Casualty nurses' attitudes to attempted suicide

This study explores the attitudes of casualty nurses to attempted suicide. The nurses' age and length of experience in casualty were the independent variables. A total of 142 nurses from 11 hospitals in Northern Ireland had questionnaires circulated to them, with a 66.9% response rate. There were significant differences on four of the variables in relation to nurses' ages, and on two of the variables in relation to the nurses' length of experience in casualty. The older and the more experienced nurses seem to have more positive attitudes than the younger or the less experienced nurses. However, further nursing research, in Northern Ireland, is needed to corroborate these findings. Other recommendations are made.     

Benevolence, a central moral concept derived from a grounded theory study of nursing decision making in psychiatric settings

Fourteen experienced nurses participated in an explorative study aimed at describing the experiential aspects of moral decision making in psychiatric nursing practice. In-depth interviews were conducted according to the grounded theory method. These were transcribed, coded and categorized in order to generate conceptual categories. The concept of benevolence was identified as a central motivating factor in the nurses' own accounts of situations in which decisions were made on behalf of the patient. This seems to conceptualize the nurses' expressed aim to do that which is 'good' for the patient in responding to his or her vulnerability. This study indicates the need for further research into the subjective, experiential aspect of ethical decision making from a contextual perspective.     

'Bending the truth': professionals' narratives about lying and deception in nursing practice

The purpose of this study was to capture an insight into the phenomenon of lying as part of the deception employed by a group of practising nurses from a variety of clinical settings. The importance of this research is that it adds to the limited knowledge of the range of situations in which nurses use deception. A case study research approach was utilised. The findings presented in this article emphasise the complexity of the subject within a dynamic social context. The article describes the nurses' intention, role, the nature of relationships and context and how institutional culture impacts on disclosure to clients. Additionally, it describes how nurses' distinguish lying from other deceptive practices. These findings have relevance for clinical practice and continuing applied ethics research.     

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.     

Struggling for control: the care experiences of 'difficult' patients in mental health services

Although there is increasing recognition of the existence of 'difficult' patients who present particular challenges to mental health nurses, no research has been conducted into their perceptions of services and their experiences of care. This study identifies mental health service users who are defined by nurses as 'difficult' and explores their perceptions of their care experience. The results support earlier studies which suggested that 'difficult' patients challenge nurses' competence and control: despite their different roles both nurses and 'difficult' patients were aware of the struggle to gain or retain a notion of control. Respondents were able to identify the qualities of nurses and nursing interventions which had a positive effect on their care experience. Where nurses were perceived to demonstrate respect, time, skilled care and a willingness to give patients some control and choice in their own care, feelings of anger were reduced. These findings are discussed within the conceptual framework of 'power over' and 'power to' and implications for practice and research are considered.     

Serotonin receptors and the acute attack of migraine

The concept of nursing expertise has been the focus of considerable debate since the early 1980s, yet an agreed definition of the concept and the precise criteria by which it can be evaluated remains elusive. This paper will describe an exploratory study into A & E nurses' constructs of the nature of nursing expertise. Seven first level Accident and Emergency (A & E) nurses were interviewed using Kelly's Repertory Grid Technique. Each was asked to provide examples of nurses with whom they are working or have worked, to match eight given examples designed to represent varying levels of clinical expertise. The informants were asked to consider in what way two of their chosen examples were alike and differed from a third in their clinical practice. A total of 55 bi-polar constructs emerged which were clustered under four main headings. These suggested that A & E nurses perceived expert practice to be characterized by a high level of empirical knowledge, supportive team building, assertive clinical leadership and patient-focused involvement.     

Nurses' knowledge and opinions about the nursing research process in The Netherlands

Nursing research is just gaining ground in The Netherlands, as it is in every European country. Therefore, this study had the purpose of discovering to what extent Dutch nurses in the clinical areas have acquired research-based knowledge since it was introduced into the country, in the 1970s. Questionnaires, which included provision for demographic data, were distributed to 110 nurses, comprising head nurses, recently qualified nurses and final-year student nurses. A 65% response was achieved and the findings revealed that nursing research as a concept was not new to the Dutch nurses. They claimed they had obtained their knowledge through nursing training, reading, conferences and other sources such as mass media. The head nurses were the most knowledgeable followed by the recently qualified nurses and then the student nurses. However, the respondents claimed that their knowledge was superficial. The need to extend nurses' knowledge through support and encouragement in relation to nursing research seminars and conferences is recommended.     

