Clinical oncology nurses' perceptions of research

Within the realm of oncology nursing, research has been an integral part in its development as a specialty practice. Yet despite the growing volume of published nursing research studies, little is known about how nurses working in oncology care settings perceive research. Therefore, the purposes of this study were to examine clinical oncology nurses' perceptions of research and to determine factors influencing their perceptions. Two hundred and eighty-three registered nurses providing cancer care to patients in 40 health care agencies across northern Ontario participated in the survey. Data were collected using a questionnaire developed by Alcock and colleagues (1990) which addressed nurses' perceived value of research, their role, interest and experience in research as well as the research climate of the agency. The findings showed that respondents valued nursing research and perceived a research role for staff nurses. However, the respondents did not perceive strong administrative or collegial support for nurses' involvement in research activities. In addition, the study results indicated that the clinical oncology nurses' perceptions of research were influenced by educational preparation.     

The hidden illness of endoscopy patients: mental health disorders, Part I

Because nearly half of all adults experience some mental health disorders in their lifetime, many endoscopy patients must have psychiatric problems along with their gastrointestinal (GI) illnesses. In addition, all patients undergoing an endoscopic procedure experiences some degree of apprehension and worry; anxiety itself is a major factor in most mental illnesses. Endoscopy nurses are very good at establishing rapport quickly with patients and learning about the patient's health history from all the available sources of information. These nurses spend much of their time teaching, listening, reassuring, and caring for people undergoing GI procedure, and these same skills are an important part of the care in mental health disorders. A series of case studies of GI patients in a busy endoscopy department document and summarize the mental health disorder each experienced and the pertinent care given by the GI nurse during an endoscopy or gastric laboratory procedure. Although it is inappropriate for endoscopy nurses to attempt to diagnose major psychiatric disease or provide psychiatric interventions for these patients, their nursing care and reassurance enable the patients to successfully complete their GI procedures.     

From psychiatric science to folk psychology: an ordinary-language model of the mind for mental health nurses

In this paper it is argued that, if mental health nurses are to integrate the skills necessary to accomplish the diverse tasks that comprise their professional role, then what is required is a conception of mind independent of any particular paradigm in the biophysical and psychosocial sciences. This is proposed as a necessary condition of articulating the professional autonomy of mental health nurses. A four-part model of mental functioning is presented and developed, drawing on the ordinary language of folk psychology. Objections to this strategy are anticipated and answered. The utility of the model is demonstrated by deploying it to analyse emotional states and to show how subjective experience is a necessary component of mental ill-health, which is why empathic understanding is a necessary skill for mental health nurses. Finally, the major research paradigms associated with scientific approaches to the care and treatment of mental ill-health are aligned with the elements of the model to demonstrate the potential of that model for clarifying the rationale of theoretically divergent treatment approaches for the benefit of both nurses and their clients. It is emphasized that the proposed model is 'theory' only in the weak sense of being a 'systematic account' of the mental life.     

A retrospective evaluation of traumatized permanent teeth

Seclusion is one of several possible interventions with which patients and health care professionals can be confronted on units for admission and crisis intervention in mental health care institutions. The way in which psychiatric nurses shape their practice with regard to seclusion and how they experience this intervention is unclear. The goal of this study is to describe this practice. The results render insight in the motives and reasons of nurses for use of seclusion, the content of the term emergency situation, the way in which decisions to seclude are taken and which interventions can be labelled as preventive. Finally conclusions are given and the questions raised in this study are discussed.     

Somatic symptoms, social support, and treatment seeking among sexual assault victims.

In an effort to clarify the relationship between the experience of sexual assault and physical health, rape victims and a matched comparison group were repeatedly assessed for somatic symptoms, psychological distress, health care use, and self-rated health perceptions during the year immediately after the assault. Women who experienced sexual assault reported more somatic complaints, poorer perceptions of physical health, greater psychological distress, and increased use of medical services. However, victims did not show a significantly higher use of mental health services and continued to seek medical attention at the end of the year after the assault, when health perceptions and somatic symptoms were no longer significantly elevated. The use of mental health services and social support as moderating variables are examined, and implications for the medical and psychological treatment of sexual assault victims are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prisoners as patients. The experience of delivering mental health nursing care in an Australian prison

Correctional or prison mental health nursing is a highly specialized area of practice that has undergone substantive role development in recent years. However, little research has explored aspects of prison-based nursing practice or practice arrangements. The experience of delivering mental health nursing care in prison can be disempowering, resulting in feelings of frustration, isolation, and stigma. In developed nations, prison mental health nurses face the rewarding challenge of gaining greater recognition for the specialized nature of their practice and their key role in the correctional and criminal justice continuum.     

