Search

Aims. (i) Explore the meaning of comfort care for hospice nurses. (ii) Provide an understanding of how this work is pursued in the hospice setting. (iii) Examine the means by which hospice nurses provide comfort to hospice patients. Background. The concepts of 'comfort' and 'comfort care' have long been a subject for examination by nurse researchers. The paper provides an overview of selected, relevant literature in this area. The methods used by nurse researchers have almost always been qualitative, and have focused on the meaning of nursing care for dying patients, from both nurses' and patients' perspectives. Design and methods. The paper reports a hermeneutic phenomenological study of the work of 15 hospice nurses based in one hospice in the north of England. Sampling was purposive, and data were collected by means of semi-structured interviews. A reflective diary was also kept. The interpretation of data was guided by phenomenological and hermeneutic methodology. Results. The nurses interviewed spoke openly about their experiences of working with hospice patients. They saw the relief of suffering through 'comfort care' as an important element of their work. The findings are presented under three thematic headings: 'Comfort and relief', 'Peace and ease' and 'Spirituality and meaning'. Conclusion. Hermeneutic phenomenology is an important method for uncovering the complex realities of nursing work. The nurses' perspectives on 'comfort care' they offer to patients were revealed by the data presented here, which were interpreted to offer a unique perspective on this type of nursing work. Relevance to clinical practice. These findings offer insights to nurses in both hospice and other settings; they give a number of perspectives on the nature of 'comfort care' and the meanings attached to it by experienced hospice nurses'. [ABSTRACT FROM AUTHOR]

AIM: This paper reports one aspect of a larger study. The aim of this aspect was to explore the role of the 'welfare officer' in promoting the health of cotton mill workers during this period. BACKGROUND: The paper considers one element of a broad exploratory study of the health of women cotton mill workers in the North West of England. The original purpose of the study, which was conducted in 2002 in two towns, Oldham and Ashton-under-Lyne, was to explore the women's own perceptions of the impact of their work on their health, and to find out what, if any, help and support they obtained. During the course of the study it was discovered that 'welfare officers', some of whom were trained nurses, had an important role in promoting the health of these workers. The study was therefore expanded to incorporate data obtained directly from interviews with a small sample of welfare officers. The present paper focuses on the issue of sanitary reform and considers the role of the 'welfare officer' in promoting public health in the workplace. METHODS: The study employed a combination of archive searches and oral history interviewing. In total, 31 interviews were undertaken between June 2001 and October 2002. The interpretive process focussed both on the ideological power structures which influenced the perspectives of participants, and on evidence for those aspects of participants' experiences which impacted on their health. FINDINGS: In considering their health, female cotton-mill workers recalled that the poor sanitary conditions in their workplaces during the middle years of the 20th century had been a source of some concern to them. They also observed that mill welfare officers took a hand in promoting improvement in available facilities. Welfare officers themselves recounted their own concern regarding the poor sanitary conditions in the mills, and their efforts to improve conditions for the mill workers. CONCLUSIONS: The paper demonstrates the role of a little-known group of health workers in the middle years of the 20th century, and demonstrates the importance of oral history work in re-capturing elements of nursing work and experience, which do not appear extensively in the written record. The study's relevance to contemporary practice lies in the insight it offers into the autonomy with which these occupational health workers defined their roles and performed their work. [ABSTRACT FROM AUTHOR]