Ratings of the performances of practicing internists by hospital-based registered nurses

PURPOSE: To examine the feasibility and reliability of ratings completed by hospital-based registered nurses of the humanistic qualities, communication skills, and selected aspects of the clinical skills of practicing internists. METHOD: In 1988-1989, registered nurses who worked in the same 175 hospitals as 232 internists with admitting privileges at these hospitals rated the internists' performances. The nurses were selected from medicine floors, specialty floors, and intensive care units and/or critical care units, using lists provided by head nurses. A total of 1,877 rating questionnaires with 13 performance categories were collected (with a mean of 8.01 nurses per internist). The ratings were analyzed to determine measurement characteristics and the relationships of the nurses' demographic characteristics to the ratings. In addition, for each of ten performance categories for 152 of the internists, the average rating each internist received from nurses was compared with the average rating each internist received from peer physicians. Statistical analysis used Pearson correlations, canonical correlations, factor analyses, Student's t-tests, analysis of variance, and stepwise multiple regression. Finally, the internists themselves, including physicians who were not actually rated by the nurses, were asked to complete a brief questionnaire that included questions about their opinions of the use of nurses' ratings. RESULTS: The nurses' ratings correlated moderately strongly with the peer physicians' ratings and had a common structure. However, the nurses' ratings were lower for several humanistic qualities, including respect, integrity, and responsibility, and their ratings were higher for medical knowledge and verbal communications. Across the 13 performance categories, approximately 10-15 ratings from nurses were needed to obtain a reliable assessment of an internist's humanistic qualities and communication skills. Many internists felt that nurses' ratings should be used equally with, or at least as a lesser contribution to, ratings by peer physicians of humanistic qualities and communication skills. CONCLUSION: Nurses' ratings appear to provide a feasible and reliable method of evaluating the internists' communication skills and humanistic qualities, when used in conjunction with ratings by peer physicians.     

The parent-nurse relationship from the perspective of parents of children with cancer

Research to date has overlooked the specific relationship between parents and nurses, particularly in the context of family-centered care for a hospitalized child with cancer. The purpose of this study was to describe how parents perceive the relationship with the pediatric staff nurse necessitated by the hospitalization of their child with cancer. Using a symbolic interactionist framework and a modified grounded theory methodology, this study explored the parent-nurse relationship when a child with cancer is hospitalized. A purposive, theoretical quota sampling method was used to recruit 16 parents. Both parents' and nurses' care were examined from the parents' perspectives; mothers and fathers were interviewed separately. Analysis of the data led to the development of a substantive theory describing parent care (Making it Better), nursing care (Going Through the Motions, Caring Incompletely and Caring Completely), and the parent-nurse relationship (Working Together). Conditions influencing the care provided by parents and nurses and in turn the parent-nurse relationship were also identified. This research describes strategies nurses use to enhance the family-centered care they provide and reveals the effect nursing care has on parents' hospital experiences. Recommendations are made for nursing research, practice, and education.     

A study of hospital nurses' attitudes toward continuing education in Kaohsiung City, Taiwan

The purpose of this study was to investigate hospital nurses' attitudes toward continuing education. Continuing education was defined as non-credit organized educational programs designed for nurses by hospitals, nursing institutions, or other related organizations to maintain or improve professional competence. It included "in-service education", "on-the-job training", and other synonymous educational activities. Six hundred and seventy-four randomly selected hospital nurses in Kaohsiung City participated in this study. The data was collected by delivering a 34-statement questionnaire through the directors of nursing. Cronbach's Alpha Coefficient was applied to determine the reliability with a value of 0.79. Factor analysis and a group of experts' suggestions were applied to determine the validity. Frequency distribution, Analysis of Variance, Scheffe' test, and Multiple Regression Analysis were conducted to analyze the research questions. The level of significance was set at 0.05 or less. The results indicated that the majority of nurses (92.65%) hold positive attitudes toward continuing education (M = 86.32). Nurses' attitudes toward continuing education were related to selected personal and professional characteristics, and hospital policies regarding continuing education. To maintain nurses' positive attitudes and to develop positive attitudes for those who hold negative attitudes, some strategies for continuing education should be considered by nursing administrators.     