Results of three courses of adriamycin, bleomycin, vindesine, and dacarbazine with subtotal nodal irradiation in 189 patients with nodal Hodgkin''s disease (stage I, II and IIIA)

This paper will explore the delivery of mental health nursing care within a neo-liberal model of mental health care delivery in New Zealand. Mental health nursing as a socially constructed activity occurs within a particular political context, which determines its role and function. This environment determines the nature of the nurse-patient relationship which is integral to the role of mental health nurses. Critical analysis of the New Zealand Government's neo-liberal health policies will be conducted to explore their effect on mental health care delivery and the nurse-patient relationship. Some of the ideologies and values maintained by current dominant discourses within nursing and the State are discussed. To establish therapeutic partnerships with service-users, mental health nurses are urged to critically analyse their practice and the context in which it occurs.     

Explaining employees' health care costs: A prospective examination of stressful job demands, personal control, and physiological reactivity.

The authors tested the ability of stressful demands and personal control in the workplace to predict employees' subsequent health care costs in a sample of 105 full-time nurses. Both subjective and objective measures of workload demands interacted with personal control perceptions in predicting the cumulative health care costs over the ensuing 5-year period. Tonic elevations in salivary cortisol, moreover, mediated the effects of demands and control on health care costs. Neither the job demands variables nor physiological reactivity measures, however, explained subsequent mental health. The results support findings from the epidemiological literature that demonstrate an important role for employees' control in explaining occupational inequalities in coronary heart disease and mortality. The authors argue that the results also encourage control-enhancing job design interventions by suggesting that their outcomes can benefit both organizations and their members. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stigma and barriers to care in soldiers postcombat.

The present study examined the effects of leadership and unit cohesion on mental health stigma and perceived barriers to care. A sample of 680 soldiers from combat support units were surveyed 3 months after their return from combat operations in Iraq. The survey included scales on psychological symptoms and perceptions of leader behaviors and unit cohesion, as well as items assessing stigma and barriers to care. The sample was used to test the independent and interactive effects of leadership and unit cohesion on soldiers’ perceptions of stigma and barriers to care. Analyses yielded significant interaction effects between leadership and cohesion in predicting stigma and barriers to care, while controlling for the effects of mental health symptoms. Soldiers who rated their leaders more highly and who reported higher unit cohesion also reported lower scores on both stigma and perceived barriers to care. Thus, positive leadership and unit cohesion can reduce perceptions of stigma and barriers to care, even after accounting for the relationship between mental health symptoms and these outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nursing, healing and spirituality

The premise of this article is that nurses are healers, primarily through the caring relationships they form with patients. Caring calls out an individual's inner strengths. These strengths include spiritual resources which support integration or wholeness of body, mind and spirit. Many nurses are unsure about giving spiritual care. This author encourages nurses to reflect on their own spirituality and learn spiritual care skills. By addressing the spiritual dimension in patient care, nurses can truly be holistic practitioners and positively affect the mental and physical health of their patients.     

Discharge of psychiatric patients into the community: how many more must die?

Since the advent of community care, mental health services are increasingly coming under scrutiny, particularly the management of people with mental health problems in the community. Several murders committed by psychiatric patients in the community have fuelled public debate. This article reports on a study examining the recommendations of the Department of Health regarding the discharge of psychiatric patients from hospital to community care. It describes the background to events such as the Clunis report and guidance from the Department of Health on the management of mental health services. Semi-structured interviews, questionnaires and document analysis were used to ascertain the views of community psychiatric nurses and managers regarding the discharge of patients into the community. The findings identify areas of good practice and the need for nurses to improve their knowledge of the care-programming approach, risk assessment and inter-agency collaboration.     

