in the Journal of Advanced Nursing is then presented, showing how frequently random sampling appears to have been misrepresented. Useful alternative techniques that might overcome these limitations are then discussed. This review is limited in scope because it is applied to one journal, and so the findings cannot be generalized to other nursing journals or to nursing research in general. However, it is possible that other nursing journals are also publishing research articles based on the misrepresentation of random sampling. The review is also limited because in several of the articles the sampling method was not completely clearly stated, and in this circumstance a judgment has been made as to the sampling method employed, based on the indications given by author(s). Quantitative researchers in nursing should be very careful that the statistical techniques they use are appropriate for the design and sampling methods of their studies. If the techniques they employ are not appropriate, they run the risk of misinterpreting findings by using inappropriate, unrepresentative and biased samples. [ABSTRACT FROM AUTHOR]

Nursing research in Spain: bibliometrics of references of research papers in the decade 1985–1994 Background. Spain is one of the few European countries to have recently totally incorporated the study of nursing into the university sector. Bibliometric studies may be of a great help for the consolidation of nursing research. Aim of the study. The aim of this paper is to describe bibliographic references in Spanish nursing research papers and their evolution over a decade. Method. The method consists of a retrospective bibliometric study of a sample (cluster sampling) of 622 research papers (original papers and review papers), which were contained in the Spanish nursing journals Enfermería Científica, Revista ROL de Enfermería, Enfermería Clínica and Enfermería Integral, and published from 1985 to 1994. The journal Nursing Research was selected for qualitative comparative purposes. A series of classic bibliometric indexes were used. Results. The mean of references per paper is 10·64 ± 10·42; this increased over time (P < 0·001). Review papers have more references (P < 0·001). Price index (percentage of references published during the last 5 years) is 44% and the Insularity (percentage of references published in same country as the article) is 55%. References to journals predominate (58·6%), with a growing tendency for references to Spanish nursing journals, although they are still scarce (18·1% of the references to journals). Spanish is the language of most of the references (60·3%), the second language being English (36·1%). Conclusions. Bibliographic references in Spanish nursing research papers are scarce and not very specific: this happens both in regard to Nursing Research and to publications in other national and international science areas. However, there is an increasing tendency of references (including references to nursing journals) in the period analysed. The age of the... [ABSTRACT FROM AUTHOR]

The article introduces a series of articles on nursing and midwifery, which appeared in the 30th anniversary issue of the "Journal of Advanced Nursing."

Holism is claimed to be the signifying feature that sets women s health apart from traditional approaches to health care. As such, articles published in the nursing literature about women s health would, one might expect, reflect the centrality of holism to women s health care nursing. The findings of a study which examined the content and the focus of articles published about women s health in journals indexed by CINAHL in the period 1993 1995 challenge this assumption. It was found that women s health is a taken-for-granted notion and is used interchangeably and synonymously to refer to reproductive health, maternal health, neonatal health, family health and (hetero)sexual health. Confounding the view that holism is foundational to a women s health perspective, the papers forming the study s sample largely depict issues to do with women s health from a narrow and stereotypical perspective and with a bio-medical focus. Women were referred to as fragmented bodies, body parts and diseases, and were depicted as being passive and silent. By contrast, the voice (and the activity) of nurses and nursing s imperative to intervene was clearly discernible. [ABSTRACT FROM AUTHOR]

AIM: The aim of this paper is to report a study to determine the effects of absorbent pads on the pressure-relieving properties of 'standard' and pressure management mattresses. BACKGROUND: Pressure ulcers and incontinence often co-exist. There is a strong association between poor mobility and continence problems and patients using pressure management products are therefore also likely to be using absorbent pads. METHODS: An instrumented articulated anthropometric phantom with simulated soft body 'tissues' in the gluteal and sacral areas was used as the 'subject'. The phantom was raised and lowered on to three mattresses (standard foam, visco-elastic foam and surface-cut foam) in three states: naked, wearing a dry pad (Tena Super, SCA Hygiene AB) and wearing a wet pad. The pressure mapping device Xsensor was used to record the distribution of pressure over the sacral and ischial areas of the phantom. Peak pressure was used as the primary outcome variable and 10 repeats were made on each mattress under each condition. RESULTS: There were substantial and significant differences for all three mattresses in recorded peak pressures between the naked buttocks and the buttocks wearing a dry pad. There were no significant differences between measurements made using the dry vs. wet pad. Peak pressures frequently occurred over areas of pad folds. Additional testing showed that pads that were 'smoothed' by hand had significantly lower peak pressures than 'unsmoothed' pads. CONCLUSIONS: Absorbent pads have a substantial adverse effect on the pressure redistribution properties of mattresses. Pad folds appear to contribute to this effect, which can be ameliorated slightly by smoothing. Absorbent pad manufacturers should consider engineering pads that minimize disruption to pressure management. Further examination of continence and pressure management products is necessary to establish optimum combinations for nursing care. [ABSTRACT FROM AUTHOR]