BACKGROUND: Fifty-four per cent of people who die in England and Wales do so in hospital. Evidence suggests that care delivered to dying people in hospital does not match up to the ideal of a good death. These studies have provided organizational and structural explanations of nurses' behaviour that support argument for change at the macro level, in order to improve the quality of care delivered to dying people. There has been little study of the perceptions of nurses working in acute medical settings in relation to their experience of caring for dying people. Therefore, there is little evidence on which to base supportive strategies at the level of individual nurses. AIM: In this study we set out to develop an understanding of care for dying people in hospital, from the perspective of newly qualified staff nurses in the UK. The purpose was to build a theory of how nurses might be helped to deliver quality care to dying people in hospital. METHODS: This paper is based on an exploratory study underpinned by phenomenological philosophy. In-depth interviews were conducted with 28 newly qualified nurses, focusing on their experiences of caring for dying people on medical wards in two acute hospitals in England in 1999. The interview transcripts were interpreted using a phenomenological approach. FINDINGS: The findings presented in this paper relate to commonalities found to underlie study participants' perceptions of their experiences. All the nurses' stories were found to be built around six essences - the personal ideal, the actual, the unknown, the alone, tension and anti-tension. These essences, and the relationships between them, were used to build a model of the experience of caring for dying people in hospital. LIMITATIONS: This descriptive study of the experience of individual nurses does not examine the wider social context. It attempts to complement existing sociological theory of death and dying. CONCLUSION: The study revealed how a group of newly qualified nurses experienced caring for dying people. We theorize that the model developed has utility as a tool for gaining understanding of the experience of caring for dying people. It is assumed that nurses, through using this model to find explanations for their emotions and behaviours, may gain emotional support that might have a positive impact on the quality of care delivered to dying people in hospital. [ABSTRACT FROM AUTHOR]

* The number of community staff nurses working in district nursing teams in the UK has increased in recent years as a result of organizational and educational initiatives such as skill mix and the Diploma in Professional Studies in Nursing (Project 2000).* Although the wider economic, philosophical and educational arguments for the role creation has been discussed in the literature, little has been written on the reality of the role from the viewpoint of the staff nurse or the relationship between the role and service requirements. The researchers conducted 16 interviews with district staff nurses from two NHS Trusts. The interpretation was guided by phenomenology and focused on the subjective perceptions of the nurses.* The data revealed dissatisfaction with their role among this group of staff nurses. Having been given a considerable degree of autonomy and responsibility as staff nurses in the hospital setting, they found that their role was limited and their skills 'suppressed' in the community.* They recognized that nurses in 'F', 'G' and 'H' Grades had greater experience and more education than they, yet they believed that they had the ability to participate more in the assessment and planning of care than was currently permitted.* They saw two factors as being mainly implicated in limiting their role: the tendency of district nurses to want to retain their 'authority' as assessors of care; and the Trust policy guidelines, which were somewhat inflexible on this issue. D Grade nurses also expressed their need for continuing education and support and for clearer career opportunities.* Although these data cannot be generalized to the population of staff nurses as a whole, the authors make tentative suggestions relating to the insights which may be taken from them. [ABSTRACT FROM AUTHOR]

As part of an interview study of community nurses' perceptions of their work, 62 staff working within the district nursing service in one English National Health Service Trust (grades B-H) were asked to recount occasions when they had been involved in wound care and to discuss the ways in which working with patients who required such care could be either enhanced or made difficult. A large number of respondents expressed the view that non-compliance could pose serious problems for the management of wounds. Data relating to compliance are presented here and are interpreted in the light of discourse analysis, an approach which permits the researcher to focus on the meanings underlying the communications of research participants and to interpret those meanings in the light of social and cultural mores and influences. The authors found that non-compliance could be explained by nurses in a number of different ways. These ranged from passive resistance, which could be due to ignorance or lack of motivation, through overt refusal, to deliberate interference in order to prolong treatment. It also seeks to outline some of the factors that appear to motivate the nurses' desire to achieve compliance. [ABSTRACT FROM AUTHOR]

Sixty-two community nurses in northern England of grades B and D to H were interviewed by a team of four researchers. The interviews were semi-structured, and were tape-recorded, fully transcribed and content analysed. They were conducted as part of a larger study, the aim of which was to examine community nurses' perceptions of quality in nursing care. One of the main themes the work focused on was decision-making as an element of quality. Data relating to wound care were considered from the perspective of the insights they offered into clinical decision-making. Data were interpreted in the light of a literature review in which a distinction had been made between theories which represented clinical decision-making as a linear or staged process and those which represented it as intuitive. Within the former category, three sub-categories were suggested: theorists could be divided into 'pragmatists', 'systematisers' and those who advocated 'diagnostic reasoning'. The interpretation of the data suggested that the clinical decisions made by community nurses in the area of wound care appeared largely intuitive, yet were also closely related to 'diagnostic reasoning'. They were furthermore based on a range of sources of information and justified by a number of different types of rationale. [ABSTRACT FROM AUTHOR]

