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Aim. This paper is a report of a literature review to identify (a) the prevalence of emotional and psychological problems after intensive care, (b) associated factors and (c) interventions that might improve this aspect of recovery. Background. Being a patient in intensive care has been linked to both short- and long-term emotional and psychological consequences. Data sources. The literature search was conducted during 2006. Relevant journals and databases were searched, i.e. Medline and CINAHL, between the years 1995 and 2006. Review methods. The search terms were 'anxiety', 'depression', posttraumatic stress', 'posttraumatic stress disorder' and 'intensive care'. Results. Fifteen papers were reviewed representing research studies of anxiety, depression and posttraumatic stress, and seven that represented intensive care follow-up clinics and patient diaries. Being in intensive care can result in significant emotional and psychological problems for a number of patients. For the majority of patients, symptoms of distress will decrease over time but for a number these will endure for some years. Current evidence indicates that emotional problems after intensive care are related to both subjective and objective indicators of a patient's intensive care experience. Evidence suggests some benefit in an early rehabilitation programme, daily sedation withdrawal and the use of patient diaries. However, additional research is required to support such findings. Conclusion. Our understanding of the consequences of intensive care is improving. Psychological care for intensive care patients has lagged behind care for physical problems. We now need to focus on developing and evaluating appropriate interventions to improve psychological outcome in this patient group. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of an analysis of the concept of adherence. Background. The transition in terminology from compliance to adherence, and more recently to concordance, requires re-clarification of 'adherence' as a concept in nursing practice. Differences exist in the use of the term adherence and how or if it differs from compliance or concordance. Data sources. Using the Medical Subject Headings terms adherence, non-adherence and treatment refusal, the Cumulative Index to Nursing and Allied Health Literature, Medline, PsychINFO and Cochrane library databases were searched for publications between 1970 and 2007. Method. The evolutionary analytic method was used to identify and explore transitions in the concept of adherence over time and across healthcare disciplines. A representative sample of papers was identified from the disciplines of nursing, medicine, psychology and pharmacy. Results. We identified 114 papers: 27 from nursing, 39 from psychology, 33 from general medicine and 15 from pharmacology sources. The final sample included eight from pharmacy and 15 from mental health, medicine and nursing. We found no distinct differentiation between adherence and compliance. The surrogate terms serving as manifestations of adherence are concordance, agreement, cooperation and partnership. The most common definition found was as follows: 'Adherence can be defined as the extent to which patients follow the instructions they are given for prescribed treatments'. No definition of adherence exists that reflects a patient-centred approach, the dynamic nature of adherence behaviour and the power imbalance implied by these terms. Conclusion. This concept analysis of adherence is a preliminary step towards broadening nurses' appreciation of the complexity of patient adherence behaviour. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a concept analysis of chronic fatigue. Background. Fatigue is a prevalent symptom encompassing both acute and chronic manifestations. It is chronic fatigue that is most problematic because of its duration and impact on life quality. The rise in prevalence of chronic conditions will result in a need to address coexistent symptoms, clarification of which is needed. Chronic fatigue is one of the most common symptoms in chronic illness. Clarification of the concept and an understanding of its use by discipline are needed. Data sources. The evolutionary method of concept analysis was used to ascertain the attributes, antecedents, consequences and surrogate terms for chronic fatigue. A review of the literature published between 1966 and 2007 was carried out to determine the contextual use of the concept of chronic fatigue among disciplines. Sources used for this analysis included CINAHL, Medline, PsychINFO and Social Work Abstracts and the search yielded 66 papers. Results. The chronic fatigue experience is associated with a multitude of physical, psychological and social factors. The defining attributes of chronic fatigue are constancy, abnormality, whole-body experience, inexplicability and disabling. The antecedents of chronic fatigue are physical disease, psychopathology, female gender and a history of abuse. Consequences found include social isolation and stigmatization, physical inactivity, psychological disturbances and a reduced quality of life. Conclusion. Further research is needed to identify the aetiology of chronic fatigue and to address the social context of living with this disabling symptom. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a literature review to identify research involving interventions to improve medication adherence in people with multiple co-existing chronic conditions. Title. Interventions to improve medication adherence in people with multiple chronic conditions: a systematic review. Background. The importance of managing co-existing, chronic conditions in people of all ages is critical to prevent adverse health outcomes. Data sources. Databases, including Cumulative Index of Nursing and Allied Health Literature, Medline, PubMed and Web of Science were searched for the period January 1997-2007 using the combined keywords adherence, compliance, drug therapy, medication, clinical trial, randomized controlled trial, intervention, chronic condition, chronic disease, multiple morbidity and comorbidity. References of retrieved papers were also considered. Methods. The inclusion criteria were: English language, oral medication adherence, self-administered medications, multiple prescribed medications for three or more chronic conditions and randomized controlled trials lasting at least 3 months. Results. Studies examining medication adherence in people with multiple chronic conditions targeted people over 70 years of age, and were primarily focused on the management of polypharmacy and reducing healthcare costs. Adherence was measured using different tools and estimates of adherence, and interventions were predominantly delivered by pharmacists. The evidence for effective interventions to enhance medication adherence in multiple chronic conditions was weak, and psychosocial interventions were absent. Conclusion. Interventions that improve medication adherence for people with multiple chronic conditions are essential, given the increased prevalence of these conditions in people of all ages. Outcomes of improved adherence, such as disease control and quality of life, require investigation. Psychosocial interventions engaging people in medication self-management offer potential for improved patient outcomes in complex diseases. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a review of the literature on community nurses' job satisfaction, including research using different scales and settings, what is known to date and directions for future research. BACKGROUND: Job satisfaction is one of the strongest predictors of intent to stay and retention of nurses. An adequate understanding of the sources of job satisfaction and their importance can aid policymakers in the community nursing setting to cope with the growing demand for its services. DATA SOURCES: A database of papers was established using ISI Web of Knowledge. Cited references were used to expand the database. Journals adding to the database were scanned for related research. This technique was repeated until no additional papers could be found. FINDINGS: Twelve job satisfaction scales were found, with striking differences in methodology, settings and sample characteristics of the studies concerned. A wide variety of job satisfaction and dissatisfaction sources is identified, but little is known on their relative importance. The Measure of Job Satisfaction and the Home Healthcare Nurses' Job Satisfaction Scale prove highly reliable and applicable. CONCLUSION: Findings on the level and sources of community nurses' job satisfaction are ambiguous. Of all the scales reviewed, the Home Healthcare Nurses' Job Satisfaction Scale seems most promising for use in future research, based on its strong psychometric properties and its specificity for the community nursing setting. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a systematic review of qualitative studies of how older people live with chronic heart failure. Background. Chronic heart failure is a global epidemic mainly affecting an ageing population. Understanding how older people live with this disease is important to help promote their adjustment to the distressing illness experience. Data sources. Eligible studies published in 1997-2007 were identified from several databases (Medline, CINAHL, PsycINFO and Sociological Abstracts). A manual search was conducted of bibliographies of the identified studies and relevant journals. Review methods. Two researchers independently reviewed the studies and extracted the data. Key concepts from the papers were compared for similarities and differences. The transactional model of stress was used to guide data synthesis. Findings. Fourteen qualitative studies were identified. Most described the illness experiences of older people with chronic heart failure and associated coping strategies. There was some emerging work exploring the adjustment process. The findings indicated that living with chronic heart failure was characterized by distressing symptoms, compromised physical functioning, feelings of powerlessness and hopelessness, and social and role dysfunction. There were gender differences in the way the disease was conceived. Adjustment required patients to make sense of the illness experience, accept the prognosis, and get on with living with the condition. Conclusion. Empowering older people to manage chronic heart failure, instilling hope and bolstering support system are means of promoting successful adjustment to the disease. Further research needs to explore the cultural differences in the adjustment process. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a review of the literature that considers how physiological parameters may affect outcome after stroke and the implications of this evidence for monitoring. Background. Throughout the world, the incidence of first-ever stroke is approximately 200 per 100,000 people per year [Sudlow et al. (1997) Stroke 28, 491]. Stroke is the third most common cause of mortality [Sarti et al. (2000) Stroke 31, 1588] and causes 5Æ54 million deaths worldwide [Murray & Lopez (1997) Lancet 349, 268]. Physiological monitoring is considered a fundamental component of acute stroke care. Currently, the strength of evidence to support its use and identify its components is unclear. Nurse-led physiological assessment and subsequent interventions in acute stroke may have the potential to improve survival and reduce disability. Data sources. Online bibliographic databases from 1966 to 2007, including MEDLINE, EMBASE, CINAHL, AMED, Cochrane and ZETOC, were searched systematically. We identified 475 published papers relating to blood pressure, oxygen saturation and positioning, blood glucose and body temperature. Review methods. Titles and abstracts were reviewed independently by two reviewers and 61 relevant studies were read in full. The quality of included studies was assessed and proformas were used to record detailed data. A narrative synthesis described how the evidence from the papers could inform our understanding of physiological parameters and their association with outcome. Results. Current evidence suggests that patient outcome is worse when physiological parameters deviate from 'normal' in the acute phase of stroke. Conclusions. The evidence supports the need for monitoring and recording of blood pressure, oxygen saturation (including consideration of positioning), blood glucose and body temperature in the acute phase of stroke. This review has reinforced the importance of monitoring physiological parameters in the acute phase of stroke and adds support to the recommendation that monitoring should play a key role within nursing care. [ABSTRACT FROM AUTHOR]

