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Aim. This paper is a report of a review examining the variables that predispose individuals to significant psychological maladjustment following burn injury. Background. The psychological sequelae of burn injury are well documented; however, the variables that influence individuals' adjustment following burn injury lack consideration. Data sources. MEDLINE, Cumulative Index of Nursing and Allied Health, and Psychological Abstracts were searched using the keywords burn injury, psychological, psychosocial, rehabilitation, premorbid psychopathology, adjustment, reintegration, body image, post-traumatic stress disorder, depression, coping. Other sources were found from a manual search of nursing, medical and psychological literature and references of identified and related papers. The search strategy was limited to English-language research published between 1997 and 2008. Review methods. An integrative review of the studies was conducted over a 6-month time period during 2007-2008. Results. Burn patients are a heterogeneous group and typically have comorbidities. While preburn personality and coping strategies can influence long-term psychological adjustment, the relationship between postburn adjustment and burn size and severity, and gender are poorly understood. Much of the literature focuses on the prevalence of psychological maladjustment rather than on identifying variables that influence psychological adjustment. Conclusion. The diversity and complexity that characterize burn patients lead to unique adjustment difficulties. Recognizing these difficulties is the first step to offering appropriate intervention and treatment for this unique patient group. [ABSTRACT FROM AUTHOR]

Title. Nursing’s ways of knowing and dual process theories of cognition Aim. This paper is a comparison of nursing’s patterns of knowing with the systems identified by cognitive science, and evaluates claims about the equal-status relation between scientific and non-scientific knowledge. Background. Ever since Carper’s seminal paper in 1978, it has been taken for granted in the nursing literature that there are ways of knowing, or patterns of knowing, that are not scientific. This idea has recently been used to argue that the concept of evidence, typically associated with evidence-based practice, is inappropriately restricted because it is identified exclusively with scientific research. Method. The paper reviews literature in psychology which appears to draw a comparable distinction between rule-based, analytical cognitive processes and other forms of cognitive processing which are unconscious, holistic and intuitive. Findings. There is a convincing parallel between the ‘patterns of knowing’ distinction in nursing and the ‘cognitive processing’ distinction in psychology. However, there is an important difference in the way the relation between different forms of knowing (or cognitive processing) is depicted. In nursing, it is argued that the different patterns of knowing have equal status and weight. In cognitive science, it is suggested that the rule-based, analytical form of cognition has a supervisory and corrective function with respect to the other forms. Conclusions. Scientific reasoning and evidence-based knowledge have epistemological priority over the other forms of nursing knowledge. The implications of this claim for healthcare practice are briefly indicated. [ABSTRACT FROM AUTHOR]

AIM: This paper critically examines the research literature relating to the psychological aspects of breast reconstruction. Particular attention is given to the role of specialist breast care nurses in supporting women faced with the decision of whether or not to opt for reconstructive surgery. BACKGROUND: Breast reconstruction is intended to offer psychological benefits (e.g. improvements to quality of life, body image, anxiety and depression) to women treated by mastectomy following diagnosis of breast cancer. METHODS: A literature search was carried out on the PSYCHINFO, MEDLINE and CINAHL databases using the terms 'breast reconstruction', 'mastectomy', 'reconstructive surgery', 'breast surgery', 'breast implants', 'transverse rectus adominis myocutaneous (TRAM) flap' and 'Lat-dorsi'. Further relevant articles were identified from the reference lists of papers detected by this literature search. Finally, proceedings of recent psychological and surgical meetings were scrutinized to identify any conference papers on this topic. FINDINGS: A thorough search of the existing literature revealed a lack of theoretically based studies examining breast reconstruction in terms of relevant psychological constructs, especially in relation to coping and decision-making. This review highlights the methodological flaws with much of the existing research in this area, in particular the reliance upon retrospective designs and the inappropriate use of randomised controlled trials. Suggestions are given for further research in this topical area. CONCLUSIONS: Existing research into the psychological aspects of breast reconstruction is limited and not sufficiently conclusive to inform changes to policy and the provision of care. More methodologically rigorous research is needed. [ABSTRACT FROM AUTHOR]

