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Biomedical subjects

J R Cutcliffe

Publications and source records attributed to J R Cutcliffe.

At least 19 recordsLinked to original sources
PubMed2003

Addressing hopelessness in people with suicidal ideation: building upon the therapeutic relationship utilizing a cognitive behavioural approach.

This article reports on how the therapeutic relationship can be enhanced by utilizing a cognitive behavioural approach when dealing with hopelessness in suicidal people. A rationale is presented regarding why this topic is deemed important. Following a brief overview of the concept of hope, the theoretical and empirical literature relating to hopelessness are examined. This literature indicates that, given the inextricable link between suicide and a sense of pervasive hopelessness, it is necessary for the practitioner to understand the methods and theoretical underpinnings of hope inspiration. Two case studies, drawn from clinical practice, are described in order to elucidate the key elements/interventions (which include the therapeutic relationship and specific cognitive behavioural techniques that the nurse therapist may utilize when attempting to ameliorate the client's sense of hopelessness). These key elements/interventions are further elaborated upon. Whilst cognitive behavioural techniques are shown to be beneficial when dealing with hopelessness, it is advocated that the therapeutic relationship is a prerequisite for successful therapy.

Adult↗
PubMed2002

Considering the care of the suicidal client and the case for 'engagement and inspiring hope' or 'observations'.

Psychiatric/mental health (P/MH) nursing has rightly been described as a 'broad church', and one that contains many contested matters and areas of differing opinion. One such contested matter is that of the appropriate care for the person who is at risk of suicide. Recent, albeit limited, debate of this issue has taken place, and the literature, such as it is, indicates two principal (though linked) positions. These can be summarized as the 'engagement and hope inspiration' position and the 'observations' position. Given the P/MH nurse's unique position in providing 24-hour, day-to-day care to suicidal clients and the growing problem of suicide within people who suffer from mental health problems, it is both necessary and perhaps timely to consider this debate in more detail. Accordingly, this paper considers the debate regarding care for suicidal mental health care clients. First, the paper briefly describes the historical policy context of care for the suicidal client. Next, it focuses on 'observations' and concludes that there is a range of well-established, empirically based problems or drawbacks to this approach. Following this, it focuses on 'engagement, inspiring hope' and points out the key processes of engagement: forming a relationship, a human-human connection, conveying acceptance and tolerance, and hearing and understanding. The value and importance of these most fundamental of interpersonal processes is described and alluded to throughout the limited research into care of the suicidal client. The paper then describes the range of criticisms that have been levelled at the engagement-inspiring hope approach and considers these criticisms in more detail. As a result of this detailed examination, the paper then reiterates the need to replace 'observations' with 'engagement-hope inspiration' as the principal approach to caring for suicidal mental health clients.

Canada↗
PubMed2001

Judging the ethics of qualitative research: considering the "ethics as process" model.

Decision-making about the ethics of qualitative research is problematic where the research design is emergent, and the balance between risks and benefits for research subjects are difficult to ascertain prior to study implementation. The discourses of health/medical research ethics and those of social research are shown to be divergent and, furthermore, where ethics committees tie themselves to the health/medical model of ethical decision-making, qualitative research approaches can be disadvantaged. Having demonstrated the dual discourses and their relevance to qualitative research ethics, a critical review of current approaches to maximising the success of qualitative research proposals being considered for approval by ethics committees is undertaken. This leads to a call for a system of monitoring qualitative research so that the "benefit to risk" ratio is always on the side of benefit. This has implications for the ways in which ethics committees are organised and the ways in which they function.

Decision Making, Organizational↗
PubMed2001

The commonality and synchronicity of mental health nurses and palliative care nurses: closer than you think? Part one.

The role of the palliative care nurse emphasizes the need for holistic care, and as this role has developed it has become evident that palliative care nurses require skills which, arguably, not all registered general nurses possess; particularly, skills pertaining to the psychological, social and spiritual domains of the person. In order to identify the skills that such nurses may require, there may be merit in considering other specialities of nursing which pay particular attention to the psychological, social and spiritual domains of the person. Consequently, this two-part paper explores the areas of commonality and synchronicity between palliative care nurses and mental health nurses. The authors argue that this commonality is best articulated under the headings: defining the needs of the client group, the role of the nurse in non-physical care, the nurse--client relationship, and the locus of control. They also argue that the differences between these groups of nurses are best articulated under the headings: facilitation/confrontation, and the focus on physical care. Part one of this paper therefore focuses on the first three areas of alleged commonality, with part two focusing on the fourth commonality, the key differences and the implications of such similarity. Given these areas of similarity the authors argue there is a case for reconsidering if the RGN qualification is an essential requirement for working within palliative care or if those with other skills -- skills based on 'being with' rather than 'doing for' -- such as RMNs, should be thought of for such roles.

