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PubMed2004

Factors related to the onset and persistence of chronic back pain in the community: results from a general population follow-up study.

INTRODUCTION: We compared the prevalence of chronic back pain (CBP) at two points 4 years apart and examined socio-demographic, health, and pain-related factors associated with its onset and persistence. METHOD: A random population sample of 2,184 adults was surveyed in 1996 and resurveyed in 2000. The questionnaire included chronic pain case definition questions (pain for 3 months or longer); the cause (1996) or site (2000) of any chronic pain; the Chronic Pain Grade questionnaire; the Level of Expressed Need (LEN) questionnaire; the SF-36 general health questionnaire; and demographic questions. Those with CBP in 1996 and 2000 had "persistent" CBP; those with CBP in 1996 but not 2000 had "recovered" CBP; those with CBP in 2000 but not 1996 had "new" CBP. RESULTS: Corrected response rates were 82.3% (1996) and 83.0% (2000). The sample prevalence of CBP was 16% (1996) and 27% (2000). Factors in 1996 independently associated with "persistent" compared with "recovered" CBP were preexisting arthritis, high LEN, poor mental health, and not living alone. Factors independently predicting "new" CBP compared with no previous CBP were previous chronic pain elsewhere and poor physical health. "Persistent" CBP was associated with more severe pain, higher LEN, and poorer general health than "new" CBP. DISCUSSION: CBP is a common and lasting problem, whose persistence and onset are predicted by clinical (especially pain) and help-seeking behavior factors, rather than socio-demographic. Prevention should focus on these factors.

Adult↗

PubMed1987

Toward a theory of helpfulness for the elderly bereaved: an invitation to a new life.

The purpose of this study was to generate a theory of helpfulness for the elderly bereaved. The theory is grounded in data from responses of 30 participants concerning the advice they would give others who have lost a spouse and how others were helpful to them. Participants responded during six interviews following death of their spouses. A content analysis of responses was the basis of a dialectical theory of helpfulness: An Invitation to a New Life.

Aged↗

PubMed1990

The hybrid model for concept development: its value for the study of therapeutic alliance.

Schwartz-Barcott and Kim's hybrid model is used as a research methodology for the development and analysis of the concept of therapeutic alliance. Empirical data gathered in a community health setting by field research techniques are used to compare, to contrast, and to rework existing definitions and related concepts from literature review. The resulting definitional refinement provides clear distinctions between the concepts of compliance and therapeutic alliance and assists in selection of appropriate nursing interventions supportive of clients' health goals.

Communication↗

PubMed1995

Ethics in the work of acting for patients.

A nursing therapeutics requires that nurses literally act for patients, and they do so in three domains: the physical the psychological, and what the author calls the "integrity of the self." Acting for the patient is a matter of inherent ethical significance. Acting for another carries the risk of instrumentality; that is, one person becomes the means to another's end. This can result in a variety of moral problems depending on who determines what the ends will be; the degree to which the ends are agreed on among nurse, patient, significant others, and physicians; and whether nurses are acting for their patients, for themselves, or for institutionalized medicine. A therapeutics exists to do something to and for another, and therefore several knowledges are relevant. While the knowledge of physiology, disease, and interventions is necessary, it is not sufficient, nor perhaps even the most important. Also required for an ethical therapeutics is the knowledge of the social and political place occupied by nurses, self-knowledge, knowledge of the person, and the knowledge of the worthiness of ends to be ends of human life.

Aged↗

PubMed1996

The ethics of compliance: a dialectic.

Compliance with prescribed therapeutic regimens is a construct that begs for consideration from an ethical perspective. This article offers a dialectical study of the nurse-client relationship, derived from Gadow's framework of ethical knowledge, that provides an alternative to compliance as context for nursing therapeutics. The dialectic move from compliance as thesis to isolated autonomy as antithesis is explored. Gadow's notion of engagement is elaborated on and offered as a synthesis that transcends the paternalistic and coercive assumptions underlying compliance and overcomes the dilemmas presented by the issues for power, consumerism, and beneficence that are inherent in isolated autonomy.

Ethics, Nursing↗

PubMed2000

Caring through relation and dialogue: a nursing perspective for patient education.