The following paper presents the findings of an exploratory ethnography, the purpose of which was to identify and describe heart health associated beliefs and behaviours of year seven (Y7) and year 10 (Y10) secondary school young people of African and African Caribbean descent in two UK cities. Data were collected by the data collection technique of focus groups. However, eight focus groups were conducted involving 47 Y7 young people and 29 Y10 pupils, 76 pupils in total. The data were analysed utilizing ATLAS/ti qualitative data analysis software. This software is informed by grounded theory. Data from the study formed six themes. The findings informed the development of an interactive health promotion website which can be found at http://www.shef.ac.uk/web/uni/projects/mshhp. The paper argues that in order to provide meaningful programmes of health promotion to be developed by health care providers including school nurses and health visitors, it is essential that interventions are informed by an understanding of the health beliefs and behaviours of African and African Caribbean young people. [ABSTRACT FROM AUTHOR]

This paper describes a process of context setting that was undertaken prior to designing a study to assess the psychosocial impact of participation in phase I and II anticancer drug trials from the patient's perspective. The paper outlines how and why this context setting was undertaken and highlights important aspects of the culture and organization of cancer clinical trials that may influence patients' experiences in trial recruitment and participation. In this way, the context setting proved to be an invaluable tool for providing an orientation to the environment where patients received their care and treatment as well as identifying issues that would need to be taken into consideration later in the research study design. [ABSTRACT FROM AUTHOR]

Seldom is the work of philosophers invoked by health professionals when examining aspects of care from a philosophical perspective. Instead, students of health care, especially nurses, have been introduced to ‘philosophies’ which are often superficially examined and poorly understood. This practice fails to develop in students an appreciation of the work of philosophers or to acquire the art of critical thinking. The introduction of models and theories of nursing in the past three decades has alerted nurses to the importance of possessing critical skills in order to identify sound theory and implement good practice. This paper goes beyond mere philosophising and examines aspects of mental health care from the perspectives of one of nineteenth century Europe’s most notable philosophers, Friedrich Nietzsche. It argues that understanding his work can enhance one’s ability to reflect on nursing practice, as well as bringing a new dimension to how we analyse ‘mental health’ problems. His work provides many insights into how we can improve our understanding of the effect of mental illness and mental health care on the individual, and how we conceptualise the process of care. This paper provides an overview of his life’s work, his impact on the history of ideas and develops some of the more provocative implications of his work for mental health care. [ABSTRACT FROM AUTHOR]

This paper explores one facet of a therapeutic relationship with a woman suffering from inoperable cervical cancer. The psychotherapy sessions were conducted in both hospital and the family home and continued on a weekly basis until final termination immediately prior to the woman’s death. Through a "suspense structure’ case study narrative, the writer, a nurse psychotherapist, describes the way in which the humanities, art and poetry can provide a means through which to understand seemingly incomprehensible feelings related to reviewing past events as a preparation for death. While no explicit critique is made of the twin psychoanalytical concepts of transference and countertransference, the occurrence is woven into the text. The essential nature of clinical supervision is illustrated in context. The author proposes that engagement in a therapeutic relationship with a dying person presents the worker with parallel struggles manifesting in elementary feelings which require discernment. The central recommendation of this paper is that the rich symbolic language and metaphors, redolent in art and poetry, be harnessed as a potent therapeutic tool. Throughout the discussion, the terms counselling and psychotherapy are used interchangeably. [ABSTRACT FROM AUTHOR]

