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The article discusses the report in this issue, "Older people with hip fracture: depression in the postoperative first year," by Y. I. L. Shyu and others.

Title. A systematic review protocol on the use of teaching portfolios for educators in further and higher education. Aim. This paper is a review protocol that will be used to identify, critically appraise and synthesize the best current evidence relating to the use of teaching portfolios for educators in further and higher education. Background. While portfolio use as a means to assist students in further and higher education has undergone extensive research and review, their use as a tool to assist educators has yet to receive systematic attention. Reviews conducted on studies related to portfolio use and undergraduate students have suggested that a teaching portfolio may have a benefit for educators in higher education as a means to provide relevancy and focus to their teaching. Design. The objectives of the review are to evaluate how a teaching portfolio assists educators in teaching and learning; to evaluate the effects of maintaining a teaching portfolio for educators in relation to personal development; to explore the type of portfolio used; to determine whether a teaching portfolio is perceived more beneficial for various grades and professional types; and to determine any motivating factors or workplace incentives behind its implementation and completion. A search of the following databases will be made: MEDLINE, CINAHL, BREI, ERIC and AUEI. The review will follow the Joanna Briggs Institute guidance for systematic reviews of quantitative and qualitative research. Conclusion. The review will offer clarity and direction on the use of teaching portfolios for educators, policymakers, supervisory managers and researchers involved in further and higher education. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study conducted to describe changes in risk of depressive symptoms and their predictors for older people with hip fracture during the first year following hospital discharge. Background. The prevalence of depression in older people with hip fracture has been reported as 9--47%. However, the longitudinal changes in prevalence rate following hip fracture have not been well-studied, particularly in Asian countries. Methods. The study was conducted in Taiwan in 2001--2003. A sample of 147 older people with hip fracture was assessed for depressive symptoms before discharge, and at 1, 3, 6 and 12 months after discharge using the Chinese version of the Geriatric Depression Scale. Longitudinal data were analysed by the generalized estimating equation approach. Findings. The majority of participants were at risk for depressive symptoms before discharge (n = 147, 57.8%) and 35.6% (n = 118) 12 months after discharge. These numbers decreased statistically significantly from before discharge to the 1st month after discharge (57.8% vs. 42.6%, P = 0.008), and from the 1st to the 6th month (42.6% vs. 31.3%, P = 0.03), and then remained stable until the 12th month after discharge. Lower emotional-social support predicted persistent depressive symptoms after discharge (P < 0.01). Conclusion. Timely psychological interventions are suggested within the first 6 months after discharge, especially the first 3 months. Healthcare professionals need to pay attention to older patients with hip fracture who are female, with poorer prefracture functioning and particularly those with lower emotional-social support. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study of the breastfeeding experience of mothers of very low birth weight babies. Background. Very low birth weight babies, being born preterm, are at risk for feeding difficulties. Medical complications may prolong their hospital stays and further delay their progression towards oral feeding. Many studies have focused on the benefits of breastfeeding to very low birth weight babies, but very few have explored the breastfeeding experiences of their mothers. Method. Data were collected between 2005 and 2007. In-depth interviews were conducted during home visits with 31 mothers who breastfed their very low birth weight babies. Following her baby's discharge from hospital, each mother was interviewed twice about her breastfeeding experience. The data were analysed using qualitative content analysis. Findings. Five themes were identified from the mothers' reports: wanting to compensate, maintaining motivation and connectedness, needing 'extra helping hands', controlling emotions and matching baby's individual pace. Mothers' self-blaming provoked them to breastfeed their very low birth weight babies to compensate babies for the harm caused by them. These mothers learned how to express breast milk and this served as an important vehicle that gradually connected them to their babies. Conclusion. Breastfeeding a very low birth weight baby is a challenging and exhausting experience for the mother. A better teaching protocol for breastfeeding and an improved breastfeeding ethos need to be implemented in the neonatal intensive care unit and special care nursery to support families of very low birth weight infants. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study conducted to explore the factors associated with nurses and midwives' attitudes towards perinatal bereavement care. Background. Caring for and supporting parents whose infant has died is extremely demanding, difficult and stressful. In some situations nurses may experience personal failure, feel helpless, and need to distance themselves from bereaved parents because they feel unable to deal with the enormity of the parental feelings of loss. Method. A correlational questionnaire study using convenience sampling was carried out in Singapore in 2007 with 185 nurses/midwives in one obstetrics and gynaecology unit. Results. Regression models showed that nurses/midwives with religious beliefs and those with more positive attitudes to the importance of hospital policy and training for bereavement care were statistically significantly more likely to have a positive attitude towards perinatal bereavement care. Nurses emphasized their need for increased knowledge and training on how to cope with bereaved parents and requested greater support from team members and the hospital. Conclusion. Bereavement counselling education and preceptorship supervision are recommended to reduce this stressful experience, increase the confidence and expertise of novices, and lead to increased quality of care for bereaved parents. [ABSTRACT FROM AUTHOR]

Title. Nurses’ attitudes towards perinatal bereavement care. Aim. This paper is a report of a study conducted to explore the factors associated with nurses and midwives’ attitudes towards perinatal bereavement care. Background. Caring for and supporting parents whose infant has died is extremely demanding, difficult and stressful. In some situations nurses may experience personal failure, feel helpless, and need to distance themselves from bereaved parents because they feel unable to deal with the enormity of the parental feelings of loss. Method. A correlational questionnaire study using convenience sampling was carried out in Singapore in 2007 with 185 nurses/midwives in one obstetrics and gynaecology unit. Results. Regression models showed that nurses/midwives with religious beliefs and those with more positive attitudes to the importance of hospital policy and training for bereavement care were statistically significantly more likely to have a positive attitude towards perinatal bereavement care. Nurses emphasized their need for increased knowledge and training on how to cope with bereaved parents and requested greater support from team members and the hospital. Conclusion. Bereavement counselling education and preceptorship supervision are recommended to reduce this stressful experience, increase the confidence and expertise of novices, and lead to increased quality of care for bereaved parents. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study carried out to describe maternal and child health nurses' experiences of communicating and raising issues with parents about children's overweight. Background. Children's overweight and obesity are rapidly increasing in many countries around the world. Maternal and child health nurses are in a unique position to influence parents, but studies of their experiences in communicating with parents about overweight are lacking. Method. Ten maternal and child health nurses in culturally diverse rural and urban areas in Melbourne, Australia, were interviewed in 2007. Data were analysed using qualitative content analysis to identify key categories. Findings. During the analysis, eight categories were identified. In summary, nurses described it as difficult to raise weight issues, especially if parents were overweight themselves. The growth chart was felt to be an essential tool in discussions about weight and nurses often described themselves as holding 'expert' roles in conversations. Denial, defensiveness and excuses about children being overweight were common reactions among parents and were described as difficult to deal with. However, a strong nurse--parent relationship was experienced as facilitating conversations about weight. Conclusion. Raising issues about weight can be difficult, especially if parents are overweight themselves. Further research in communications is needed to understand and approach parents better -- especially overweight parents -- about their children's weight. Interventions involving patient-centred approaches in this context have potential, but the area is still relatively unexplored. Maternal and child health centres could be important contributors in such future interventions. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study conducted to examine the effect of participating in an education program on burnout for mothers of children with an intellectual disability. Background. Mothers with an intellectually disabled child are prone to suffer from excessive stress and burnout. There is limited evidence for the effectiveness of education interventions aimed at reducing burnout levels in this population. Methods. After baseline screening, mothers who agreed to participate (n = 90) were randomized to an intervention or control group. The intervention group participated in an interactive education programme for 1 hour, in addition to using an educational booklet designed and presented by the researchers. The booklet contained information about the characteristics of intellectually disabled children, the specific health care and education they require, non-profit organizations and foundations providing assistance, and ways in which mothers can cope with stress. The control group received the same intervention separately after completing the posttest. The study was carried out from 2004 to 2005. Findings. Intervention group members reported fewer episodes of emotional burnout compared to the control group, indicating that participation in a nursing education programme reduced the level of burnout experienced by mothers who have an intellectually disabled child. There were no effects of the education programme on perceptions of personal success, i.e. mother's feelings of competence and successful achievement in care of their intellectually disabled child. Conclusion. Nurse-administered education should be provided for mothers who have an intellectually disabled child in order to reduce the degree of emotional burnout that these mothers typically experience. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study of the attitudes of Dutch nursing students towards people with physical or intellectual disabilities. Background. Attitudes of healthcare professionals are a major factor in the rehabilitation and self-acceptance of persons with disabilities. Consequently, it is important that nurses develop or maintain positive attitudes towards people with disabilities during their education. However, more knowledge is needed about current attitudes of nursing students and factors influencing these attitudes. Methods. A sample of Dutch nursing students (n = 81) and an age-matched group of non-nursing peers (n = 48) completed standardized scales measuring attitudes about physically or intellectually disabled people. Data were collected in 2006. Findings. Nursing students were more positive towards physically disabled people than their peers, and more strongly endorsed empowerment and similarity of intellectually disabled people. These attitudinal differences generally remained statistically significant after multivariate adjustment for demographic variables and experience and contact with individuals with disabilities. An important independent determinant of a positive attitude towards physically disabled people in the total sample was having a relative or friend with a physical disability. This association, however, was not apparent in attitudes towards intellectually disabled persons. Conclusion. Educational interventions aimed at improving attitudes towards people with disabilities should include focus on forms of contact beyond the context of formal care relationships. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study of the correlates of mammogram use among Korean American women. Background. Despite the increasing incidence of and mortality from breast cancer, Asian women in the United States of America report consistently low rates of mammography screening. A number of health beliefs and sociodemographic characteristics have been associated with mammogram participation among these women. However, studies systematically investigating cultural factors in relation to mammogram experience have been scarce. Methods. We measured screening-related health beliefs, modesty and use of Eastern medicine in 100 Korean American women in 2006. Hierarchical logistic regression was used to examine the unique contribution of the study variables, after accounting for sociodemographic characteristics. Findings. Only51%reportedpastmammogramuse. Korean Americanwomenwhohad previously had mammograms were statistically significantly older and had higher perceived benefit scores than those who had not. Perceived benefits (odds ratio = 6.3, 95% confidence interval = 2.12, 18.76) and breast cancer susceptibility (odds ratio = 3.18, 95% confidence interval = 1.06, 9.59) were statistically significant correlates of mammography experience, whereas cultural factors did not correlate. Post hoc analysis showed that for women with some or good English skills, cultural factors statistically significantly correlated with health beliefs and breast cancer knowledge (P < 0Æ05). Conclusion. Nurses should consider the inclusion in culturally tailored interventions of more targeted outreach and healthcare system navigation assistance for promoting mammography screening in Korean American women. Further research is needed to unravel the interplay between acculturation, cultural factors and health beliefs related to cancer screening behaviours of Korean American women. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study investigating the effects of clinical factors (side effects of immunosuppressive medications, transplant-related hospitalizations, donor type, duration of dialysis before transplantation and time post-transplant) on cognitive appraisal of health, perceived self-efficacy, perceived social support, coping and health-related quality of life after renal transplantation. Background. Some clinical factors such as hospitalizations, side effects of medications, donor type and dialysis, which influence the health-related quality of life of renal transplant recipients, have been investigated. However, the effects of these clinical factors on psychosocial variables after renal transplantation have not been well documented. Method. Using a descriptive cross-sectional design, a convenience sample of 160 renal transplant recipients was recruited (N = 55 < 1 year post-transplant; N = 105 1--3 years post-transplant) from May, 2005 to January, 2006. Standardized instruments were used to measure the key constructs. Multivariate analysis of variance was used to examine the effects of clinical factors on the psychosocial outcome measures. Results. Participants reporting more (>17) immunosuppressive medication-associated side effects appraised their health more negatively, used more disengagement coping, had lower degrees of perceived self-efficacy, and reported lower physical and mental health-related quality of life than those with fewer symptoms (

