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PubMed1996

Helping the vulnerable or condoning control within the family: where is nursing?

The World Health Organization urges nurses to heed the health needs of the vulnerable groups 'to permit all citizens to lead socially and economically productive lives'. The characteristics of vulnerable adults and children are linked to relationship problems (Browne et al. 1988) within the family. Because of the diverse nature of families, it is not surprising that there is some ambiguity and complexity to the concept of vulnerability. This paper explores vulnerability within families through the explanations for domestic violence and child abuse; and concludes with the implications for nursing practice.

Adult↗
PubMed1996

An analysis of the concept of empowerment.

This paper is an analysis of the concept of empowerment and its use in nursing practice, education, research and health promotion. The paper adopts an eclectic approach to concept analysis, incorporating the methods advocated by Walker & Avant and Rodgers. The concept is analysed and a theoretical definition given. Defining attributes, related concepts, antecedents and consequences of empowerment are proposed and a model case presented. The analysis demonstrates that empowerment is: a helping process; a partnership valuing self and others; mutual decision making; and freedom to make choices and accept responsibility. Implications for practice conclude the paper.

Decision Making↗
PubMed2005

Clinical education facilitators: a literature review.

AIMS AND OBJECTIVES: The aim of this literature review, set within an Irish context, is to present a broad overview of former and existing clinical support personnel, explore the concept of facilitation and examine what is known about the role of the clinical education facilitator. BACKGROUND: The importance of providing a supportive clinical environment to enhance clinical teaching and learning is strongly portrayed in the literature. While the past two decades have borne witness to various clinical support personnel, the literature identifies conflicting demands that these personnel face. No suggestions are advanced as to how to overcome these difficulties, which inevitably influence the quality and quantity of their clinical teaching role. An identifiable gap exists over who has prime responsibility for clinical teaching. It is timely that alternative possibilities for organizing clinical teaching are investigated. A new post emerging in practice settings is that of the clinical education facilitator who is meant to be the key linchpin in clinical areas for reducing the theory-practice gap. METHOD: Relevant literature for this review was sourced using the computerized databases CINAHL, Medline and Synergy. Manual searching of relevant nursing journals and sourcing of secondary references extended the search. Government reports and other relevant documents were obtained through pertinent websites. RESULTS: Papers that explicitly examined the concept of facilitation and explored the posts of clinical education facilitators were included; six research papers were accessed and reviewed. In addition seven non-empirical papers were included. CONCLUSIONS: It is clear that considerable lack of role clarity resides over what constitutes clinical facilitation and the role of the clinical facilitator. Thus, it is paramount to strengthen this support role with Irish empirical evidence. RELEVANCE TO CLINICAL PRACTICE: A major advantage in having a ward-based clinical education facilitator is the benefit of having access to someone who can concentrate solely on clinical education and support with attempts to narrow the theory-practice divide.

Clinical Competence↗
PubMed2006

Mealtimes in hospital--who does what?

AIM: This paper describes the findings of a descriptive study about what nurses do at mealtimes in relation to monitoring/assisting the eating practices of older patients in an acute care facility. BACKGROUND: The prevalence of under nutrition is known to be high in hospitalized older patients and insufficient dietary intake is regarded as a major cause. However, most of the research tends to concentrate on the nursing home setting. Little is known about the situation in acute care facilities. METHODS: Two medical wards participated in the study. Ward 1 had introduced a change of nurses' meal break time and ward 2 continued with normal practice. Convenience sampling was used. Fifty nurses and 48 patients were observed at different mealtimes during two weeks. Four nurses and four patients who were observed were also interviewed. Data were analysed using descriptive statistics and thematic analysis. RESULTS: Kitchen staff delivered all meals and collected the majority of the meal trays. Older patients did not receive enough assistance during mealtimes. Interruptions happened frequently and social interaction was neglected. About one-third of patients observed left more than two-third of their meals. CONCLUSION: Nutrition issues appeared to receive less priority in the ward than other nursing care activities and nurses' assistance was generally insufficient and not provided in a timely manner. Relevance to clinical practice. Findings highlight the deficiency in practice that should suggest to nurses that they examine their practice and put into place strategies to ensure older patients are properly/adequately hydrated and receive sufficient nutrient intake.