In the United Kingdom at the present time, there are radical changes taking place in the nursing profession. In order to cope with these new ideas, it has been suggested that nursing needs to attract into its ranks individuals who are not only highly intelligent but also highly creative. This paper examines the concept of creativity as it has been used in the fields of education and psychology and seeks to examine whether or not nurses with creative attributes are desirable or acceptable in current nursing practice. The ability of the nurse educator to provide for the needs of the highly divergent thinker is also questioned. The paper concludes with a suggested alternative for the use of creativity within the profession, that of the creation of innovative, original and humanistic approaches to the education of the student of nursing. [ABSTRACT FROM AUTHOR]

In this paper, the nature of educational studies is considered and discussed. Following some introductory comments, the paper deals with philosophy, psychology and sociology in relation to education. This is followed by a section on social psychology and the paper ends with a section on the history of education. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

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

AIM: This paper is a report of a study conducted to examine changes in personality from late pregnancy to early motherhood in primiparas having vaginal or caesarean deliveries. BACKGROUND: Birth of the first child is a major life event, possibly influencing personality. The physiological and emotional processes that start in pregnant women have a major impact on the evolving mother-child relationship. Knowledge about changes in personality during pregnancy and motherhood is scarce. METHOD: A prospective, group-comparative cohort study including 314 healthy primiparas having either 'caesarean section on maternal request' (n = 74) or 'spontaneous vaginal delivery group' (n = 240). The self-report inventory Karolinska Personality Scales was mailed to participants at 37-39 gestational weeks in pregnancy and 9 months after delivery. Data were collected from January 2003 to June 2006. RESULTS: All mean values of the personality variables were within the normal range. There was a statistically significant increase in Impulsivity (P = 0.046) and decrease in Socialization (P = 0.004). The scores developed differently depending on mode of delivery. Thus, women in the vaginal delivery group increased their scores on the Psychic anxiety and Guilt scales, while those in the caesarean delivery group decreased their scores. Although women in both groups became more impulsive and less socialized, personality remained comparatively stable in the transition from late pregnancy to motherhood. CONCLUSION: As interactive therapeutic midwife/client relationships and maternal/social role preparation have been shown to have a great effect on progress in becoming a mother, knowledge about how personality may affect this process is important so that healthcare professionals can attempt to reduce women's anxiety levels during pregnancy. [ABSTRACT FROM AUTHOR]