Title. Exploring research supervision through Peshkin’s I’s: the yellow brick road Aim. This paper is a report of a systematic approach used to explore subjectivity as a research student and demonstrates how the process enhanced the quality of the research experience. Background. High non-completion rates of research students are of global concern and means of enhancing the quality of the doctoral experience are needed. Among the literature on doctoral education, very little is authored by students. This paper is influenced by the work of Peshkin from the discipline of education. Peshkin articulated the need for researchers to systematically identify their subjectivity by searching for their subjective I’s. I share my experience of adopting this approach as a research student by using reflexive journal entries made during 2005–2007 as data. Findings. I use the analogy of the ‘Yellow Brick Road’ from The Wizard of Oz to represent my experience of being a doctoral student and draw comparisons between my subjectivity and the characters in the story. I demonstrate how a systematic approach to exploring my subjectivity revealed aspects of my being as a research student that had potential for influence throughout the entirety of my experience. I argue that cognizance of my subjective I’s improved the quality of my research endeavour. Conclusion. The approach is offered for consideration by other research students as a means of exploring subjectivity. I argue that the resultant self-awareness can enhance the quality of the doctoral experience. The flexibility of the approach means it has transferability across a number of disciplines and cultural contexts. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a literature review to explore the concept of personal resilience as a strategy for responding to workplace adversity and to identify strategies to enhance personal resilience in nurses. Background. Workplace adversity in nursing is associated with excessive workloads, lack of autonomy, bullying and violence and organizational issues such as restructuring, and has been associated with problems retaining nurses in the workforce. However, despite these difficulties many nurses choose to remain in nursing, and survive and even thrive despite a climate of workplace adversity. Data sources.The literature CINAHL, EBSCO, Medline and Pubmed databases were searched from 1996 to 2006 using the keywords 'resilience', 'resilience in nursing', and 'workplace adversity' together with 'nursing'. Papers in English were included. Findings. Resilience is the ability of an individual to positively adjust to adversity, and can be applied to building personal strengths in nurses through strategies such as: building positive and nurturing professional relationships; maintaining positivity; developing emotional insight; achieving life balance and spirituality; and, becoming more reflective. Conclusion. Our findings suggest that nurses can actively participate in the development and strengthening of their own personal resilience to reduce their vulnerability to workplace adversity and thus improve the overall healthcare setting. We recommend that resilience-building be incorporated into nursing education and that professional support should be encouraged through mentorship programmes outside nurses' immediate working environments. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a systematic review to assess the effectiveness of family-focused smoking cessation interventions for people with chronic obstructive pulmonary disease and to determine what data on families are documented in studies of smoking cessation interventions. Background. Chronic obstructive pulmonary disease is a major public health problem and cigarette smoking is the most important factor contributing to its development and progression. However, smoking cessation rates are low and relapse is common. The role of families in smoking cessation efforts has received little attention. Methods. All studies were included in the review that (i) addressed an evaluation of a psycho-social/educational smoking cessation intervention for people with chronic obstructive pulmonary disease, (ii) addressed some information on the family (i.e. living arrangements, marital status, smoking history of family members, support for quitting) and/or included the family as part of the intervention and (iii) were published between 1990 and 2006. Electronic data sources, existing systematic reviews of smoking cessation interventions and the grey literature were reviewed. Results. Seven studies were included. Six studies (11 papers) included data on marital status, smoking status of household members, support for quitting smoking and related variables. In two of the studies, the variable on the family was used to analyse smoking cessation outcomes. One additional study met the inclusion criterion of an evaluation of a smoking cessation intervention, which also included a family focus in the intervention. Conclusion. No conclusions about the effectiveness of a family-focused smoking cessation intervention could be drawn from this review. Further research is needed to determine if a more family-focused intervention, in conjunction with pharmacological and counselling approaches, would lead to improved smoking cessation outcomes. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a concept analysis of harmony. Background. Historically, harmony has been poorly defined in nursing research. Harmony has been typically associated with music, but this concept also has a place in nursing. The term is used in current literature in various contexts, including the environment, and relating to mind, body, and spirit. Use of the term harmony is also evident in describing physical characteristics and connections between subjects or ideas, and as an adjective. Methods A literature search was conducted using the CINAHL, MEDLINE, PubMed, and OVID data bases from 1998 to 2003 with the keyword 'harmony'. The reference lists of the identified papers were then searched for further sources and 29 papers were identified for inclusion into the paper. Wilson's process was used to conduct the concept analysis. Findings. Harmony is a major aspect of personal relationships, working relationships, and nurse-patient relationships. Both patient-clinician and clinician-clinician relationships are affected by the three attributes of harmony: balance, peace and rhythm. This balance is also an important factor in the incidence of disease and for optimal health. Five consequences of the concept are identified as pleasant environment, sense of satisfaction, positive self-concept, beautiful sound, or effective programme. Conclusion. Harmony is potentially relevant to many aspects of nursing. In order for a nurse to have a positive relationship with a patient, harmony must be present in terms of a pleasant environment, feelings of satisfaction, positive self-concepts, and effective nursing intervention programmes. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to identify and synthesize all published qualitative research studies exploring patients' experiences of living with a leg ulcer. Background. Leg ulceration is a common chronic condition with over 40% of patients having open ulceration for over a year. Leg ulceration can have a significant and detrimental effect on a persons' life. Data sources. Electronic searches of Ovid MEDLINE (R) (1966-2005), CINAHL (1982-2005), EMBASE (1980-2005), British Nursing Index (1985-2005), ASSIA, Social Science Citation Index (SSCI) and PsychINFO (1985-2005) were carried out in June 2005. Review methods. Studies were included if: they described experience of living with a leg ulcer, e.g. phenomenological studies, grounded theory, descriptive, focus groups or interview studies; included adults with chronic leg ulceration (venous, mixed or arterial); published in English. Analysis was undertaken using the Qualitative Assessment and Review Instrument software for synthesis of qualitative research. Results. Twelve studies met the inclusion criteria. There were eight phenomenological studies, two using grounded theory and two 'descriptive studies'. The location of the research was United Kingdom (7), United States of America (2), Sweden (1), Australia (1). Five common themes related to the experience of living with leg ulceration were identified: Physical effects of leg ulceration; Describing the leg ulcer journey; Patient-professional relationships; Cost of a leg ulcer; Psychological impact. Conclusion. Leg ulceration should be viewed as a chronic, debilitating condition. The clinical focus of care should be symptom management through the 'leg ulcer journey'. [ABSTRACT FROM AUTHOR]