Perceptions of acute care physical therapy practice: issues for physical therapist preparation

BACKGROUND AND PURPOSE: Acute care physical therapists have experienced the effects of dramatic changes in health care reimbursement systems and population demographics. Acute care hospitals now serve a patient population of much older, chronically ill patients who are hospitalized for shorter periods of time in a practice environment in which physical therapy staffing resources are often inadequate. The purposes of this study were to document common experiences in the practice of acute care physical therapy and to identify differences in the perceptions of physical therapists with varying levels of experience and in various sizes of acute care facilities. SUBJECTS AND METHODS: A survey questionnaire was mailed to 500 randomly selected physical therapists employed in acute care facilities. The therapists answered questions regarding the frequency of various physical therapy evaluation and treatment practices, problems encountered in delivering physical therapy services, coordination of the discharge planning process, and perceptions of staffing trends in the acute care setting. The responses of 188 physical therapists who completed the survey were compared by their experience levels and the size of the institutions in which they practiced. RESULTS: Subjects reported that patient factors, such as medical complications and cooperation; organizational factors, such as staffing shortages and large caseloads; and health care system constraints, such as difficulty changing orders and limited time in which to work with the patient interfered with patients reaching physical therapy goals. CONCLUSION AND DISCUSSION: Inadequate skills for successful acute care practice and maladaptive therapist beliefs about acute care career possibilities may adversely affect physical therapist career longevity in the acute care setting.     

Primary healthcare workers: training needs in mental health

Particular attention is currently being given to the role of primary healthcare workers in supporting people with mental health problems in primary care (McFadyen et al, 1996). The aim of this study was to survey the views of primary healthcare workers regarding their previous mental health training and to identify their current perceived mental health training needs. A sample of 200 primary healthcare workers within Trent Health Region were interviewed using a short semi-structured interview schedule. Forty-six completed questionnaires were also received. An additional 22 respondents participated in exploratory in-depth interviews. Respondents included GPs, health visitors, practice nurses, district nurses, midwives and community psychiatric nurses. The need for further training in communication skills, particularly basic counselling skills, was highlighted. Respondents also perceived a need for additional training in coping with their own personal stress, the assessment and treatment of depression and stress/anxiety management in clients. Several themes which developed from the research were explored, including communication skills training, problems with collaborative working, coping with personal stress, the prevention of burnout and depression training. The reason why some respondents had no mental health training needs whatsoever was also addressed.     

Predictors of patient outcomes following interactions with nurses

A research and theory-based model was used to identify outcome predictors of hospitalized patients' perceptions of caring and support by nurses. The model tested the effects of cogent personal characteristics of patients (general level of self-esteem and need for control while hospitalized) on their perceptions of humanistic caring and support from nurses and, in turn, considered the effect of these variables on situational appraisal, coping strategies, psychological distress, and coping effectiveness. The 120 hospitalized adult patients indicated that the moderate amount of humanistic caring they received was beneficial. Several factors influenced caring ratings. Higher positive ratings were received from younger patients; however, people with low self-esteem and those desiring more control over their care or reporting a high degree of pain tended to perceive more threat and psychological distress as a results of their encounters with nurses. Following positive caring experiences with nurses, patients with higher self-esteem levels reported effective coping. Overall, positive caring experiences, along with coping strategies and decreased psychological distress levels, explained 40% of the variance of hospitalized patients' ability to cope effectively following their encounters with nurses.     

The 1997 Schering Lecture. Quality of life in oncology: nurses' perceptions, values and behaviours

Quality of life is an important dimension of cancer care. Yet, within our current environment of fiscal restraint, restructuring and cancer care system reform, pressures exist which may make it difficult to provide care which attends to issues of quality of life. Oncology nurses are key providers of cancer care and their perspectives on quality of life for cancer patients are very important. In addition, much of the satisfaction oncology nurses experience in their practice emerges from matters related to attending to quality of life issues. Are oncology nurses currently able to incorporate quality of life issues into their daily care of patients? How are they doing so? The purpose of this qualitative study is to identify major themes and dimensions of nurses' perceptions and values related to quality of life and create a profile of the oncology nurse's role in integrating quality of life in nursing practice. A total of 25 oncology nurses in regional cancer centres across Ontario were interviewed. Each semistructured interview was taperecorded and transcribed. Analysis was completed to identify the major themes and dimensions. This presentation will report the findings from the study and will focus on understanding the existing values oncology nurses hold surrounding quality of life, how quality of life is conceptualized, and the patterns of practice and decision-making regarding quality of life.     

