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Issue 143 - 14 July 2010


1. Nurse Practitioners diagnosing breast disease: how much evidence do we need? Journal of Advanced Nursing, Volume 66 Issue 7: p1421

2. Nurses' intention to leave the profession: integrative review. Journal of Advanced Nursing, Volume 66 Issue 7: p1422-1434

Aim. This paper is a report of a study conducted to (1) review and critique the published empirical research on nurses' intention to leave the profession and (2) synthesize the findings across studies.
Background. Lack of nurses and nurse turnover represent problems for the healthcare system in terms of cost, the ability to care for patients and the quality of care. At a time of current nursing shortage, it is important to understand the reasons why nurses intend to leave the profession.
Data sources. A review was conducted through an initial search of MEDLINE, CINAHL and PsycINFO computerized databases for the period from 1995 to July 2009. The keywords for the search were: Nurs* AND (Personnel turnover OR Career Mobility). Research on nurses' organizational turnover was excluded.
Review methods. An integrative literature review was carried out using Cooper's five-stage methodology provided a framework for data collection, analysis and synthesis.
Results. A total of 31 studies matching the inclusion criteria were identified. Variety in samples, measurement instruments and measures of intention to leave led to difficulties when attempting to compare or generalize study findings. A number of variables influencing nurses' intention to leave the profession were identified, including demographic, work-related and individual-related variables.
Conclusions. Further research is needed using sound measurement instruments, consistent measures of leaving intention and more rigorous sampling. More in-depth research is needed to give nurses opportunities to explain in their own words the reasons for their intentions to leave.

3. Mothering disrupted by illness: a narrative synthesis of qualitative research. Journal of Advanced Nursing, Volume 66 Issue 7: p1435-1445
This paper is a report of a literature review of qualitative empirical research investigating women's experiences of mothering disrupted by illness.
Background. As a primary identity, motherhood is endangered by illness. Illness can interfere with a woman's ability to mother her child/children. Healthcare professionals regularly fail to acknowledge a woman's dual identities of mother and patient.
Data Sources. CINAHL, Medline, PsychInfo, Scopus and Sociological abstracts were searched 1980–2009.
Methods. A narrative synthesis was used, with quality appraisal guided by the Critical Appraisal Skills Programme method. Concepts were analysed thematically, explicating common experiences of women disrupted in their mothering by illness. This allowed for both descriptive and narrative synthesis to occur.
Results. Thirteen papers were included in the final review. Themes identified were: mechanism of disruption; reframing the mother role; protecting the children; experiencing guilt or shame; problems with healthcare professionals; and living to mother, mothering to live.
Conclusion. Women disrupted in their mothering by illness view themselves as a mother first and a patient second. Women found themselves unsupported in their mothering role by healthcare professionals, and this may have left them reluctant to broach difficulties they had relinquishing mothering duties when ill. Nurses are well-positioned to support women in illness by acknowledging the importance of their identity as mothers, offering them opportunities to discuss how illness is disrupting their ability to mother, providing support to help them negotiate the social/emotional distress experienced when mothering is disrupted and, where necessary, referring them to other members of the healthcare team, such as social workers.

Effectiveness of interventions using empowerment concept for patients with chronic disease: a systematic review; Effectiveness of Nurse Practitioners in nursing homes: a systematic review; Effectiveness of strategies to promote safe transition of older people across care settings; Management of disruptive behaviour within nursing work environments: a comprehensive systematic review of the evidence.
Journal of Advanced Nursing, Volume 66 Issue 7: p1446-1451

RESEARCH PAPERS - Original Research

5. Breast disease diagnostic ability of nurse practitioners and surgeons. Journal of Advanced Nursing, Volume 66 Issue 7: p1452-1458
This paper is a report of a study to compare history-taking and breast and axillary examination skills of nurse practitioners and surgeons.
Background. In the United Kingdom, patients referred by their general practitioners with suspected breast cancer should be seen within 2 weeks by a specialist. As a result of the European Working Time Directive there has been a reduction in junior doctors' working hours within the European Union. This makes such targets harder to achieve and risks delays in patient assessment and diagnosis. Trained nurse practitioners can perform an important role in assessing new patients in breast clinics to ensure that they are seen expeditiously. Nurse practitioners' competence assessing patients with breast disease needs to be objectively demonstrated.
Methods. Between 1st March 2007 and 31st March 2008 patients referred to a symptomatic breast disease clinic were seen by a single nurse practitioner and a single consultant surgeon. Findings were recorded on a standardised proforma and compared using one-way analysis of variance.
Findings. Assessments were recorded for 128 patients. No abnormality was found in 41% of patients but nine (7%) had breast cancer. There was no evidence of a statistically significant mismatch in scoring between the nurse practitioner and consultant surgeon. Thirty-seven lumps were identified in 35 patients. There was no difference in mammography requests from the nurse practitioner and surgeon.
Conclusion. The diagnostic accuracy of a nurse practitioner compares favourably with that of a consultant surgeon.