Aim. This paper reports on a study exploring parents' longer-term experiences of having a child with type 1 diabetes. Background. Parents of children with type 1 diabetes may experience a grief reaction at diagnosis similar to that normally associated with bereavement, but little is known about their long-term emotional adaptation. Chronic sorrow, a sustained but intermittent grief reaction, is identified in adults with diabetes but has not previously been explored in relation to parents. Methodology. In-depth interviews were conducted in 2007 with a convenience sample of 17 parents of children with type 1 diabetes 7-10 years after diagnosis. Data were explored within a theoretical framework of grief, loss, adaptation, and change. Findings. Parents had adapted to the needs of diabetes management but most had not 'come to terms' with the diagnosis. They experienced a resurgence of grief at critical times during their child's development and some, particularly mothers, became upset during their interviews, even though these took place 7-10 years after their child's diagnosis. Mothers elaborated more on their emotions than fathers, but continuing feelings associated with grief, such as anger and guilt, were expressed by both fathers and mothers. Conclusion. Greater understanding of parents' long-term emotional responses and recognition that grief may never resolve in these parents may enable healthcare professionals to provide appropriate and timely support at critical times. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to explore the phenomenon of resilience in the lives of adult patients of mental health services who have experienced mental illness. Background. Mental illness is a major health concern worldwide, and the majority experiencing it will continue to battle with relapses throughout their lives. However, in many instances people go on to overcome their illness to lead productive and socially engaged lives. Contemporary mental health nursing practice primarily focuses on symptom reduction, and working with resilience has not generally been a consideration. Method. A descriptive phenomenological study was carried out in 2006. One participant was recruited through advertisements in community newspapers and newsletters and the others using the snowballing method. Information was gathered through in-depth individual interviews which were tape-recorded and subsequently transcribed. Colaizzi's original seven-step approach was used for data analysis, with the inclusion of two additional steps. Findings. The following themes were identified: Universality, Acceptance, Naming and knowing, Faith, Hope, Being the fool and Striking a balance, Having meaning and meaningful relationships, and 'Just doing it'. The conceptualization identified as encapsulating the themes was 'Viewing life from the ridge with eyes wide open', which involved knowing the risks and dangers ahead and making a decision for life amid ever-present hardships. Conclusion. Knowledge about resilience should be included in the theoretical and practical education of nursing students and experienced nurses. Early intervention, based on resilience factors identified through screening processes, is needed for people with mental illness. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to investigate the relationship between structural empowerment/psychological empowerment and innovative behaviour. Background. Innovative behaviour is essential for nurses in today's dynamic healthcare systems. Empowerment has become an increasingly important factor in predicting innovative behaviour. Structural empowerment refers to power based on the employee's position in the organization, while psychological empowerment consists of the fundamental personal convictions that employees have about their role in the organization. Methods. A cross-sectional correlational survey was conducted in the Netherlands in 2007 with 519 Registered Nurses. The instruments used were the Conditions of Work Effectiveness Questionnaire II, the Psychological Empowerment Instrument and the Questionnaire Innovative Behaviour. Four hypotheses were tested using descriptive statistics, bivariate and multiple regression and one-way analysis of variance. Results. Structural and psychological empowerment were statistically significant predictors of innovative behaviour. Informal power and impact were the most relevant determinants of innovative behaviour, the latter the strongest. Psychological empowerment functioned as a mediator between structural empowerment and innovative behaviour. The expected moderating effect of structural empowerment was not proven. Conclusion. Organizations need to create the right conditions to be able to strengthen nurses' empowerment. Networking is an important skill which should be incorporated in the nursing education. Future research should take into consideration nursing culture and personality traits as determining factors. Replication of this study in another setting and a study examining causality are recommended so that additional empirical evidence may be obtained. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to investigate healthcare managers' perspectives on factors contributing to the increase of healthcare employees on sick leave for burnout symptoms. Background. Current turbulent healthcare reorganization has resulted in structural instability, role conflicts and vague responsibility commitments, all of which contribute to increasing numbers of sick days caused by burnout symptoms. Managers' perceptions of burnout sources are important as these perceptions guide the actions taken to prevent burnout. Method. Interviews were carried out with 30 healthcare managers, with different occupational backgrounds and from different units. The data were collected in Sweden in 2003 and analysed using thematic qualitative content analysis. Findings. According to the healthcare managers, continuous reorganization and downsizing of healthcare services has reduced resources and increased demands and responsibilities. These problems are compounded by high ideals and expectations, making staff question their own abilities and worth as well as making them feel less confirmed and less valued as people. The main finding indicates that healthcare employees are thrown into a spiralling sense of inadequacy and an emerging sense of pessimism and powerlessness. Conclusion. To understand and influence people's actions, one has to understand their perceptions and thoughts - their explanatory models. This study shows the complexity and interconnection between sources of burnout as perceived by healthcare managers, and highlights the encouragement of realism without the destruction of enthusiasm as an important factor in management and healthcare practice. [ABSTRACT FROM AUTHOR]