Surgical removal of subretinal neovascular membranes

Although families can provide important support for individuals with life-threatening illnesses or injuries, the highly technological nature of critical care often limits opportunities for family involvement. While critical care nurses are seldom family specialists, they frequently provide support and assistance to patients' families. This paper describes four types of questions drawn from the family therapy literature that can be used by nurses who are not mental health specialists to support families and mobilize their problem solving skills. A case model of a head-injured child demonstrates the use of these questions with a family. These questions should be useful for the brief, problem-focused, family encounters which characterize critical care settings.     

Isolation and characterization of apoptosis-resistant mutants from a radiosensitive mouse lymphoma cell line

This paper reports the findings of a research study funded by the English National Board for Nursing, Midwifery and Health Visiting (ENB), which explored the impact of community care reforms on mental health and learning disability nurses and their practice. In this study we were struck by the divergent views of our respondents about the nature of mental health and learning disability nursing as practice disciplines and the implications of these views for the future shape of preregistration educational preparation. We noted, in particular, the debate between those who advocate what is referred to as specialist educational preparation and others who favour generic preparation. The specialist-generic debate is relevant to nursing as a whole but was magnified in the context of our study because genericism was perceived by many of our respondents as a threat to the minority branches and especially to those (arguably mental health and learning disability) that are not rooted in the biomedical tradition of general nursing. This paper seeks to contribute to this debate as it impinges on the two nursing specialties by developing models of future nurse education grounded in the empirical data from our research and interrogating them to draw out their central features. Two models are clearly independent: the 'specialist' and the 'generic' models. Another three models are partial in that they draw upon the first two: the 'pragmatic' model, the 'unity-of-nursing' model, and the 'social care' model. A common feature of the pragmatic and unity-of-nursing models is that they support the existing DipHE programme, which is now the dominant form of preregistration nurse preparation in the UK. The social care model is applicable principally to learning disability nursing.     

Supraannular aortic root enlargement in patients with small aortic annulus: efficacy and safety

In response to several women who presented with postpartum depression in 1 year, a group of nurses developed a task force made up of hospital nurses, obstetricians, psychiatrists, pediatricians, family practitioners, lactation specialists, home care nurses, and mental health counselors. The purposes of this task force were to educate health care professionals about postpartum depression, to help identify women who might be affected, and to develop interventions for adjusting to parenthood. This article details the evolution of that task force, and how it has assisted not only the women but also the health care providers involved.     

Family caregiving of hospitalized patients. Caregiver and nurse perceptions at admission and discharge

To ensure patients will be discharged to stable, health-promoting home environments, nurses must understand family caregivers' perceptions of the patients' needs and problems in caring for them. At the time patients were admitted to and discharged from the hospital, there was little agreement between family caregivers and nurses about the kinds of things caregivers needed to care for older patients or about problems that might prevent the continuation of caregiving. There was slightly more overall agreement between family care-givers and admission nurses than discharge nurses, despite the fact that discharge nurses reported spending more time with patients and being more knowledgeable about them. Future discharge planning models should build opportunities for nurses to communicate with other health care colleagues who can contribute to a more accurate and complete picture of patients' and family caregivers' needs and problems in the transition from hospital to home.     

Serious mental health problems: policy changes

Recent developments in services and strategies for helping people with serious mental health problems represent a watershed in mental health provision. This has implications not only for specialist mental health nursing, but also-- as increasing numbers of people with serious mental health problems live in the community-- for nurses working in all areas of health care, who will have to play a role in meeting their needs. This article describes current developments in policy and practice, and seeks to explain the basic principles of working with people in this client group.