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Aim. This paper is a report of a concept analysis of harmony. Background. Historically, harmony has been poorly defined in nursing research. Harmony has been typically associated with music, but this concept also has a place in nursing. The term is used in current literature in various contexts, including the environment, and relating to mind, body, and spirit. Use of the term harmony is also evident in describing physical characteristics and connections between subjects or ideas, and as an adjective. Methods A literature search was conducted using the CINAHL, MEDLINE, PubMed, and OVID data bases from 1998 to 2003 with the keyword 'harmony'. The reference lists of the identified papers were then searched for further sources and 29 papers were identified for inclusion into the paper. Wilson's process was used to conduct the concept analysis. Findings. Harmony is a major aspect of personal relationships, working relationships, and nurse-patient relationships. Both patient-clinician and clinician-clinician relationships are affected by the three attributes of harmony: balance, peace and rhythm. This balance is also an important factor in the incidence of disease and for optimal health. Five consequences of the concept are identified as pleasant environment, sense of satisfaction, positive self-concept, beautiful sound, or effective programme. Conclusion. Harmony is potentially relevant to many aspects of nursing. In order for a nurse to have a positive relationship with a patient, harmony must be present in terms of a pleasant environment, feelings of satisfaction, positive self-concepts, and effective nursing intervention programmes. [ABSTRACT FROM AUTHOR]

AIMS OF THE PAPER: This paper examines the care provision for people suffering from dementia and explores the potential benefits associated with an approach to care that emphasizes the importance of relationships. BACKGROUND: Recent research findings have provided an incentive to re-evaluate the established approaches to care for this client group. Two separate studies identified education and intellectual stimulation as important determinants of the onset of Alzheimer's disease (Ott et al. 1995, Snowdon et al. 1996). These findings have encouraged the hypothesis that potential symptomatic benefits may be achieved by providing a more stimulating environment for people with dementia. METHODS: A case study is outlined which illustrates an approach to caring influenced by the Continental philosopher, Emmanuel Levinas. Primacy is given to the relationships that make up caring, and not to a method that sets out to achieve an identified objective. The issue of mutual responsibility within the provision of care is highlighted in the case study. FINDINGS: The hypothesis presented in this paper is that a person has more of an opportunity to develop to the limits of their potential by establishing the importance of relationships in providing care by means of education and training of the people involved. The beneficiaries might be the caregiver or the person in receipt of care. CONCLUSIONS: An environment that attempts to educate people to recognize the importance of relationships will be more effective in achieving the potential benefits of symptom alleviation identified by the research into Alzheimer's disease outlined in this paper. [ABSTRACT FROM AUTHOR]

Much has been written about power which seems to be of interest to the various professions including nursing. One theory, which asserts that the urge to dominate (i.e. the imbalance of power over love) is the source of most difficulty in human relationships, seems to have received little attention. The authors, therefore, decided to examine the nursing literature for evidence of power/love imbalances. Such evidence was discovered and, in this paper, this evidence is presented and the potential impact of such imbalances on nursing, particularly nursing research, theory and practice is considered. [ABSTRACT FROM AUTHOR]

Aim. This paper is an exploration of the challenge of negotiating the highly personalized concept of spirituality within the public sphere of professional-patient interactions. Background. Spirituality has become increasingly prominent within the nursing discourse, and providing spiritual care is often positioned as an ethical obligation of care. However, bringing such a personal concept into the public domain of care creates some unique tensions and ethical risks. Discussion. Nurses bring three potentially competing identities to spiritual care encounters with patients. Firstly, they are professionals with a public trust in health promotion and restoration, including those areas that intersect with spiritual health. Secondly, they are citizens of a liberal society where non-judgmental pluralism as it relates to spirituality is enshrined. Thirdly, they are individuals who hold particular beliefs and values about spirituality. Each of these identities may result in particular, and potentially conflicting, approaches to spiritual care. Ultimately, the identity which nurses choose to adopt is often determined by how they view themselves in the spiritual care encounter, either as experts with legitimate authority to intervene in the spiritual lives of patients or as people in a shared relational encounter. Each of these approaches carries ethical risks, although the nature of these risks is different. Conclusion. The identities which nurses bring to spiritual care encounters have far-reaching implications for patient experiences in those encounters. Nurses who position themselves as experts run the risk of objectifying the spiritual, being experienced as coercive and transcending nursings' competence. The work of Martin Buber is presented as a model that, while acknowledging competing identities, sets forth a vision of spirituality and spiritual care based upon relational reciprocity. [ABSTRACT FROM AUTHOR]

AIM: The aim of the study was to explore the relationship between impersonal trust, governmentality and professional activity through an analysis of professional discourse. BACKGROUND: This study emerged from an earlier paper that described a four-dimensional model based on Luhmann's definition of trust as 'reducing complexity and managing expectations'. Linking trust with the Foucauldian notion of governmentality develops this further. Governmentality raises the question of how professional authority is constituted through the practice of nurses and other health and welfare professionals. METHOD: Discourse analysis was used to explore the text from two genres--academic literature and interview material (n = 17)--in the context of community residential services for people with learning disabilities. Findings. The study provided evidence to support claims that trust is produced through impersonal systems. Trust is contested in a dynamic process where there are gains and losses. Professionals in organisations actively promote trust, often through systems of distrust. The study also built on the four-dimensional model of impersonal trust--trust, mistrust, abuse and hope--and re-conceptualized the trust-hope dimension. CONCLUSION: There are theoretical links between governmentality and trust. Similarly, in order to understand trust nurses need to understand the dynamic nature of the systems in which they operate. The proposition that trust could frustrate hope adds an element of controversy to the discussion of hope in the nursing literature. [ABSTRACT FROM AUTHOR]

