Search

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

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

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

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

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

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

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

Explores the existing status of electronically accessible theory construction papers in nursing literature. Features of the Cumulative Index to Nursing and Allied Health Literature; Advantages of the theory construction in nursing practices; Presentation of traditional and non-traditional methods of tapping into the electronic domain for theory construction.

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

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

Aim. This paper is a report of a narrative literature review conducted to explore how expectations and wants are distinguished in empirical research on hope and illness and the related issues of realistic hope and temporality. Background. Particularized hope has been identified as comprising wants and expectations. The distinction is important in relation to debates around 'realistic' hopes, the temporal dimension of hope and hope-sustaining strategies. Data sources. A systematic search of the literature was undertaken for qualitative research papers published between January 1996 and July 2007 relating to hope and recovery in adults with physical ill health. Seven papers were identified. Review methods. A narrative synthesis approach was adopted and the papers were appraised for quality using the Critical Appraisal Skills Programme method. Textual descriptions and tabulation were used to compare central themes and thematic analysis was used to explore the findings. Results. A lack of conceptual clarity in relation to hope as a want or an expectation was identified. Healthcare professionals' role in encouraging 'realistic' hopes emerged as problematic because of the lack of understanding about the possible benefits of hope and difficulties in identifying 'realistic' hopes. There has been limited research exploring temporality and the impact of hope-sustaining activities. Conclusion. The lack of clarity about particularized hope, its dimensions, properties or different forms limits knowledge about the conditions under which hope is a positive force versus when it can be damaging. Distinguishing conceptually between hope as a want and hope as an expectation has potential value in improving healthcare practice and informing future investigations. [ABSTRACT FROM AUTHOR]

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

The article discusses the new format for the "Journal of Advanced Nursing." The section that features research papers is subdivided into the categories Original Research and Research Methodology. The journal will also publish theoretical research studies that offer scholarly analysis and discussion of conceptual, philosophical, theoretical or professional issues that have relevance to the journal's readership.

Aim. This paper presents an evaluation of the effectiveness of three search strategies to identify research for a qualitative synthesis of patient experiences of living with a leg ulcer. Background. Systematic reviews of research are increasingly the form of evidence used for evaluation of health care. There are well-established methods for conducting systematic reviews of effectiveness incorporating randomized controlled trials. Methods have been developed for the synthesis of qualitative research, but these are not widely used or evaluated. Searching for qualitative research is one of the least developed and tested areas in systematic reviewing of qualitative research. Method. The replication of three search strategies (free text, thesaurus and broadbased terms) developed for identification of qualitative research papers within electronic databases is described. Each strategy was run in seven electronic databases: MEDLINE, CINAHL, EMBASE, British Nursing Index, Social Science Citation Index, Applied Social Sciences Index and Abstracts, PsychInfo. The effectiveness of these strategies for identifying qualitative research for a synthesis of patients' experiences of living with a leg ulcer is discussed. Findings. Each of the three search strategies produced similar numbers of potentially and actually relevant papers from each of the seven databases. These results were most striking for CINAHL, when all of the papers ultimately included in the review were identified by each search strategy. No other database identified all included papers. Conclusion. A simple search strategy using broad-based terms was as effective as a complex one (free text) in locating qualitative research examining patients' experiences of living with a leg ulcer. For a question with a clear nursing focus, it may be sufficient to search only CINAHL in order to locate qualitative research. This result needs replicating with other nursing topics. [ABSTRACT FROM AUTHOR]