Aim. This paper is a discussion of the use of a systematic approach to explore researcher subjectivity and how this enhanced the rigour of a qualitative study. Background. The need for rigour in qualitative research is widely documented; the means by which it is enhanced are varied and numerous. Although most qualitative health researchers espouse the notion of being aware of their own subjectivity, the methods by which their self-awareness is developed is seldom made explicit. Method. This paper draws on the work of Peshkin from the discipline of education, who articulated the need for researchers to identify their subjectivity systematically throughout the course of their research by searching for their subjective I's. I share my experience of adopting this approach by using a reflexive journal as data. I recorded the journal as an integral part of a study in which I explored the meaning of empowerment for nursing students during the period 2005-2006. Findings. This systematic approach to exploring my subjectivity revealed four subjective I's that had potential for influence throughout the entire study. I argue that cognisance of my subjective I's improved the trustworthiness of the research. Conclusions. I offer this approach for consideration by healthcare researchers as a robust means of illuminating researcher subjectivity. This is not intended as a narcissistic process; it is one that is advocated for use as part of an audit trail as a means of enhancing the rigour of qualitative research. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a systematic review to answer the question: what is the relevance, acceptability, validity and effectiveness of tools designed to screen for postnatal depressed mood for South Asian women living in the UK? BACKGROUND: Standard methods to screen women for postnatal depressed mood were developed with Caucasian populations. This study reviews postnatal screening tools adapted or developed for United Kingdom-based South Asian women. METHOD: A structured systematic review of English language studies initially was completed between 1980 and May 2003, and later updated to January 2005. The review was based on an a priori search strategy with inclusion and exclusion criteria and analysis included a quality assessment tool. Findings were tabulated against criteria for acceptability and effectiveness of diagnostic tools. RESULTS: Seven papers were included in the review. None addressed all preset quality criteria. Four papers among them reported on translations of two existing tools (Edinburgh Postnatal Depression Scale and General Household Questionnaire). Two new tools were reported between the remaining three papers (Punjabi Postnatal Depression Scale and 'Doop Chaon'. Doop Chaon is a visual tool. The other tools used either Bengali or Punjabi, based on written scales. The General Household Questionnaire did not appear to be appropriate for this population. None of the studies were rigorous enough to demonstrate generalizable sensitivity or specificity. Qualitative data indicated that women preferred face-to-face interviews to self-complete questionnaires. CONCLUSIONS: None of the tools are currently sufficiently evaluated for clinical practice. Questions are raised specifically about use of language-based tools to measure postnatal depressed mood in this population and about the extent to which focused interviews could be used as an alternative for specific sub-sections of population groups. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a literature review that aimed to analyse the way in which nursing intensity and patient dependency have been considered to be conceptually similar to nursing workload, and to propose a model to show how these concepts actually differ in both theoretical and practical terms. Background. The literature on nursing workload considers the concepts of patient 'dependency' and nursing 'intensity' in the realm of nursing workload. These concepts differ by definition but are used to measure the same phenomenon, i.e. nursing workload. Method. The literature search was undertaken in 2004 using electronic databases, reference lists and other available literature. Papers were sourced from the Medline, Psychlit, CINAHL and Cochrane databases and through the general search engine Google. The keywords focussed on nursing workload, nursing intensity and patient dependency. Findings. Nursing work and workload concepts and labels are defined and measured in different and often contradictory ways. It is vitally important to understand these differences when using such conceptualizations to measure nursing workload. A preliminary model is put forward to clarify the relationships between nursing workload concepts. Conclusion. In presenting a preliminary model of nursing workload, it is hoped that nursing workload might be better understood so that it becomes more visible and recognizable. Increasing the visibility of nursing workload should have a positive impact on nursing workload management and on the provision of patient care. [ABSTRACT FROM AUTHOR]