A study of practising nurses’ perceptions and experiences of intimacy within the nurse–patient relationship Aim. This study investigated the perceptions and experiences of intimacy within the nurse–patient relationship. Background. Intimacy is an increasingly recognized nursing concept, which is intrinsically related to the therapeutic potential of nursing. However, the nature of intimacy as practised in nursing remains largely unexplored. A qualitative design was used and a purposive sample of 10 nurses was involved. Data were collected by means of semistructured interviews and diaries. Findings. Content analysis of the data yielded five categories relating to the nature of intimacy, involvement, resources, affinity for the patient and the rejection of intimacy. This paper focuses on the first of these categories. Intimacy emerged as a complex concept and included the subcategories of disclosure, levels of disclosure, sharing personal experiences, patient dependency and vulnerability, instrumental touch and intimacy and intimacy as an inappropriate term for the nurse–patient relationship. These findings are discussed in the light of existing theories and recommendations made for further research to expand and develop the issues highlighted. Conclusions. The paper concludes by highlighting the complexity of the concept and identifies some of the constraints to intimacy in practice such as insufficient resources, the health care system and role changes. [ABSTRACT FROM AUTHOR]

Mutual relating: developing interpersonal relationships in the community Aim of the paper. This paper, which is part of a larger study that examined how community mental health nurses promoted wellness with young adult who were experiencing an early episode of psychotic illness, aims to explicate how nurses develop interpersonal relationships with these consumers. Rationale. Research into the development of interpersonal skills is important because they are an essential foundation to the promotion of wellness in psychotic illness. Design/methods. The study used Strauss and Corbin’s approach to grounded theory methodology. Concurrent data collection and analysis was undertaken incorporating interviews and observations. The study took place in the community, in rural and regional New South Wales, Australia, and involved consumers, significant others, and community mental health nurses. Results. The findings show that several strategies are associated with mutual relating. Attempting to understand necessitates nurses trying to see it from insiders’ points of view, while acknowledging that they can never completely understand their illness experience. Being friendly indicates that the qualities of a friendly relationship should be implicit in a professional friendship. Tuning in involves taking account of and adjusting to consumers’ ways of dressing, communicating, and the types of approaches that consumers prefer. Revealing oneself is a process that helps put both consumers and nurses at ease, and helps dispel the perception consumers take part in a one-sided relationship. Being there for them, is a particular type of obligation that entails nurses being accountable for the care they provide, being a spokesperson for consumers, if required, and avoiding collusion with others. Related to avoiding collusion, is the issue of maintaining confidentiality, particularly within the context of interacting with significant others. Conclusion. The results of the study have implications for the way nurses develop and maintain interpersonal relationships with consumers, and this is affected by nurses’ personal and professional attributes. [ABSTRACT FROM AUTHOR]

Debate in the health care professions about the politics of interpersonal relationships between professionals and their patients or clients is increasingly organized around proxy measures of the quality of professional services such as patient satisfaction, or the extent to which the provision of care avoids routines and is genuinely individualized. This paper explores some of the problems which arise from this in relation to patients' autonomy and nurses' authority. [ABSTRACT FROM AUTHOR]

Some reservations have been expressed about the use of the concept of client satisfaction in relation to client's views of services received. There has also been little research on clients' perspectives of mental health work. This paper explores client satisfaction with extended intervention from practitioners based at a community mental health centre. Considerable differences are identified between satisfied and not satisfied clients in the service received and their perception. These relate clearly to the use of interpersonal skills such as those of communication, empathy, listening, openness and genuineness. Taken together with research on brief intervention, this paper both indicates that the concept of satisfaction does meaningfully represent the client's experience and provides considerable support for the fundamental importance of the acquisition and use of these skills in practice. [ABSTRACT FROM AUTHOR]

Research, theoretical and educational literature on interpersonal relations between nurses and patients has proliferated since the 1960s. This has generated a range of divergent accounts of what the nurse-patient relationship (NPR) ought to be; how this should be achieved; and how the NPR is constituted in practice. In this paper -- through a selective review of the literature -- the development of two contending perspectives on NPR and on nurse-patient interaction (NPI) characterized as technocratic and contextual, is discussed, and related to the increasingly problematic status of the relationship between nurses and patients in nursing theory and research. [ABSTRACT FROM AUTHOR]

The value of sound communication/interpersonal skills in nursing has been clearly demonstrated over recent years. However, precise definition of what constitutes such skills, and how these skills should be developed, remains comparatively ill-defined. This lack of positive definition in turn presents considerable difficulties for nurse training in communication skills, where both the basic purpose and value of such training may be perceived quite differently by teachers and by student nurses. Based on a field study in Nothern Ireland, this paper not only highlights some of the existing inadequacies of current nurse training in communication skills, but also examines some of the disturbing wider educational implications of this problem. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the reliability, validity, and utility of the 'Inventory of Piaget's Developmental Tasks' (IPDT) with elderly persons. The IPDT is a paper-pencil assessment of levels of cognitive functioning. Seventy elderly adults responded to a battery of instruments. Reliability and validity estimates for the IPDT were acceptable. Data indicated that the IPDT has promise as a clinical assessment of cognitive functioning. Implications for patient teaching by nurses is discussed and suggestions for clinical use are made. [ABSTRACT FROM AUTHOR]

The research on which this paper is based was designed to investigate nurses' perceptions of relationships in their work. The most important issue to emerge from their descriptions of relationships was that of the nature of authority. From their own accounts; examples of which are included in this paper; it can be seen that views of authority in the hospital setting are both complex and varied. We have identified four different types of authority as seen by nurses: parental, reciprocal, political and arbitrary. Our research suggests that any analysis of authority relationships based purely on structural arrangements would be too simplistic. One possible implication of the findings we present might be that more explicit discussion of the nature of authority in nursing relationships should be encouraged both in training and subsequently. [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]