This paper reports findings from a study conducted in one community health care trust where 62 members of the district nursing team (grades B-H) were interviewed. An adaptation of the critical incident technique was used to determine factors which contributed or detracted from high quality care for a number of key areas including palliative care. The centrality of knowing the patient and his/her family emerged as an essential antecedent to the provision of high quality palliative care. Factors enabling the formation of positive relationships were given prominence in descriptions of ideal care. Strategies used to achieve this included establishing early contact with the patient and family, ensuring continuity of care, spending time with the patient and providing more than the physical aspects of care. The characteristics described by the community nurses are similar to those advocated in 'new nursing' which identifies the uniqueness of patient needs, and where the nurse-patient relationship is objectified as the vehicle through which therapeutic nursing can be delivered. The link with 'new nursing' emerges at an interesting time for community nurses. The past decade has seen many changes in the way that community nursing services are configured. The work of the district nursing service has been redefined, making the ideals of new nursing, for example holism, less achievable than they were a decade ago. This study reiterates the view that palliative care is one aspect of district nursing work that is universally valued as it lends itself to being an exemplar of excellence in terms of the potential for realizing the ideals of nursing practice. This is of increasing importance in the context of changes that militate against this ideal. [ABSTRACT FROM AUTHOR]

* As part of a study of community nurses' perceptions of quality in nursing care, the author conducted in-depth qualitative interviews with seven community-based nurses. * As part of the study, nurses were asked to describe episodes of wound care and to discuss the factors which could affect the quality of such care. * One of the most interesting themes to emerge from the data was the apparent ambivalence of the nurses' attitudes towards infection control in wound care. * Nurses discussed the concept of 'aseptic technique' in fatalistic terms and seemed uncertain about what could be achieved in terms of infection control. * Although their policy guidelines referred to 'aseptic technique', their educational experience appeared to have made them feel uncertain about the implementation of the measures involved. * With the proviso that this was a small scale qualitative study, the author concludes by suggesting that there is a need for greater clarity, both in what is taught and in what is included in practice policy with regard to infection control in wound care. [ABSTRACT FROM AUTHOR]

The United Kingdom Central Council's proposals for nurse education (Project 2000: A New Preparation for Practice) were implemented in 13 demonstration districts in England in 1989. In 1991, as part of an English National Board-funded research study, the author conducted 15 interviews with first line managers from three of these demonstration districts. The data were reinterpreted in 1995; the experience of implementing educational change in the community setting was discovered to be a complex and difficult process for the managers involved. They found themselves confronted with sometimes conflicting responsibilities; their perception of their role encompassed the meeting of a range of needs, which are presented in this paper within three categories. Firstly, the managers felt they had an obligation to meet the needs of students and of education in general in order both to provide an adequate experience for each individual student and to safeguard standards in community nursing in the long term. Secondly, they were confronted with the need to mitigate the pressures Project 2000 placed on 'their' staff. The new educational programme meant that community nurses spent much more time with students than formerly, and the difficulties they encountered were exacerbated by uncertainty about their role with these students. Finally, and most importantly, managers were responsible for ensuring that clients' needs were met. In particular, they saw it as their role to ensure that the presence of large numbers of students in the community for long periods of time did not compromise standards in the delivery of community nursing services. [ABSTRACT FROM AUTHOR]

The findings of one element of an English National Board-funded research study conducted in two phases between 1989 and 1992 are discussed. The study examined one aspect of the new Project 2000 courses introduced in 13 'demonstration districts' in England in the autumn of 1989. During Phase 2 of the study (1991-1992), 14 district nursing sisters and 12 of the students they supervised were interviewed. Data were re-transcribed and interpreted in 1993; the interpretation was based on a phenomenological paradigm which focused on the subjective perceptions of students and supervisors. Participants identified 'learning', as it took place in the community setting, as a sequential process, which is referred to here as the 'learning career'. Using terminology adopted by participants themselves, the authors identify the stages of the 'learning career' as: 'encountering reality'; 'having a go'; 'gaining confidence'; 'thinking through and understanding'; 'developing ideas'; 'being independent'; and 'being assessed'. Supervisors could ease their students' passage through this complex and anxiety-provoking sequence of events in a number of ways. They could demonstrate their practice and provide opportunities for students to gain experience for themselves; they could teach their students about nursing, and enable them to reflect on their own practice; and they could also monitor and assess their students' work. [ABSTRACT FROM AUTHOR]