Aim. This paper presents a concept analysis of the phenomenon of postoperative recovery. Background. Each year, millions of patients throughout the world undergo surgical procedures. Although postoperative recovery is commonly used as an outcome of surgery, it is difficult to identify a standard definition. Method. Walker and Avant's concept analysis approach was used. Literature retrieved from MEDLINE and CINAHL databases for English language papers published from 1982 to 2005 was used for the analysis. Findings. The theoretical definition developed points out that postoperative recovery is an energy-requiring process of returning to normality and wholeness. It is defined by comparative standards, achieved by regaining control over physical, psychological, social and habitual functions, and results in a return to preoperative level of independence/dependency in activities of daily living and optimum level of psychological well-being. Conclusion. The concept of postoperative recovery lacks clarity, both in its meaning in relation to postoperative recovery to healthcare professionals in their care for surgical patients, and in the understanding of what researchers in this area really intend to investigate. The theoretical definition we have developed may be useful but needs to be further explored. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a concept analysis identifying the attributes, antecedents and consequences of the concept of routine and examining the implications and applications of this concept in the field of nursing. Background. Routine may be a pivotal concept in understanding functional adaptation and wellbeing. Nurses in institutional settings work according to scheduled routines, patient care is largely orchestrated in routines set by organizations and regulations, and persons receiving care have their own life routines determining identity, capacities and frame of reference. However, to date, nursing has paid little attention to the relevance of routine and the role it may play in patient care. Method. A concept analysis was conducted using Rodgers' guidelines. The literature search was based on the following databases: PsycInfo, CINAHL, MedLine, Social Services, and Social Work abstracts. To be included in the analysis, papers had to relate directly and essentially to the concept of routine. Seventy-four papers published from 1977 to 2005 were included in the final stage of the analysis. The analysis included target populations, disciplinary perspectives, type of manuscript, themes and definitions, theoretical models, antecedents and consequences, as well as related terms. Results. Routine is a concept pertaining to strategically designed behavioural patterns (conscious and subconscious) and is used to organize and coordinate activities along different axes of time, duration, social and physical contexts, sequence and order. It emerges from the literature as a strategy that serves adaptation, in general, especially in the face of change and stressful situations. The conceptual structure, relations with other concepts, antecedents and consequences are described. Conclusion. The concept of routine is ill-defined and seldom used in the field of nursing, despite the promise it may hold for a better understanding of a wide range of health-related issues. This concept analysis offers an integrative view of routine and suggests directions for future research and practice. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a meta-synthesis exploring the accounts of intrapartum midwifery skills, practices, beliefs and philosophies given by practitioners working in the field of intrapartum maternity care who are termed expert, exemplary, excellent or experienced. Background. Expertise in nursing and medicine has been widely debated and researched. However, there appear to be few studies of practitioners' accounts of expertise in the context of maternity care. Given current international debates on the need to promote safe motherhood, and, simultaneously, on the need to reverse rising rates of routine intrapartum intervention, an examination of the nature of maternity care expertise is timely. Method. A systematic review and meta-synthesis were undertaken. Twelve databases and 50 relevant health and social science journals were searched by hand or electronically for papers published in English between 1970 and June 2006, using predefined search terms, inclusion, exclusion and quality criteria. Findings. Seven papers met the criteria for this review. Five of these included qualified and licensed midwives, and two included labour ward nurses. Five studies were undertaken in the USA and two in Sweden. The quality of the included studies was good. Ten themes were identified by consensus. After discussion, three intersecting concepts were identified. These were: wisdom, skilled practice and enacted vocation. Conclusion. The derived concepts provide a possible first step in developing a theory of expert intrapartum non-physician maternity care. They may also offer more general insights into aspects of clinical expertise across healthcare groups. Maternity systems that limit the capacity of expert practitioners to perform within the domains identified may not deliver optimal care. If further empirical studies verify that the identified domains maximize effective intrapartum maternity care, education and maternity care systems will need to be designed to accommodate them. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a systematic review of the literature on interventions to promote oral nutritional intake of older people with dementia and feeding difficulty between 1993 and 2003. Background. Older people with dementia commonly experience difficulty with feeding, especially in the later stages of the condition. This topic and related nursing care was reviewed in 1993 and the conclusion was that there was little research into interventions that nurses could use to alleviate feeding difficulty. Method. A systematic review of the literature was carried out using the CINAHL, Medline, EMBASE and Cochrane databases and the search terms 'feeding', 'eating' and 'dementia' combined as follows: '(feeding or eating) and (dementia)'. A second search was carried out combining the search terms 'mealtimes' and 'dementia' as follows: 'mealtimes and dementia'. The literature search was carried out on 1 December 2003 and papers were included in the review if retrieved by 31 December 2003. English language papers only were retrieved. Results. Sixty-seven papers were retrieved, of which 13 addressed interventions aimed at helping older people with dementia to feed. All studies reported positive outcomes but only one randomized controlled trial was reported. Music was the most common intervention but there were no standardized interventions or outcomes across the studies and none reported the use of power analysis to decide on sample size. There were problems in some studies with confounding variables. Conclusions. Further research is needed into interventions aimed at how nurses can help older people with dementia to feed. There are some promising lines of enquiry, with music being one of these, but future studies need to use adequate samples and to use power calculations and account adequately for confounding variables. There is also a need to standardize interventions and outcomes across such studies to facilitate meta-analysis. [ABSTRACT FROM AUTHOR]