Background. The scientific community views the publication of academic papers as a means of disseminating information, ensuring transparency and good practice in terms of research utilization. However, the choice of journal in which to publish is frequently influenced by other, less obvious, factors. This paper describes the lengthy route taken to get a methodological paper about pilot studies into print. Aim and method. This paper shares some of our experiences and discusses the lessons that we learned about the process of getting into print. A case study approach is adopted to help the reader understand the different influences on this process. Findings. Our methodological paper was submitted to six different academic journals before it was finally accepted for publication. The choice of journal was influenced by the need to reach an appropriate academic audience, the estimated turn around time (the time taken between submission of a paper and its subsequent publication) and the level of academic credibility of the journal (often assessed by the journal's Impact Factor). Publishing in 'high impact' academic journals assumed considerable importance for us in view of the UK Research Assessment Exercise (RAE). However, the consequence of going down the journal status hierarchy was that we lost about 1 year through submitting, rewriting according to each of the journal's specific requirements and resubmitting. The case study also demonstrates that getting into print often depends on a range of factors, not just the quality of the written text. Conclusions. Getting a paper published may depend not only on the intrinsic quality of the paper, but also whether it is submitted to the 'right' academic journal. Moreover, if journals do not take certain papers (e.g. ones with negative findings or those reporting multi-disciplinary studies) then this can lead to publication bias. [ABSTRACT FROM AUTHOR]

Aim. The aim of the paper is (1) to offer an overview of different theoretical approaches to discourse analysis and (2) to review papers published in the Journal of Advanced Nursing from 1996-2004 in which discourse analysis is identified as a method of data analysis. Background. Discourse analysis offers rigorous approaches to analysing naturally occurring talk and texts. Forms of discourse analysis have developed across broad theoretical bases. Such development has created challenges for researchers wishing to adopt this methodology and readers wishing to evaluate the quality of discourse analytic work. Methods. First, key documents which describe the theoretical range of discourse analysis are used to provide (i) a comprehensive overview of the approach, (ii) the identification of categories of discourse analysis and (iii) minimum criteria for determining if an individual paper can realistically claim to be adopting discourse analysis. Secondly, an electronic search followed by hand search of the Journal of Advanced Nursing full- contents between 1996 and 2004 was undertaken. The papers were grouped into the types of approach identified in i, and evaluated to see whether they met the 'minimum criteria' also identified in i. Findings. The search of Journal of Advanced Nursing revealed 24 papers where the authors stated that discourse analysis was among the methods or was the sole method of data analysis. The majority of the papers cluster around critical approaches to discourse analysis. Only a few approach discourse analysis primarily as analysis of conversation. Some papers are excellent, while others offer analysis that bears little resemblance to any form of discourse analysis. Conclusions. A strategy for improvement could include more rigorous attention on the part of those practising discourse analysis to methodology and the key features that differentiate the different approaches to discourse analysis from other qualitative methods. Authors should include sufficient detail of their approach. [ABSTRACT FROM AUTHOR]

Aim. This paper discusses the theoretical limitations of the use of random sampling and probability theory in the production of a significance level (or P-value) in nursing research. Potential alternatives, in the form of randomization tests, are proposed.Background. Research papers in nursing, medicine and psychology frequently misrepresent their statistical findings, as the P-values reported assume random sampling. In this systematic review of studies published between January 1995 and June 2002 in the Journal of Advanced Nursing, 89 (68%) studies broke this assumption because they used convenience samples or entire populations. As a result, some of the findings may be questionable.Discussion. The key ideas of random sampling and probability theory for statistical testing (for generating a P-value) are outlined. The result of a systematic review of research papers published in the Journal of Advanced Nursing is then presented, showing how frequently random sampling appears to have been misrepresented. Useful alternative techniques that might overcome these limitations are then discussed.Review limitations. This review is limited in scope because it is applied to one journal, and so the findings cannot be generalized to other nursing journals or to nursing research in general. However, it is possible that other nursing journals are also publishing research articles based on the misrepresentation of random sampling. The review is also limited because in several of the articles the sampling method was not completely clearly stated, and in this circumstance a judgment has been made as to the sampling method employed, based on the indications given by author(s).Conclusion. Quantitative researchers in nursing should be very careful that the statistical techniques they use are appropriate for the design and sampling methods of their studies. If the techniques they employ are not appropriate, they run the risk of misinterpreting findings by using inappropriate, unrepresentative and biased samples. [ABSTRACT FROM AUTHOR]

BACKGROUND: Spain is one of the few European countries to have recently totally incorporated the study of nursing into the university sector. Bibliometric studies may be of a great help for the consolidation of nursing research. AIM OF THE STUDY: The aim of this paper is to describe bibliographic references in Spanish nursing research papers and their evolution over a decade. METHOD: The method consists of a retrospective bibliometric study of a sample (cluster sampling) of 622 research papers (original papers and review papers), which were contained in the Spanish nursing journals Enfermeria Cientifica, Revista ROL de Enfermeria, Enfermeria Clinica and Enfermeria Integral, and published from 1985 to 1994. The journal Nursing Research was selected for qualitative comparative purposes. A series of classic bibliometric indexes were used. RESULTS: The mean of references per paper is 10.64 +/- 10.42; this increased over time (P < 0.001). Review papers have more references (P < 0.001). Price index (percentage of references published during the last 5 years) is 44% and the Insularity (percentage of references published in same country as the article) is 55%. References to journals predominate (58.6%), with a growing tendency for references to Spanish nursing journals, although they are still scarce (18.1% of the references to journals). Spanish is the language of most of the references (60.3%), the second language being English (36.1%). CONCLUSIONS: Bibliographic references in Spanish nursing research papers are scarce and not very specific: this happens both in regard to Nursing Research and to publications in other national and international science areas. However, there is an increasing tendency of references (including references to nursing journals) in the period analysed. The age of the references places Spanish nursing in an intermediate position between the 'hard' sciences and the humanities; and, according to the type of documentation used, we find it halfway between experimental and natural sciences, and technologies and social sciences. There has been a slight increase in references in English in recent years. [ABSTRACT FROM AUTHOR]