Activities of Daily Living↗
PubMed1983

A national survey of young people's perceptions of mental handicap.

Over 1300, 15 and 16-year-old students throughout Ireland, completed a range of questionnaires which covered their past contact with mentally handicapped adults, their perceptions of them, their views on integration within society and their knowledge about the causes of this disability. It was found that only one quarter of the students had ever interacted with a mentally handicapped adult and nearly half of them had never been in their company. There were marked differences between these subgroups in their perceptions of, and attitudes to, mentally handicapped people. Equally striking were the differences between male and female students, although the effects of social background, city versus country and socio-economic status, were less pronounced. The implications for school-based, educational programmes on disability are discussed and areas for further research are highlighted.

Adolescent↗
PubMed2005

Staff in services for people with intellectual disabilities: the impact of stress on attributions of challenging behaviour.

BACKGROUND: There is a lack of a conceptual framework as to how stress and attribution variables interact and influence staff behaviour in response to challenging behaviour. To address this, a model is tested examining the impact of stress on attributions of challenging behaviour within Weiner's model of helping. METHOD: A total of 107 staff working in community homes for people with intellectual disabilities completed a self-report questionnaire that measured stress, burnout, attributions, emotions, optimism and helping behaviour in response to challenging behaviour. RESULTS: Partial support was found for the role of attributions and emotions. However, although staff reported high stress levels and moderate burnout, this did not appear to relate to their reporting of thoughts and feelings regarding challenging behaviour predicted by Weiner's helping model. It was not possible to fully test the helping model, as the 'help' variable was not normally distributed. CONCLUSIONS: There was little evidence to suggest that stress has a primary role in determining staff responses when examined within Weiner's model of helping. Limited support in general was offered for Weiner's helping model. Potential conceptual difficulties and clinical implications are explored and alternative models for future research are discussed.

Adult↗
PubMed2005

Children with Prader-Willi syndrome vs. Williams syndrome: indirect effects on parents during a jigsaw puzzle task.

BACKGROUND: Genetic disorders predispose individuals to exhibit characteristic behaviours, which in turn elicit particular behaviours from others. In response to the strength of Prader-Willi syndrome (PWS) and weakness of Williams syndrome (WS) in visual-spatial tasks such as jigsaw puzzles, parents' behaviours can be affected by their child's level of puzzle ability or syndrome diagnosis. METHODS: Children were asked to complete two jigsaw puzzles (one with the experimenter and the other with the parent) for 5 min each. Frequencies of parental helping and reinforcement behaviours, along with ratings of parental directiveness, were examined as parents interacted with their children on a jigsaw puzzle task. Within each aetiological group, correlates of parental behaviours with child characteristics were also examined. RESULTS: Compared to parents of children with PWS, parents of children with WS engaged in a more directive style of interaction, and provided more help and reinforcement. Relative to parents of children with higher puzzle abilities (from both aetiologies), parents of children with lower abilities also showed the same pattern. Both the child's aetiology and puzzle abilities were important in predicting parents' directiveness and helping and reinforcement behaviours. Within the PWS group, parents' behaviours correlated negatively with the child's puzzle abilities and general cognitive functioning; no such relations occurred in the WS group. CONCLUSIONS: Parents' behaviours were affected by both the child's diagnosis and actual puzzle abilities, suggesting important implications for understanding and intervening with parents and children with different genetic syndromes.

Adolescent↗
PubMed1994

The influence of clients' perceptions of the helping relationship in the development of an empathy scale.

The paper includes a discussion about the origins of items on a measure of cognitive-behavioural empathy. This scale was originally produced by the author as a teaching tool for an empathy education programme (for RNs) and subsequently developed into a quantitative measure of empathy. The instrument is being used as part of a triangulated approach for data collection on research into the effectiveness of an educational programme about registered nurses' empathy. Antecedents of the initial item pool for the scale stem from theoretical views about empathy, the professional experience of others, and the researcher's experience with clients. While this scale has undergone some investigation for reliability and validity, this work will only be summarized briefly. The major focus for the paper is clients' reports of interpersonal conditions which they perceive as being helpful, or unhelpful, in respect of building therapeutic nurse-client relationships.

Attitude to Health↗
PubMed2005

Aspects of the relationship between doctors and depressed patients that enhance satisfaction with primary care.