AIMS: This paper describes a concept analysis carried out to remove some of the ambiguity surrounding the conceptual meaning of perceived parental efficacy and to distinguish it from related concepts such as parental confidence and parental competence. BACKGROUND: Constructing parental efficacy is a crucial step for family members after the birth of their first child. For some authors, perceived parental efficacy is a motor for adequate parental practices. Confusion about the definition and measurement of this concept has hindered both psychology and nursing practice and research. Concept delineation and concept clarification are required in order to further the development of the concept of perceived parental efficacy. METHODS: A literature search using a variety of online databases yielded 113 articles between the years 1980 and 2000. The final sample (n=60) consisted of 30 articles from two disciplines: nursing and psychology. A content analysis of the literature was done using Rodger's evolutionary concept analysis method. FINDINGS: Content analysis of the literature yielded four contributors to perceived parental efficacy: positive enactive mastery experiences, vicarious experiences, verbal persuasion and an appropriate physiological and affective state. Perceived parental efficacy can thus be defined as 'beliefs or judgements a parent holds of their capabilities to organize and execute a set of tasks related to parenting a child'. CONCLUSION: This conceptual analysis has allowed perceived parental efficacy to be distinguished from parental confidence and parental competence. Both nursing and psychology research, practice and education will benefit from a more precise and delineated concept. [ABSTRACT FROM AUTHOR]

BACKGROUND: A number of studies have explored nurses' attitudes toward older people. However many of those have produced inconclusive results. Moreover dated attitudinal measures have been used to answer a broad range of questions relating to older people. AIM: The aim of this paper is to report a study examining whether negative attitudes and beliefs toward older adults persist. METHODS: Focus group interviews were used identifying factors which may influence attitudes and beliefs both negatively and positively. Nine Registered Nurses from care of older adult areas, four from acute areas, six nurse teachers, and 17 nursing students participated in the study. Ten themes were identified from the findings. FINDINGS: The findings show that the student nurses had varying experiences in older adult settings. Some of which had the effect of turning them away from the specialty. However, nurses who worked with older adults were very positive about their work and the nursing opportunities they had to offer student nurses. They were rather critical of the content of the pre-registration curriculum, which they perceived to over-rely teaching the negative aspects of ageing, and there was also criticism of the currency of teachers' knowledge. Nurses who worked in acute settings also did not escape criticism, in that they were identified as attributing a lack of sense of humour to older adults. The limitations include the small sample size although it is congruent with qualitative research. CONCLUSIONS: All nursing staff need to be more aware of their influence on the attitudes of student nurses toward older people. Good practice includes the ability to demonstrate that older people in hospital settings are valued. Nurse teachers need to review the way they prepare students for this specialist work in order to avoid inadvertently conveying negative attitudes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Emancipation as a nursing concept is derived from a long-standing history of social oppression and is easily addressed by both critical social theory and feminist theory. It is the apparent concept to describe a phenomenon witnessed in nursing when caring for women in the decision-making process about health care issues. Emancipation has been recognized by expert clinical observation. AIM: The aim of this paper is to define the concept of emancipation for possible future application to nursing practice for the promotion of humanistic nursing care in women's health, specifically applied to the decision-making process. METHOD: A literature search was carried out using the CINAHL database and the keywords nursing and emancipation, and covering the period 1985-2003. The Rodgers and Knafl (2000) method of concept analysis was then used to derive a conceptual meaning of emancipation that benefits patient care as well as professional nursing development. Emancipation is broken down into antecedents, attributes and consequences. Related concepts are also explored, compared and discussed to synthesize relevant characteristics. FINDINGS: This concept analysis identifies emancipation in decision-making as a nursing phenomenon by discussing the antecedent of oppression and exploring the identified attributes: (a) empowerment, (b) personal knowledge, (c) social norms, (d) reflection and (e) flexible environment. The consequence of emancipation is free choice. It is a futuristic concept with strong historical ties in need of exploration and development within the context of women's health care in relation to decision-making. CONCLUSIONS: The concept model illustrates emancipated decision-making, with its five attributes in relation to oppression as a non-linear phenomenon. Areas for further study include the exploration of the contribution of each critical attribute and its relationship to emancipated decision-making, and the decision-making process in relation to patient satisfaction and how long the person continues to adhere to the decision. Also the professional nursing role in promotion of emancipated decision-making is virtually unexplored, but is an important concept in the paradigm of shared decision-making about health care alternatives. [ABSTRACT FROM AUTHOR]