This paper considers some of the initiatives taken by community nurses in England in implementing Project 2000 placements. The data were obtained during an English National Board funded study in two phases. The first phase involved a series of exploratory interviews, a postal questionnaire survey, and semi-structured interviews with 15 managers. In phase two, one Project 2000 demonstration district was studied in depth by means of interviews complemented by small-scale questionnaire studies. Community nurses had confronted a number of difficulties in implementing Project 2000. Among the most serious of these were shortage of time, poor communication with the colleges of nursing and lack of preparation. As a consequence, community nurses took what they saw as independent approaches to students' placements. Many set their own aims and objectives for placements and produced written guidelines and teaching plans for students. Many also asserted the importance of their role in the assessment of students' practical work. [ABSTRACT FROM AUTHOR]

Current health policy, high-profile failures and increased media scrutiny have led to a significant focus on patient experience in Britain's National Health Service (NHS). Patient experience data is typically gathered through surveys of satisfaction. The study aimed to support a better understanding of the patient experience and patients' expression of it through consideration of the aspects of the patient experience on NHS wards which are by their nature impossible to capture through patient satisfaction surveys. Existential phenomenology was used to develop an in-depth exploratory narrative, expressed through the voices of the participants. Data collection involved in-depth face-to-face interviews with 12 purposively sampled participants, with analysis by means of hermeneutics. Though the individuality of each experience was apparent and cannot be overemphasised, common factors emerging from the data included uncertainty and unexpectedness, suffering and finitude, the futility of feedback and bureaucracy and absurdity. Overall, participants demonstrated how their individual personalities and expectations affected their response both to illness or injury and to their hospital admissions, highlighting feelings of vulnerability and voicelessness as a response to hospitalisation. The findings of this study provide useful insight into the patient experience on British hospital wards, and the value of an existential-phenomenological approach is demonstrated., (© 2023 John Wiley & Sons Ltd.)

The purpose of this contemporary history study is to analyse nursing strategy documents produced by NHS Trusts in England in the period 2009-2013, through a process of discourse analysis. In 2013 the Francis Report on the Mid-Staffordshire NHS Foundation Trust was published. The Report highlighted the full range of organisational failures in a Trust that valued financial efficiency over patient care. The analysis that followed, however, dwelt heavily on the failings of the nurses. Nursing strategy documents at that time served to set the future direction for NHS Trusts, prescribing specific value frameworks for each nursing workforce. However, the values chosen frequently conflicted with each other pitting nursing values against a managerial trope. It is argued that documents provided a response to wider NHS concerns and high-profile failures in care, particularly the Francis Report, paying lip service to staff engagement whilst maintaining a corporate focus. Nursing values were placed firmly within a managerialist discourse, one that has needed to be re-evaluated in the current Covid-19 pandemic. Wider implications of the research suggest discussion of value conflict may be beneficial within nursing education and a truly local approach to strategy creation would potentially promote staff buy-in to strategy documents., (© 2022 John Wiley & Sons Ltd.)