Depression will be the second most common threat to health by the end of the next decade. The incidence of depression in primary care is already high. This has serious implications for the types of services available, the range of personnel who deliver them and the extent to which patients are helped by the treatments provided. Research reveals that approximately two-thirds of patients with depression are treated with medication, although it is not known how effective medication is in the long term. It would appear that the relationship between the patient and prescriber is a highly significant factor in determining whether or not patients adhere to treatment regimens and to what extent they improve. This study used a qualitative approach to identify how patients treated with medication for their depression perceived the relationship with their prescribing clinician, what kinds of information and advice they received and what they wanted. Several aspects of the helpful relationship are identified, such as the characteristics and behaviour of the clinician, as well as the way in which information is imparted. The frequency of monitoring consultations and patients' perceptions of their importance were also examined. The issue of stigma, particularly self-stigma and what can be done to prevent it, is discussed. The paper concludes with suggestions for improving the quality of primary care for patients' prescribed medication for depression, and especially for making maximum use of the initial consultation. The main implication for mental health nurses is that central to all interventions for depression is the primacy of the relationship, without which, clients' belief in treatment is diminished.

Adult↗
PubMed2005

Exploring the concept of recovery in schizophrenia.

The concept of recovery in psychosis has gained much momentum in recent years in the UK. Current government policy describes its underpinning philosophy as the way forward for mental health services. Many mental health professionals now claim to embrace this concept yet fail to make the desired impact upon the care and treatment of individuals with schizophrenia. This article reviews some of the literature and explores what the concept of recovery means. The formal evidence will be augmented with personal accounts about recovery written by individuals who have schizophrenia. In doing so the main components that appear to have influenced the recovery process will be highlighted, and the implications for mental health nurses and practitioners will be discussed.

Attitude of Health Personnel↗
PubMed2006

The principles and processes of inspiring hope in bereavement counselling: a modified grounded theory study--part one.

The concept of hope has received attention within nursing and healthcare literature of late yet it is fair to say that despite this increased interest, considerable gaps remain in our substantive knowledge base. Particularly noticeable is the paucity of empirically derived theory regarding the principles of inspiring and instilling hope in certain client groups and with persons enduring certain experiences. Accordingly, this two-part paper attempts to bridge one of these gaps by answering the question: do bereavement counsellors inspire hope in their clients and if so, how? Using a modified grounded theory method data were collected by means of semi-structured interviews; undertaken with a theoretical sample of bereavement counsellors and ex-clients who had received bereavement counselling. In keeping with the tenets of grounded theory, the data were coded and analysed using the constant comparison method, and this produced an emerging, substantive theory of the principles and processes of hope inspiration for this client group. This theory is comprised of a core variable: the implicit projection of hope and hopefulness, and three sub-core variables: forging the connection and the relationship; facilitating a cathartic release; and experiencing a healthy (good) ending. Given that the details of the core variable have been published previously, part one of this paper deals with a review of the literature and focuses on stage one; highlighting each of the individual categories. Where as part two focuses on stages two and three, again highlights the categories therein and offers a discussion and conclusion.

Adaptation, Psychological↗
PubMed2006

The principles and processes of inspiring hope in bereavement counselling: a modified grounded theory study--part two.

This second part of a two-part paper attempts to answer the question: do bereavement counsellors inspire hope in their clients and if so, how? Using a modified grounded theory method data were collected by means of semi-structured interviews; undertaken with a theoretical sample of bereavement counsellors and ex-clients who had received bereavement counselling. In keeping with the tenets of grounded theory, the data were coded and analysed using the constant comparison method, and this produced an emerging, substantive theory of the principles and processes of hope inspiration for this client group. This theory is comprised of a core variable: the implicit projection of hope and hopefulness, and three sub-core variables: forging the connection and the relationship; facilitating a cathartic release; and experiencing a healthy (good) ending. Part one of this paper included a review of the literature and focused on stage one. Part two on the other hand, focuses on stages two and three, and highlights the categories therein. The paper concludes by highlighting implications arising from the findings (other discussion points have been published elsewhere).

Attitude of Health Personnel↗
PubMed1976

Self-descriptions of applicants to medical school.