BACKGROUND: Emotional labour has been widely accepted in the literature as part of nursing work, however the contribution of emotional intelligence in the nursing context requires further study. AIM: This paper aims to present an analysis of the literature on emotional intelligence and emotional labour, and consider the value of emotional intelligence to nursing. METHOD: A literature search was undertaken using the CINAHL and MEDLINE databases. Search terms used were 'emotions', 'intelligence', 'emotions and intelligence' and 'emotional labour'. A hand-search of relevant journals and significant references added to the data. RESULTS: Emotional intelligence plays an important part in forming successful human relationships. Emotional labour is important in establishing therapeutic nurse-patient relationships but carries the risk of 'burnout' if prolonged or intense. To prevent this, nurses need to adopt strategies to protect their health. The potential value of emotional intelligence in this emotional work is an issue that still needs to be explored. CONCLUSIONS: Analysis of the literature suggests that the modern demands of nursing draw on the skills of emotional intelligence to meet the needs of direct patient care and co-operative negotiations with the multidisciplinary team. The significance of this needs to be recognized in nurse education. The link between emotional intelligence and emotional labour is a fruitful area for further research. The potential benefits of gaining a better understanding of how these concepts interact is largely conjecture until we have more evidence. The prospect that there may be advantages to both nurses and patients is a motivating factor for future researchers. [ABSTRACT FROM AUTHOR]

BACKGROUND: Self-neglect can be defined as the failure to engage in those self-care actions necessary to maintain a socially acceptable standard of personal and household hygiene and/or a failure to adequately care for one's own health. It is generally acknowledged that research and practice in the area of self-neglect has been hampered by a lack of theoretical development. Socio-psychological theories, such as 'social constructivism' and 'negotiated interactionism' can contribute to a deeper understanding of the phenomenon and to the further development of self-neglect theory. AIMS: This paper seeks to apply social and psychological theories to understanding self-neglect. Self-neglect is an underconceptualized phenomenon, which requires to be studied within a broader theoretical context than is at present the case. IMPLICATIONS: Sociological and psychological theories offer radically different ways of looking at self-neglect, as opposed to the medical model, as they seek to explain and understand, rather than simply classify it as a medical disorder caused by some form of underlying psychopathology. These theories emphasize the dynamic and interpretative nature of self-neglect and illustrate the arbitrary way in which this label is applied. [ABSTRACT FROM AUTHOR]

BACKGROUND: The phenomenon of infant responsiveness to the caregiver during feeding interactions has been of interest to researchers for many years, because of its associated implications for child growth and development. Although many studies have examined feeding responsiveness in caregiver-infant dyads, it is infrequently and inconsistently defined in the literature. SPECIFIC AIMS: The purpose of this paper is to clarify the concept of infant feeding responsiveness through the provision of a working definition of the concept for further study and usage. METHODS: Medline, CINAHL, and PschInfo databases from the year 1970 to the present were searched for English articles containing the keywords 'infant', 'feeding', 'responsiveness', 'synchrony', and/or 'interaction'. Articles were selected for inclusion according to whether or not the phenomenon of infant feeding responsiveness was defined or assessed. Walker and Avant's (1995) method for concept analysis was employed for the development of defining attributes, case examples, antecedents, and consequences for further clarification of the concept of infant feeding responsiveness. FINDINGS: Infant feeding responsiveness was defined as the manifestation of physiologically influenced visual, expressive, vocal and motor reactive behaviours expressed by an infant in reaction to a caregiver's feeding attempts, indicating a readiness to feed. CONCLUSIONS: Implications for nursing are explored as well as the need for refinement of measures of this concept. [ABSTRACT FROM AUTHOR]