Holistic Nursing↗
PubMed2001

The commonality and synchronicity of mental health nurses and palliative care nurses: closer than you think? Part two.

This is the second of a two-part paper which explores the areas of commonality and synchronicity between palliative care (PC) nurses and mental health nurses. The authors argue that this commonality is best articulated under the headings: defining the needs of the client group, the role of the nurse in non-physical care, the nurse--client relationship, and the locus of control. They also argue that the differences between these groups of nurses are best articulated under the headings: facilitation/confrontation and the focus on physical care. Part one focused on the first three areas of commonality, whereas this paper focuses on the fourth commonality, the locus of control. It also focuses on key differences and the implications of such similarity. The paper highlights the practice, education and research implications of this alleged commonality. It suggests, given the evidence that clients perceive the therapeutic relationship as the vital and unique aspect of PC nursing, that those working within palliative care need to question whether or not RGN registration is an essential requirement, or whether those with other skills, such as psychiatric/mental health (P/MH) nurses, should be considered for such roles. It highlights the need for the provision of post-basic counselling courses and the potential value for PC nurses of receiving clinical supervision from P/MH nurses or mental health liaison nurses. Lastly, it posits that the research issues arising out of this alleged commonality centre on the potential impact such transitions in care delivery may have on the care delivered, on the nurses themselves and on the clients.

Curriculum↗
PubMed2001

Mass media, 'monsters' and mental health clients: the need for increased lobbying.

A review of the limited empirical and theoretical literature indicates that current mass media representations of mental health service users appear to emphasize violence, dangerousness and criminality. This is despite the empirical evidence that indicates a decline over the last 40 years in the number of homicides carried out by people identified as suffering from mental health problems. Such inappropriate representations do much to increase stigma, ostracism, harassment and victimization of these individuals by the public. Furthermore, it can be argued that there is another repercussion of these representations and that is the subsequent government position/policy and the resulting legislation concerning care of people with mental health problems. Consequently, this paper argues that there is a clear need for psychiatric/mental health (P/MH) nurses to become more mindful of the wider, socio-political environment in which their practice occurs, particularly if psycho-social approaches to practice are adopted in their fullest sense, and as a result increase their political lobby. Such increased lobbying should occur on behalf of, and in collaboration with, service users, and accordingly the authors describe a range of activities under the broad headings of pro-active and reactive lobbying. Furthermore, it is incumbent upon P/MH nurse educationalists to prepare aspirant P/MH nurses for this lobbying role and equip them with the skills necessary to do so.

Humans↗
PubMed2001

What are the principles and processes of inspiring hope in cognitively impaired older adults within a continuing care environment?

This study focuses on the principles and processes that psychiatric/mental health (P/MH) nurses use to inspire hope in cognitively impaired older adults within a National Health Service (NHS) continuing care environment. Using a grounded theory method, the data were coded and analysed, in an attempt to produce an integrated conceptual framework of hope inspiration. This comprised four core variables: applied humanistic code, pragmatic knowledge, interpersonal relations and nurse as utilizer. The authors postulate a relationship between the function of caring, the activity of helping and the practice of instilling hope, as a basis for suggesting that inspiring hope to clients is one of the primary acts of P/MH nursing. The authors conclude that the four core variables are intertwined and inseparable from one another, and bound up with P/MH nursing practice. From this position, it is suggested that the processes of inspiring and instilling hope cannot be separated from the qualities of being a P/MH nurse. However, a more detailed and complete understanding of the concept of hope can increase the nurse's effectiveness as a carer.

Age Factors↗
PubMed2000

Mental health nurses and qualitative research methods: a mutual attraction?