6. Facilitators and barriers to intervening for problem alcohol use. Journal of Advanced Nursing, Volume 66 Issue 7: p1459-1468
This article is a report of a study exploring nurses' perceived facilitators and barriers to conducting brief interventions for problem alcohol use.
Background. Excessive alcohol use has been associated with health, social and legal problems. Healthcare providers worldwide need help to detect and intervene with hazardous/harmful drinkers.
Methods. For this cross-sectional study, ten hospitals were randomly selected throughout Taiwan during 2007. Nurses (N = 741) were selected from the emergency department, and psychiatric and gastrointestinal medical-surgical units where most patients with alcohol problems are seen. Data collected using facilitator and barrier scales and a demographic information form were analysed by descriptive statistics and stepwise, multiple linear regression analysis.
Results. Nurses identified the top facilitator to intervening for problem alcohol use as 'patients' drinking problems are related to their illness'. Top barriers were 'patients lack motivation to change' and 'patients express no interest in receiving intervention'. Perceived facilitators were associated with nurses' work unit, intention to intervene for problem alcohol use, and age. Perceived barriers were associated with work unit, experience in intervening for problem alcohol use, and having attended a training course.
Conclusion. Source of perceived barriers reflected cultural influences. Taiwanese nurse education needs to be strengthened in terms of brief interventions for problem alcohol use. Emergency department nurses need to become more aware of their important role in alcohol intervention. Alcohol-related education is needed for the general population and hospital policymakers to enhance facilitators and reduce barriers to intervening for problem alcohol

7. Factors influencing arrival of patients with acute myocardial infarction at emergency departments: implications
for community nursing interventions. Journal of Advanced Nursing, Volume 66, Issue 7: p1469-1477
This paper identifies the characteristics of Greek patients with acute myocardinal infraction who have long prehospital delays and identifies the factors that are specifically associated with these delays.
Background. The time between the first appearance of symptoms until the hospitalization of the patient with myocardial infarction correlates statistically significantly with in-hospital and long-term mortality.
Methods. The study took place in two Greek coronary care units from 1 June 2007 to 31 July 2008. From 232 consecutive patients with myocardial infarction, 160 were enrolled. Data were collected by a trained hospital staff nurse, who interviewed all patients within 48 hours of hospital admission.
Results. Smokers arrived statistically significantly sooner at the hospital than non-smokers [smokers' prehospital time delay: 78·9 (sd = 3·2) minutes vs. non-smokers' prehospital time delay: 98·2 (sd = 4·1) minutes, Mann–Whitney U-test, Z = −2·5, P < 0·05]. Patients with hyperlipidaemia arrived with a mean delay of 13 minutes less than normolipidaemic patients. Those with inferior ST segment elevation myocardial infarction exhibited statistically significantly shorter delay times than those with anterior or lateral (inferior vs. anterior, P = 0·003, inferior vs. lateral, P = 0·024, anova with Bonferroni-Holm post hoc test, F = 7·5, P = 0·001).
Conclusion. Community nurses should educate all patients about myocardial infarction, not only those at high risk but also those without known risk factors for ischaemic heart disease.

8. Self-management and chronic low back pain: a qualitative study. Journal of Advanced Nursing, Volume 66, Issue 7: p1478 - 1486.
This paper is a report of a study of the self-management strategies of people with chronic low back pain and how their healthcare professionals perceived their role in facilitating self-management.
Background. Chronic low back pain is a complex disorder, challenging to treat, and associated with wide-ranging adverse consequences including physical disability, psychosocial disruption, and increased use of healthcare resources. Most clinical guidelines suggest that self-management strategies are the best treatment option.
Design. A qualitative analysis was conducted of semi-structured interviews with 64 people identified as having chronic low back pain and 22 healthcare professionals nominated by that person. The interviews were conducted in 2008. The people with chronic low back pain were asked about their self-management strategies; healthcare  professionals were asked about how they perceived their role in the person's self-management. Data were analysed
using a content analysis.
Findings. The most common strategies used by participants to manage their chronic low back pain were medication, exercise and application of heat. The nominated healthcare professionals were predominantly physiotherapists and general practitioners. Physiotherapists described exercises, particularly those aimed at improving core strength, as the main strategy that they encouraged people to use. General practitioners regarded themselves as primarily having three roles: prescription of pain medication, dispensing of sickness certificates, and referral to specialists.
Conclusion. People with chronic low back pain use self-management strategies that they have discovered to provide relief and to prevent exacerbation. The strategies reflect an active process of decision-making that combines personal experience with professional recommendations.