During the Korean War (1950-1953) the Norwegian government sent a mobile army surgical hospital (MASH) to support the efforts of the United Nations (UN) Army. From the first, its status was ambiguous. The US-led military medical services believed that the "Norwegian Mobile Army Surgical Hospital" (NORMASH) was no different from any other MASH; but both its originators and its staff regarded it as a vehicle for humanitarian aid. Members of the hospital soon recognized that their status in the war zone was primarily that of a military field hospital. Yet they insisted on providing essential medical care to the local civilian population as well as trauma care to UN soldiers and prisoners of war. The ambiguities that arose from the dual mission of NORMASH are explored in this article, which pays particular attention to the experiences of nurses, as expressed in three types of source: their contemporary letters to their Matron-in-Chief; a report written by one nurse shortly after the war; and a series of oral history interviews conducted approximately 60 years later. The article concludes that the nurses of NORMASH experienced no real role-conflict. They viewed it as natural that they should offer their services to both military and civilian casualties according to need, and they experienced a sense of satisfaction from their work with both types of patient. Ultimately, the experience of Norwegian nurses in Korea illustrates the powerful sense of personal agency that could be experienced by nurses in forward field hospitals, where political decision-making did not impinge too forcefully on their clinical and ethical judgment as clinicians., (© Copyright 2020 Springer Publishing Company, LLC.)

Aim: To describe the life and work of the international nurses of the International Brigades during the Spanish Civil War and to examine their role in relation to their contribution to Spanish nursing in this period., Methods: This historical study is based primarily on the memoirs of the international nurses who joined the war health services of the International Brigades during the Spanish Civil War. The evidence that was elicited from these sources was compared and contrasted with other contemporary documents in order to compare their perspectives with those of other contemporaries., Results: The nurses of the International Brigades joined the front line health services as part of the mobile medical and surgical teams that were attached to the fighting units. They lived and worked under extreme conditions, often under fire. Their work while in Spain was not limited to care delivery but also included managerial and educational aspects. The international nurses' observations of Spanish nursing at the time were not always accurate, which might be explained by a lack of contact with qualified Spanish nursing staff due to a shortage of fully qualified nurses., Conclusion: In the absence of the voices of the Spanish nurses themselves, the written records of the international nurses were invaluable in analyzing Spanish nursing in this period. Their testimonies are, in essence, the international nurses' legacy to the Spanish nurses who stayed behind after the departure of the International Brigadists in 1938., (© 2018 Japan Academy of Nursing Science.)

Public perceptions of the work of nurses and VAD-volunteers in the First World War have been heavily influenced by a small number of VAD-writings. The work of trained, professional nurses in supporting and supervised the work of VADs has been largely overlooked. This paper examines several of the writings of both volunteers and professionals, and emphasises the overlooked supervisory, managerial and clinical work of trained nurses. In this centenary year of the First World War's opening months, the paper also explores the ways in which the British mass-media--notably the BBC--have chosen to cling to a romantic image of the untrained nurse, whilst at the same time acknowledging the significance of trained, professional nursing., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Oral history methodology was used to investigate the perspectives of retired British district nurses and Australian domiciliary nurses who had practiced between 1960 and 2000. Interviews yielded insights into the dramatic changes in community nursing practice during the last four decades of the 20th century. Massive changes in health care and government-led drives for greater efficiency meant moving from practice governed by "experiential time" (in which perception of time depends on the quality of experience) to practice governed by "measured time" (in which experience itself is molded by the measurement of time). Nurses recognized that the quality of their working lives and their relationships with families had been altered by the social, cultural, and political changes, including the drive for professional recognition in nursing itself, soaring economic costs of health care and push for deinstitutionalization of care. Community nurses faced several dilemmas as they grappled with the demands for efficiency created by these changes.

The trauma-writings of World War I nurses have been identified as an important and influential corpus of early 20th-century works. Not only did the rediscovery of these writings in the later 20th century serve to recognize the importance of women's writings as part of the historical record, and identify certain female writers as some of the most important thinkers of the modernist movement; they also demonstrated the importance of the nursing perspective as one element of wartime experience. This paper considers a number of influential works written by both nurses and members of the Voluntary Aid Detachments (VAD) who assisted with nursing work during the war. The paper identifies how nurses and VADs presented their experiences of war trauma. It also considers how some writers strove to attach meaning to (or in some, cases expressed their sense of the meaninglessness of) the suffering caused by the war. The paper considers further how some nurses themselves experienced trauma as a result of their exposure to wartime work, and how some writers developed what are referred to as "philosophies of suffering," in which they struggled to understand suffering as an element of human experience.