Mental health nurses and qualitative research methods: a mutual attraction? In response to issues arising out of curriculum developments, the authors wished to examine more closely the potential reasons why psychiatric/mental health (P/MH) nurses appear to gravitate towards certain research methodologies. This paper therefore briefly examines the essential differences between qualitative and quantitative research paradigms, focusing on philosophical, epistemological and methodological issues. It then proceeds to examine some of the essential characteristics and attributes of P/MH nurses and suggests some differences in emphasis between these and other disciplines of nursing. The authors posit that psychiatric/mental health nurses are drawn to the qualitative paradigm as a result of the potential synchronicity and linkage that appears to exist between the practice of mental health nursing and qualitative research. This apparent synchronicity appears to centre around the three themes of: (a) the purposeful use of self; (b) the creation of an interpersonal relationship; and (c) the ability to accept and embrace ambiguity and uncertainty. Given this alleged synchronicity the authors argue that there are implications for nurse education and nursing research. Further it is possible that each nursing situation where the mental health nurse forms a relationship and attempts to gain an empathic sense of the individual's world is akin to an informal phenomenological study, the product of which would be a wealth of qualitative data. However, as this would be a subconscious, implicit process, the data would remain predominantly unprocessed. The authors conclude that perhaps these data are the knowledge that expert practitioners draw upon when making intuition-based clinical judgements.

Attitude of Health Personnel↗
PubMed2000

Methodological issues in grounded theory.

Examination of the qualitative methodological literature shows that there appear to be conflicting opinions and unresolved issues regarding the nature and process of grounded theory. Researchers proposing to utilize this method would therefore be wise to consider these conflicting opinions. This paper therefore identifies and attempts to address four key issues, namely, sampling, creativity and reflexivity, the use of literature, and precision within grounded theory. The following recommendations are made. When utilizing a grounded method researchers need to consider their research question, clarify what level of theory is likely to be induced from their study, and then decide when they intend to access and introduce the second body of literature. They should acknowledge that in the early stages of data collection, some purposeful sampling appears to occur. In their search for conceptually dense theory, grounded theory researchers may wish to free themselves from the constraints that limit their use of creativity and tacit knowledge. Furthermore, the interests of researchers might be served by attention to issues of precision including, avoiding method slurring, ensuring theoretical coding occurs, and using predominantly one method of grounded theory while explaining and describing any deviation away from this chosen method. Such mindfulness and the resulting methodological rigour is likely to increase the overall quality of the inquiry and enhance the credibility of the findings.

Humans↗
PubMed1999

Qualified nurses' lived experience of violence perpetrated by individuals suffering from enduring mental health problems: a hermeneutic study.

The incidence of violence within the National Health Service is rising and attention to the issue is increasing. Due to the ramifications in terms of physical, psychological and economic cost, the need to understand all the dynamics and variables involved in violence becomes evident. If nurses can provide care that reduces the frequency, intensity and negative consequences of violence, then clients, nurses and the organisation all benefit. This study attempted to discover the lived experience of nurses who experience violence perpetrated by individuals suffering from enduring mental health problems. It adopted a hermeneutic, phenomenological, method and produced an emerging theory comprised of the three key themes; Personal construct of violence, Feeling equipped and Feeling supported. Furthermore, the author suggests relationships between exposure to violent incidents and the nurse's ability to deal with the incidents therapeutically and how formal support systems for nurses influence this relationship. Strategic plans that are concerned with caring for violent individuals need to consider this reciprocity, as staff who feel well supported may well have a substantial impact on the quality of care offered to these people.

Adaptation, Psychological↗
PubMed1999

The development of empathy in students on a short, skills based counselling course: a pilot study.

This paper reports on a pilot study to measure the development of empathy in students on a short skills-based counselling course. Thirty-eight students from a total population of 56 produced mean empathy scores prior to and following the counselling training. The results indicate that changes in levels of student empathy occurred in all but one of the students with a wide variation in the degree of change. Whilst the results obtained in this study in no way allow any firm conclusions to be drawn, they do provide tentative evidence that student empathy levels can increase as a consequence of undertaking a short skills-based counselling course and, further more, comprehensive research in this area is indicated. This apparent increase in students' empathy appears to be a positive development, yet it could also create difficulties for the nurse due to the possibility of increased emotional demands created by this empathy. Despite the arguments for attempting to develop empathy in students being robust, there may be some individuals who would argue that short skills-based counselling training does not enable empathic development in the students. Whilst the authors argue that there is a need to demystify counselling training, they in no way suggest that there is no need for lengthy, more intensive counselling training. There appears to be a case for having both forms of counselling training.