Nursing's recognition of the importance of patient education is evident in nursing's history and in the work of early nurse theorists. However, to date, there has been no clear articulation of a nursing framework specific to this essential aspect of clinical care. A nursing perspective for patient education based on a conceptualization of caring is presented. This perspective includes explication of philosophic views for nursing and patient education. A middle-range theory for patient education is generated from this philosophic premise.

Communication↗

PubMed2000

Experiencing transitions: an emerging middle-range theory.

Changes in health and illness of individuals create a process of transition, and clients in transition tend to be more vulnerable to risks that may in turn affect their health. Uncovering these risks may be enhanced by understanding the transition process. As a central concept of nursing, transition has been analyzed, its components identified, and a framework to articulate and to reflect the relationship between these components has been defined. In this article, the previous conceptual analysis of transitions is extended and refined by drawing on the results of five different research studies that have examined transitions using an integrative approach to theory development. The emerging middle-range theory of transitions consists of types and patterns of transitions, properties of transition experiences, facilitating and inhibiting conditions, process indicators, outcome indicators, and nursing therapeutics. The diversity, complexity, and multiple dimensionality of transition experiences need to be further explored and incorporated in future research and nursing practice related to transitions.

Adaptation, Psychological↗

PubMed2002

A phenomenological study of the art of nursing: experiencing the turn.

This study contributes to an understanding of the art of nursing by defining and focusing on the nurse's experience in achieving the object of nursing art. Nursing art is conceptualized as a transition that the nurse helps facilitate with a patient who has become "stuck" in some way. The request posed to participants was: "Tell me of your experience in helping a patient turn a corner in his or her illness and come to see his or her situation in a new way." This research resulted in three sets of findings; only those relevant to transitions are presented here.

Adaptation, Psychological↗

PubMedDate not supplied

Despairing women and healing outcomes: a unitary appreciative nursing perspective.

The purpose of this article is to explicate unitary appreciative nursing and the emergence of healing outcomes associated with despairing women. Unitary appreciative nursing was derived from the science of unitary human beings, informed by the participatory worldview of cooperative inquiry, and shaped by the voices and perspectives of despairing women. It integrates 3 strands of responsiveness (unitary, appreciative, and participatory) to the chosen focus of practice. Healing outcomes for despairing women reflect a conceptualization of healing that involves realizing, knowing, and appreciating the wholeness of life, clarifying understandings of life patterning, and elucidating potentials and opportunities for the betterment of life-a journey toward human flourishing.

Adaptation, Psychological↗

PubMedDate not supplied

Utilizing the language of Jean Watson's caring theory within a computerized clinical documentation system.

The healthcare facility described in the following article is part of an eight-hospital organization that adopted Watson's Theory of Caring as part of their nursing philosophy. According to Watson, this theory is an attempt to find and deepen the language specific to nurse caring relations and its many meanings. Yet during the implementation of the theory within the setting described, it was noted that there was no mechanism in the current documentation system for clinical nursing staff to document the patient experience using any language specific to the theory. Nursing members recognized an opportunity to develop a new context in charting during an extensive clinical documentation system upgrade. A discussion of the steps taken and the results within the clinical documentation system supporting the newly adopted caring philosophy are summarized here.

Altruism↗

PubMedDate not supplied

Satisfaction for health care employees: a quest for the Holy Grail?

This article proposes that, across industries, too much has been made of the importance of job satisfaction and its impact on organizational effectiveness. In addition, so much attention has been directed toward satisfaction that many health care employees, particularly nurses, now expect job satisfaction from their employers as an entitlement. In nursing, feelings about job satisfaction may, in fact, be exacerbated by the idealism which leads the young person entering the field to expect to be in a "helping profession" where workers almost automatically encounter the satisfaction that comes from giving the help which the patient desperately needs. Faced with the realities of long hours, grueling and often menial tasks, and sometimes churlish patients and physicians, the young nurse may, in fact, enter a period of deep dissatisfaction and of questioning nursing as a career choice. This situation is not unique to nurses. Many health care professionals face equally dissatisfying aspects of their jobs. Our focus is primarily on reducing job dissatisfaction, rather than improving job satisfaction, through practical solutions for those charged with attracting and retaining health care employees during tight labor markets.

Attitude of Health Personnel↗

PubMed2003