Introduces reports published in the January 2006 issue of the "Journal of Advanced Nursing."

Presents abstracts of articles featured in the September 2005 issue of the "Journal of Advanced Nursing." "Nurse Prescribers: Who Are They and How Do They Perceive Their Role?" by E. Bradley et al;"Needlestick and Sharps Injuries Among Nursing Students," by D. R. Smith and P. A. Leggat; "Parent or Nurse? The Experience of Being the Parent of a Technology-Dependent Child," by S. Kirk et al.

This paper presents a review of the qualitative literature which examines the experiences of patients with coronary heart disease. The paper also assesses whether the experiences of both female and male patients are reflected in the literature and summarizes key themes. Understanding patientsâ experiences of their illness is important for coronary heart disease prevention and education. Qualitative methods are particularly suited to eliciting patientsâ detailed understandings and perceptions of illness. As much previous research has been âgender neutralâ, this review pays particular attention to gender. Published papers from 60 qualitative studies were identified for the review through searches in MEDLINE, EMBASE, CINAHL, PREMEDLINE, PsychINFO, Social Sciences Citation Index and Web of Science using keywords related to coronary heart disease. Early qualitative studies of patients with coronary heart disease were conducted almost exclusively with men, and tended to generalize from âmaleâ experience to âhumanâ experience. By the late 1990s this pattern had changed, with the majority of studies including women and many being conducted with solely female samples. However, many studies that include both male and female coronary heart disease patients still do not have a specific gender focus. Key themes in the literature include interpreting symptoms and seeking help, belief about coronary âcandidatesâ and relationships with health professionals. The influence of social roles is important: many female patients have difficulties reconciling family responsibilities and medical advice, while male patients worry about being absent from work. There is a need for studies that compare the experiences of men and women. There is also an urgent need for work that takes masculinity and gender roles into account when exploring the experiences of men with coronary heart disease. [ABSTRACT FROM AUTHOR]

Provides an overview of articles on issues and innovations in nursing practice.

