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Issue 111 - 23 Sept 2009

►'Glimpses through History'  ►
≈ 2010 Pictorial Calendar ≈
Photographs of nurses over the last 100 years - at work and at play, in meetings and on the streets protesting against health cuts, overseas during war time and mopping ward floors in the 1950s feature in NZNO’s new centennial calendar ($10.00 each plus postage of 1.50 - includes gst)
http://www.nzno.org.nz/activities/centennial/articletype/articleview/articleid/276

To order a calendar, please post your cheque made out to NZNO, with your full name, postal address and phone number to:
Lynette Kirby
New Zealand Nurses Organisation
National Office
PO Box 2128
WELLINGTON 6140
lynettek@nzno.org.nz

Articles

EDITOR'S CHOICE
1. How do we judge reliability of information on the World Wide  Web? Journal of Advanced Nursing, Volume 65, Number 9, September 2009: p1777

REVIEW PAPERS
2. Bodily change following faecal stoma formation: qualitative interpretive synthesis. Journal of Advanced Nursing, Volume 65, Number 9, September 2009: p1778-1789

Aim. This paper is a report of a literature review conducted to answer the question 'How has the experience of bodily change following stoma formation been explored and interpreted through existing qualitative research?'.
Background. A faecal stoma alters the function, appearance and sensation of the body. Quantitative research highlights the importance of bodily change following stoma formation but is limited in being able to explore what this experience means to ostomists. Qualitative research can identify ways in which ostomists experience their changed body but a conceptual framework of their experience drawn from qualitative findings which can inform patient-centred care
has not yet been identified.
Method. The Amed, ASSIA, CINAHL, Embase, Medline and Psycinfo databases were searched from inception to April 2009 using predefined inclusion criteria. Of 144 papers identified, 11 were selected for review. An interpretive review methodology for qualitative research synthesis was employed.
Findings. Three broad themes of bodily experience following stoma formation were identified: loss of embodied wholeness, awareness of a disrupted lived body and disrupted bodily confidence. These highlight the impact of the experience of living with a stoma on the embodied self and the ostomist's embodiment within their lifeworld.
Conclusion. A loss of embodied wholeness which underpins the experience of stoma formation can be represented through awareness of the disrupted lived body and impact on the lifeworld. Findings suggest the need for further research to identify a comprehensive conceptualization of bodily change, which can more
closely match healthcare service to individual patient need.

3. Evaluation of empathy measurement tools in nursing: systematic review. Journal of Advanced Nursing, Volume 65, Number 9, September 2009: p1790-1806
Aim.
This paper is a report of a systematic review conducted to analyse, evaluate and synthesize the rigour of measures used in nursing research to assess empathy, in order to identify a 'gold standard' for application in future studies.
Background. Empathy is considered essential to the provision of quality care. We identified 20 different empathy measures used in nursing research. There are inconsistencies between tools, indicating both the inherent complexity of measuring empathy and the need to evaluate the rigour of the measures themselves. Data sources. An extensive search was conducted for the period 1987 and 2007 using the Medline, CINAHL and PsycINFO databases and the keywords 'empathy', 'tool', 'scale', 'measure', 'nurse' and 'nursing'. Twenty-nine studies were identified as relevant, in which 20 different empathy measurement tools were used. Twelve tools met the inclusion criteria for this review.
Method. Twelve measures were critically reviewed and analysed. A 7-criterion framework was developed to appraise the rigour of the empathy measures, with a score range of 0–14 for each measure.
Results. Quality scores obtained were low (2–8 of 14). Validity and reliability of data were commonly reported, but responsiveness to change was tested in only three measures. None of the measures were psychometrically robust or covered all the domains of empathy. User involvement was limited and only five were developed in nursing settings.
Conclusion. Most measures have undergone rigorous development and psychometric testing, although none is both psychometrically and conceptually satisfactory. Empathy measures need to cover all relevant domains reflecting users' own perspectives and be tested with appropriate populations in relevant care settings