Philosophical analysis is increasingly applied to nursing issues. Whereas pre-analytical discussions might be sloppy, analysis should bring rigour. This paper explores some mistakes and misconceptions concerning nurse-related reasonings. It uses, as a running theme, a recent paper in the Journal of Advanced Nursing by Rolfe. The mistakes and misleadings to be found in the paper are not uncommon; so the paper's correction quest aims more widely than single author critique. The mistakes and misconceptions could initially appear abstract and without practical outcome; in order to avoid the threatened appearance, a nursing case study is presented, displaying some undesirable consequences for a nurse who is misled by her reading. It is hoped that this paper shows how some accuracy may be well leading. [ABSTRACT FROM AUTHOR]

There has been little professional debate in the UK literature about nursing diagnosis and this paper explores some of the reasons why nursing diagnosis has failed to gain momentum among nurses in the United Kingdom. The nursing diagnosis movement has now reached some European countries and in the light of the International Classification of Nursing Project (ICNP) and the Strategic Advisory Group for Nursing Information Systems (SAGNIS) project commissioned by the NHS Executive (NHSE), requires a close examination by British nurses. The unsuccessful attempt by the North American Nursing Diagnosis Association (NANDA) to have its taxonomy accepted for inclusion in the World Health Organization's 10th revision of the International Classification of Diseases, an innovation which would have made the NANDA taxonomy the definitive classification of nursing, should alert British nurses to the importance of nursing diagnosis. Although nurses effectively diagnose as part of the nursing process, adoption of the concept of nursing diagnosis as a driving force for practice evades many of them. This paper reflects upon some of the logistical and conceptual difficulties including issues of culture and terminology. It is suggested that nursing diagnosis has a great deal to offer British nurses in their efforts to improve the quality of care and to provide data in this area for both practice and research. [ABSTRACT FROM AUTHOR]

Presents a review of paper published in the Journal of Advanced Nursing, 1976–1979 and 1989–1992. Criteria noted on the submission of the papers; Final analysis on the characteristics of authors under the headings; General topics addressed in papers.

A great deal of the caring work of nursing is accomplished and mediated through language. This paper attempts to characterize some of this language in quantitative and stylistic terms in an attempt to characterize the genre of nursing report language. Nursing students (n = 26) and graduate nurses (n = 3) viewed a videotape of a person being interviewed by a psychiatrist and produced written reports. These showed a large proportion of words relating to the person and to feelings and needs, compared to existing databases of the English language in general. The language produced by the participants also contained many modal or modifying words and is similar to spoken rather than written English in terms of the proportion of lexical content. There was much diversity in their descriptions and the vocabulary used to refer to the client. Graduate nurses showed more scepticism of the evidence provided by the video and advocated more investigation and questioning of the client. The use of standard forms and techniques of expression suggests that these reports were assembled on a language production line. Finally, we advocate a more systematic approach to educating nursing students about the power of the language they use. [ABSTRACT FROM AUTHOR]

Holism is claimed to be the signifying feature that sets women's health apart from traditional approaches to health care. As such, articles published in the nursing literature about women's health would, one might expect, reflect the centrality of holism to women's health care nursing. The findings of a study which examined the content and the focus of articles published about women's health in journals indexed by CINAHL in the period 1993-1995 challenge this assumption. It was found that women's health is a taken-for-granted notion and is used interchangeably and synonymously to refer to reproductive health, maternal health, neonatal health, family health and (hetero) sexual health. Confounding the view that holism is foundational to a women's health perspective, the papers forming the study's sample largely depict issues to do with women's health from a narrow and stereotypical perspective and with a bio-medical focus. Women were referred to as fragmented bodies, body parts and diseases, and were depicted as being passive and silent. By contrast, the voice (and the activity) of nurses and nursing's imperative to intervene was clearly discernible. [ABSTRACT FROM AUTHOR]

This paper discusses some of the measures used by a research team to overcome threats to validity and reliability of a semi-structured interview exploring the perceptions and needs of continuing professional education among nurses in practice in two district health authorities. [ABSTRACT FROM AUTHOR]

Presents an analysis of papers published in the "Journal of Advanced Nursing" throughout 2002. Country of origin of the papers; Categorization of the papers; Data collection methods used in empirical papers.

This action research study was undertaken to address practical concerns over curriculum development in nursing. The applied physiology component of a post-registration nursing diploma was evaluated in terms of its impact on patients rather than on the nurses themselves. The reported data were triangulated, all the findings indicated that patient care could be enhanced when nurses applied their knowledge of physiology to practice. Despite its limitations of scale, this study contributes to the curriculum debate in nurse education. [ABSTRACT FROM AUTHOR]

Nancy Goddard's 'spirituality as integrative energy' serves to highlight the importance of spirituality, while at the same time seeking to transform its nature. In this reply I take issue with the concept of spirituality as integrative energy, arguing that such a reconceptualization effectively strips spirituality of its meaning in the name of a spurious scientism. I argue that science is not the only valid mode of knowledge, and that, indeed, the scientific way of knowing may be particularly inappropriate in the context of the spiritual sphere. I briefly consider the gradual separation of spirit from body in the development of western medical science, and point out the commonalities between the scientific and spiritual modes of apprehending the world. While it is important that nurses be aware of the spiritual dimension, I argue that this awareness should not be purchased by reducing spirituality to more 'acceptable' 'scientific' terms, but rather that nurses should be afforded the opportunity to study the concept in its historical, literary and philosophical context. [ABSTRACT FROM AUTHOR]