Title. Resource-enhancing psychosocial support in family situations: needs and benefits from family members’ own perspectives. Aim. This paper is a report of a study conducted to evaluate a resource-enhancing family nursing intervention to identify and meet mothers’, fathers’ and children’s psychosocial support needs. Background. Although a family’s resources are a central concept in nursing science, descriptions of the content of the concept and ways to enhance families’ resources are scant. Studies have usually identified the need for support by families with children from the perspective of one family member, most often the mother. Method. A total of 75 family members from 30 families with small children participated in the study in 2004–2005. The data were collected before and after intervention, using structured questionnaires called the Family Situation Barometer. Descriptive statistics and nonparametric Wilcoxon tests were used as statistical methods. Results. Participants’ need for psychosocial support was reduced or alleviated during the family nursing intervention. The mental health of the mothers and fathers improved, as did their marital relationships and emotional lives. Furthermore, their social support networks increased and their employment situation improved. There were also positive changes in the mental health and sleep-related issues of the children. Conclusion. The resource-enhancing family nursing proved to be useful in improving the well-being and health of family members. The Family Situation Barometer proved to be a practical tool in the home context and can supplement the instruments developed earlier in family nursing science. Research into supporting interpersonal and family-systems nursing remains a future challenge. [ABSTRACT FROM AUTHOR]

Title. Principle-based concept analysis: recognition in the context of nurse–patient interactions. Aim. This paper is a report of a principle-based concept analysis of recognition in the context of nurse–patient interactions. Background. Recognition is a concept employed in practice and research. Since nursing is patient-centred and care is problem-driven, the specificity and accuracy of recognition may have an impact on how nurses label patient phenomena, interventions initiated and patient outcomes. Data sources. The data set included 98 English language articles published from 1997 to 2008 and retrieved through Medline and CINAHL searches. Methods. Principle-based concept analysis was used to examine the state of the science according to major perspectives of the philosophy of science. Conceptual components were integrated into a theoretical definition and the process of recognition was conceptually modelled. Findings. The scientific literature dealing with recognition in the context of nurse–patient interactions relies on implied meaning. Recognition is a process marked by an awareness of evidence coupled with the formulation of a conceptual label summarizing the identified pattern of patient phenomena. Contextual features of the nurse, patient and organization are relevant during nurse–patient interactions, resulting in pivotal points in nursing care. These pivotal points are the moments of recognition when the nurse consciously applies a summary label to interpreted evidence. Outcomes of recognition include a choice to act or not to act, each option carrying significant outcomes for nurses, patients, and at times, organizations. Conclusion. A working definition was produced that will serve as a foundation for future concept-driven research to advance the concept toward greater precision and usefulness in nursing science. [ABSTRACT FROM AUTHOR]

Title. Nurse-Physician Collaboration Scale: development and psychometric testing. Aim. This paper is a report of a study conducted to develop and test the psychometric properties of the Nurse–Physician Collaboration Scale. Background. The importance of cooperation between healthcare professionals is widely acknowledged in Europe and the United States of America, but there have been no specific studies of interactions between healthcare professionals or of nurse–physician cooperation in Japan. Methods. The 51-item Nurse–Physician Collaboration Scale was developed using a process of item design, item refinement, and testing for reliability and validity. Random sampling was used to identify potential respondents from 27 of the 87 acute care hospitals in one city in Japan in 2006. Valid responses were obtained from 446 physicians and 1217 nurses (response rate 78·7% for nurses, and 54·4% for physicians). Construct validity was first confirmed by an exploratory factor analysis and then by a confirmatory factor analysis. Finally, a simultaneous analysis of several groups was performed. The test–retest method and Cronbach’s α coefficients were used to assess reliability. Findings. Exploratory factor analysis yielded three factors. The three-factor models were confirmed by a confirmatory factor analysis (CFI >0·9, RMSEA <0·08). Simultaneous analysis of several groups (RMSEA = 0·046, AIC = 3115·888) showed the same factor structure for both nurses and physicians. The r values of the test–retest reliability correlations were all 0·7 or above. Internal consistency was demonstrated by a Cronbach’s α = 0·8 or above. Conclusion. The Nurse–Physician Collaboration Scale can be used to establish standards for nurse–physician collaboration, to measure the frequency of collaborative activity, and to verify unit-specific relationships between collaboration and quality of care. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study exploring the impact of neuropathic pain on family, social and working relationships among patients at a pain clinic serving a large urban area. Background. Neuropathic pain is a particularly distressing type of chronic pain which is extremely difficult to manage successfully. It produces a range of unpleasant symptoms and adversely affects patients' quality of life, but little is known about its personal impact. Method. A descriptive and exploratory approach was used and 10 participants participated in three focus groups in 2005. Because of the low response rate of 20% from the initial sample, a second sample of 16 patients was invited to participate. However, only one person responded and therefore it was not possible to convene an additional group. Findings. The unpleasant and bizarre nature of neuropathic pain underpinned much of its impact in terms of respondents' difficulties in maintaining a range of relationships. For closer relationships, key difficulties centred on the reduction in quality and/or number of personal relationships. For more distant relationships and those with professionals, frustration at the invisibility of their pain and their own failure to communicate symptoms and its consequences were central. Conclusion. More extensive work is needed to improve our understanding of how neuropathic pain is experienced, how it affects close and more distant kinds of relationships, and how healthcare professionals might best support people with persistent neuropathic pain to maintain personal and social relationships, and to communicate their pain effectively. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of the development of a theoretical framework of nursing practice based on the convergence of the concepts art of nursing, presence and caring. Background. Convergence of similar concepts to form broad yet useful theories is a relatively unexplored area, despite the fact that systematically examining and integrating nursing concepts can help to build theory and leads to enhanced understanding of the discipline. Research results suggest that unarticulated similarities exist among the art of nursing, presence and caring; thus, qualitative convergence of these concepts is justified. Data sources. Findings from qualitative studies of the art of nursing (published between 1993 and the third quarter of 2006) and meta-syntheses of presence and caring (published in 2006 and 2007 respectively) were inductively analysed and integrated. Results. A theoretical framework of nursing practice was developed to illustrate the areas of convergence among the concepts art of nursing, presence and caring. Nursing involves an intimate relationship-centred partnership between the nurse and patient. Situation-specific nursing actions result from multiple forms of personal and professional knowledge and are based on a value system of holistic beneficence and patient empowerment. Nursing actions are promoted by a conducive work environment and result in enhanced well-being among patients and nurses. Conclusion. Results of this concept convergence provide an enhanced understanding of nursing practice and offer insight into areas of nursing practice that are not encompassed within the concepts art of nursing, presence and caring. Further work is recommended to expand the proposed framework, especially in terms of the wide variety of nurse-patient relationships that exist. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a study to determine the national spread of incidents of disagreement within and between professional groups in operating departments and the frequency of perceived aggressive behaviour demonstrated by operating department personnel. BACKGROUND: There is both anecdotal and empirical evidence supporting the idea of the operating team as the ultimate example of teamworking in health care. At the same time, international concern is expressed over the level of interprofessional conflict and aggression reported in operating departments. Such reports do not sit well with notions of excellence in teamwork as conceptualized by theorists. METHOD: A questionnaire survey was designed, and sent to a random sample of National Health Service operating departments in England (n = 62) in 2002. Usable survey questionnaires were returned from 37 departments (response rate 59.6) and yielded 391 individual responses. Respondents included nurses (58%, n = 227), surgeons (9.7%, n = 38), anaesthetists (14.32%, n = 56) and operating department practitioners (17.9%, n = 70) of all grades. FINDINGS: Half of the respondents reported experiencing aggressive behaviour from consultant surgeons (53.4%, n = 209). Daily disagreements between nurses and consultants about list management were reported. Perceptions of lack of understanding of roles and shared goals for patient care between the professional groups were also reported. Similar reports were received from all geographical locations in the sample. CONCLUSION: Further research is needed to conceptualize the complex nature of interprofessional working in operating theatres before steps can be taken to develop a less stressful and more efficient working environment. [ABSTRACT FROM AUTHOR]