lindsay b. (2004) Journal of Advanced Nursing 45(1), 84–94 Randomized controlled trials of socially complex nursing interventions: creating bias and unreliability? The randomized controlled trial is viewed by many researchers as the ‘gold standard’ research design. It is used increasingly to evaluate the effectiveness of socially complex activities such as nursing interventions. This use is seen by many commentators as problematic, while others are concerned about the quality of many published trial reports. One area of concern is that of intervention bias: the impact that a sentient intervention, such as a nursing one, may have consciously or unconsciously on study outcomes. This paper reports on an analysis of intervention definitions and possible intervention bias in 47 reports of randomized controlled trials of nursing interventions published in 2000 or 2001. This study evaluates four characteristics of the included reports: intervention sample size, intervention definition, involvement of intervention nurses in other aspects of the trial, and the claimed generalizability of results. Reports of randomized controlled trials published in 2000 or 2001 were identified. Full-text versions of 47 papers were obtained and information about the four characteristics was extracted and analysed. Problems relating to possible intervention bias were identified in each of the papers. Inadequate intervention definition was the commonest problem, leading to difficulties in calculating the ‘intervention dose’ and in replicating or generalizing from the studies. None of the included studies met the requirements of the Consolidated Standards of Reporting Trials. Four types of intervention bias were identified, and their possible implications for the reporting of trials of nursing interventions are discussed. This was a small-scale study, limited by time and resources. Its results are suggestive of a major problem of intervention bias but larger-scale investigations are necessary to quantify its extent. Intervention bias is potentially a problem in randomized controlled trials. Lack of detail about interventions in published papers could be corrected by stricter adherence to guidelines such as the Consolidated Standards of Reporting Trials, but this will not correct the underlying problem of inadequate study design that appears to be widespread in randomized controlled trials of nursing interventions. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a systematic review and meta-ethnography of the experience of heavy menstrual bleeding. Background. Heavy menstrual bleeding is common. Not all women seeking help have heavy menstrual bleeding as measured objectively and, conversely, some who do have this problem do not seek help. Data sources. Seven electronic databases were searched in 2004 and updated in 2008, and supplemented with hand-searching. Method. We identified four papers describing qualitative research among women with heavy menstrual bleeding. Key themes and concepts were extracted and synthesised using meta-ethnography, the key process of which is translation, identifying similar or contradictory findings in primary research. In the updated search three papers were identified. Findings. Three papers were largely descriptive. These provided support for the fourth paper's conceptual framework of a lay model of heavy menstrual bleeding which shows little overlap with the traditional clinical definition. Details of physical, practical and emotional elements of this model were identified. A matrix of uncertainties were identified suggesting reasons why women may or may not seek medical help for heavy menstrual bleeding. Women and healthcare professionals may conspire to privilege blood loss over other symptoms and the disease model of heavy menstrual bleeding is little help to either. Two papers from the updated search were also largely descriptive. The third interpreted key elements of the lay model as relating to the need for concealment demanded by 'menstrual etiquette'. Conclusion. A lay model of heavy menstrual bleeding is proposed, detailing key physical, social and emotional impacts that women find problematic. [ABSTRACT FROM AUTHOR]

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

elliott l., crombie i.k., irvine l., cantrell j. & taylor j. (2004) Journal of Advanced Nursing 45(2), 117–125 The effectiveness of public health nursing: the problems and solutions in carrying out a review of systematic reviews In 1999 the Scottish Office, United Kingdom, intimated that the Chief Nursing Officer would undertake a policy review of nurses’ contribution to improving the public's health. The importance of reviewing the scientific literature on the effectiveness of public health nursing was recognized as a crucial part of the policy review. A final report was expected within a 6-month period. The reason for the short time period was to fit the policy-making schedule. This paper discusses our literature review for this work. The aim was to conduct a review of the international scientific literature that gave the greatest coverage of the role and potential role of nurses in improving the public's health in relation to 14 major health topics. This paper describes the methods used, outlines the rationale underpinning the methods, discusses the problems encountered and offers solutions to some of these problems. The initial search for relevant scientific literature revealed 709 suitable primary papers. Reviewing this number was beyond the time limit set by the funding organization. Therefore, a decision was made to concentrate on the evidence contained in systematic reviews. Reviewing systematic reviews raises a number of methodological problems to which there are often no predetermined solutions, such as ensuring that important interventions are included, assessing the relevance and quality of the reviews, and grading the strength of the evidence. Reviewing systematic reviews provides the scope to increase the number of topics that might be covered. However, it is possible that a number of interventions may be missed, particularly those that are not subject to review or those assessed using qualitative techniques. The definition of public health nursing used in the present study was also restrictive, and could be widened to include community interventions. Finally, assessing the quality of reviews and grading the evidence proved difficult and there is lack of consensus on how these tasks should be achieved. Nevertheless, the review presented policy makers with accessible information on a large number of relevant international studies. [ABSTRACT FROM AUTHOR]