An exchange for 1 day a week between a clinical nurse specialist and a lecturer gave rise to the opportunity to evaluate the introduction of case management on a newly created rehabilitation floor at an elderly care hospital. The aims of the study were to examine the feelings and concerns of new case managers, their conception of case management and their perceived educational needs. Qualitative research methods were employed to achieve the aims. Rigour was addressed, in part, through concurrent analysis of data with data collection, which encouraged probing of issues important to research participants. Thematic categories are presented under the headings: 'structure' and 'process'. The data collected revealed vividly that, as with any change, the people involved experienced anxieties and/or confusion over their new roles, but that some of the problems arose from the relocation of staff when the rehabilitation floor was established. Despite these difficulties, there was general enthusiasm for the potential of case management. [ABSTRACT FROM AUTHOR]

The telephone survey method is discussed in the light of the experiences of one research team investigating case management practices among nurses working in the community using a multiple-method design. An account is given of the strategies employed to recruit a study sample, minimize non-response and bias and ensure the use of sound practices during data collection. The findings highlight the benefits of using the telephone survey method when recruiting respondents across a wide geographical area and/or working within a continually changing environment. However, the findings also highlight the challenge of non-response caused by non-contact and the resource implications of 'doing more' to recruit key informants via the telephone. [ABSTRACT FROM AUTHOR]

Presents a brief review of papers published in the 'Journal of Advanced Nursing,' 1983–1992. Classification of paper; Topics covered in the papers; Number of publications and papers featured.

Aim. The aim of this paper is to identify the broad epistemological debates which underpin conflicting statements on ‘rigour’ and ‘good practice’ in qualitative research; to relate divergences in statements of ‘good practice’ in focus group design made by the pre-eminent commentators on focus group methodology to these broader epistemological debates; and to stimulate further reflection on the range of possible uses for focus groups in health services research. Considerations of the analysis of focus group data are beyond the scope of this paper. Discussion. Focus groups are a popular form of qualitative data collection, and may be defined as a particular form of group interview intended to exploit group dynamics. While qualitative research may be broadly characterized as concerned with exploring people's lived experiences and perspectives in context, it is a heterogeneous field incorporating many theoretical traditions. Consequently, qualitative researchers may be informed by a wide range of assumptions about the nature of knowledge (epistemology). These assumptions, whether implicit or explicit, have important consequences for claims about rigour and ‘good practice’ in data collection. Thus, while there is broad agreement over the general form of focus groups, statements of ‘good practice’ in terms of its application are varied. A close reading of texts by the two pre-eminent commentators on the practical application of focus groups identifies differences in ‘best practice’ focus group design related to their respective epistemological assumptions, and differences principally related to sampling techniques, composition of groups, the perceived role of group interaction and the nature of inference. Conclusion. Explicit consideration of the epistemological basis of divergent statements of ‘best practice’ in focus group design forces health services researchers to balance the demands of theory with the practicalities of conducting focus group research within complex host organisations; and encourages readers to apply appraisal criteria appropriate to the stated intentions of researchers. [ABSTRACT FROM AUTHOR]

On September 28, 1981, Great Britain's Central Council produced a consultation paper in which certain proposals are made for election to the recently constituted National Boards for Nursing, Midwifery and Health Visiting. The purpose of the election is to elect nurses, midwives and health visitors as members of the National Boards for Nursing, Midwifery and Health Visiting in England, Scotland, Wales and Northern Ireland. It is proposed that there should be three categories of candidates--nurses, midwives and health visitors. To be eligible to stand as a candidate a person must be either a practising nurse, practising midwife or a practising health visitor.

Aim. This paper explores the sexual health interview from a critical perspective, and to demonstrate how the confession ritual involved in this interview is implicated in the construction of subjectivities (meaning identities) as well as in fostering self-surveillance (self-regulation). Background. The concept of public health depends primarily on several surveillance tools that monitor both the incidence and prevalence rates of certain diseases. Within the subgroup of infectious diseases, sexually transmitted infections comprise a group that is closely monitored. As a result, surveillance techniques, including policing sexual practices, are part of the public health worker's mandate. Method. Using a Foucauldian perspective, we demonstrate that confession is a political technology in the sexual health domain. Findings. As one group of frontline workers in the field of sexual health, nurses are responsible for data collection through methods such as interviewing clients. Nurses play an integral role in the sexual health experience of clients as well as in the construction of the client's subjectivity. We strongly believe that a Foucauldian perspective could be useful in explaining certain current client behavioural trends (for example, an avoidance by at-risk groups of interactions with nurses in sexual health clinics) being observed in sexual health clinics across the Western hemisphere. Conclusion. Clinicians need to be aware of the confessional nature of their questions and provide requested services rather than impose services that they determine to be important and relevant. By appreciating that the sexual health interview is an invasive and embarrassing sexual confession, healthcare providers and policy-makers may be better able to design and implement more user-oriented, population-sensitive sexual health services. [ABSTRACT FROM AUTHOR]

Nursing, as a profession in its own right and a discrete health discipline, is responsible for planning, organizing, implementing and evaluating nursing services as a distinct segment of health care, and for educating practitioners to provide these services. The primary responsibility of nursing is to provide care direct to the patient, client, family or community. Like medicine, it is concerned with maintaining, promoting and protecting health, treating the sick and providing rehabilitation. It deals with the psychosomatic and psychosocial aspects of life as these affect health, illness and dying. In modern health services, nursing care is often best given by a nursing care team which usually consists of two or more categories of workers. These workers together make up the nursing personnel subsystem, which is a distinct entity within the overall health personnel system of a country.

Provides information on the process of reviewing papers for publication in the "Journal of Advanced Nursing." Role and significance of reviewers; Information on the journal's review process using Manuscript Central, the journal's online manuscript processing system; Expectations on reviewers and their reviews.