The section comments on the article "Beyond Empathy: Expanding Expressions of Caring," by J. M. Morse, et al, which appeared in the 1992 issue of the "Journal of Advanced Nursing." It expresses opinion on the opening sentence of the paper which suggests that empathy has been touted as appropriate and desirable. It asserts that the paper is unsatisfying and, from a contemporary perspective, seems naive. It states the reasons for the paper's lack of substance.

Presents a list of articles included in a November 2004 issue of "Journal of Advanced Nursing." "Central Venous Catheters: A Survey of ICU Practices"; "The Struggle for Sanitary Reform in the Lancashire Cotton Mills, 1920-1970"; "Glass Contamination in Parenterally Administered Medication."

Presents a list of several studies related to nursing and healthcare management. "Analysis of the Moral Habitability of the Nursing Work Environment," by E. H. Peter, A. V. Macfarlane and L. L. O' Brien-Pallas; "Implementing Local Pay Systems in Nursing and Midwifery," by E. Meerabeau, S. Corby, J. Druker and G. White; "Nurses' Attitudes Towards Lesbians and Gay Men," by G. Röndahl, S. Innala and M. Carlsson.

Offers a summary of articles featured in the 2004 issue of the "Journal of Advanced Nursing." "Promoting Participation in Cardiac Rehabilitation: Patient Choices and Experiences"; "A Preventative Health Education Programme for Osteoporosis"; "Nursing Care at Night: An Evaluation Using the Night Nursing Care Instrument"; "Staff and Patient Perceptions of Seclusion: Has Anything Changed?"; "Evaluating a Nurse-Led Model for Providing Neonatal Care."

Presents summaries of articles on issues and innovations in the nursing practice worldwide as of May 2004. "Medical Hegemony in Decision-Making - A Barrier to Interdisciplinary Working in Intensive Care?," by M. Coombs and S. J. Ersser; "The Postmodern Heart: War Veterans' Experiences of Invasive Cardiac Technology," by C. C. Anderson; "Rational Suicide: Uncertain Moral Ground," by K. L. Rich and J. B. Butts.

Presents a table of contents of the Volume 45, number 4, 2004 issue of "Journal of Advanced Nursing."

Presents abstracts of several articles on nursing. "The Effectiveness of Public Health Nursing: The Problems and Solutions in Carrying Out a Review of Systematic Reviews," by L. Elliott, I.K. Crombie, L. Irvine, J. Cantrell and J. Taylor; "Expert Qualitative Researchers and the Use of Audit Trails," by J.R. Cutcliffe and H.P. McKenna; "Using Student Nurses as Teachers in Inquiry-Based Learning," by D. Morris and P. Turnbull; "Occupational Health and School Health: A Natural Alliance?," by E. Croghan and C. Johnson.

Provides information on several articles that appeared in the December 15, 2003 issue of "Journal of Advanced Nursing." "Nurse-Managed Clinics: Issues in Evaluation"; "Management of Chronic Illness: Voices of Rural Women"; "Hysterectomy: A Case Study of One Woman's Experience."

Presents an overview of articles featured in the November 2003 issue of the "Journal of Advanced Nursing."

BACKGROUND: This paper's starting point is the recognition (descriptive not normative) that, for the vast majority of day-to-day clinical decision-making situations, the 'evidence' for decision-making is experiential knowledge. Moreover, reliance on this knowledge base means that nurses must use cognitive shortcuts or heuristics for handling information when making decisions. These heuristics encourage systematic biases in decision-makers and deviations from the normative rules of 'good' decision-making. AIMS: The aim of the paper is to explore three common heuristics and the biases that arise when handling complex information in clinical decision-making (overconfidence, hindsight and base rate neglect) and, in response to these biases, to illustrate some simple techniques for reducing the negative influence of heuristics. DISCUSSION: Nurses face a limited range of types of uncertainty in their clinical decisions and draw primarily on experiential knowledge to handle these uncertainties. This paper argues that experiential knowledge is a necessary but not sufficient basis for clinical decision-making. It illustrates how overconfidence in one's knowledge base, being correct 'after the event' or with the benefit of hindsight, and ignoring the base rates associated with events, conditions or health states, can impact on professional judgements and decisions. The paper illustrates some simple strategies for minimizing the impact of heuristics on the real-life clinical decisions of nurses. CONCLUSION: The paper concludes that more research knowledge of the impact of heuristics and techniques to combat them in nursing decisions is needed. [ABSTRACT FROM AUTHOR]

Provides information on several research regarding nursing. Innovations in nursing practice including cultural childbirth practices and beliefs in Zambia; Nursing theory and concept development or analysis; Attitudes of nurses and nursing education.