What is the evidence on evidence-based nursing? An epistemological concern Aim. This paper adopts an epistemological perspective in order to support the assertion that there is very little evidence to support the existence of evidence-based nursing as a distinct construct or process. Rationale. This analysis of concept meaning is based on the theory of symbolic interactionism. By adopting this theory the commonalities and inconsistencies in the use of evidence-based symbolism by nurses and other health care professionals can be used to evaluate the perceived meaning of the term. Methods. A frequency analysis of relevant key words in one publications data-base demonstrates the increasing use of evidence-based terminology and its euphemistic status visa vi research. An epistemological analysis is conducted on a sample of concept clarification statements taken from the popular literature, defining the nature of `evidence' and `evidence-based practice'. Findings. The results of the frequency analysis show that the keywords `evidence-based medicine' revealed 5612 papers, evidence-based practice (EBP) 432 papers, evidence-based nursing 47 papers, evidence-based health care 60 papers, and evidence-based decision making 43. Almost all of these papers have been published since 1995 and the earliest use of the symbol `evidence-based' is 1992. There is also an increase in papers adopting `evidence-based' symbolism along with a commensurate decrease in the use of the term `research' in the nursing context. Conclusion. `Evidence-based practice' is commonly a euphemism for information management, clinical judgement, professional practice development or managed care. There is insufficient evidence to demonstrate that evidence-based nursing is a single construct or process that can be distinguished from its concomitants. The term adds little more to the existing long standing traditions of quality assurance and research-based practice. Nurses must avoid the inefficiency brought about by the `intense enthusiasm followed by sad disenchantment' that has been associated with other attempts to introduce innovation in health care delivery (Fienstein & Horowitz 1997). [ABSTRACT FROM AUTHOR]

This paper describes a district nursing study that considered the experiences and responses of primary health care professionals and their patients to changes taking place within the community. As a qualitative study it employed interviews as the main method of data collection and was informed by both ethnography and interpretative phenomenology. Forty-three study participants were interviewed, eliciting opinion on whether care is more than just a hands-on activity, whether patient need is being met and to what extent service policy is in tune with care delivery. Describing the views of primary health care professionals and patients in order to illustrate the complexity of the district nursing service and professional roles, the paper finds little shared vision between staff and managers of each other's responsibilities. It concludes that a more holistic approach to understanding professional roles is needed in order to satisfy the differing agendas of managers, staff and patients. It propounds the need for closer collaborative practice between health care professionals, for it finds that they value the ability to communicate as an essential element of their jobs. It reflects that, without such collaboration, it will be difficult for nurses to take a lead position on changes shaping community care. [ABSTRACT FROM AUTHOR]

Recently, the relationship between theory and research has received more attention. It seems that in the past 10 to 15 years more research studies have been published that are more or less conceptualized within (nursing) theories. However, it is not always clear how the theory has been used. The purpose of this study was to analyse the role of theory in nursing practice research. To this end, papers published in six nursing journals between 1986 and 1990 have been studied. It can be concluded that, in comparison with earlier analyses, the use of theories in nursing research studies has increased (from 13% to 21%), but the use of nursing theories has not become more frequent. However, the testing of nursing theories is minimal. On the other hand, research results are being cumulated progressively in regard to theory or to other research. [ABSTRACT FROM AUTHOR]

Introduces a series of articles about medical care and nursing.