Title. The multidimensionality of caring: a confirmatory factor analysis of the Caring Nurse–Patient Interaction Short Scale Aim. This paper is a report of a study to evaluate the construct validity of the four-dimensional Caring Nurse–Patient Interaction–Short Scale using confirmatory factor analysis. Background. Validating theoretical structures of caring is an ongoing challenge in the discipline of nursing. Our previous work has contributed to this literature by the exploration of the dimensionality of the Caring Nurse–Patient Interaction Short Scale via an exploratory factor analysis. The Caring Nurse–Patient Interaction Short Scale comprises 23 items reflecting four caring domains: humanistic care, relational care, clinical care and comforting care. Method. A methodological study was conducted involving a convenience sample of 531 nursing students in a baccalaureate nursing programme (20% were already Registered Nurses). Data were collected in 2002 and 2004. Confirmatory factor analysis of the Caring Nurse–Patient Interaction Short Scale was performed. Findings. As expected with large samples and models, the chi-squared-associated P-value was statistically significant (χ2 = 811·43, d.f. = 224, P < 0·01). However, the other indices reached acceptable levels with 0·054 for the standardized root mean-squared residuals, 0·070 for the root mean-square error of approximation, 0·88 for the goodness of fit index, 0·98 for the comparative fit index and 0·97 for the normal fit index. The factor loadings for all items with their hypothesized factor were ≥0·48 and statistically significant at the 0·01 level. Conclusion. The Caring Nurse–Patient Interaction Short Scale model was judged to fit the data adequately. Although further testing of the scale with different samples of patients is warranted, our model emerged as a middle-range theory during the construct validity process and still reflects Watson’s theory while offering a structure that is testable in clinical research. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to examine adjustment and its relationship with stoma acceptance and social interaction, and the link between stoma care selfefficacy and adjustment in the presence of acceptance and social interactions. Background. There have been significant advances in stoma appliances and an increase in nurses specialising in stoma care. Despite this, a large proportion of patients continue to experience adjustment problems, which suggests that improvements in the management of the stoma are by themselves not enough to enhance psychosocial functioning. Illness acceptance and interpersonal relationships are widely reported as correlates of adjustment to chronic illness, but these have not been specifically examined in patients with a colostomy. Evidence of their association could offer stoma therapists alternative ways of aiding adjustment. Method. Between 2000 and 2002, 51 patients with colostomies provided demographic and clinical data and completed validated questionnaires to measure acceptance of the stoma, relationship with others and stoma care self-efficacy 6 months after surgery. Findings. Multiple regression analysis showed that stoma care self-efficacy, stoma acceptance, interpersonal relationship and location of the stoma were strongly associated with adjustment. The model explained 77% of the variance. Stoma-care self-efficacy accounted for 57.5%, the psychosocial variables 13% and location of the stoma 4.6%. The addition of gender, which was not statistically significant (P > 0.05), explained a further 1.9% of the variance. Conclusion. Addressing psychosocial concerns should become part of the care routinely given to stoma patients. We recommend more emphasis on dispelling negative thoughts and encouraging social interactions. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to explore the way in which Registered Nurses relate to and interact with each other in the workplace, and to identify factors that influence nurses' interactions with each other. Background. Intraprofessional relations are an important topic both for nurses and nursing as we face the ongoing challenges of nurse shortages. Poor colleague relationships, together with workplace conflict, cause job dissatisfaction. As a consequence, some nurses leave the profession while others continue working but remain chronically unhappy. Method. An explanatory multiple case study design was adopted. Data were collected from multiple sources on three different wards within one hospital in Australia between July 2005 and January 2006. Findings. The workplace can be a difficult place for both very experienced and less experienced nurses, regardless of the clinical environment. Nurses navigate their way in the workplace through a series of complex negotiations with each other and develop skills to assess the potential success of an interaction before approaching another nurse. Some also develop a resilience to conflict in their workplace, accepting it as part of working life. Conclusion. Creation of a more positive work environment requires increased understanding of the way nurses relate to each other and appreciation of the factors in the environment that contribute to conflict and a negative atmosphere. This appreciation is a necessary prerequisite to developing a more satisfying and productive workplace enhancing the recruitment of new nurses and the retention of experienced nurses. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study investigating how knowledge of social network and integration influenced mental health professionals' understanding and practice. Background. Community mental health work focuses on people suffering from mental health problems as well as the consequences for the person involved and their family or network. There is a need to expand community mental health workers' knowledge about social networks and their functions. Method. A qualitative study using a co-operative research approach was used to develop participants' knowledge of social network and social integration theory. Action research has the potential to facilitate changes in the field. Data were collected using focus groups. Qualitative content analysis was employed to develop the theme and categories. The data were collected in 2004-2005. Findings. The main theme identified was the potential of experiential knowledgebased competence, which was characterized by the following categories: (1) increased knowledge, (2) awareness of social interactions, (3) cross-disciplinary professionalism and (4) potential for changes in practice. Participants' knowledge and awareness of the potential of social integration as a tool for social network interventions were considerably strengthened. However, this knowledge needs to be implemented in practice. Conclusion. Co-operative research is an approach that can be beneficial in the public sector. To achieve the best possible results, the whole team must be involved and play an active part in all areas of the research project. If the groups involved are too large, participants' level of engagement may suffer. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a study to describe meanings that couples mutually assign to, and practices they develop, after the onset of cardiac disease and to understand the impact of the illness on the couples’ relationships in everyday life. Background. Patients as well as partners are affected by the onset of cardiovascular disease. Social support within intimate relationships has been shown to be important for patient survival and well-being, and couples’ coping strategies are pivotal for well-being and adjustment to the chronic condition in both patients with cardiovascular disease and their partners. Method. Twenty-four couples participated in this phenomenological study. Data were collected during 2003. Participants were interviewed after having been hospitalized due to an acute event and having participated in a rehabilitation programme. Three in-depth interviews were obtained for each dyad: one couple interview and two individual interviews with each partner of the dyad. Paradigm cases were sought and thematic analyses conducted. Findings. All couples experienced a ‘brush with death’ at the onset of heart disease, which called for changes in lifestyle. Three distinct patterns of dealing with the illness emerged. The first revealed that some couples assess the illness as a positive, transformative experience in their lives, bringing them closer together. The second showed that a proportion of couples experience the illness as a threat which imposes fear on both partners. The challenges are faced as mutual tasks and new routines are developed. The third pattern revealed couples who experience a missed opportunity to change. These couples are disenchanted about each other but return to life as usual. Conclusions. Nurses can use the information gained from this study to support couples in their attempts to come to terms with the illness, and can enhance their supportive role in rehabilitation efforts. [ABSTRACT FROM AUTHOR]