Expression of IGFs and their receptors is a potential marker for embryo quality

This paper is based on a one-year ethnographic study that focused on nurse-patient relationships on a ward where therapeutic nursing and professional autonomy were explicit nursing goals. Through participant observation and semi-structured interviews, it was found that nurses, as a team, adopted a highly relaxed form of posture. Their informal and open stance served to emphasize their 'closeness' with patients, supporting nurses' claim of a special role in the healthcare team, and making flesh some of the differences between nursing and medical roles. The interpretation of nurses' bodily practice rested in part on the meanings given to the ward space patients felt the ward to be a private domain in which nurses' informality endorsed their sense of being cared for as if by family, while for medical staff the ward remained a public space in which female nurses tacitly challenged their authority as men through the adoption of a masculine bodily praxis. The paper thus looks at links between the gendered body, the gendered professions of medicine and nursing, and the gendered nature of space. It argues that work on occupational closure has previously privileged the discursive, and suggests that understanding how nurses arbitrate professional boundaries in everyday practice will benefit from consideration of the nurse's body as a point of political resistance.     

Using standardized patients and standardized physicians to improve patient-care quality: results of a pilot study

BACKGROUND: We conducted evaluation research with a sample of registered professional staff nurses in a large, inner-city, tertiary medical center for a pilot study of videotaped case scenarios using standardized patients and standardized physicians to enhance nurses' communication and collaboration skills. METHOD: Change scores from pre-test to post-test on a self-reported rating scale to assess nurse-physician-patient interactions and communications for 28 nurses were compared with a control group of 38 nurses who did not participate in the videotaped sessions. RESULTS: Repeated measures of analysis of variance (ANOVA) detected no statistically significant differences between the intervention and control groups. However, positive changes were noted in some aspects of nurse-physician and nurse-patient interactions in the intervention group. Immediate feedback from the videotaped scenarios heightened nurses' awareness of the impact of their body language. CONCLUSIONS: Nurses must continuously practice and enhance their collaborative and communication skills. This pilot study suggests that it is beneficial to use videotaping with standardized patients and standardized physicians to enhance such nurses' skills.     

Hospital ethics committees and nurses' participation

The hospital ethics committee's mandates of patient care review, policy formation, and education make them central to nurses and healthcare delivery. In a study examining nurses' communication exchange frequency and perceived effectiveness as members of hospital ethics committees, nurses represented the largest proportion, were moderately active, and rated their participation effectiveness the highest: they are more involved in discussions regarding patients than policy formation and education. Nurse administrators can provide strategies and education for nurses that enhance nurses' participation in all three committee functions. Policies affect patient care; therefore, policy decisions, too, benefit from nurses' participation.     

Selective impairment of endothelium-mediated vasodilation in liver transplant recipients with cyclosporin A-induced hypertension

An understanding of the importance of language as a symbolic artefact, particularly with reference to metaphor, has been little addressed within the nursing literature. Consequently, the potential richness of people's accounts may be missed. Data from a study which explored the nature of hospice work and nurses' experiences of professional and personal bereavements are used to illustrate the different understanding which an exploration of metaphor can bring to research. Meanings of metaphor and its role in language are initially presented before drawing on data concerned with the emotional aspects of hospice work. Root metaphors of emotion are identified and examples from nurses' accounts indicate how nurses draw on these metaphors to articulate their experiences. The strategies nurses employ to continue working within the hospice culture are identified both practically in their work and metaphorically in the language they use.     