Attitude of Health Personnel↗
PubMed1999

Establishing the credibility of qualitative research findings: the plot thickens.

Qualitative research is increasingly recognized and valued and its unique place in nursing research is highlighted by many. Despite this, some nurse researchers continue to raise epistemological issues about the problems of objectivity and the validity of qualitative research findings. This paper explores the issues relating to the representativeness or credibility of qualitative research findings. It therefore critiques the existing distinct philosophical and methodological positions concerning the trustworthiness of qualitative research findings, which are described as follows: quantitative studies should be judged using the same criteria and terminology as quantitative studies; it is impossible, in a meaningful way, for any criteria to be used to judge qualitative studies; qualitative studies should be judged using criteria that are developed for and fit the qualitative paradigm; and the credibility of qualitative research findings could be established by testing out the emerging theory by means of conducting a deductive quantitative study. The authors conclude by providing some guidelines for establishing the credibility of qualitative research findings.

Data Interpretation, Statistical↗
PubMed1998

Hope, counselling and complicated bereavement reactions.

This paper examines the relationship between hope and complicated bereavement, and then considers if current bereavement counselling theory addresses this issue. Bereavement can be considered to have a number of phases or stages which need not occur in a linear fashion, but this does not make bereavement a mechanistic process. Whilst there are commonalities in people's experience of bereavement and loss, the experience of bereavement is unique to each individual. A person needs to reach a state of acceptance, to resolve conflicts related to grieving in order to complete the bereavement. Yet all individuals do not achieve this resolution naturally. Some individuals appear to experience delay in this process, and this can be described as a complicated grief reaction. Unequivocally bound up with bereavement are hope and hopelessness, with a completed bereavement process being bound up with the re-emergence of hope and complicated bereavement process being bound up with continued hopelessness. There are many theories of bereavement counselling, and commonalities exist between these theories. Whilst the theories indicate implicitly the re-emergence of hope in the bereft individual as a result of the counselling, there is a dearth of specific reference to how this inspiration occurs. Since the reemergence of hope appears to be linked to a person's movement towards a completed bereavement reaction, and this movement is facilitated by means of bereavement counselling, this paper concludes that there is a clear need to examine how this resolution occurs.

Counseling↗
PubMed1997

Introducing change in nursing: the case of research.

This paper examines the issue of encouraging change in nursing and focuses on how to move from task-orientated to science-based practice. Therefore, it considers the current theory on the process of change and using two clinical vignettes (one from psychiatric and one from general nursing practice) illustrates how science based practice was introduced. From these vignettes it draws four conclusion: (1) small-scale cultural change is possible even within large bureaucracies; (2) the nature and identity of change agents is not always immediately obvious; (3) there is arguably no one singular best way of bringing about change and; (4) change activists need to have an understanding of several models of change. It then makes managerial, educational and structural recommendations based on these conclusions.

Diffusion of Innovation↗
PubMed1997

The nature of expert psychiatric nurse practice: a grounded theory study.

This study examines what psychiatric nurses regard as the nature of expert psychiatric nurse practice. The study focuses on the beliefs and principles of psychiatric nurses currently working within a psychiatric unit. Using grounded theory methodology, data were coded and analysed, producing an integrated framework of expert psychiatric nurse practice comprised of four core variables: 'attitudes/philosophy', 'knowledge', 'skills' and 'roles'. It is suggested that the nature of expert psychiatric practice is an evolutionary concept and that as this practice develops the integrated theory presented will need to develop in parallel.

Attitude of Health Personnel↗
PubMed1995

How do nurses inspire and instil hope in terminally ill HIV patients?

In this study the researcher examined how nurses inspire and instil hope in terminally ill HIV patients. The study therefore focuses on the interventions, attitudes, principles and process utilized by nurses working within a liaison psychiatry unit where in-patient care for terminally ill HIV patients is available. Using grounded theory methodology, the data were coded and analysed, producing an integrated theory of hope inspiration, comprised of four core variables: reflection in action; affirmation of worth; creating a partnership; and the totality of the person. The researcher postulates that hope is inspired in terminally ill HIV patients by means of nursing the totality of the person within the context of a formed partnership, underpinned by the affirmation of the individual's worth, which is assured by the nurse entering into the process of reflection in action. The researcher further suggests that hope inspiration is inextricably linked to effective nursing practice, and is interwoven with the concepts of nursing, caring and helping.

HIV Infections↗