REVIEW PROTOCOL
4. The Information Matters Project: health, medicines and self-care choices made by children, young people and their families: information to support decision-making. Study protocol. Journal of Advanced Nursing, Volume 65, Number 9, September 2009: p1807-1816
Aim. This protocol outlines a study to address knowledge gaps about the types and formats of children's information which could support decision-making in respect of health, medicines and self-care.
Background. Partnership between the public and health services is seen as the key to a healthier society and cost-effective care. A requirement of participative models is the provision of high quality information. Little information is available specifically for children, young people and their families and little evidence concerning types and formats which could support decision-making.
Methods. A mixed-method study will be conducted through three inter-related phases. Tracer-conditions will be used to focus the research, with a specific, although not exclusive, emphasis on medicines. Phase 1: Context: systematic literature review and critical discourse analysis of currently available children's information. Phase 2: In-depth study: we will conduct focus groups, semi-structured interviews and non-participant observation to address a range of questions about what children think about currently available information sources (focus groups), what information children and their families need and how and when they and healthcare professionals use information sources to support decision-making concerning choice (interviews and observation). Phase 3: data synthesis and comparative analysis.
Discussion. Outcomes include the types, formats and characteristics of information likely to support children's decision-making and choices predominantly around medicines and clinical options

REVIEW SUMMARIES
5. Summaries of systematic reviews on nursing-related issues from the Cochrane Library, Joanna Briggs Institute and other evidence review organizations
Journal of Advanced Nursing, Volume 65, Number 9, September 2009: p1817-1822
[Dance therapy for schizophrenia; The effectiveness of integrated care pathways for adults and children in healthcare settings; the experiences of caregivers in providing home-based care to persons with HIV/AIDS in Africa; The role for osmotic agents in children with acute encephalopathies].

RESEARCH PAPERS
6. Original Research: A communication intervention for nursing staff in chronic care. Journal of Advanced Nursing, Volume 65, Number 9, September 2009: p1823-1832
Aim.
The paper is a report of a study conducted to evaluate the effect of a brief, focused educational intervention on the quality of verbal interactions between nursing staff and patients in a chronic care facility.
Background. Positive nurse–patient communication in chronic care is crucial to the quality of life and well-being of patients. Despite this, patients are dissatisfied with these interactions and nursing staff indicate the need for additional training.
Method. A repeated-measures design was used to collect data between April 2003 and February 2004, by audiotaping verbal interactions between nursing staff and patients during morning care. Baseline data were analysed and an educational intervention was developed based on the results of the pretest. Five months after the educational intervention, interactions between the same nursing staff and patients were audiotaped. Twenty-seven randomly chosen patients and selected nursing staff participated in the study. Data were analysed using a qualitative comparative method, and a quantification technique was developed to compare the quality of the interactions before and after the intervention.
Findings. Preintervention interactions were task-oriented, superficial and dominated by nursing staff. Results statistically significantly improved after the intervention was implemented. Nursing staff were less authoritative, used more solution-focused communication and interactions had a statistically significantly higher positive ratio.
Conclusion. Brief interventions can change nursing staff's communication practice and they realized the importance of effective communication as a fundamental component to deliver patient-focused care.

7. Does self-efficacy mediate the relationship between transformational leadership behaviours and healthcare workers' sleep quality? A longitudinal study.
Journal of Advanced Nursing, Volume 65, Number 9, September 2009: p1833-1843
Aim.
This paper is a report of a study conducted to investigate the longitudinal relationship between transformational leadership behaviours and employees' sleep quality, and the mediating effects of self-efficacy.
Background. Although there is evidence for the influential role of transformational leadership on health outcomes, researchers have used either attitude outcomes (e.g. job satisfaction) or softer health measures, such as general well-being. Specific measures of well-being such as sleep quality have not been used, despite its association with working conditions.
Methods. A longitudinal design was used to collect data from Danish healthcare workers at time 1 in 2005 (n = 447) and 18 months later at time 2 in 2007 (n = 274). Structural equation modelling was used to investigate the relationships between transformational leadership, self-efficacy and sleep quality at both time points independently(cross-sectionally) and longitudinally.
Results. For all constructs, time 2 measures were influenced by the baseline level. Direct relationships between transformational leadership and sleep quality were found. This relationship was negative cross-sectionally at both time points, but positive between baseline and follow-up. The relationship between leadership and employees' sleep quality was not mediated by employees' self-efficacy.
Conclusion. Our results indicate that training managers in transformational leadership behaviours may have a positive impact on healthcare workers' health over time. However, more research is needed to examine the mechanisms by which transformational leadership brings about improved sleep quality; self-efficacy was not found to be the explanation.