AIM: The aim of this paper is to discuss the opinions of the key individuals involved in implementing the integration of nurse education into higher education in the United Kingdom (UK) about why nurse education moved into higher education and why this happened when it did. BACKGROUND: In 1995 the last of the old-style schools of nursing in the UK was fully integrated into higher education and were detached financially, legally and organizationally from District Health Authorities. However, only 6 years before, when Working Paper 10 was produced, there were only a few nursing degree courses located within higher education. What made this move into higher education particularly noteworthy was that there was never a clear statement of intent from the government that this integration of health care education was intended. Despite the fact that this is one of the most significant changes ever to take place in nurse education, there has been relatively little empirical research about why the development occurred. METHODS: A qualitative approach was selected for this study and the methods used were policy analysis and interviews. A purposeful sample of 70 implementers involved in the integration process was selected and asked for their views on this issue. FINDINGS: Participants believed that integration had occurred because of a combination of complex factors, but there was a division between those who thought that it was centrally planned and others who felt that it was an accidental outcome of the particular events of the time. CONCLUSIONS: It is not clear whether policy was influencing action or action influencing policy. Understanding of why this change occurred is needed if health care professionals wish to have greater control over future changes in education. [ABSTRACT FROM AUTHOR]

BACKGROUND: In an era when information technology developments are being harnessed by governments to improve patient care, it is important to consider the issues raised by the use of computers in health care practice and policy. AIM: The aim of this paper is to provide an appraisal of considerations raised by the use of computers in health care. REVIEW FOCUS: Drawing on a range of studies in the social and medical sciences, the paper reviews the considerations. The introduction to the paper maps out the policy context, which is followed by three substantive sections: first, computer hardware and software considerations; second, issues around confidentiality; and third, personal, social and cultural considerations. CONCLUSION: This paper demonstrates that information technology developments must be allied with government or state direction and should be informed by evidence. Whilst the issues discussed are of primary relevance to the United Kingdom National Health Service, they have wider relevance to health care systems internationally. [ABSTRACT FROM AUTHOR]

BACKGROUND/RATIONALE: Current nursing literature that describes the nurse-client relationship as a partnership provides little clarity about the elements and processes of this partnership. This is hardly surprising as conceptual definitions of partnership differ in scope and vary according to the context of the partnership and types of partners. AIMS OF THE PAPER: This paper examines the concept of partnership using Rodgers's (2000) evolutionary approach to concept analysis. The paper describes the antecedents, attributes and consequences of partnership as well as changing socio-political and economic contexts that illuminate how and why nurse-client partnership emerged. Temporal changes in the concept of partnership are also examined. FINDINGS: The nurse-client relationship as partnership evolved from a growth in democratic thinking and progress in clarifying how to honour basic human rights in health care relationships. The attributes of partnership include structural and process phenomena. The structure of partnership includes the phases of the relationship, focus and aims of each phase, and roles and responsibilities of the partners. The process of partnership embodies power sharing and negotiation. The main consequence of partnership is client empowerment, which is understood to be the improved ability of the client to act on his/her own behalf. CONCLUSIONS: The paper concludes with suggestions for further development of the concept of partnership through empirical research. [ABSTRACT FROM AUTHOR]

Aim of the study. The purpose of this paper is to present ICU nurses' experiences with a computerized nursing care plan system at a medical centre in Taiwan. Background. Computerized nursing care plans have been implemented in recent years, but users' perceptions of this technology have not been comprehensively explored. It is believed that by taking into consideration users' experiences with computer use, strategies and programs can be developed to help users adapt to new systems. Methods. A qualitative study, involving one-to-one interviews, was conducted with 12 Registered Nurses. Data were analysed according to Miles and Huberman's data reduction, data display and conclusion verification process. Findings. Themes related to the clinical impact of system use were: 'saves paper/time', 'time-consuming for print-outs', 'de-individualization of care plan', 'routine/paperwork requirement', 'no consensus for nursing diagnoses', and 'guidelines for the novice'. Conclusions. Nurses prefer tools that can help them save time with paperwork and focus on targeting patient problems. With careful assessment and evaluation of nurses' experiences in the use of clinical computer systems, the success of computer implementation can be enhanced. [ABSTRACT FROM AUTHOR]

Provides an overview of the articles published in the volume 36, number 3, November 2001 edition of the periodical 'Journal of Advanced Nursing.' Inclusion of the spiritual well-being dimension in the provision of nursing care; Mental disturbance and perceived complexity of nursing care in medical inpatients; Relationship between informal caregivers of older people and health care workers.

Presents updates on issues and topics related to nursing as of October 2005. Release of a series of issue papers on the global storage of registered nurses by the International Council of Nurses; Launch of the Learn the Signs. Act Early child development campaign by the U.S. Centers for Disease Control and Prevention; Findings of a study by the Yokohama Rehabilitation Center and the Institute of Psychiatry on the link between measles-mumps-rubella vaccine and autism.

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]

From modest developments of 'popular' nursing journals many years ago, there has been a prolific growth in the numbers of nursing journals published each year. This growth is particularly noteworthy in the increase in the numbers of specialist interest and scholarly nursing journals. The different types of journals have also tended to influence each other's contents, as well as the contents of nursing textbooks. Over the years, nurses themselves have emerged as the main contributors to the journals. Increasingly the focus of all the journals has been on nursing practice - and the factors associated with professional practice and the professional education and development of nurses. Whilst it is conceded that it is difficult to demonstrate that nursing journals have made a direct impact on care, some indirect impact can be claimed. This claim is based, among other things, on the contribution of nursing journals to the development of nursing as a profession, their contribution to the individual development of professional nurses, and their contribution to the documentation of the body of nursing knowledge. [ABSTRACT FROM AUTHOR]