Focuses on the selection of keywords for several research papers to be published in the "Journal of Advanced Nursing." Limitation in the number of keywords for each paper; Categories of selecting keywords for papers.

Aim. This paper is a theoretical discussion of a mathematical explanation for Benner's theory of practice development. Background. Benner's practice development theory demonstrates how a nurse moves from a beginning, rule-based practice through to expert care. Her notion of expert practice as intuitive has not been well-accepted or understood in nursing. A new description of expert practice includes three types of intuitive practice (cognitive, transitional and embodied), the development of which are dependent on knowledge, experience and reflective time. Data sources. This paper is based on phenomenological research conducted in 2000-2003 and Benner's publications, as well as recent discussions about the relationship between mathematics and phenomenology. Discussion. The mathematical explanation for Benner's theory of practice development relates reflective time and knowledge to the mathematical power of experience and links the unique components of intuitive practice to expert care. On reaching expert practice, the three types of intuition include previously identified themes (knowledge, experience, connection, feeling, syncretism and trust) as differentials along the reflective time axis. When graphically represented, expert practice becomes a three-dimensional figure as practice becomes more complex, rather than a two-dimensional one as seen in previous stages. Conclusion. Having the intuitive component of expert practice further clarified from Benner's first vision confirms it as a valid component of practice. It is important to recognize that experience is a powerful component of practice and that it is essential to the development of expertise. Although this discussion has been nested within nursing practice, it has wide implications for medical, psychological and educational practice. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a review examining the variables that predispose individuals to significant psychological maladjustment following burn injury. Background. The psychological sequelae of burn injury are well documented; however, the variables that influence individuals' adjustment following burn injury lack consideration. Data sources. MEDLINE, Cumulative Index of Nursing and Allied Health, and Psychological Abstracts were searched using the keywords burn injury, psychological, psychosocial, rehabilitation, premorbid psychopathology, adjustment, reintegration, body image, post-traumatic stress disorder, depression, coping. Other sources were found from a manual search of nursing, medical and psychological literature and references of identified and related papers. The search strategy was limited to English-language research published between 1997 and 2008. Review methods. An integrative review of the studies was conducted over a 6-month time period during 2007-2008. Results. Burn patients are a heterogeneous group and typically have comorbidities. While preburn personality and coping strategies can influence long-term psychological adjustment, the relationship between postburn adjustment and burn size and severity, and gender are poorly understood. Much of the literature focuses on the prevalence of psychological maladjustment rather than on identifying variables that influence psychological adjustment. Conclusion. The diversity and complexity that characterize burn patients lead to unique adjustment difficulties. Recognizing these difficulties is the first step to offering appropriate intervention and treatment for this unique patient group. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a concept analysis of community health. Background. Community health is a term that has been broadly used in both research and practice. Although local communities are invested in community health improvement, this process often occurs without a clear definition of the concept of community health. Data sources. Data sources included a sample of 537 papers covering the period 1990 to 2004 and representing the disciplines of nursing, public health, medicine and sociology and landmark works concerning community health, six community health assessment instruments and interviews with seven key community health informants. Review methods. Rodgers' Evolutionary Method of Concept Analysis was used to design the study and analyse the data. The professional literature was analysed and compared with the use of the concept of community health in community health assessment instruments and by key informants. Results. Dynamic and contextual, community health is achieved through participatory, community development processes based upon ecological models that address broad determinants of health. The primary focus of this collaborative work is population-based health promotion and disease prevention. Conclusion. The definition derived from the concept analysis of community health makes explicit the importance of community-based participatory action in local health improvement processes. Identification of the attributes of community health will enhance communication across disciplines involved in community health practice, research and education. [ABSTRACT FROM AUTHOR]

Title. Expert nursing practice: a mathematical explanation of Benner’s 5th stage of practice development. Aim. This paper is a theoretical discussion of a mathematical explanation for Benner’s theory of practice development. Background. Benner’s practice development theory demonstrates how a nurse moves from a beginning, rule-based practice through to expert care. Her notion of expert practice as intuitive has not been well-accepted or understood in nursing. A new description of expert practice includes three types of intuitive practice (cognitive, transitional and embodied), the development of which are dependent on knowledge, experience and reflective time. Data sources. This paper is based on phenomenological research conducted in 2000–2003 and Benner’s publications, as well as recent discussions about the relationship between mathematics and phenomenology. Discussion. The mathematical explanation for Benner’s theory of practice development relates reflective time and knowledge to the mathematical power of experience and links the unique components of intuitive practice to expert care. On reaching expert practice, the three types of intuition include previously identified themes (knowledge, experience, connection, feeling, syncretism and trust) as differentials along the reflective time axis. When graphically represented, expert practice becomes a three-dimensional figure as practice becomes more complex, rather than a two-dimensional one as seen in previous stages. Conclusion. Having the intuitive component of expert practice further clarified from Benner’s first vision confirms it as a valid component of practice. It is important to recognize that experience is a powerful component of practice and that it is essential to the development of expertise. Although this discussion has been nested within nursing practice, it has wide implications for medical, psychological and educational practice. [ABSTRACT FROM AUTHOR]