Colin Fraser Brockington was Professor of Social and Preventive Medicine at the University of Manchester from 1952 to 1965. During that time he developed the Diploma in Community Nursing, the first pre-registration training course for nurses at a British University. This paper traces Brockington's education and career and explores his commitment to university-based nursing education which appears to have stemmed from his desire to enhance and broaden the role of the health visitor. It also considers the implications of the innovative course at Manchester and evaluates the way in which it influenced the gradual movement of nursing education into the university sector throughout the UK.

In the UK, policies on health recognise the importance of supporting healthcare professionals if they are to realise their potential for delivering quality services. Little is known about how nurses working in hospitals cope with caring for dying people and, hence how they might be best supported in this work. This paper reports a qualitative study informed by phenomenological philosophy, which developed a theory of how newly qualified nurses cope with caring for dying people in acute hospital medical wards. On the basis of the theory, interventions are proposed that could help support nurses in their work with dying people.

This study explored the perceptions of 12 patients attending a day care unit in June/July 1996, with the purpose of finding out what was important to these people about their day care experiences. It used a phenomenological methodology derived from Paterson and Zderad's Humanistic Nursing Theory. The patients described numerous aspects of the day care service that were important to them. All 12 people interviewed considered the service satisfactory, and a number considered it to be more than anyone could or should expect. Day care was found to help them feel comfortable, to feel of value and to feel less isolated. In addition, the participants were found to be living with cancer in two different ways. All 12 knew they had cancer and might be terminally ill. Yet some seemed to "tolerate" their life with cancer, whereas others saw it as requiring "adaptation". The day care service was supporting both these styles of managing life with cancer. The interpretation of the findings suggests that the reason patients expressed such satisfaction with the service offered was because the care was humanistic. It responded to individual opinions, feelings and understandings of health and well-being, by giving people time and responding to their individual concerns. In this way, it was flexible enough to support people in managing their illness using their own preferred style.

A series of twenty-six interviews, fourteen with district nursing sisters and twelve with students they supervised, was conducted in 1992 in one Project 2000 demonstration district in England. The data were collected as part of an English National Board funded research study; data were reinterpreted in 1994 and formed one element in the author's PhD thesis. Participants described the ways in which a supervisor might enable a student to learn during a community placement. One of the most important means by which supervisors could provide assistance was by creating an environment in which the students felt supported. Students described how supervisors demonstrated concern, acceptance and understanding, attributes which bore striking resemblance to the qualities of congruence, unconditional positive regard and empathic understanding identified by Carl Rogers as enabling learning.

In 1992, as part of a study funded by the English National Board for Nursing, Midwifery and Health Visiting, the author conducted 26 interviews, 12 with students on the newly-introduced Diploma in Higher Education for Nurses, and 14 with District Nursing Sisters who supervised them during their community placements. The approach to the work was interpretive and was guided by phenomenology. It was discovered that one of the most valuable contributions of their 'community experience' was the opportunities it gave the students to 'think through' and develop their own ideas about their practice. The author's interpretation of these findings was influenced by Donald Schon's ideas about reflective practice and coaching. His theory that professional practice is based on 'knowing-in-action' and 'theories-in-use' which are formulated and modified through a process of 'reflection-in-action' seemed to have direct relevance for the learning acquired by students. The help and guidance given to students by their supervisors bore some resemblance to the types of coaching advocated by Schon, to which he gave the names 'Joint Experimentation', 'Follow Me' and 'Hall of Mirrors'. The interpretation placed on the data discussed here also, however, differs from Schon's theories in advocating that more attention should be given to the academic theory referred to by him as 'technical rationality'.

As part of an English National Board funded research study, the authors sent questionnaires to 2500 individuals with community nursing qualifications. The survey was complemented by a series of interviews with community nurse managers. Data indicated that community nurses were spending very considerable amounts of time with students. The number of placements provided per year varied considerably from one respondent to another, as did the average duration of a placement. Community nurses were providing community experience for a variety of types of nursing students, as well as students of other professions, and the time commitment involved placed them under considerable strain. The authors conclude that there is a need to recognise the time given by community nurses to work with students, and the resource implications of this commitment.