8. Alarm limit settings for early warning systems to identify at-risk patients. Journal of Advanced Nursing, Volume 65, Number 9, September 2009: p1844-1852
Aim.
This paper is a report of a study conducted to provide objective data to assist with setting alarm limits for early warning systems.
Background.
Early warning systems are used to provide timely detection of patient deterioration outside of critical care areas, but with little data from the general ward population to guide alarm limit settings. Monitoring systems used in critical care areas are known for excellent sensitivity in detecting signs of deterioration, but give high false positive alarm rates, which are managed with nurses caring for two or fewer patients. On general wards, nurses caring for four or more patients will be unable to manage a high number of false alarms. Physiological data from a general ward population would help to guide alarm limit settings.
Methods. A dataset of continuous heart rate and respiratory rate data from a general ward population, previously collected from July 2003–January 2006, was analyzed for adult patients with no severe adverse events. Dataset modeling was constructed to analyze alarm frequency at varying heart rate and respiratory rate alarm limits.
Results. A total of 317 patients satisfied the inclusion criteria, with 780·71 days of total monitoring. Sample alarm settings appeared to optimize false positive alarm rates for the following settings: heart rate high 130–135, low 40–45; respiratory rate high 30–35, low 7–8. Rates for each selected limit can be added to calculate the total alarm frequency, which can be used to judge the impact on nurse workflow.
Conclusion. Alarm frequency data will assist with evidence-based configuration of alarm limits for early warning systems.

9. Search and destroy policy for methicillin-resistant Staphylococcus aureus: cost-benefit analysis. Journal of Advanced Nursing, Volume 65, Number 9, September 2009: p1853-1859
Aim.
This paper is a report of a cost-benefit analysis of a 'search and destroy' policy as compared with the absence of such a policy for methicillin resistant Staphylococcus aureus from a hospital perspective, including the impact of nurses on the costs and benefits of this policy.
Background. The 'search and destroy' policy involved screening, isolation, decontamination and antimicrobial treatment of methicillin-resistant Staphylococcus aureus.
Methods. A prospective analysis was carried out in one intensive care unit and one gerontology unit of a university hospital in 2007. A benefit-cost ratio was calculated by dividing the benefits of the 'search and destroy' policy by its costs related to screening and quarantine. Benefits consisted of hospital savings through avoidance of isolation, decontamination, antimicrobial therapy and extended hospital stay of affected patients. Resource utilization data
were gathered from a time-and-motion study of nurses, patient medical records, hospital databases and the literature. Unit costs pertained to 2005.
Results. The benefit-cost ratio of the 'search and destroy' policy as compared with the absence of such a policy was 1·17 in the intensive care unit and 1·16 in the gerontology unit. Nurses accounted for 23% of costs and 16% of benefits of the policy as compared with the absence of such a policy in the intensive care unit, and 19% of costs and 28% of benefits in the gerontology unit.
Conclusion. Hospital managers should consider implementing a 'search and destroy' policy for methicillin-resistant Staphylococcus aureus and to support the contribution of nurses and other healthcare workers to such a policy.

10. Factors associated with lower quality of life among patients receiving palliative care.  Journal of Advanced Nursing, Volume 65, Number 9, September 2009: p1860-1871
Aim.
This paper is a report of a study conducted to (1) assess the quality of life (QoL) and physical functioning status of patients diagnosed with advanced cancer and receiving palliative care; (2) determine if there was a statistically significant relationship between their physical functioning and QoL and (3) identify the demographic and disease-related variables related to their QoL.
Background. Achieving the best possible QoL is a major goal in palliative care. However, research findings about the relationship between QoL and demographic variables have been inconsistent.
Method. Three hundred patients with advanced cancer were recruited from four district hospitals in Hong Kong between February 2005 and July 2006. Their QoL and physical functioning status were assessed by face-to-face interview, using the McGill Quality of Life Questionnaire (Hong Kong version) and the Palliative Performance Scale respectively.
Results. Participants reported reduced ambulation, inability to perform hobbies or housework, and the need for occasional assistance in self-care (mean: 64·6 out of 100, sd: 19·3, range: 20–100). QoL was fair (mean: 6·2 out of 10, sd: 1·5, range: 0·9–10). There was a weak positive association between physical functioning and QoL scores. Multiple regression analysis showed that patients who were older, female, had ever been married, or had higher physical functioning tended to have better QoL.