Quality of life is of central concern in evaluative research; improved quality of life is probably the most desirable outcome of all health care policies. However, definitions of quality of life are as numerous and inconsistent as the methods of assessing it. Stemming from a larger piece of work looking at the definition and measurement of quality of life, this paper highlights the lack of a consensus definition of quality of life by means of a taxonomy of definitions that emerge from the literature. The paper describes and gives examples of four main types of definition which make up the taxonomy: global (type I); component (type II); focused (type III); and combination definitions (type IV). In addition, an outline of factors influencing the definition of quality of life is given, and an alternative strategy for both defining and measuring the concept (the use of lay definitions) is suggested. [ABSTRACT FROM AUTHOR]

Breast self-examination (BSE) is recommended in order to help women detect possible breast cancer early in its development. Correct BSE performance has been shown to be positively associated with breast lump detection ability. Few women, however, report practising BSE, citing reasons such as: dislike of touching one's own breasts, fear of finding a lump, lack of confidence in their ability to perform BSE. The purpose of this study was to test a breast examination facilitation device (BEFD) for women, which would provide a teaching/screening tool, as well as a shield between breast and fingers for women who are reluctant to touch their breasts. A sample of 36 registered nurses in the United States was asked to perform BSE on three separate occasions using a BEFD made of latex, paper or cloth on which a wedge pattern for BSE had been imprinted. Subjects found the BEFD to be a useful tool for teaching/learning BSE, and expressed a clear preference for the latex material. One size of BEFD is not adequate for all women. A smaller size for women who wear A and B cup-size bras, and a larger size for women who wear C cup size and above, would be more acceptable. [ABSTRACT FROM AUTHOR]

This paper examines nurses' health education work from a philosophical perspective. Two key concepts, choice and autonomy, are explored by analysing examples of the health education work of the practice nurse and the health visitor. As a result, the question, 'what changes in health behaviour might nurses logically expect from their health education work?' is considered. The individualistic assumption within nurses' health education work that individual patients and clients face certain choices and are able to exert some control over their health status, is reviewed. Choices related to healthy eating, for example, are recognized to be constrained by issues such as finance, time and social circumstances. The choice not to smoke is similarly constrained, for example, by social deprivation, cultural patterns and advertising. The paper both rejects an overly determined conception of patients and clients where they are viewed as unable to make any choices, but also cautions against the danger of victim-blaming. Constraints on patients' and clients' autonomy in health education by nurses are also considered. These limitations on health education work include, for example, a lack of scientific knowledge related to an individual's propensity to develop disease. In contrast, health education work within nursing may also be enabling people to be more autonomous in relation to their health by imparting knowledge about health risks. Health education work by nurses thus emerges from the analysis as a constrained but valuable activity. [ABSTRACT FROM AUTHOR]

An account of the operation of a journal club in a Postgraduate Certificate in Education course for teachers of nursing is reported here. The paper is based on three issues: the background to journal clubs, the process involved in the operation of the club concerned, and the expected outcomes. The origins of journal clubs and the reading habits of nurses are considered in the background section through a review of some of the relevant literature. The negotiation involved, the frequency of meetings and the ethos in which they were conducted are discussed in the section on the processes involved. In the final section, both the tangible and personal outcomes are discussed and the conclusion reached is that a journal club is a worthwhile educational activity. [ABSTRACT FROM AUTHOR]

This paper focuses upon an exploration into the world of the cancer nurse regarding stress and persons with cancer. It is proposed that the cancer nurse's world often is not emphasized or even acknowledged within clinical practice and, for the most part, remains ignored. It is argued that the cancer nurse's world is rich with meaning, and the knowledge, skills and values within this domain need to come to the fore. A phenomenological approach was adopted for the study, because of the inherent emphasis upon meaning and understanding within the cancer nurse's everyday practice. Methodological triangulation involved qualitative interviews with nursing staff on an acute oncology unit, observation of the nursing admission assessments of cancer patients and use of archival sources (nursing kardexes). Content analysis of the interview findings revealed that the common-sense understandings of the cancer nurse were present in relation to stress and the person with cancer. Although these construals have not been adequately studied, the framework of common-sense knowledge involves the informal views and the wealth of knowledge individuals have. Common-sense construals are linked to the nurses' experience, both past and present, and derived from both professional practice and educational experiences. In practice, however, the nurses often failed to rely on this knowledge, apparently because of the mainstream influence of the medical model. The study led to the recommendation reported on in this paper that nurses must bring their common-sense knowledge and values to the fore in order to provide holistic care of persons with cancer. [ABSTRACT FROM AUTHOR]

It has been estimated that up to 40% of people with moderate to severe dementia live in residential homes or long-stay hospital wards. This paper examines some of the ethical issues that arise in nursing people suffering from dementia within an institutional setting. The paper focuses first on the nursing profession and the recently published Strategy for Nursing. The fundamental patient/client values within the strategy recognize the uniqueness of the individual and the importance of providing nursing care which is tailored to meet individual needs. The next part of the paper will examine the difficulties associated with individualizing care for people suffering from dementia and highlight some of the ethical issues involved are examined and some tentative suggestions are put forward as to how some of the identified problems might be tackled. [ABSTRACT FROM AUTHOR]

In the early 1980s Canadian professional nursing associations officially adopted the goal of baccalaureate entry to practice by the year 2000. In the ensuing years, nursing educators have explored a variety of means to work toward achieving this goal. This paper describes a collaborative model of baccalaureate programme delivery developed between a university school and a hospital-based diploma school in Vancouver, British Columbia. The paper documents the history of the collaboration and the organization of human and physical resources for implementation. The issues and challenges encountered in the transition, the strategies used to facilitate the process, and the benefits gained by each partner are discussed. [ABSTRACT FROM AUTHOR]