Reaction of different cell populations in mouse thymus to a single gamma-irradiation

Acute care facilities are no longer viewed as the center of the health care network. Efforts to reduce hospital length of stay will continue to spur the growth of care delivered in homes. With the downsizing of many hospitals, the need for nurses in acute care settings will decline. Many acute care nurses are finding themselves seeking employment opportunities in home health care settings. The purpose of this study was to examine nurses' experiences when they change from hospital-based practice to home health care nursing. The qualitative mode of inquiry was used to conduct taped-recorded interviews of 25 baccalaureate-prepared nurses in a large metropolitan area. Stressors experienced by the nurses were identified as well as adaptations required to minimize role stress. Continuing education programs can provide information and skills needed to improve nurses' competencies to function in a health care system projected to be more community-based, which includes home health care.     

Rural school nurses' attitudes about AIDS and homosexuality

The AIDS epidemic has spread to rural areas of the United States. Conservative rural communities are facing the challenge of having children with HIV entering school. School nurses, as the only health care providers in the schools, are in a strong position to facilitate the education of children with HIV and to provide AIDS education to students, faculty, and parents. School nurses' knowledge and attitudes about AIDS and people with AIDS influence their effectiveness in prevention activities and care of HIV-infected children. This study examined the relationship between specific demographic, practice, and cultural variables and rural school nurses' attitudes about AIDS and homosexuality. Sixty-nine school nurses responded to a mailed questionnaire as part of a larger study of rural nurses. Results indicate attitudes about homosexuality were related to nurses' homosexual knowledge and religious beliefs while attitudes about AIDS were related to nurses' willingness to care for people with AIDS and feeling prepared to do so.     

Nurse coaching and cartoon distraction: an effective and practical intervention to reduce child, parent, and nurse distress during immunizations

Evaluated a low cost and practical intervention designed to decrease children's, parents', and nurses' distress during children's immunizations. The intervention consisted of children viewing a popular cartoon movie and being coached by nurses and parents to attend to the movie. Ninety-two children, 4-6 years of age, and their parents were alternatively assigned to either a nurse coach intervention, a nurse coach plus train parent and child intervention, or a standard medical care condition. Based on previous findings of generalization of adult behaviors during medical procedures, it was hypothesized that training only the nurses to coach the children would cost-effectively reduce all participants levels of distress. Observational measures and subjective ratings were used to assess the following dependent variables: children's coping, distress, pain, and need for restraint; nurses' and parents' coaching behavior; and parents' and nurses' distress. Results indicate that, in the two intervention conditions, children coped more and were less distressed, nurses and parents exhibited more coping promoting behavior and less distress promoting behavior, and parents and nurses were less distressed than in the control condition. Although neither intervention was superior on any of the variables assessed in the study, nurse coach was markedly more practical and cost-effective. Therefore, nurses' coaching of children to watch cartoon movies has great potential for dissemination in pediatric settings.     

Testing the stress-response sequence model in paediatric oncology nursing

The causes and intensity of role-related stress experienced by paediatric oncology nurses, the nurses' ability to respond to the stressors, and the professional and personal consequences of those stressors for the nurses are issues of concern for administrators and staff. The concern evolves from the anticipated relationships among stressors, the ability to cope with role-related stressors, and the expected negative outcomes such as resignation. However, the relationships among these components have not been previously measured concurrently in paediatric oncology nurses. The primary purpose of this study was to test the complete stress-response sequence model in a sample of paediatric oncology nurses by obtaining concurrent measures of the model's individual components: nurses' stressors, reactions, mediators, and consequences. A total of 126 nurses completed six questionnaires (Stressor Scale for Paediatric Oncology Nurses, Perceived Stress Scale, Measure of Job Satisfaction, Organized Commitment Questionnaire, Group Cohesion Scale, and Intent to Leave) and a demographic sheet. The majority of participating nurses were married, worked full-time and had worked 5 or more years in oncology. Qualitative data were analysed using a semantic content analysis technique. Relationships among the components of the model were examined using a two-stage least squares technique. The components were only weakly associated and unable to explain significant variation in each other. The combined qualitative and quantitative data indicate that an important explanatory variable - role-related meaning - is missing in the content model.