Aim. This paper is a report of a study conducted to determine the possibility of performing colonoscopy without medication, elucidate the factors related to a painful colonoscopy experience and compare colonoscopy patients' reported pain assessment to nurses' and endoscopists' observations. Background. Sedation and pain medication are routinely administered for colonoscopies in many countries. However, medication-free colonoscopies have attracted attention because the use of medication requires a time commitment from patients and increases complications. Earlier studies show that, for instance, gender, age and pelvic operations may increase the risk of painful colonoscopy and those healthcare professionals and patients appear to assess pain differently. Method. A cross-sectional descriptive study was conducted in a Finnish university hospital using questionnaires developed for this study and analysed statistically. The sample of 138 colonoscopy patients, 11 nurses and 11 endoscopists was recruited in 2006. Results. Over three-quarters of patients reported mild pain or no pain at all. Patients' nervousness is a risk factor for experiencing pain during colonoscopy. Both nurses and endoscopists slightly underestimated the intensity of pain experienced by patients. Conclusion. It is possible to perform colonoscopy without medication with most patients and focus sedation and pain medication on at-risk patients, especially those who are nervous. Before the procedure, nurses must devote time to discovering which patients are nervous and at risk of having a painful colonoscopy to present them for sedation. To improve pain management for patients having colonoscopy, endoscopists and nurses should participate systematically in pain education and use pain scales. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study assessing pressure ulcer incidence and factors affecting pressure ulcer development among older nursing home residents. Background. Previous researchers have shown that demographic, clinical, health status, risk and human resources factors affect pressure ulcer development among older people in various healthcare settings, but none has investigated their interactive effects among older nursing home residents. Method. This was a prospective cohort study involving 346 residents aged 65 years or over from four private nursing homes in Hong Kong. We collected information on participant demographics and assessed their clinical characteristics, health status and pressure ulcer risk factors. Subsequently, we assessed their skin condition every 2 days for 4 weeks to detect pressure ulcers that developed after the initial assessment. The data were collected between December 2006 and September 2007. Results. The pressure ulcer incidence was 25.16%. The model in which the factors of clinical characteristics, health status, pressure ulcer risk and human resources were controlled was more reliable in predicting pressure ulcer development than the other two models. It showed that bedfast or chairfast residents, especially those with co-morbidities (renal failure and stroke) and living in nursing homes where there were no nurses but more nursing assistants, were at higher risk for pressure ulcer development. Conclusion. Evidence-based interventions should be adopted to minimize the possible problems of pressure, malnutrition, friction and shear force, and the decreased pain perception of bedfast or chairfast residents in nursing homes, especially those with renal failure or stroke. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study conducted to develop a theoretical model of the process nurses use to deliver care over the telephone. Background. Telephone nursing is practised internationally in diverse settings, and research has shown it to be an effective service. Although studies have identified important variables that influence the practice, the telephone nursing process in its entirety has not been described. Method. In this grounded theory study, data were collected from ten experienced telephone nurses from four different sites using semi-structured interviews. Concurrent data collection and analysis took place in 2005. A cumulative process of theoretical sampling and constant comparison was used to identify initial concepts, and then expand, validate, and clarify them until the concepts and relationships were fully developed. The findings were validated through peer and participant review. Findings. Telephone nursing is a dynamic and goal-oriented process consisting of three phases: gathering information, cognitive processing, and output. While generally sequential, the phases can be simultaneous or recurring in response to caller needs. Interpreting takes place throughout the call; that is, the nurse translates data from the caller into healthcare information and healthcare information into caller language. Factors shaping the process are call prioritization and level of complexity, resource availability, and the nurse's need for validation. Conclusion. Telephone nursing training and practice should emphasize gathering information, using implicit and explicit information to identify client needs, and translating healthcare information back into language comprehensible to clients. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to develop a grounded theory to explain how district nurses meet the emotional needs of dying patients in the community. Background. There has been a policy commitment internationally to improve community services and enable people with terminal illnesses to die in their own homes. This increasing trend towards home deaths in the United Kingdom (UK) makes more demand on district nurses to provide emotional support for dying patients. Methods. A 'classic' grounded theory study was conducted in the UK between 2002 and 2005. Unstructured observations and semi-structured interviews were conducted with a purposive sample of nine district nurses, nine patients and four family carers. A further theoretical sample of five books of authors' accounts of their dying experiences and three district nurses who were advanced practitioners were selected. Findings. Five categories were identified in the data: 'outside world', 'dying world', 'entering dying world', 'maintaining connections' and the core category 'bridging worlds'. The theory of 'bridging worlds' indicated that dying patients experienced 'dying world' and 'outside world'. District nurses met dying patients' emotional needs by acting as a bridge between their two worlds, encouraging them to maintain connections with the outside world so that they did not become isolated in their dying world. Conclusion. District nurses should ensure that they meet both the physical and emotional needs of dying patients. Nursing education and literature need to concentrate on raising awareness of nurses' role in providing emotional support. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study conducted to test Kanter's organizational empowerment theoretical model specifying the relationships among demographics, structural empowerment, and job satisfaction. Background. Empowerment has become an increasingly important factor in determining nurses' job satisfaction in current restructured work environments in China. Methods. A correlational, cross-sectional design was used to test Kanter's organizational empowerment model with a sample of 650 full-time nurses employed in six Chinese hospitals in 2007, with a response rate of 92% (n = 598). The instruments used were the Demographic Data Questionnaire, Conditions of Work Effectiveness Questionnaire-II, and Job Satisfaction Scale. Results. The three lowest scoring items for Conditions of Work Effectiveness Questionnaire-II were resources, opportunity and informal power. The job satisfaction items revealing most dissatisfaction were workload and compensation, professional promotion, amount of work responsibility, work environments, and organizational policies. A statistically significant positive correlation was found between empowerment and job satisfaction (r = 0.547, P < 0.01). The demographic factors influencing empowerment were work objectives and age. The influencing factors for job satisfaction were work objectives and education level. Conclusion. The results provide support for Kanter's organizational empowerment theory in the Chinese nurse population. Nurses who view their work environments as empowering are more likely to provide high quality care. Enhancing empowerment in a supportive environment would allow nurses to experience satisfaction with their jobs. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study investigating the association between the support experienced by supervisors from superiors and from fellow supervisors, on the one hand, and the support experienced by subordinates from their supervisors, on the other hand, in organizations under external pressure. Background. It is known from studies in other sectors that supervisors' support of workers is important for retaining them in the organization. From the literature on social exchange in the workplace it can be hypothesized that support from managers is one way to generate supervisor supportiveness towards their subordinates. Methods. A survey was conducted in 15 Danish local government services providing care for senior citizens. The data were collected in 2006. Results. Multilevel analyses revealed that the more supervisors felt supported by fellow supervisors, the more their subordinates felt supported by them. There was no statistically significant association between how much supervisors felt supported by their immediate superiors and how much supervisors' subordinates felt supported by them. Conclusion. Under conditions comparable to those of Danish elder care today, more is to be gained in terms of generating supportive behaviour towards subordinates from supervisors by empowering them to support each other rather than by increasing support from their superiors. Research is needed to identify methods and structures of mutual support between supervisors in the healthcare sector that will aid them in supporting their subordinates. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to evaluate the influence of interdisciplinary seminars for undergraduate nursing and social work students on development of their understanding of the meaning of caring. Background. There is growing international interest in interprofessional education, which is believed to have the potential to improve patient care. If interprofessional education and subsequent collaboration are truly to be patient-centred, it is important to identify a value base which creates a healthcare professional identity that facilitates collaboration. Caring, as a humanistic value, is found in both nursing and social work professionals. Method. A mixed method approach, primarily qualitative but with a quantitative component, was chosen for evaluation of the interprofessional seminars. The data were collected between 2007--2008 by videotape recordings of the sessions, followup telephone interviews and a questionnaire. Findings. There was cultivation in the nursing students of a deeper understanding of caring based on openness and a non-judgmental approach, learned from their social work counterparts. Reciprocally, social work students learned about the nursing students' daily activities as they observed the natural process of trust and communication in the context of caring. Conclusion. Enhanced understanding of caring in practice is not possible via learning through a uni-professional approach. Students' reflections and dialogue enable their development of relation-centred caring, particularly in the realm of biomedical and technical environments. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study examining the labour processes of male nurses in the conduct of bodywork, and is part of a broader study of social practices that configure masculinity through the lives of male nurses. Background. Bodywork is defined as the direct work on others' bodies, and involves interactions of bodies and the control of emotions. As the body is an arena in which social practice occurs then bodywork is a form of social engagement. Bodywork is inextricably intertwined with gender where bodywork is socially structured and culturally accepted as women's work. Method. Life history method was used in this study. Twenty-one life stories from male registered nurses were gathered in 2003--2004 using semi-structured interviews. Each life story underwent structural analysis, using a four-dimension structural model of gender relations. Findings. The ability of male nurses to do bodywork and provide care is dependent on the way they 'do' gender, that is, they have to be perceived to be performing the masculine identity that best represents the individual patient's ideology of what it is to be a man, which is set in a particular location and time. In addition, they have to counter the representations of the male nurse, whether it is homosexual, paedophile or heterosexual deviant. Respondents develop labour processes and workplace strategies to overcome the effects of gender stereotypes that may hinder their nursing work. Conclusion. Nursing procedures, policies and texts should reflect the complexity and multiplicity in the conduct of bodywork in nursing and refrain from representing essentialist ways (reinforcing nursing as feminine) of doing nursing. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study exploring the reporting behaviours of nursing students who had experienced verbal abuse while gaining clinical experience. Background. Under-reporting of incidents of verbal abuse has been identified internationally as a limitation leading to incomplete data collection when researching aggression in healthcare facilities. This can call into question conclusions, recommendations and policy initiatives based on the research. Method. Questionnaires were distributed in 2005 to a convenience sample of 156 third year nursing students from one preregistration nursing programme in England. A total of 114 questionnaires were returned, giving a response rate of 73.0%. Fiftyone students (44.7%) reported verbal abuse and all of these gave details of the behaviours concerned. Results. Thirty-two students (62.7%) of those reporting verbal abuse) stated that they had reported the incident and 19 (37.3%) of respondents stated that they had not. Only four incidents resulted in formal documentation. The most frequent feelings reported by respondents were embarrassment and feeling sorry for the abuser. Conclusion. Failure to document experiences of verbal abuse formally was prevalent and reporting practices were variable. Both higher education institutions and healthcare providers should consider establishing process for formal reporting and documenting of incidents of verbal abuse during nurse education, and students should have access to formal support services. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study conducted to determine if satisfaction with irregular working hours that are a form of shiftwork operates as a mediator between work and home characteristics and health problems. Background. Shiftwork contributes to health problems, decreased well-being and poorer health habits. It also affects employees' decisions to leave the healthcare sector. Although many nurses voluntarily work shifts, there have been few studies of their satisfaction with irregular working hours when these are a form of shiftwork. Methods. A survey was carried out with 144 nurses working in three nursing homes and one care home in the Netherlands. Questionnaires were distributed in 2003 to 233 nurses who worked shifts (response rate 60%). The questionnaire contained items on work and home characteristics, satisfaction with irregular working hours that are a form of shiftwork and health. A new scale to measure satisfaction with irregular working hours was constructed. Results. All work characteristics, but no home characteristics, were associated with satisfaction with irregular working hours. The work characteristics 'job demands' and the home characteristics 'autonomy at home' and 'home demands' were associated with health. Satisfaction with irregular working hours did not mediate between work/home characteristics and health. Those reporting more social support, lower job demands and more job autonomy were more satisfied with their irregular working times that were a form of shiftwork. Conclusions. Satisfaction with irregular working hours is a useful construct that requires further longitudinal study. The results also underline the importance of considering home characteristics when predicting health outcomes. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of the psychometric testing of the Dundee Ready Education Environment Measure with Chinese nursing students. Background. Although the Dundee Ready Education Environment Measure has been widely used to measure educational environments in the healthcare professions, no psychometric evaluation of the measure with Chinese nursing students has been reported. Method. Data from 214 nursing students were collected during a 2-month period between December, 2004 and January, 2005. Exploratory factor analysis, internal consistency reliability and Cronbach's alpha were examined. Results. Five factors were found by principal components analysis with Oblimin with Kaiser Normalization rotation. The original factor names were maintained, but items in each factor changed. These five factors all achieved eigenvalues >1, and in total accounted for 52.186% of the variance. Cronbach's alpha ranged from 0.623 to 0.9 across factors, with an overall alpha of 0.949. Conclusion. The Chinese version of the Dundee Ready Education Environment Measure could be a valuable measurement for nursing educators in professional development programmes and nursing curriculum design. Further studies need in different Chinese nursing schools and larger sample sizes to be conducted to validate its stability and factor structure. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study of the psychometric properties of the Spanish version of the Childbirth Self-efficacy Inventory. Background. Enhancing the confidence of women in their ability to cope with pain in labour is a key element of effective childbirth education programs. The Childbirth Selfefficacy Inventory is a suitable instrument for testing hypotheses about the development of self-efficacy for childbirth. Analysing its psychometric properties in the light of Bandura's Self-Efficacy Theory is relevant for the validation of the instrument. Methods. Translation and back-translation of the questionnaire took place in 2002 using a pilot sample of 12 women. The study was conducted using a sample of 146 childbearing women recruited from different national healthcare centres in Spain during the last 6 months of 2003. The psychometric study was carried out using the Statistical Package for Social Sciences. Results. Principal components analysis supported the ability of the Self-Efficacy Inventory to distinguish between outcome and self-efficacy expectancies. Internal Consistency Reliability of the Inventory was found adequate. Previous knowledge was identified as the most important factor influencing the confidence of a woman to coping with labour. Conclusion. Results are consistent with previous findings, and contribute to give support to the reliability and validity of the Inventory. The findings provide an additional and useful insight into practical ways of enhancing a woman's confidence to coping with childbirth: self-efficacy can be strengthened through persuasion by healthcare professionals, childbirth educators, and family and friends who offer support to the pregnant woman. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of an analysis of the use of theory in qualitative approaches to research as exemplified in qualitative end-of-life studies. Background. Nurses researchers turn to theory to conceptualize research problems and guide investigations. However, researchers using qualitative approaches do not consistently articulate how theory has been applied, and no clear consensus exists regarding the appropriate application of theory in qualitative studies. A review of qualitative, end-of-life studies is used to illustrate application of theory to study design and findings. Data sources. A review of theoretical literature was carried out, focusing on definitions and use of theory in qualitative end-of-life studies published in English between 1990 and 2008. Discussion. The term 'theory' continues to be used in a variety of ways by theorists and researchers. Within the reviewed end-of-life studies, the use of theory included theory creation or provision of a comparative framework for data analysis and interpretation. Implications for nursing. Nurses who conduct qualitative studies should examine the philosophical and theoretical bases of their selected methodological approach, articulate a theoretical framework that fits the phenomenon being studied, and adopt a critical, flexible and creative attitude when applying theory to a study. Conclusion. Theory can be put to several uses in qualitative inquiry and should guide nurse researchers as they develop and implement their studies. Nurse educators who teach qualitative approaches to research should emphasize a variety of ways to incorporate theory in qualitative designs. [ABSTRACT FROM AUTHOR]

A list of upcoming articles in the "Journal of Advanced Nursing" is presented including "Determinants of hospital nurse intention to remain employed: broadening our understanding," by A. E. Tourangeau and others; "Continuity of care and monitoring pain after discharge: patient perspective," by R. S. Soler and others; and "How nurses seek and evaluate clinical guidelines on the Internet," by F. Verhoeven and others.

An introduction to the journal is presented in which the editor discusses an article published within the issue about nursing students' knowledge and attitudes towards HIV/AIDS.

Aim. This paper is a report of a literature review conducted to examine current research studies into attitudes of nursing students towards caring for people with HIV/AIDS and to identify factors that influenced those attitudes to inform current nursing practice and to develop nursing education regarding care provided to people with HIV/AIDS. Background. Attitudes of nurses towards people living with HIV/AIDS have long been scrutinized. Studies show that some nurses have negative attitudes and are reluctant to provide care to people with HIV/AIDS, resulting in poorer quality nursing support being provided. Attitudes of nursing students towards caring for people with HIV/AIDS is thus of vital importance since they become the future practising nurses. Data sources. Eight electronic data bases were searched from 1996-2008. Review methods. Criteria used for study selection were: attitudes of nursing students towards caring for people with HIV/AIDS, primary research studies, published in English language in peer reviewed journals from 1996 to June 2008. Sixteen studies were identified for inclusion in this thematic review. Results. The following themes were identified: education and knowledge of HIV/AIDS; fear of contracting HIV/AIDS; reluctance to care for people with HIV/AIDS; homophobia; and stigma associated with HIV/AIDS. Conclusion. There is reluctance on the part of some nursing students in specific regions of the world to provide care for people with HIV/AIDS. Educational programmes based on research evidence must play a leading role in developing strategies to help nursing students understand and overcome such attitudes. [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]

Aims. The aim of the study was to describe Registered Nurses' reports of unmet nursing care needs and examine the variation of nursing care quality across hospitals. Background. Large proportions of Registered Nurses have reported leaving necessary care activities undone because they lacked the time to complete the activities. Nursing care left undone can be expected to adversely affect the quality of care. However, little is known about the degree of variation in the quality of nursing care across hospitals. Methods. In 2008, a secondary analysis of a 1999 survey of Registered Nurses (n = 10,184) was conducted using descriptive and comparative statistics. Data were derived from inpatient staff nurses working in acute care hospital settings (n = 168). A hospital-level measure (i.e. unmet nursing care needs) of the quality of nursing care was developed from care needs left undone among all nurses. Results. Across hospitals there was a wide range in the proportion of Registered Nurses who reported leaving each nursing care need undone. They reported leaving two of seven necessary nursing care activities undone during their last shift. After controlling for nurses' demographic information, we found statistically significant variations in the quality of nursing care across hospitals. Conclusion. Differences in nursing care quality across hospitals appear to be closely associated with variations in the quality of care environments. Understanding the determinants of unmet nursing care needs can support policy decisions on systems and human resources management to enhance nurses' awareness of their care practices and the care environment. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study conducted to describe the health of children with cerebral palsy and investigate predictors of stress in their parents. Background. Children with severe cerebral palsy tend to have poorer health than their able-bodied peers, and their parents are more likely to be stressed and have poorer health. Method. A cross-sectional survey with home visits using standard questionnaires was administered to parents in 2004-05. A total of 102/199 (51%) children and parents participated. The children were compared with a normative sample. Results. Children with cerebral palsy had poorer physical health, and 79% of parents reported that their child had moderate to severe pain. Their poorer health, in comparison with the normal sample and measured by the Child Health Questionnaire, was related to feeding problems and seizures, general health perceptions to intellectual and feeding impairment, and family activities with severe motor, intellectual and feeding impairment. Poorer psychological well-being on the hyperactivity domain of the Strengths & Difficulties Questionnaire was related to feeding difficulties, on the prosocial domain to more severe forms of all child impairments, and on the social impairment scale to intellectual impairment. Children with psychological problems had statistically significantly increased odds (OR = 7.2, 95% CIs 2.6-20.3) of having parents with high stress. Conclusion. Children with cerebral palsy and associated impairments are at higher risk of poorer health and family well-being. A family-centred approach to the care of children with cerebral palsy and their families is essential to ensure both receive adequate care and support. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of study of parent, infant and environmental correlates of mothers' and fathers' perceptions of their parenting self-efficacy. Background. Many parents are not confident in their ability to be good parents. Parenting self-efficacy is important for parents' sense of well-being, is a possible predictor of parenting practices and might be an indicator of risk. However, very little evidence exists on factors that influence fathers' perceptions of parenting, or comparisons between the parents. Methods. The data were collected by questionnaire in 2006-2007 in two hospitals with a convenience sample of Finnish-speaking parents (N = 1300 families) during the first postpartum week. Multiple-birth and early-discharge parents were excluded. The response rate for mothers was 66% (n = 863) and for fathers 40% (n = 525). Comparisons were made by percentages and means. Statistical significance was determined by Generalized Estimating Equations models and one-way anova. Pearson's and Spearman's correlation coefficients were used to determine correlations, and multiple regression analysis to clarify the effect size. Results. Mothers scored higher than fathers on parenting self-efficacy. Parity, self-concept, depressive symptoms and state of mind on discharge contributed to parenting self-efficacy. Experiences of childbirth and life change correlated with mothers', but not with fathers', parenting self-efficacy. Perceptions of infant, family functioning, health and advice from personnel were major contributory factors. Conclusion. Assessments of parenting self-efficacy are recommended to identify at-risk groups and at-risk parents. More research is recommended to look into the effect of rooming-in, feeding practices, fathers' presence and social support from personnel and parenting self-efficacy and to evaluate risk scales for at-risk parents. Parent attributes had a greater effect on mothers' parenting self-efficacy, while environmental attributes had a greater effect on fathers' parenting self-efficacy. At-risk parents can be supported by conducting face-to-face discussions about significant topics. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study of lesbian parents' experience of antenatal care, childbirth and postnatal care. Background. In a strictly heteronormative-based care system, 'parents' naturally implies a man and a woman, and all communication and routines are based on heterosexual couples. Method. A qualitative interview study was carried out in 2008. Ten mothers, eight of whom were in a relationship with another woman, participated. The participants had experience from several care facilities from three different cities in central Sweden. Findings. Most participants had positive experiences but also complained that the focus was not always on the pregnancy and that no parenthood education had been offered. Heteronormativity was communicated by midwives and nursing staff throughout the process - from antenatal care to postnatal care, via forms, journals, verbal communication and orientation visits. This was experienced as embarrassing for the participant parents, and they also described encountering what they interpreted as embarrassment on the part of care providers. Participants called for increased knowledge about lesbian parenting, since they believed this would influence and facilitate communication, not least with midwives in antenatal care. Conclusion. Midwives educated in lesbian issues could ask questions and communicate in a more neutral way at the first meeting, and thereby make prospective parents feel less insecure. Special parenthood education groups for lesbians are recommended so that lesbian couple can meet others with similar experiences and so that the focus will be on prospective parenthood and not on their sexual orientation. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study of the effect of empowering surgical nurses to ensure that patients receive antibiotic prophylaxis after caesarean birth. Background. Despite the consensus that single dose antibiotic prophylaxis is beneficial for women have either elective or non-elective caesarean delivery, hospitals need methods to increase compliance rates. Method. In a study in Israel in 2007 surgical nurses were empowered to ensure that a single dose of cefazolin was given to the mother after cord clamping. A computerized system was used to identify women having caesarean births, cultures sent and culture results. Compliance was determined by chart review. Rates of compliance, suspected wound infections, and confirmed wound infections in 2007 were compared to rates in 2006 before the policy change. Relative risks were calculated dividing 2007 rates by those in 2006, and 95% confidence intervals were calculated using Taylor's series that does not assume a normal distribution. Statistical significance was assessed using the chi-square test. Findings. The compliance rate was increased from 25% in 2006 to 100% in 2007 (chi-square test, P < 0.001). Suspected wound infection rates decreased from 16.8% (186/1104) to 12.6% (137/1089) after the intervention (relative risk 0.75, 95% confidence interval, 0.61-0.92). Conclusion. Surgical nurses can ensure universal compliance for antibiotic prophylaxis in women after caesarean birth, leading to a reduction in wound infections. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study of the lived experiences of women using vaginal pessaries for the treatment of urinary incontinence (UI) and/or pelvic organ prolapse. Background. The use of a vaginal pessary offers a non-surgical treatment option to provide physical support to the bladder and internal organs. As the literature asserts, a woman's choice to use a pessary is very individual and involves not only physical, but also psychological and emotional considerations. Method. Narrative inquiry was used to conduct face-to-face semi-structured interviews in 2007 with 11 postmenopausal women who accessed services from a Urogynecology Clinic in Eastern Canada. Findings. The women's stories revealed that living with a pessary is a life-changing experience and an ongoing learning process. The women's comfort level and confidence in caring for the device figured prominently in their experiences. Psychosocial support provided by the clinic nurses also played a primary role in the women's experiences. Conclusion. Women and healthcare professionals need to be aware of the personal isolation and embarrassment, and social and cultural implications that urinary incontinence may cause as well as the subjective experiences of using a pessary. With appropriate support, vaginal pessaries can provide women with the freedom to lead active, engaged and social lives. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study of the coping experiences of Taiwanese adolescents with cancer. Background. Cancer treatments have adverse effects and negatively affect adolescents' lives. Psychological coping strategies are antecedents to adjustment. Little is known about the essential structure of the coping experience in adolescents with cancer. Method. Ten adolescents aged 12-18 years who were receiving chemotherapy were interviewed in 2007. Open-ended interviews were conducted in a quiet in-hospital setting. Interview data were analysed using Giorgi's four-step procedures. Findings. The essential structures of the coping experience were losing confidence and rebuilding hope. Losing confidence included sub-themes of physical and psychological suffering; rebuilding hope included sub-themes of thought restructuring, revaluing what I have, and envisioning hopeful images of the future. Interviewees vacillated between moving on and giving up, depending on the strength of their hope. A focus on rebuilding hope helped the adolescents to move on in the midst of many distressful events. Conclusion. Understanding adolescents' coping processes relative to cancer can facilitate the establishment of a more supportive milieu. The findings can provide guidance for instrument development on coping for adolescents with cancer and be useful in guiding intervention development to promote positive psychological adjustment. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study examining the benefits that university students with Type 1 diabetes associate with diabetes self-care routines, and the barriers that they experience in enacting self-care routines in the university environment. Background. Many young adults with Type 1 diabetes attend university, and it is thought that these students might experience difficulties with their self-care routines while they are there. Method. A qualitative method was chosen to explore students' own perspectives. Seventeen students with diabetes were interviewed twice, and each kept a research diary for a 2-week period. Interviews and diaries were analyzed using standard qualitative techniques. The study was conducted in 2004-2005. Findings. Routines had a number of identity-producing benefits for students. However, students often experienced difficulties routinizing their self-care practices at university. These difficulties stemmed both from the irregular nature of university life and from students' desires not to let their diabetes interfere with their student lives. Most participants learned to adjust to university and enact self-care routines, although they could still experience routine difficulties during times of transition and stress. Conclusion. Healthcare professionals need to be aware of the difficulties that university students with Type 1 diabetes experience with their self-care routines. This awareness needs to encompass older students in the second, third and fourth years of their undergraduate degrees and postgraduate students as well as students in their first year at university. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study of the relations of spiritual well-being, global job satisfaction, and general self-efficacy to hope in Continuing Care Assistants. Background. Healthcare providers have described their hope as an important part of their work and a form of work motivation. Hope may be an important factor in preventing burnout and improving job satisfaction. Methods. A concurrent triangulation mixed method design was used. Sixty-four Continuing Care Assistants (personal care aides) who registered for a 'Living with Hope' Conference completed a demographic form, Herth Hope Index, Global Job Satisfaction Questionnaire, Spiritual Well-Being Scale, General Self-Efficacy Scale, and a hope questionnaire. Data were collected in 2007. The response rate was 58%. Results. Using linear regression, 29.9% of the variance in Herth Hope Index score was accounted for by scores from the General Self-Efficacy Scale and Spiritual Well-Being Scale. General Self-efficacy scores (positive relationship) and Spiritual Well-Being scores (negative relationship) accounted for a significant part of the variance. Qualitative data supported all findings, with the exception of the negative relationship between hope and spiritual well-being; participants wrote that faith, relationships, helping others and positive thinking helped them to have hope. They also wrote that hope had a positive influence on their job satisfaction and performance. Conclusion. Hope is an important concept in the work life of Continuing Care Assistants. Supportive relationships, adequate resources, encouragement by others, and improving perceptions of self-efficacy (ability to achieve goals in their workplace) may foster their hope. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to determine (1) the course of anxiety, depression and perceptions of control, and (2) the influence of perceptions of control, in patients undergoing coronary artery bypass grafts before surgery, after surgery in hospital and 2 weeks after discharge. Background. Anxiety and depression are common in patients undergoing coronary artery bypass graft surgery patients and predictive of worse outcomes. Few researchers have examined the influence of perceived control on these emotional states in the acute surgical period. Methods. A prospective, descriptive design was used with a convenience sample of patients having coronary grafts (n = 155). Anxiety and depression were measured by the Hospital Anxiety and Depression Scale and perceptions of control over their cardiac illness by the Control Attitudes Scale before surgery, after surgery during hospitalization and 2 weeks after hospital discharge. The data were collected in 2005. Results. Patients had low levels of anxiety at each timepoint; however, borderline or clinically significant levels were common before surgery (38.7%) and after discharge. (38.6%). Depression levels were low, but increased over time (F = 27.03, P < 0.001). Patients had low to moderate perceptions of control over their illness before surgery, which increased over time (F = 25.51, P < 0.001). Those with stronger perceptions of control were less anxious or depressed at all times and those who were more anxious or depressed before surgery continued to be so afterwards. Conclusion. Routine assessment of anxiety, depression and perceptions of control are justified to identify patients at risk and to intervene to promote control perceptions. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a trial to identify the effect of thermal therapy with far-infrared rays in comparison with non-thermal therapy on uremic pruritus and biochemical parameters. Background. Uremic pruritus remains one of the most frustrating, common, and potentially disabling symptoms in patients undergoing haemodialysis. The mechanism underlying uremic pruritus is poorly understood. Although enough is known to determine a reasonable treatment approach, more research is needed to evaluate more reliable treatments. Methods. A randomized, double-blind, controlled trial was conducted in 2005 using questionnaires and measurement of blood biochemical parameters. A total of 41 uremic patients on maintenance haemodialysis were randomly assigned either to the thermal therapy group or the control group. The thermal therapy group was treated with 40 degrees C thermal therapy with far-infrared rays at the Sanyinjiao acupoint for 15 minutes once a day on two days a week for a total of 18 sessions. The control group received a plain adhesive patch placed on the same acupoint. Findings. Both groups showed statistically significant improvements but there were no differences between groups, while a relatively large decrease in pruritus scores was found in the thermal therapy group (P < 0.001) as compared with the non-thermal therapy group. Serum calcium level decreased statistically significantly in the thermal therapy group and was statistically significantly different from that of the control group. Conclusion. The lack of effect does not necessarily demonstrate that thermal therapy is not effective or has no therapeutic benefits for uremic pruritus in patients having haemodialysis. Further investigation is warranted, with larger samples and longer intervention. [ABSTRACT FROM AUTHOR]

Aim. The aim of this study was to explore and explain how disfigurement is addressed in interactions between patient and nurse during the period in hospital immediately after undergoing disfiguring facial surgery. Background. Facial disfigurement as a result of head and neck or eye cancer surgery is associated with psychosocial problems; however no successful intervention program has been developed. Empirically derived knowledge about what goes on in the patient-nurse interaction is missing. Method. A grounded theory design was used, with data derived from audio-recorded conversations between and individual interviews with 14 patients and their connected nurses, from three participating university hospitals. Data were collected in 2007. Findings. A substantive model with silencing disfigurement as a core category was developed. The model included three categories; minimizing disfigurement, disfigurement is a luxurious problem and another time, another place. A condition of implicit and unverified professional assumptions about addressing the issue of disfigurement became an underlying character. Without this the core category could not exist. Conclusion. The model elucidates a silencing process maintained by preconceived assumptions which need to be challenged to help patients adjust to their changed appearance after facial cancer treatment. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study conducted to describe postoperative self-management behaviours, perceived self-efficacy and health outcomes in adult organ transplant recipients who participated in a fitness support group. Background. Self-management behaviours designed to promote patient autonomy contribute to positive health outcomes after therapeutic interventions. Despite an increase in organ transplantation, little is known about the impact of self-management on health outcomes after adult organ transplantation. Even less has been investigated regarding nursing interventions in the organ transplantation patient demographic to promote positive outcomes. Method. Using a cross-sectional descriptive design, 20 participants completed a questionnaire that included measures of self-management, self-efficacy and health status during the 2006 training season. Findings. Participants were, on average, 55 years of age and 6 years since transplantation. Their results were compared to mean values as reported in the literature, and revealed consistently superior scores for the outcome variables. The mean amount of weekly aerobic exercise in the transplant group was 3.2 hours (sd 1.4). Participants demonstrated impressively high amounts of self-efficacy. Confidence was inversely related to extent of illness interference in activities of daily life (r = -0.772, P = 0.01). Health status scores also exceeded the norms, with all participants reporting at least 'good' health. Seventeen participants reported zero emergency department visits in the last 6 months. Nursing interventions geared toward maximizing patient self-efficacy may improve health outcomes for adults after solid organ transplantation. Conclusion. Group participation in a fitness programme may support achievement of self-management activities and feelings of self-efficacy in maintaining disease management. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study conducted to determine how people who suffer from head injuries perceive respect for their dignity and to discover what patients mean by the concept of 'dignity'. Background. We know something about what the phenomenon of dignity means. However, we still lack knowledge about how patients perceive dignity in their lives and how dignity may be fostered and supported. Methods. Qualitative interviews were carried out during 2007 with 14 patients suffering from head injuries, diagnosed as having mild to moderate disability. The study was explorative and descriptive, with a content analysis. Findings. Patients experienced their dignity as maintained when they were taken seriously, received appropriate information and were reality-oriented. They experienced their dignity as violated if they had been neglected or had encountered healthcare personnel who lacked knowledge, were sceptical about their stories, and where the patient experienced extra burden when they were mistrusted. The importance of adequate information was underscored. As interviewees said, head injuries do not show on the outside and people with head injuries do not have a high status in society. Conclusion. Patients living with head injuries should be informed about consequences and be taught strategies for how to live with head injuries as early as possible after the injury in order to maintain dignity. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study of the health beliefs, knowledge and selected demographic variables that influence mammography utilization among Asian-American women. Background. Breast cancer is the most frequently occurring cancer in Asian-American women and its incidence is increasing at a greater rate than for other racial and ethnic groups in the United States of America (USA). Compared to White women, breast cancer also is more likely to be diagnosed at a later stage with larger tumours in Asian-Americans. Method. A self-administered questionnaire was used with Asian-American women residing in the USA. Data were collected in 2005 and 315 women participated in the study. Results. Fifty-five per cent of participants reported having their last mammogram within the past 13 months, and 33% reported having annual mammograms in each of the past 5 years. Based on multivariate logistic regression analyses, clinical breast examination, barriers and knowledge of recommendations of the frequency of mammography screening were associated with both recent and regular mammography practice after controlling for all other demographic, psychosocial and behavioural variables in the model. Conclusion. Intervention strategies tailored to knowledge, language and cultural factors associated with mammography use should target at-risk subgroups, particularly those who are recent immigrants and those with limited English language ability. Culturally appropriate strategies should be developed to promote lifelong mammography screening for this rapidly growing and diverse population. [ABSTRACT FROM AUTHOR]

Aim. This paper is the report of a study to explore how the process of storytelling might facilitate women's emancipatory knowing, using examples from women's breastfeeding stories. Background. Storytelling, as an interactive process, can give women a way to explain pivotal life events, justify choices, examine reality and find meaning in experiences. Emancipatory functions of storytelling have been identified as contextual grounding, bonding with others, validating and affirming experiences, venting and catharsis, resisting oppression and educating others. Method. Secondary data analysis was conducted in 2008 on breastfeeding stories originally gathered from 13 women from 2002 to 2004 for a feminist hermeneutic study of maternal breastfeeding confidence. The stories were re-examined through the lens of the emancipatory functions of storytelling. Illustrations of contextual grounding, validating and affirming experiences, venting and catharsis and acts of resistance were found in the breastfeeding stories and presented as exemplars of emancipatory knowing. Findings. Women revealed the difficulties they encountered breastfeeding, transforming these experiences as they discovered their meaning. They described collisions that occurred when personal, familial, healthcare professionals' or cultural expectations differed from their experience. The stories suggested possible liberation from old ideologies about breastfeeding as women redefined the difficulties they encountered. Conclusion. Storytelling has potential as a simple, yet profound, and powerful emancipatory intervention which nurses can use to help women in their care make sense of and transform experiences of health and illness. Storytelling may have global implications for nursing practice and research. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to test the psychometric properties of the Self-Evaluated Core Competencies Scale for baccalaureate nursing students. Background. Baccalaureate nursing students receive basic nursing education and continue to build competency in practice settings after graduation. Nursing students today face great challenges. Society demands analytic, critical, reflective and transformative attitudes from graduates. It also demands that institutions of higher education take the responsibility to encourage students, through academic work, to acquire knowledge and skills that meet the needs of the modern workplace, which favours highly skilled and qualified workers. Methods. A survey of 802 senior nursing students in their last semester at college or university was conducted in Taiwan in 2007 using the Self-Evaluated Core Competencies Scale. Half of the participants were randomly assigned either to principal components analysis with varimax rotation or confirmatory factor analysis. Results. Principal components analysis revealed two components of core competencies that were named as humanity/responsibility and cognitive/performance. The initial model of confirmatory factor analysis was then converged to an acceptable solution but did not show a good fit; however, the final model of confirmatory factor analysis was converged to an acceptable solution with acceptable fit. The final model has two components, namely humanity/responsibility and cognitive/performance. Both components have four indicators. In addition, six indicators have their correlated measurement errors. Conclusion. Self-Evaluated Core Competencies Scale could be used to assess the core competencies of undergraduate nursing students. In addition, it should be used as a teaching guide to increase students' competencies to ensure quality patient care in hospitals. [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]

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 new approach to reflection in nursing and demonstrates its positive outcomes for student learning in clinical practice. Background. Reflection is a popular educational tool in nursing and most traditional reflective models take an incident as the starting point. We have developed a new approach that focuses on subjective thoughts and feelings. We were inspired by the work of Peshkin and his focus on the 'subjective I'. For this reason, we have termed this new way of reflecting 'The Peshkin Approach'. Data sources. Eight nursing students kept a reflective diary during a 6-week clinical placement in 2008. The focus was on recording their thoughts and feelings. They analysed the diary entries using a systematic approach. The aim was to identify aspects of their subjectivity influencing them in clinical practice. Discussion. Through analysis of journal entries, the students became aware of the subjective I's that were influencing their experiences. They found the advantages of the approach to be twofold: increased self-awareness and enhanced learning. Conclusion. Maintaining a reflective journal that focuses on subjectivity can enhance the clinical experiences of nursing students. We advocate this new approach as complementary to more traditional forms of reflection and argue for its incorporation into nurse education programmes. In comparison to traditional reflective models that we have used, the Peshkin Approach to Reflection has significant advantages in terms of promoting student learning in clinical practice. We hope the approach can be critiqued and developed further by those interested in enhancing nurse education. [ABSTRACT FROM AUTHOR]