Title. Is children’s choice in health care rhetoric or reality? A scoping review. Aim. This paper is a report of a scoping review examining children and young people’s health services with respect to choice in order to inform future development of choice initiatives. Background. The importance of including children and young people in the choice agenda reflects the increasing acknowledgement that, individually and collectively, they are important consumers of health care in their own right. Data sources. A scoping review of all major health and medical research databases was undertaken using current guidelines to identify original relevant research papers and grey literature sources from 1990 to 2006. Review methods. Reference Manager software was used to collate, summarize, categorize, store and retrieve the search results. Papers meeting the inclusion criteria were read in full and descriptively summarized using a data extraction sheet. Each paper was repeatedly selected using a snowballing approach until saturation was reached. Results. Children and young people want more say in the planning and development of appropriate hospital and community health services. However, little evaluative research was found about whether these choices are acted upon and lead to more responsive services. Conclusion. Choice for children and young people is viewed as a positive development in health care and many innovative examples of their involvement in decision-making were found. These illustrated that, given the opportunity, children and young people are willing and able to make decisions about their healthcare services. However, there is a long way to go before the rhetoric of the choice agenda is realized. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of an integrative review of research investigating computer assisted learning for clinical skills education in nursing, the ways in which it has been studied and the general findings. Background. Clinical skills are an essential aspect of nursing practice and there is international debate about the most effective ways in which these can be taught. Computer assisted learning has been used as an alternative to conventional teaching methods, and robust research to evaluate its effectiveness is essential. Data sources. The CINAHL, Medline, BNI, PsycInfo and ERIC electronic databases were searched for the period 1997-2006 for research-based papers published in English. Electronic citation tracking and hand searching of reference lists and relevant journals was also undertaken. Findings. Twelve studies met the inclusion criteria. An integrative review was conducted and each paper was explored in relation to: design, aims, sample, outcome measures and findings. Many of the study samples were small and there were weaknesses in designs. There is limited empirical evidence addressing the use of computer assisted learning for clinical skills education in nursing. Computer assisted learning has been used to teach a limited range of clinical skills in a variety of settings. Conclusion. The paucity of evaluative studies indicates the need for more rigorous research to investigate the effect of computer assisted learning for this purpose. Areas that need to be addressed in future studies include: sample size, range of skills, longitudinal follow-up and control of confounding variables. [ABSTRACT FROM AUTHOR]

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

When concepts and the `paper and pencil' tests used to measure these concepts are developed in fields other than nursing and subsequently arc used for nursing purposes. the perspective mismatch heralds a validity issue. This paper presents a case for clinical construct validity as one method of evaluating whether the substantive meaning of a test captures the nursing meaning. [ABSTRACT FROM AUTHOR]

The section comments on the article "Music Improves Sleep Quality in Older Adults," by Hui-Ling Lai and Marion Good, which appeared in the 2005 issue of the "Journal of Advanced Nursing." It identifies the factors that made the paper stand out from other studies. It asserts the paper's popularity based on how much media coverage it received.

The intention of this study was to develop insight into how the concept of human sexuality has been addressed within a popular nursing medium, namely the publication Nursing Times, during the decade 1980-1990. The study begins by clarifying discourse analysis and its role in the social construction of language. Exploration of the use of metaphors within nursing text is made to highlight the ability to convey multiple meaning and ideology within nursing practice. The 86 text papers generated during this decade were subjected to a process of qualitative data analysis entitled 'Framework'. The emerging themes from this process were used to inform a discussion of the ideological and practice relationships that exist between nursing and human sexuality. [ABSTRACT FROM AUTHOR]

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

AIM: This paper is a report of a concept analysis of adolescent smoking cessation self-efficacy. BACKGROUND: Smoking cessation is a key preventive care/health promotion strategy offered by nurses worldwide. Most programming is tailored to adults although the reasons for smoking, along with coping strategies, resources and developmental stage, differ in adolescence. Understanding of the concept of self-efficacy as it relates to the adolescent population will assist nurses in addressing smoking cessation behaviours with this population. DATA SOURCES: The CINAHL and Proquest Nursing databases were searched for papers published between 1977 and 2007 using the keywords self-efficacy, adolescents and smoking cessation. The Walker and Avant method of concept analysis was applied. FINDINGS: Adolescent smoking cessation self-efficacy is the confidence, perceived capacity and perceived ability that the teen possesses to quit smoking. Identified antecedents include developmental stage, past life support, emotional support, coping strategies, resources and emotional status. Consequences are smoking cessation: positive or negative. Empirical measures are identified. CONCLUSION: Levels of self-efficacy have been shown to be an important consideration in the approach of nurses to smoking cessation counselling with the adolescent client. The theoretical definition for this concept will provide the basis for nurses to design appropriate interventions for use in smoking cessation programmes targeted to adolescents. This definition identifies the key attributes of this concept that should be addressed when caring for this population. [ABSTRACT FROM AUTHOR]