Aim. This paper is a discussion of evidence-based core measures for developmental care in neonatal intensive care units. Background. Inconsistent definition, application and evaluation of developmental care have resulted in criticism of its scientific merit. The key concept guiding data organization in this paper is the United States of America's Joint Commission's concept of 'core measures' for evaluating and accrediting healthcare organizations. This concept is applied to five disease- and procedure-independent measures based on the Universe of Developmental Care model. Data sources. Electronically accessible, peer reviewed studies on developmental care published in English were culled for data supporting the selected objective core measures between 1978 and 2008. The quality of evidence was based on a structured predetermined format that included three independent reviewers. Systematic reviews and randomized control trials were considered the strongest level of evidence. When unavailable, cohort, case control, consensus statements and qualitative methods were considered the strongest level of evidence for a particular clinical issue. Discussion. Five core measure sets for evidence-based developmental care were evaluated: (1) protected sleep, (2) pain and stress assessment and management, (3) developmental activities of daily living, (4) family-centred care, and (5) the healing environment. These five categories reflect recurring themes that emerged from the literature review regarding developmentally supportive care and quality caring practices in neonatal populations. This practice model provides clear metrics for nursing actions having an impact on the hospital experience of infant-family dyads. Conclusion. Standardized disease-independent core measures for developmental care establish minimum evidence-based practice expectations and offer an objective basis for cross-institutional comparison of developmental care programmes. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study conducted to explore the determinants of satisfaction with health and social care services in the last 3 months and 3 days of life as reported by bereaved relatives of thosewho died froma stroke in an institutional setting. Background. There is limited research about how best to meet the needs of those who die from stroke. A thorough understanding of the determinants of satisfaction with end of life care is crucial for effective service provision to increase awareness of the needs of dying patients. Methods. During a six-month period in 2003, a population-based survey of bereaved relatives of patients after stroke was conducted using a stroke-specific version of the Views of Informal Carers Evaluation of Services postal questionnaire (183 informants, response rate 37%). The sub-sample included those informants who reported that the deceased person had died in an institutional setting (91%, n = 165). The analysis was divided into two phases: univariate (Pearson chi-square test) and multivariate phase (logistic regression). Results. Logistic regressions showed that discussing any worries about the treatment of the deceased person and feeling that the doctors and nurses knew enough about their condition were predictors of satisfaction with doctors and nurses in the last 3 months of life. Meeting the personal care needs of the deceased person, being involved in decisions and feeling that the deceased person died in the right place were predictors of satisfaction with care in the last 3 days of life. Conclusion. End of life care needs to address the individual needs of patients who die from stroke and those close to them. This study shows that individualised end of life care increases satisfaction and, although the data reported in this paper reflect care in 2003, there is no more recent evidence that contradicts this important overall finding. [ABSTRACT FROM AUTHOR]

Aim. The aim of this paper is to describe the development and testing of a questionnaire intended to determine key professionalism attributes and key environmental attributes that influence the professionalism of nurses in their practice environments. Background. Rapid changes in the healthcare sector and human resource shortages have had an impact on the stability of global work environments, making maintaining professionalism a challenge. The literature consists of descriptive research, opinion and theoretical papers. Method. The Professionalism and Environmental Factors in the Workplace Questionnaire® was developed and tested from 2005 to 2007 in three phases: item generation, pretesting and pilot testing. Convenience sampling was used to obtain representative samples of the target population in the pretest and pilot test. Mailed survey methodology was used in the pretest and pilot test. Sample sizes for the pretest and pilot test were 46 and 848 respectively. Results. Psychometric testing indicated preliminary instrument validity and reliability. Factor analysis resulted in stable factors that mirrored the conceptual basis of the questionnaire. The results summarize nurses' ratings of professionalism and environmental attributes that play a role in their work lives. Conclusion. The questionnaire helps nurses reflect on their practice and provides a starting point for discussion, planning and implementation of methods to support professionalism in practice and healthy work environments. It is internationally relevant because professionalism is a construct that transcends culture. Confirmatory factor analysis is needed to validate the results of this study. Testing with populations in different settings and additional validity and reliability testing will strengthen the questionnaire. [ABSTRACT FROM AUTHOR]

Title. The Professionalism and Environmental Factors in the Workplace Questionnaire®: development and psychometric evaluation. Aim. The aim of this paper is to describe the development and testing of a questionnaire intended to determine key professionalism attributes and key environmental attributes that influence the professionalism of nurses in their practice environments. Background. Rapid changes in the healthcare sector and human resource shortages have had an impact on the stability of global work environments, making maintaining professionalism a challenge. The literature consists of descriptive research, opinion and theoretical papers. Method. The Professionalism and Environmental Factors in the Workplace Questionnaire® was developed and tested from 2005 to 2007 in three phases: item generation, pretesting and pilot testing. Convenience sampling was used to obtain representative samples of the target population in the pretest and pilot test. Mailed survey methodology was used in the pretest and pilot test. Sample sizes for the pretest and pilot test were 46 and 848 respectively. Results. Psychometric testing indicated preliminary instrument validity and reliability. Factor analysis resulted in stable factors that mirrored the conceptual basis of the questionnaire. The results summarize nurses’ ratings of professionalism and environmental attributes that play a role in their work lives. Conclusion. The questionnaire helps nurses reflect on their practice and provides a starting point for discussion, planning and implementation of methods to support professionalism in practice and healthy work environments. It is internationally relevant because professionalism is a construct that transcends culture. Confirmatory factor analysis is needed to validate the results of this study. Testing with populations in different settings and additional validity and reliability testing will strengthen the questionnaire. [ABSTRACT FROM AUTHOR]