AIM: In this paper we aim to clarify the issue of spiritual care in the context of mental health nursing. BACKGROUND: The concept of spirituality in nursing has received a great deal of attention in recent years. However, despite many articles addressed to the issue, spiritual care remains poorly understood amongst nursing professionals and, as a result, spiritual needs are often neglected within the context of health care. METHODS: A series of focus groups was conducted to obtain the views of service users, carers and mental health nursing professionals about the concept of spirituality and the provision of spiritual care in mental health nursing. RESULTS: According to the views expressed in our focus groups, spiritual care relates to the acknowledgement of a person's sense of meaning and purpose to life which may, or may not, be expressed through formal religious beliefs and practices. The concept of spiritual care was also associated with the quality of interpersonal care in terms of the expression of love and compassion towards patients. Concerns were expressed that the ethos of mental health nursing and the atmosphere of care provision were becoming less personal, with increasing emphasis on the 'mechanics of nursing'. CONCLUSIONS: The perceived failure of service providers to attend adequately to this component of care may be symptomatic of a medical culture in which the more readily observable and measurable elements in care practice have assumed a prominence over the more subjective, deeply personal components. In order for staff to acknowledge these issues it is argued that a more holistic approach to care should be adopted, which would entail multidisciplinary education in spiritual care. [ABSTRACT FROM AUTHOR]

Despite enormous progress in the understanding and treatment of disease during the 20th century, the amount of care individuals receive from health professionals is arguably less than in previous decades. Being in the presence of caring people who practised human caring has always been the bedrock of services to individuals who were ill. With the rise of scientific positivism in the mid-19th century, traditional ways of caring for sick people, not susceptible to scientific investigation and intervention, were either abandoned or discouraged. The spread of outcome-orientated health services has led to care being redefined as the provision of the finest form of treatment that is financially viable. The spectre of a service in which the human dimension of caring is either prescribed or seen as invalid gives cause for concern. This paper argues for urgent re-examination of what we understand by 'care'. [ABSTRACT FROM AUTHOR]

Specialist nurse counsellor interventions at the time of diagnosis of breast cancer: comparing `advocacy' with a conventional approach ¶ Over recent years, specialist breast care nurses have become increasingly recognized as core members of any breast care team within the UK. Part of the role is to support patients at the highly stressful stage of receiving a diagnosis. This paper describes an `advocacy' style of nurse counsellor intervention which aims to improve patients' preparation for, and involvement in, the diagnostic consultation and provides a framework for future counselling support. One hundred and three women undergoing surgery following diagnosis of breast cancer or a benign breast lump were supported using either this advocacy intervention or a more conventional model of care. The aim was to identify the most effective and appropriate method of intervening at this important stage. Assessment took place before surgery, with 2-week and 6-month follow-ups, and included the Hospital Anxiety and Depression Scale, Rotterdam Symptom Check List and semi-structured interviews addressing perceived quality of care, involvement in decision-making and psycho-social functioning. Whilst the results of many measures were similar for women in the two intervention groups, qualitative data support the implementation of the advocacy method by the breast care nurse. [ABSTRACT FROM AUTHOR]

‘The Awful Rowing Toward God’: therapeutic conversations with a woman following major surgery ¶ Listening is a complex event requiring skills and competencies that encompass the personhood of the listener. This paper explores a clinical conversation with a woman experiencing serious illness. The ideas of Klein offer the theoretical means for understanding exchanges. Reflexivity is addressed through exploring the writer’s thoughts and feelings in response to significant events. The benefits of supervision, as support and guidance, are discussed in context. The discussion concludes with the suggestion that although many layers of interpretation are possible, and can be informed by various ways of knowing, the act of listening offers potential benefits. [ABSTRACT FROM AUTHOR]