Title. Informed consent to healthcare interventions in people with learning disabilities – an integrative review. Aim. This paper is a report of an integrative review of informed consent to healthcare interventions in people with learning disabilities. Background. Consent to treatment lies at the heart of the relationship between patient and healthcare professional. In order for people with learning disabilities to have equity of access to health care, they need to be able to give informed consent to health interventions – or be assessed as incompetent to give consent. Data sources. The British Nursing Index (BNI), CINAHL, MEDLINE, Social Care Online, ERIC and ASSIA and PsycINFO databases were searched using the search terms: Consent or informed choice or capacity or consent to treat* or consent to examin* AND Learning disab* or intellectual* disab* or mental* retard* or learning difficult* or mental* handicap*. The search was limited to papers published in English from January 1990 to March 2007. Review methods. An integrative review was conducted and the data analysed thematically. Results. Twenty-two studies were reviewed. The main themes identified were: life experience, interaction between healthcare professionals and participants, ability to consent, and psychometric variables. A consensus seemed to emerge that capacity to consent is greater in people with higher cognitive ability and verbal skills, but that the attitudes and behaviour of healthcare professionals was also a crucial factor. Conclusion. The findings support use of the functional approach to assessing mental capacity for the purpose of obtaining informed consent. Future research into informed consent in people with learning disabilities is needed using real life situations rather than hypothetical vignettes. [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]

Title. Living with chronic heart failure: a review of qualitative studies of older people 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 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 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 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 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]

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/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]

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.

This paper describes a research project which attempted to evaluate the preregistration preparation of nurses as an educational pursuit. It argues that two major learning paradigms exist, education and training. These paradigms can be differentiated on the basis of three critical aspects of the curriculum which also indicate the key areas for quality assurance. These aspects are; the purposes of learning, the extant forms of knowledge and the nature of teacher-student relationships. The paper describes a structural analysis of previous research on nurse education in the United Kingdom, and a student nurse opinion survey which aimed to identify those aspects of their course which were of most significance to student nurses. It was concluded that the preregistration preparation of nurses subsumed under a training paradigm and that the major determinant of this was the practice setting. There was also some indication that the nursing curriculum was not patient-centred and that the training paradigm did not encourage personal development in critical thinking, self-reliance and problem solving. The final part of the paper describes an experiment which attempted to demonstrate a link between practice teacher-student relationships and practitioner competence utilizing video presentation of 'teacher' behaviours and a patient-centredness measuring instrument. The experiment supported this link. In conclusion, it is argued that if UKCC Project 2000 is to avoid a replication of the past then educational development must be focused on the practicum and not just on forging links with higher education if a professional nurse education is to be achieved. [ABSTRACT FROM AUTHOR]

In this paper the constructs `stress' and `coping' as defined in an earlier paper (Clarke 1984) are used as a perspective for the interpretation of disease processes. The second half of the paper is devoted to an examination of the nurse's role which is seen as concerned with helping patients in the reduction or avoidance of stress and the strengthening of coping. General hospital nursing and district nursing is analyzed in greater depth than other types of nursing. [ABSTRACT FROM AUTHOR]

This paper is concerned with the evaluation of a workshop for teachers of nursing devoted to an individualized teaching and learning strategy. The paper gives a brief account of the history of such workshops and continues by defining individualized teaching. Following this the characteristics of the Keller Plan strategy are outlined. This is followed by details of the course organization; its aims and objectives, and the characteristics of the course members. Finally, the method of evaluation is described and results are discussed. [ABSTRACT FROM AUTHOR]

In the United Kingdom, the audio-visual revolution has steadily gained converts in the nursing profession. Nurse tutor courses now contain information on the techniques of educational technology and schools of nursing increasingly own (or wish to own) many of the sophisticated electronic aids to teaching that abound. This is taking place at a time of hitherto inexperienced crisis and change. Funds have been or are being made available to buy audio-visual equipment. But its purchase and use relies on satisfying personal whim, prejudice or educational fashion, not on considerations of educational efficiency. In the rush of enthusiasm, the overwhelmed teacher (everywhere; the phenomenon is not confined to nursing) forgets to ask the searching, critical questions: 'Why should we use this aid?', 'How effective is it?', 'And, at what?'. Influential writers in this profession have repeatedly called for a more responsible attitude towards published research work of other fields. In an attempt to discover what is known about the answers to this group of questions, an eclectic look at media research is taken and the widespread dissatisfaction existing amongst international educational technologists is noted. The paper isolates out of the literature several causative factors responsible for the present state of affairs. Findings from the field of educational television are cited as representative of an aid which has had a considerable amount of time and research directed at it. The concluding part of the paper shows the decisions to be taken in using or not using educational media as being more complicated than might at first appear. [ABSTRACT FROM AUTHOR]