Aim. The aim of this paper is to report a study exploring how members of multiprofessional healthcare teams talk about their team. Specifically, the team members' talk was analysed to explore the discursive patterns that emerged and their functions. Background. Over recent decades there has been an increasing demand in Western countries to change care organizations and to coordinate resources and professional competencies to meet the needs of patients/service users better. Because society promotes this kind of work, it may be valuable to explore the self-presentations of a multiprofessional healthcare team. Methods. A discourse analysis was carried out on existing empirical data from focus group interviews with a member-identified category sample comprising 32 healthcare professionals in six authentic multiprofessional teams in south-east Sweden. The analysis focused on the participants' discursive constructions of multiprofessional teamwork, on the way they talked about their group, and, in particular, on their use of the pronouns we, they and I. Findings. The constructions of 'we' by multiprofessional healthcare teams showed discursive patterns that are here referred to as knowledge synergy and trusting support, which included factors such as cross-learning and personal chemistry. The pronoun we was also used as a flexible resource to manage expertise, power and leadership within the teams, and it might also function to ease the pressure for consensus. Conclusion. These discursive patterns provided powerful rhetorical resources for team members, both to affirm their choice of membership and to claim superiority in relations with the surrounding community (the others) by linking to a societal discourse that promotes collaboration. [ABSTRACT FROM AUTHOR]

The aim of this paper is to show how a framework of relational ethics may be used in establishing trusting relationships with at-risk families. Public health nurses have historically carried out assessment and monitoring of parenting within the family home, particularly with at-risk families. In this role, they are placed in the position of simultaneously supporting and policing the family. A trusting relationship may be difficult to develop if parents feel threatened by the surveillance aspect of home visiting and the threat of action (such as removal of children) being taken against the family. Development of optimal trust relationships may be a challenge when families are experiencing powerlessness and oppression. The four themes of relational ethics â mutual respect, engaged interaction, embodiment and creating environment â provide a framework for developing trusting relationships with families. It is possible to have a moral and trusting relationship with at-risk families, but this needs to based on critical self-reflection by nurses and mutually respectful nurse-family relations. [ABSTRACT FROM AUTHOR]

AIM: The aim of this paper is to identify the core, enduring attributes of nursing caring in order to increase understanding of the concept and to identify its implications for research and practice. BACKGROUND: Caring is considered a core concept in nursing as a practice discipline. During the past 20 years, research into nurse caring has been evolving, but the concept of caring remains ambiguous. METHODS: Using a rigorous evolutionary method of concept analysis, the concept caring was examined for its significance, use and application as it has unfolded over time, between 1988 and 2002. After applying inclusion and exclusion criteria and a sampling method, a total of 61 articles was included in the final analysis. RESULTS: Defining attributes, antecedents, and consequences of caring were identified. Core attributes included relationship, action, attitude, acceptance and variability. CONCLUSION: Identification of the core attributes of concepts, including caring, allows nurses to determine appropriate research questions, develop theory and identify practice priorities at a time of increasing demands and constrained resources. [ABSTRACT FROM AUTHOR]