Title. Bodily change following faecal stoma formation: qualitative interpretive synthesis.Aim. This paper is a report of a literature review conducted to answer the question 'How has the experience of bodily change following stoma formation been explored and interpreted through existing qualitative research?'.Background. A faecal stoma alters the function, appearance and sensation of the body. Quantitative research highlights the importance of bodily change following stoma formation but is limited in being able to explore what this experience means to ostomists. Qualitative research can identify ways in which ostomists experience their changed body but a conceptual framework of their experience drawn from qualitative findings which can inform patient-centred care has not yet been identified.Method. The Amed, ASSIA, CINAHL, Embase, Medline and Psycinfo databases were searched from inception to April 2009 using predefined inclusion criteria. Of 144 papers identified, 11 were selected for review. An interpretive review methodology for qualitative research synthesis was employed. Findings. Three broad themes of bodily experience following stoma formation were identified: loss of embodied wholeness, awareness of a disrupted lived body and disrupted bodily confidence. These highlight the impact of the experience of living with a stoma on the embodied self and the ostomist's embodiment within their lifeworld.Conclusion. A loss of embodied wholeness which underpins the experience of stoma formation can be represented through awareness of the disrupted lived body and impact on the lifeworld. Findings suggest the need for further research to identify a comprehensive conceptualization of bodily change, which can more closely match healthcare service to individual patient need. [ABSTRACT FROM AUTHOR]

AIM: This paper is a presentation of issues that arise when conducting research with women from vulnerable populations. BACKGROUND: Conducting research with ethnic minority populations has accentuated the challenges inherent in research, particularly when the populations participating are considered 'vulnerable' due to additional variables such as low levels of income. DATA SOURCES: The paper is based on the experiences of three authors using feminist methods in separate but similar research trajectories that include (a) low-income women in the Southern African country of Malawi, (b) women diagnosed with schizophrenia in the United States of America, and (c) rural, indigenous Aymara women of the highlands of Peru. The data forming the basis of this paper were collected over 3- to 6-month periods between 2005 and 2006. DISCUSSION: We examine the impact of the researcher's power on the research process. Our research provides examples that illuminate the limitations of informed consent in research with vulnerable populations of women. We offer critical questions about and recommendations for nursing and other health care researchers, both in the third world and the western world, regarding appropriate research methods with vulnerable populations: methods that acknowledge the oppressive realities of the participants, methods that deliberately avoid further marginalization of participants, and methods that have the potential to improve the life situations of the women who participate in our research. CONCLUSION: These examples show the need for new methods to ensure that participants in research understand their role and the benefits they may expect to receive from research. [ABSTRACT FROM AUTHOR]

AIM: The aim of the paper is to explain how poetry reading can be used to teach interpretive analysis of qualitative data. BACKGROUND: A number of studies were located in the nursing literature that focused on using poetry to help students develop empathy for patients, to teach students to reflect on their own practice, and to assist them in developing self-understanding. No studies were found that described the use of poetry reading as a way of teaching the skill of interpretive analysis. There are, however, a number of parallels between the principles of poetry reading and qualitative analysis that suggest that this method of teaching would be successful. DATA SOURCES: International papers published on PubMed, Medline, and CINAHL were reviewed to identify challenges facing educators and ways of teaching the process of qualitative data analysis using poetry reading. FINDINGS: Using poetry reading to teach skills of qualitative data analysis helps motivate students, cultivates a reflective mindset, and develops the skill of working as a member of an interpretive group. Framing interpretive work as being like reading poetry helps students pick up more quickly on the art that is a major component of the work. This approach also helps students learn the importance of cultural and contextual particulars as they begin analyzing qualitative data. CONCLUSION: Using poetry reading to introduce students to the complex skill of qualitative data analysis is an effective pedagogical strategy. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a concept analysis of fatigue in children with long-term conditions. BACKGROUND: There is little research focused on the experience of fatigue in children. Previous work has focused primarily on children living with cancer. It is necessary to clarify and refine the concept, and add to the knowledge base that supports ongoing theoretical work in order to improve the clinical care of children with long-term conditions who experience fatigue. METHOD: English language literature published from 1989 to 2007 was searched using the CINAHL, Medline and PsychINFO data bases. Sixty-two papers and two book chapters were used in this concept analysis. Rodgers' method of evolutionary concept analysis was used. This inductive method helps us to view the concept in a sociocultural and temporal context. FINDINGS: The number of publications focusing on fatigue in children is increasing. The analysis yielded two surrogate terms, five attributes, three antecedents and seven consequences. Based on this analysis, fatigue in children with long-term conditions appears to be a subjective experience of tiredness or exhaustion that is multidimensional and includes physical, mental, and emotional aspects. CONCLUSIONS: Evidence suggesting children with long-term conditions experience fatigue is increasing, but conceptual gaps remain. This analysis has yielded a view of fatigue in children that illustrates healthcare professionals' limited yet growing awareness of the symptom. Ongoing study as a means to refine our understanding of the concept could potentially lead to important contributions to clinical care of children with long-term conditions. [ABSTRACT FROM AUTHOR]

AIM: This paper presents an integrative literature review conducted to describe the utility of the objective structured clinical evaluation (OSCE) as a strategy of measuring one form of clinical competence in nursing. BACKGROUND: The emergence of the OSCE, one form of evaluation of clinical competence used in medicine, is gaining more scrutiny and consideration in nursing education. DATA SOURCES: The review was conducted through an initial search of computerized databases CINAHL, Cochrane Database of Systematic Reviews, Academic Search Premier and MEDLINE for the period from 1960 to 2008. METHODS: An integrative review was performed and 41 papers met the inclusion criteria. RESULTS: The complexities of evaluating clinical competence can be addressed through use of an OSCE process. Concerns related to the conceptual limitations and the lack of psychometric properties of the tools available for measurement in nursing education have been identified. CONCLUSION: Major gaps exist in the nursing literature regarding the examination of the psychometric properties of the OSCE, the suitability of the design of the OSCE structure and tools for nursing to measure clinical competency, and the associated costs in the application of this evaluative method. Research conducted on the psychometric properties of the OSCE tool used and correlations to other evaluative methods currently used to evaluate nursing clinical competence would inform educational practices. [ABSTRACT FROM AUTHOR]