11.Understanding nursing on an acute stroke unit: perceptions of space, time and interprofessional practice. Journal of Advanced Nursing, Volume 65, Number 9, September 2009: p1872-1881.
Aim.
This paper is a report of a study conducted to uncover nurses' perceptions of the contexts of caring for acute stroke survivors.
Background. Nurses coordinate and organize care and continue the rehabilitative role of physiotherapists, occupational therapists and social workers during evenings and at weekends. Healthcare professionals view the nursing role as essential, but are uncertain about its nature.
Method. Ethnographic fieldwork was carried out in 2006 on a stroke unit in Canada. Interviews with nine healthcare professionals, including nurses, complemented observations of 20 healthcare professionals during patient care, team meetings and daily interactions. Analysis methods included ethnographic coding of field notes and interview transcripts.
Findings. Three local domains frame how nurses understand challenges in organizing stroke care: 1) space, 2) time and 3) interprofessional practice. Structural factors force nurses to work in exceptionally close quarters. Time constraints compel them to find novel ways of providing care. Moreover, sharing of information with other members of the team enhances relationships and improves 'interprofessional collaboration'. The nurses believed that an interprofessional atmosphere is fundamental for collaborative stroke practice, despite working in a multiprofessional environment.
Conclusion. Understanding how care providers conceive of and respond to space, time and interprofessionalism has the potential to improve acute stroke care. Future research focusing on nurses and other professionals as members of interprofessional teams could help inform stroke care to enhance poststroke outcomes
Conclusion. More could be done in symptom and psychosocial management to improve patients' QoL, in particular for those who are younger, male or single, or who have lower physical functioning.

12. Nurses' moral strength: a hermeneutic inquiry in nursing practice. Journal of Advanced Nursing, Volume 65, Number 9, September 2009:p1872-1881.
Aim.
This paper is a report of a study to interpret nurses' experiences of moral strength in practice.
Background. Moral strength is said to be beneficial in providing nursing care for patients, thereby contributing to high qualitative care. However, few studies focus on the meaning of nurses' moral strength.
Methods. This study included eight Registered Nurses working in different aspects of health care in southern Sweden. Individual interviews were conducted in 2006 and 2007. We recorded, transcribed verbatim, and interpreted the interviews by a method grounded in hermeneutics.
Findings. Three themes were interpreted on three different levels: the action level as 'having courage to act on one's convictions', the relational level as 'being attentive and recognizing vulnerability', and the existential level as 'facing the unpredictable'. Overall, moral strength was understood as a driving force to be someone special in the care of patients, i.e. someone who makes a difference.
Conclusion. The value of nurses' moral strength in patient care should be recognized. Attention must be given to aspects outside the individual, e.g. professional and institutional processes that influence the work environment. Clinical team supervision can help make such processes visible and supportive

13. Comfort as a basic need in hospitalized patients in Iran: a hermeneutic phenomenology study. Journal of Advanced Nursing, Volume 65, Number 9, September 2009
: p1891-1898
Aim.
This paper is a report of a study conducted to explore the comfort experiences of hospitalized patients during their admission to medical–surgical wards in an Iranian hospital.
Background. Comfort has various definitions, ranging from a basic human need, to a process, function or an outcome of nursing. As comfort is a substantive need throughout life in health and illness, providing comfort is a major function and challenge for holistic nursing care.
Method. This hermeneutic phenomenological study was conducted between July 2006 and April 2007 in six medical–surgical wards of one of a university hospital in Iran. Data were generated with 22 participants (16 hospitalized patients and six nurses), using in-depth interviews to capture their detailed experiences of comfort. Analysis based on the framework of Diekelmann enabled data interpretation and elaboration of shared themes.
Findings. One constitutive pattern, 'Comfort: a need of hospitalized patients' and four related themes – A friend in hospital, Relief of suffering within a calm environment, Seeking God, and Presence among family – were identified in the data.
Conclusion. These findings offer unique insight for planning and implementing appropriate clinical practices in Iran, especially in caring for Muslim patients. Two major implications are to: (1) consider comfort criteria during nursing assessment and planning of care during a patient's hospitalization and (2) note that Shiite people in particular are more comfortable and feel better when they are able to follow their religious principles.

14. Supportive counselling programme for nursing students experiencing academic failure: randomized controlled trial.  Journal of Advanced Nursing, Volume 65, Number 9, September 2009: p1899-1906
Aim.
This paper is a report of a study examining the effects of a supportive counselling programme on the academic performance of Iranian nursing students experiencing academic failure.
Background. In order to using limited educational resources effectively, nursing students experiencing academic failure should be immediately identified in order that appropriate intervention can take place.
Method. Data were collected over a 12-month period in 2006–2007, with 42 Bachelor of Science nursing students who displayed poor academic performance. They were randomly allocated to receive either supportive or ordinary counselling. The mean grades in basic theoretical courses, special courses, and also the combination of both basic and special courses was compared between the two groups.
Findings. Over the study period, there were improvements in the mean grades of special courses and also in both basic and special courses of male students in the experimental group, compared with those of male students in the control group (0·27 against -1·43, P = 0·014; and 1·87 against -0·40, P = 0·009; respectively).
Conclusion. A supportive counselling programme can improve the academic performance of male nursing students. Replication of the current study with larger samples and longer duration is recommended.