AIM: This paper reviews the key research literature regarding men's health-related help seeking behaviour. BACKGROUND: There is a growing body of research in the United States to suggest that men are less likely than women to seek help from health professionals for problems as diverse as depression, substance abuse, physical disabilities and stressful life events. Previous research has revealed that the principle health related issue facing men in the UK is their reluctance to seek access to health services. METHOD: The investigation of men's health-related help seeking behaviour has great potential for improving both men and women's lives and reducing national health costs through the development of responsive and effective interventions. A search of the literature was conducted using CINAHL, MEDLINE, EMBASE, PsychINFO and the Cochrane Library databases. RESULTS: Studies comparing men and women are inadequate in explaining the processes involved in men's help seeking behaviour. However, the growing body of gender-specific studies highlights a trend of delayed help seeking when they become ill. A prominent theme among white middle class men implicates 'traditional masculine behaviour' as an explanation for delays in seeking help among men who experience illness. The reasons and processes behind this issue, however, have received limited attention. CONCLUSIONS: Principally, the role of masculine beliefs and the similarities and differences between men of differing background requires further attention, particularly given the health inequalities that exist between men of differing socio-economic status and ethnicity. Further research using heterogeneous samples is required in order to gain a greater understanding of the triggers and barriers associated with the decision making process of help seeking behaviour in men who experience illness. [ABSTRACT FROM AUTHOR]

mok e.&chiu p.c. (2004) Journal of Advanced Nursing48(5), 475–483Nurse–patient relationships in palliative careThe aim of this paper is to report a study exploring aspects of nurse–patient relationships in the context of palliative care.Although there are numerous studies addressing nurse–patient relationships, little research has focused on these in the context of palliative are. Furthermore, no previous study has examined the relationship in the Chinese context.Qualitative data were collected from 10 hospice nurses and 10 terminally ill patients by means of open ended unstructured interviews. Respondents were asked to reflect on practices and incidents that would allow an understanding of the meaning of nurse–patient relationships in palliative care.Four major categories emerged from the perspectives of patients and nurses: (1) forming a relationship of trust; (2) being part of the family; (3) refilling with fuel along the journey of living and dying; and (4) enriched experiences. Responses revealed that a relationship of trust is formed, and that nurses are not only regarded as health professionals, but also become part of the family or a good friend. Nurses who develop trusting relationships demonstrate a holistic approach to caring, show their understanding of patients’ suffering, are aware of their unvoiced needs, provide comfort without actually being asked, and are reliable, proficient, competent and dedicated in their care.Trust, the achievement of the goals of patients and nurses, caring and reciprocity are important elements of nurse–patient relationships in palliative care. Such relationships not only improve patients’ physical and emotional state, but also facilitate their adjustment to their illness, ease pain and can ultimately lead to a good death experience. It is nurses’ personal qualities and skills, which are embedded in these relationships, that constitute excellence in nursing care. Nurses also derive satisfaction and are enriched through the relationships. [ABSTRACT FROM AUTHOR]

dunning t.l. & ward g.m. (2004) Journal of Advanced Nursing 47(5), 467–474 Testosterone replacement therapy – perceptions of recipients and partners The androgenic hormones are important determinants of sexual behaviour in men. Testosterone replacement is important treatment for pituitary disease to maintain normal functioning. Although the physical effects of testosterone replacement have been well documented, little is known about the effects on relationships, particularly from the point of view of the sexual partners of men receiving testosterone replacement. This paper reports a study exploring the perceptions of testosterone replacement on well-being and sexual functioning. Semi-structured interviews were conducted with five men receiving testosterone implants (recipients), their permanent partners, and five recipients without partners. Recipient serum testosterone concentration was measured at 0, 1 and 4 months after testosterone implantation. The three groups reported similar effects of testosterone on well-being and sexual functioning. Recipient and partner ratings were also similar. Strength was less affected by decreasing testosterone concentration than energy in men with partners, but both strength and energy declined in men without partners. Decreased testosterone levels had a statistically significantly different effect on libido at time zero between men with and without partners ( P < 0·015) and on ability to sustain an erection, but the ability to achieve an erection persisted over the 6 months in both male groups. Intercourse frequency increased from once per week at time 0 to ≥3 per week between 1 and 4 months after implant in men with partners. There were important effects of testosterone deficiency on general and sexual relationships, and these differed between men with partners and those without. Testosterone has important physical and psychological benefits that may be related to the age at which testosterone replacement commences and the indications for its use. The small sample size may limit the ability to generalize the findings outside the study. [ABSTRACT FROM AUTHOR]

jonsdottir h., litchfield m. & pharris m.d. (2004) Journal of Advanced Nursing 47(3), 241–250 The relational core of nursing practice as partnership Consideration of the relational core of nursing has gained significance in today's health systems, where the work of nurses is dominated by technologically-driven, prescriptive, and outcome-oriented approaches. This has led to disregard for individual experiences of living life with diverse health conditions. The aim of this paper is to articulate the relational core of nursing practice as partnership. The relational core of nursing practice is explicated as a process of professional partnership, focusing on the evolving dialogue between nurse and patient. In partnership, the dialogue is open, caring, mutually responsive and non-directive. The nurse attends to that which is of concern to patients in relation to their health predicaments and the meaning in the health experience unfolds. Nurse and patient reach insight that represents more useful ways of comprehending and acting on their health predicaments. Partnership represents theoretically-driven practice that invites nurses to meet patients where they are in understanding their health predicaments and what can be done about them. As such, partnership strengthens the resolve of nurses to resist the pressures of contemporary health service delivery to provide a technical form of practice and it protects the relational core of a fully professional practice. [ABSTRACT FROM AUTHOR]

John Heron’s six-category intervention analysis: towards understanding interpersonal relations and progressing the delivery of clinical supervision for mental health nursing in the United Kingdom Aims. This paper provides a critique of how Heron’s six-category intervention analysis framework has been adopted by nursing in the United Kingdom (UK) as a theoretical framework in nursing research and model for clinical supervision. From this, its merits as an analytic framework and model for clinical supervision in nursing are discussed. Background. Heron’s six-category intervention analysis has been acknowledged as a means by which nursing could develop its therapeutic integrity. It has also been used as a theoretical framework in nursing research focusing on nurses’ perceptions of their interpersonal style. More recently descriptions of this framework have been proposed as a structure for clinical supervision. However, its use as a theoretical framework to underpin research investigating the interpersonal skills of nurses and as a model of clinical supervision must firstly be scrutinized. Findings. Returning to Heron’s original description and comparing this with its current adoption in the UK, misconceptions of this framework can be identified. Its value as an analytic tool investigating interpersonal relations in nursing has still to be evaluated. Furthermore, nursing’s emphasis on certain intervention categories has undermined the potential potency of this framework and its contribution as a model for clinical supervision in nursing. Conclusion. We argue that Heron’s six-category intervention analysis as a framework to investigate the interpersonal competence of nurses, particularly mental health nurses, requires investigation. This, in turn, would provide an opportunity to challenge the framework’s theoretical standpoint. In addition to its value as an analytic tool, all six categories of Heron’s... [ABSTRACT FROM AUTHOR]