Title. Theoretical substruction: establishing links between theory and measurement of military women's attitudes towards menstrual suppression during military operations. Aim. The aim of this paper is to establish a theoretical model for the exploration of the phenomenon of menstruation and women's attitudes towards menstrual suppression during military operations. Background. In the emerging field of literature that explores menstruation among military women, there are indications that menstrual symptoms and hygiene are problematic under the circumstances of deployment to military operations. While menstrual suppression may be a solution to problems that women encounter with menstruation during deployment, there is little research exploring the phenomenon. Data sources. CINAHL and Medline were used to locate peer reviewed journal papers published from 1977 to 2007. International military reports were obtained through an internet search engine (Google[TM]). Discussion. Issues that military women encounter surrounding menstruation during deployment are framed according to components of human ecology and social ecology theories, creating a theoretical model for the study of military women's menstrual health. Theoretical substruction is then used to evaluate the proposed theoretical and operational systems for measuring military women's attitudes during deployment. The process of theoretical substruction validates the model and the theoretical integrity of the proposed research on women's attitudes towards suppression. Conclusion. A theory-based model for women's health under challenging environmental conditions will enhance the holistic consideration of women's health issues by care providers. The theoretical model clearly explicates the phenomenon of menstruation during deployment and the theoretical and operational systems are soundly linked in the proposed measurement model of military women's attitudes towards menstrual suppression. [ABSTRACT FROM AUTHOR]

Title. Theoretical substruction: establishing links between theory and measurement of military women’s attitudes towards menstrual suppression during military operations. Aim. The aim of this paper is to establish a theoretical model for the exploration of the phenomenon of menstruation and women’s attitudes towards menstrual suppression during military operations. Background. In the emerging field of literature that explores menstruation among military women, there are indications that menstrual symptoms and hygiene are problematic under the circumstances of deployment to military operations. While menstrual suppression may be a solution to problems that women encounter with menstruation during deployment, there is little research exploring the phenomenon. Data sources. CINAHL and Medline were used to locate peer reviewed journal papers published from 1977 to 2007. International military reports were obtained through an internet search engine (Google™). Discussion. Issues that military women encounter surrounding menstruation during deployment are framed according to components of human ecology and social ecology theories, creating a theoretical model for the study of military women’s menstrual health. Theoretical substruction is then used to evaluate the proposed theoretical and operational systems for measuring military women’s attitudes during deployment. The process of theoretical substruction validates the model and the theoretical integrity of the proposed research on women’s attitudes towards suppression. Conclusion. A theory-based model for women’s health under challenging environmental conditions will enhance the holistic consideration of women’s health issues by care providers. The theoretical model clearly explicates the phenomenon of menstruation during deployment and the theoretical and operational systems are soundly linked in the proposed measurement model of military women’s attitudes towards menstrual suppression. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of an integrative review conducted to critically analyse the contemporary use of qualitative case study methodology in nursing research. BACKGROUND: Increasing complexity in health care and increasing use of case study in nursing research support the need for current examination of this methodology. DATA SOURCES: In 2007, a search for case study research (published 2005-2007) indexed in the CINAHL, MEDLINE, EMBASE, PsychINFO, Sociological Abstracts and SCOPUS databases was conducted. A sample of 42 case study research papers met the inclusion criteria. METHODS: Whittemore and Knafl's integrative review method guided the analysis. RESULTS: Confusion exists about the name, nature and use of case study. This methodology, including terminology and concepts, is often invisible in qualitative study titles and abstracts. Case study is an exclusive methodology and an adjunct to exploring particular aspects of phenomena under investigation in larger or mixed-methods studies. A high quality of case study exists in nursing research. CONCLUSION: Judicious selection and diligent application of literature review methods promote the development of nursing science. Case study is becoming entrenched in the nursing research lexicon as a well-accepted methodology for studying phenomena in health and social care, and its growing use warrants continued appraisal to promote nursing knowledge development. Attention to all case study elements, process and publication is important in promoting authenticity, methodological quality and visibility. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a review in which decision theory from economics and psychology was applied to understand why some women with access to care do not seek cancer screening. BACKGROUND: Mammography and cervical smear testing are effective modes of cancer screening, yet many women choose not to be screened. Nurses need to understand the reasons behind women's choices to improve adherence. DATA SOURCES: Research papers published between January 1994 and November 2008 were identified using the Cumulative Index to Nursing and Allied Health Literature, MEDLINE and PsycINFO data bases. The search was performed using the following terms: cervical cancer screening, breast cancer screening, decision, choice, adherence and framing. Forty-seven papers were identified and reviewed for relevance to the search criteria. METHODS: Nineteen papers met the search criteria. For each paper, reasons for obtaining or not obtaining cancer screening were recorded, and organized into four relevant decision theory principles: emotions, Prospect Theory, optimism bias and framing. FINDINGS: All women have fears and uncertainty, but the sources of their fears differ, producing two main decision scenarios. Non-adherence results when women fear medical examinations, providers, tests and procedures, do not have/seek knowledge about risk and frame their current health as the status quo. Adherence is achieved when women fear cancer, but trust care providers, seek knowledge, understand risk and frame routine care as the status quo. CONCLUSION: Nurses need to address proactively women's perceptions and knowledge about screening by openly and uniformly discussing the importance and benefits. [ABSTRACT FROM AUTHOR]