An analysis of self-descriptive essays by applicants who successfully gained entry to medical school shows that five sub-types of entrant can be differentiated. Medical schools have not yet deliberated on the sort, or sorts, of person most needed in the medical profession, but doubtless individual selectors exercise personal if undeclared preferences.

Career Choice↗
PubMed1987

The stability and attitudinal correlates of warmth and caring in medical students.

It is often said that medical school admits students who are compassionate, nurturant and person-oriented, and transforms them into cold, impersonal graduates. These attributes describe two ends of a personality trait continuum referred to as psychological femininity. The Femininity Scale of the Personal Attributes Questionnaire was administered to a class of medical students four times over 3 years. Measures of empathy, attitudes towards doctor-patient relations and attitudes towards professional psychological help were also obtained. Femininity appears to be normally distributed, remarkably stable over a 28-month interval and predictive of attitudinal measures of empathy, readiness to make psychiatric referrals, recognition of one's own need for psychological help, and a non-cynical, person-oriented approach to patient care. Such findings suggest a different state of affairs within medical training than is usually portrayed. Rather than viewing medical school as having a universally adverse effect on student compassion, medical school has virtually no effect on self-reports of warmth, kindness, helpfulness, etc. Students at different ends of the femininity continuum may require different interventions aimed at teaching communication skills and interpersonal sensitivity.

Attitude of Health Personnel↗
PubMed1989

A retrospective study of attitude change during medical education.

A retrospective attitude questionnaire was administered to 70 of 157 graduating seniors at the end of the medical school year. Students perceived that they became more cynical during medical education. In addition, they perceived that they were more concerned with making money, more concerned for patients, and more helpful. These findings relate to the developmental stressors of medical education as they affect the individual student. Burn-out and impairment are possible consequences; a preventive approach is advocated.

Adult↗
PubMed1993

The donation cycle: a framework for the measurement and analysis of blood donor return behaviour.

The donation cycle represents a new framework for the measurement of blood donor return behaviour. Because it is based on the interval between successive donation attempts, it is more efficient than previously reported methods and the resulting data can be analysed using the statistical techniques for interval data. To illustrate the merits of this quantitative approach to the study of blood donor behaviour, the donation cycle framework is used to analyse the interval between the first and second donation attempts in a random sample (n = 5,183) of type 0, whole blood donors from the Gulf Coast Regional Blood Center. Simple statistical tools such as the log-rank test are employed to describe and to evaluate relative differences in the return behaviour of Rh-negative and Rh-positive donors. The analysis indicates that Rh-negative donors are significantly (p < 0.001) more likely than Rh-positive donors to attempt to donate on a second occasion. Kaplan-Meier estimates of the survival function of these first-time donors reveal marked elevations in the rate of return exactly 52 weeks after the initial donation. The donation cycle paradigm provides transfusion researchers with quantitative tools which are essential for designing statistically efficient, prospective intervention studies. By using the knowledge which such studies could provide, blood banks might be better able to manage donor return behaviour and thereby the safety of the blood supply.

Blood Donors↗
PubMed2004

Giving voice to the burden of blame: a feminist study of mothers' experiences of mother blaming.

Mother blaming has been identified as a pervasive and serious problem and it is known that the professional literature has strong and entrenched mother-blaming messages. Using a feminist approach, this paper explores mother blaming as it has been experienced by a group of mothers themselves. Analysis of narrative exposes mother blaming as a burden that complicates the already-complex responsibilities that comprise mothering. Health providers are among those identified by women as being particularly likely to attribute problems with (even grown) children to maternal fault. Implications for practice and research are drawn from the findings of this paper.

Adolescent↗
PubMed2005

A focus for nursing intervention: realistic acceptance or helping illusions?

Despite having a life-threatening disease, some people decide to live every remaining moment with intensity. Although they have accepted that their deaths might be imminent, they do not dwell on the possibility. They choose life and are sustained by vivid thoughts and inspirations. What can a nurse do to nourish such thoughts? Traditional theories of grief and loss maintain that one way to adjust to advanced stages of progressive disease is to accept death and prepare for it. Is it possible that these theories are simplistic and limiting in their assumptions about the way people "work through" the stage of adjusting to loss? This article is a critical reflection of the process.

Acquired Immunodeficiency Syndrome↗