This paper looks at the phenomenon known as care and the medium through which it is expressed - caring. It explores some of the meanings of these terms but focuses particularly on nursing care. Superficially, nurses and society have a broad understanding of what 'care' means but common usage of the word belies its complexity. When examined alongside the writings of scholars the inconsistent nature of care and caring emerges. We reflect on the difficulties this presents for both the nurse and the cared for when, on the one hand care is promoted as the essence of nursing, while on the other there is no acceptable definition of care on which to base this claim. Encompassed within our discussion is the underlying theme that although care is an appropriate ideal for nursing it does not capture all of the day-to-day realities and hence it is not an overriding ideal. Care in nursing in this sense is contradictory and we describe it as paradoxical. [ABSTRACT FROM AUTHOR]

This paper is a theoretical exploration of the discursive context that shapes the nurse-patient relationship. It represents a feminist poststructural consideration of the broader institutional and social context that influences the dynamics of that relationship. The characteristics of that relationship can be regarded as performances of subjectivity shaped by managerial, medical and nursing discourses. Both nurse and patient signify particular discursively constituted meanings to each other which shape the relationship. It is proposed that the discourses which inform how each should respond to the other encourage the utilization of disciplinary tactics by the nurse which relay to the patient what is expected of him/her. An effect of these disciplinary procedures is to rein in the caring potential of nursing practices. However, nursing's relationship with women's work and the social history of caring may provide it with a discursive context that recognizes the social significance of this work. [ABSTRACT FROM AUTHOR]

Nursing typically has been viewed as a moral practice, for instance by new developments in the ethics of care. Nevertheless, many philosophical-ethical presuppositions of nursing theories remain to be clarified. This paper presents a philosophical-ethical analysis of the work of Hildegard E. Peplau. Analysis of the philosophical-ethical background of Peplau's works illuminates a view on nursing practice that is relevant today. Three main components are analysed more deeply, i.e. the professionalization of nursing, the philosophical underpinnings of Peplau's view on nursing science, and the nurse-patient relationship as the central event in nursing. [ABSTRACT FROM AUTHOR]

This paper gives a brief description of a research project carried out to test the assumption that there is a relationship between a student nurse's description, on paper, of how she would care for a patient, and the actual observed behaviour. No relationship was found in more than two-thirds of subjects in 19 hospitals. The paper goes on to look at the possible reasons for this phenomenon and suggests alterations in the training programmes for nurses in England and Wales which could crate a greater correlation between the theory and practice of nursing. The views expressed are those of the author and not necessarily of any organization. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to examine three topics related to nurse educators and research productivity. The first section is an analysis and synthesis of what is known about nurse educator involvement in research activities from published studies. The second section is an examination of factors that may enhance or deter nurse educators from engaging in research activities. The focus of the last section is on the relationship between research and teaching quality. Empirical data are examined and recommendations made for nurse faculty. [ABSTRACT FROM AUTHOR]

Most definitions, or descriptions of nursing emphasize that it is an interpersonal activity focusing on the understanding of the patient as an individual. In addition, such descriptions highlight not only the caring aspect of the role of nursing but also the health maintenance and rehabilitation aspects. The paper discusses the fact that despite these definitions, nursing is still task orientated, largely based on the medical model and hidebound by tradition. Suggestions are made of ways in which this approach may be altered. The use of the nursing process, the concept of the primary nurse and the developing of empathetic understanding being some of the ways in which individualized care may become a reality. The adherence to tradition highlights that nurses are the greatest hindrance to progress in nursing. [ABSTRACT FROM AUTHOR]

The most widely used process for evaluating teachers' effectiveness is student ratings. Although student ratings of teachers are vitally important in the evaluation process, self-evaluation and that of peers are equally important in accurately defining an individual's effectiveness in his/her teaching role. The model for self-evaluation of clinical teaching presented in this paper is adapted from the analysis in Jacobson's model of instruction evaluation. This model comprises three steps: the pre-active, interactive, and post-active. The pro-active step in clinical teaching includes such activities as preparing objectives for both teacher and students, and communicating them to the students before clinical practice. The interactive step in clinical teaching may be seen as the actual process of teaching in the clinical area, with its central activity as being the preparation and presentation of clinical assignments to the students. It is in this step when the teacher- student relationship is put to a real test. The post-active step is a process for finding out the extent to which the teacher has achieved the desired results. This step also entails such activities as grading assignments, evaluating students' clinical performance, and conducting post-experience clinical conference. A check list for self-evaluation of clinical teaching is included. [ABSTRACT FROM AUTHOR]

The purpose of this one year's research on two hospital wards was to explore the perceptions of nurses concerning their jobs. Specifically, the focus of this paper is on how nurses' perceptions were influenced by their interaction with physicians, singling out both the stratification system within the hospital and the structure of the two wards as a major source of conflict. Physicians are viewed as being 'significant others' in the nurse's definition of self and therefore physicians, involved in daily interaction with nurses, are included in the study in order that their perceptions of the nurse's job may be seen to influence the perceptions which nurses have of themselves. An assumption, basic to this study, is that physicians are in a dominant position within the hospital and nurses are subordinates in the organization. A ward comparison viewed the relative power position of doctors at various levels in the medical hierarchy (such as clinical clerks, interns, residents and specialists) as affecting the amount of agreement and understanding that existed between nurses' and physicians' perceptions of the nurse's job. [ABSTRACT FROM AUTHOR]