Painful crisis is the most common manifestation of sickle cell disease and accounts for the second greatest number of admissions with an average length of stay of 7 days in central London. Despite this frequency of admissions, the management of pain is fraught with problems. This is not surprising since the psychological challenges presented by sickle cell disease are manifold, resulting in significant psychological distress for some individuals. This paper considers the literature on the psychosocial impact of sickle cell disease, and the American research evidence which suggests that pain management strategies that incorporate a psychological intervention can significantly reduce psychological distress as well as hospital admissions. Britain has been slow to incorporate psychology in the pain management strategies, and we have embarked on research to fill this gap. Although this research constitutes work in progress, an argument is put forward for utilizing the cognitive-behavioural perspective in the management of pain in sickle cell disease and we conclude by giving a brief summary of pilot work which is both the foundation and justification for the current ongoing research. [ABSTRACT FROM AUTHOR]

The paper presents the results of a pilot study which involved 50 nurses from several departments of internal medicine of The State Clinical Hospital of the Collegium Medicum, Jagiellonian University in Cracow. The results are based on the Statement Response Questionnaire. They show that the most common responses of the nurses in the face of anxiety expressed by patients are cheering up the patient, collecting information about the symptom, and offering explanation of the symptom. The least common responses included expressing one's own positive emotions and showing empathy towards the patient. [ABSTRACT FROM AUTHOR]

Undergoing diagnostic investigations for symptoms of breast disease constitutes an intensely stressful experience for any woman. The widespread use of contemporary fine-needle techniques throughout specialist breast clinics, whilst removing the necessity of hospitalization and general anaesthesia for many women, has introduced the notion of the ’waiting game’. The ability to ascertain definitive results within a matter of hours has led to diversification in the structure of diagnostic breast services; however, the significance of the ’waiting game’ in terms of distress experienced by women has not been investigated. This paper systematically reviews the research that has explored psychosocial morbidity in this phase of the disease trajectory, and provides summative recommendations for further research. [ABSTRACT FROM AUTHOR]

This paper explores lay explanations of developing a cancer disease and 'recovering' from the disease, both phenomena of importance in understanding how information on cancer prevention and recovery is made sense of by nonprofessionals. The data derive from interviews conducted with persons diagnosed with a malignant disease during 1987 at one hospital in urban Sweden. Forty-six patients were interviewed in 1988-1989, and 20 of those surviving were interviewed again in 1992. Explanations most often appear to be negotiated forth because they are able to fulfil a positive function for the patient in the sickness process. Intricate combinations of explanations are found which avoid individual blame, provide the possibility of positive influence and allow for individual successes. These micro-level explanations are discussed in relation to general discourse about prevention of sickness in our culture. [ABSTRACT FROM AUTHOR]

The experience of cancer places considerable physiological and psychological demands upon the patient. In recent years the potential benefits of relaxation training have generated widespread interest in both the lay and professional literature, particularly in the area of stress management. This paper examines the use of relaxation training as a method for helping patients cope with the experience of cancer and reviews a number of studies which have used progressive muscle relaxation and guided imagery in the oncology setting. Although these studies have produced some encouraging results, there are a number of issues which need to be addressed if future relaxation studies are to be useful for nursing practice, and these are discussed. [ABSTRACT FROM AUTHOR]

This paper was written whilst the author was doing the Cassel Hospital course in psycho- social nursing and was written following a particularly difficult weekend duty experienced at the Cassel Hospital. The social defence systems used in general nursing are compared with those used when nursing in a psychotherapeutic community. In such a community staff, especially nurses, by the very nature of their work, meet their patients at a more mutual level, and this can hopefully help to examine anxiety-provoking situations more honestly, to the greater benefit of the patient. 'Mutual', in this sense, refers to a reciprocal relationship which relies on a refined sensitivity in emotion and taste, quickness and acuteness of apprehension and feeling, and a readiness to feel compassion that is not just pity but a complete blend of empathy and understanding. It does not rely on equality, but this absence of equality need not lead to feelings of inferiority on one side and superiority on the other. This kind of 'mutuality' inevitably leads to vulnerability of both nurse and patient and, to be able to use experiences to enable growth, a strong support system becomes necessary. [ABSTRACT FROM AUTHOR]