15. HIV/AIDS and universal precautions: knowledge and attitudes of Nepalese nursing students. Journal of Advanced Nursing, Volume 65, Number 9, September 2009:p1907-1915
Aim.
This paper is a report of a study exploring Nepalese nursing students' knowledge and attitudes about HIV/AIDS and universal precautions.
Background. Nepal is facing an HIV epidemic, and nurses are primary caregivers for people living with HIV/AIDS. Insufficient knowledge and negative attitudes on the part of nursing students translate into fear, stigmatization and unwillingness to care for patients with HIV/AIDS.
Method. Data were collected in 2005 for this cross-sectional study in which we examined HIV/AIDS-related knowledge, attitudes and universal precautions in three levels of Nepalese nursing students (N = 127). Instruments included the HIV/AIDS Knowledge Questionnaire, HIV/AIDS Attitudes Questionnaire, HIV/AIDS
Transmission Attitudes Questionnaire and Universal Precautions Questionnaire. Descriptive statistics and chi-square analyses were employed to examine socio-demographic data. One-way anova, with level in school as the between-groups factor, were calculated to examine students' knowledge and attitudes.
Findings. Nepalese nursing students have a large knowledge gap and negative attitudes, regardless of level of education. Their HIV/AIDS knowledge differed statistically significantly by group but there were no statistically significant group differences in general attitudes towards HIV/AIDS. Although knowledge of universal precaution improved with year of education, overall universal precautions knowledge was poor among all students, regardless of level of education.
Conclusion. Nursing curricula must include adequate and culturally relevant content on HIV/AIDS, attitudes towards people living with AIDS, and universal precautions.

16. Judging nursing information on the WWW: a theoretical understanding. Journal of Advanced Nursing, Volume 65, Number 9, September 2009:p1916-1925
Aim.
This paper is a report of a study of the judgement processes nurses use when evaluating World Wide Web information related to nursing practice.
Background. The World Wide Web has increased the global accessibility of online health information. However, the variable nature of the quality of World Wide Web information and its perceived level of reliability may lead to misinformation. This makes demands on healthcare professionals, and on nurses in particular, to ensure that health information of reliable quality is selected for use in practice.
Method. A grounded theory approach was adopted. Semi-structured interviews and focus groups were used to collect data, between 2004 and 2005, from 20 nurses undertaking a postqualification graduate course at a university and 13 nurses from a local hospital in the United Kingdom.
Findings. A theoretical framework emerged that gave insight into the judgement process nurses use when evaluating World Wide Web information. Participants broke the judgement process down into specific tasks. In addition, they used tacit, process and propositional knowledge and intuition, quasi-rational cognition and analysis to undertake these tasks. World Wide Web information cues, time available and nurses' critical skills were influencing factors in their judgement process.
Conclusion. Addressing the issue of quality and reliability associated with World Wide Web information is a global challenge. This theoretical framework could contribute towards meeting this challenge.

17. Health-related quality of life after coronary artery bypass grafting. Journal of Advanced Nursing, Volume 65, Number 9, September 2009: p1926-1936
Aim.
The purpose of this study was to monitor changes in health-related quality of life and to identify associated factors among patients having coronary artery bypass grafting and their significant others.
Background. Heart disease and its treatment affects the lives of both patients and their significant others, and the early stage of recovery from surgery causes particular anxiety for both.
Method. In this longitudinal study, three sets of questionnaire data were collected 1, 6 and 12 months after coronary artery bypass grafting surgery from patients and significant others at one university hospital in Finland in 2001–2005. We recruited all patients who had been admitted for elective coronary artery bypass grafting surgery during the period specified. The data consisted of the responses from those patients and significant others who had completed all three questionnaires and for whom patient–significant other pairs existed (n = 163).
Findings. Patients' and their significant others' health-related quality of life was at its lowest one month after the operation and improved during follow-up. The change in the mean health-related quality of life score differed between patients and significant others; the improvement in the patients' health-related quality of life was greater than that in the significant others. Neither the background variables used in the study nor social support w

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