Health promoting nursing practice is seen as the way forward for the nursing profession. This paper outlines the meaning of health promotion and distinguishes between a traditional and new paradigm approach. The research examining the extent to which a new paradigm approach is practised demonstrates that, to date, nurses predominantly adopt the traditional approach to health promotion. It is argued that the integration of interpersonal skills and health promotion within nursing curricula is crucial in enabling the transfer of theoretical concepts into practice. The ways in which this integration has been approached within one college of nursing are described. The difficulties encountered in attempting this integration and accomplishing a philosophical shift from a traditional to a new paradigm approach to health promotion are discussed and critiqued. Specifically conflicts that occur at an interpersonal, organizational and societal level are identified and proposed as explanations for the slow implementation of health promoting nursing. [ABSTRACT FROM AUTHOR]

This paper shows how gynaecological nursing is perceived by nurses working in this specialism. To gain an emic perspective a qualitative study was conducted with 12 qualified nurses working in a gynaecological unit. Data were obtained by means of in-depth interviews and the use of paradigmatic cases. Analysis showed the nurses to identify many aspects to their work that could be shared with nursing in general. However, the specific nature of gynaecological nursing indicated a special focus on interpersonal work related to the private and sensitive nature of gynaecological disorders, with social, psychological and emotional implications for sexuality, reproduction, future life and relationships. [ABSTRACT FROM AUTHOR]

Title. ‘Caring for’ behaviours that indicate to patients that nurses ‘care about’ them Aim. This paper is a report of a study to explore what constitutes nurse–patient interactions and to ascertain patients’ perceptions of these interactions. Background. Nurses maintain patient integrity through caring practices. When patients feel disempowered or that their integrity is threatened they are more likely to make a complaint. When nurses develop a meaningful relationship with patients they recognize and address their concerns. It is increasingly identified in the literature that bureaucratic demands, including increased workloads and reduced staffing levels, result in situations where the development of a ‘close’ relationship is limited. Method. Data collection took two forms: twelve 4-hour observation periods of nurse–patient interactions in one cubicle (of four patients) in a medical and a surgical ward concurrently over a 4-week period; and questionnaires from inpatients of the two wards who were discharged during the 4-week data collection period in 2005. Findings. Observation data showed that nurse–patient interactions were mostly friendly and informative. Opportunities to develop closeness were limited. Patients were mostly satisfied with interactions. The major source of dissatisfaction was when patients perceived that nurses were not readily available to respond to specific requests. Comparison of the observation and survey data indicated that patients still felt ‘cared for’ even when practices did not culminate in a ‘connected’ relationship. Conclusion. The findings suggest that patients believe that caring is demonstrated when nurses respond to specific requests. Patient satisfaction with the service is more likely to be improved if nurses can readily adapt their work to accommodate patients’ requests or, alternatively, communicate why these requests cannot be immediately addressed. [ABSTRACT FROM AUTHOR]

dunckley m., hughes r., addington-hall j.m. & higginson i.j. (2003) Journal of Advanced Nursing 44(4), 420–426 Translating clinical tools in nursing practice The widespread use of clinical tools in nursing practice reflects their usefulness in guiding patient care, evaluating treatment effectiveness and conducting audit. Cultural awareness and the provision of culturally competent care is a high priority for nurses in the United Kingdom (UK), given patterns of increasing ethnic diversity. However, meeting the individual needs of patients can be difficult when language barriers hinder communication. One way to address these difficulties is to translate existing clinical tools. The aim of this paper is to appraise the potential for, and limitations of, translating clinical tools for use in nursing practice. Drawing on a range of studies from the disciplines of health and social science, this review describes and discusses some key considerations relevant to translating clinical tools in nursing. These considerations include the need to ensure cultural equivalence, lack of familiarity with clinical tool formats in some cultures and its impact on responses, and low literacy levels in some populations. Clinical tools provide benefits in identifying patients’ problems, guiding patient care, and evaluating treatments and interventions. Translating these tools can help to bridge the language gap that hinders good communication between nurses and patients. Translated clinical tools can be of acceptable cultural equivalence and validity if high quality translation methodologies are employed, together with an awareness of culturally relevant issues when interpreting the information gained from the tools. [ABSTRACT FROM AUTHOR]

Comments on dilemmas in health care and nursing. Factors that contribute to such dilemmas which include economics; Discourse resulting from addressing the relational core of nursing practice as partnership; Discussion on the relationship of nurses and patients in addressing health matters.

grinstead l.n., leder s., jensen s. & bond l. (2003) Journal of Advanced Nursing 44(3), 318–326 Review of research on the health of caregiving grandparents To provide a critical review of research literature on the health of grandparents raising grandchildren, and identify directions for future research. Approaches used to access the research studies for this review included a comprehensive search using relevant electronic databases and a thorough examination of the references in each published study. All studies but one were published after 1990. Samples consisted primarily of African-American and Caucasian grandmothers in the United States of America. Earlier studies tended to describe health and other related concepts while more recent studies began to examine relationships between concepts. Most of the studies had a cross-sectional design and only one evaluated interventions. Inconsistencies in the results of these studies were prevalent. Evaluation studies, longitudinal designs, and more varied study samples including cross-cultural comparisons are needed to advance knowledge about grandparent caregivers’ health. [ABSTRACT FROM AUTHOR]

Interaction relating to privacy, identity, autonomy and security. An observational study focusing on a woman with dementia and ‘behavioural disturbances’, and on her care providers Aim. The study aims to illuminate how one woman with severe dementia and so-called behavioural disturbances acts in relation to her care providers and how the care providers act in relation to her. Methods. Fourteen participant observations, including one woman with dementia and six care providers, were performed. A reflective dialogue focusing on the interaction between the woman and her care providers followed each observation. The tape-recorded observational notes and reflective dialogues were fixed as a text, which was subjected to a thematic content analysis. Findings. The main findings are that the interaction between a woman with severe dementia and ‘behavioural disturbances’ and her care providers relates to privacy, identity, autonomy and security. The phenomena are intertwined and also in conflict with each other. Interaction is a complex dialectic process in which those who are engaged meet problems that can be solved and are involved in dilemmas that cannot be solved, only related to. [ABSTRACT FROM AUTHOR]