9. Nurse-led self-management group programme for patients with congestive heart failure: randomized controlled trial. Journal of Advanced Nursing, Volume 66, Issue 7: p1487-1499
This paper reports on of the effects of the Chronic Disease Self-Management Programme on psychosocial attributes, self-care behaviour and quality of life among congestive heart failure patients who experienced slight to marked limitation of physical activity.
Background. Most self-management programmes for congestive heart failure patients emphasize the medical aspects of this chronic condition, without incorporating psychosocial aspects of self-management. The programme has been used with various patient groups, but its effectiveness with congestive heart failure patients when led by pairs of cardiac nurse specialists and peer leaders is unknown.
Method. A randomized controlled trial with 12 months of follow-up from start of the programme was conducted with 317 patients. Control group patients (n = 131) received usual care, consisting of regular outpatient checkups. Intervention group patients (n = 186) received usual care and participated in the six-week self-management programme. The programme teaches patients medical, social and emotional self-management skills. Twenty-one classes were conducted in six hospitals in the Netherlands, and data were collected between August 2004 and January 2007.
Results. Directly after the programme, statistically significant effects were found for cognitive symptom management (P < 0·001), self-care behaviour (P = 0·008) and cardiac-specific quality of life (P = 0·005). No effects were found at 6- and 12-month follow-up.
Conclusion. Further research is necessary to study how long-term effectiveness of the programme with patients with congestive heart failure can be achieved, and how successful adaptations of the programme can be integrated into standard care.

10. Perceived support from healthcare practitioners among adults with type 2 diabetes. Journal of Advanced Nursing, Volume 66, Issue 7: p1500-1509
This paper is a report of a study of how adults with type 2 diabetes perceive different attributes of support provided by healthcare practitioners and how various attributes of support can influence people's motivation to self-manage their disease.
Background. Motivational problems seem to be a major reason for poor diabetes management. According to well-known theories of motivation, expectations of being able to perform certain behaviours are a key element. Different attributes of support from healthcare practitioners are likely to influence such expectations. To date, no
researchers have specifically examined how people with type 2 diabetes perceive different attributes of support from healthcare practitioners and how these may influence their motivation to manage their disease themselves.
Methods. A descriptive/explorative qualitative design and focus groups were used to collect data. The sample consisted of 19 adults with type 2 diabetes, and the data were collected in 2007 and analysed using qualitative content analysis.
Findings. Five themes were identified, reflecting perceived attributes of support from healthcare practitioners:
(1) an empathetic approach, (2) practical advice and information, (3) involvement in decision-making, (4) accurate and individualized information and (5) ongoing group-based support.
Conclusion. Healthcare practitioners may strengthen the self-management motivation among adults with type 2 diabetes by enhancing expectations of being able to perform the necessary diabetes care, and through the provision of empathetic, individualized, practical and ongoing group-based support.

11. Healthcare professionals' perceptions of existential distress in patients with advanced cancer. Journal of Advanced Nursing, Volume 66, Issue 7: p1510-1522
This paper is a report of an exploration of the phenomenon of existential distress in patients with advanced cancer from the perspectives of healthcare professionals.
Background. Existential distress is an important concern in patients with advanced cancer; it affects their well-being and needs to be addressed in the provision of holistic care.
Method. Focus groups were conducted from November 2008 to February 2009 with physicians, nurses, social workers, occupational therapists, physiotherapists, and chaplains working in a palliative care unit that served patients with advanced cancer in Hong Kong. Data collection and analysis were guided by the grounded theory approach. All categories were saturated when five focus groups had been held with a total number of 23 participants.
Findings. We found three causal conditions of existential distress: anticipation of a negative future, failure to engage in meaningful activities and relationships, and having regrets. Three basic (caring, relating and knowing) and six specific (positive feedback, religious support, new experiences, task setting, exploring alternatives and
relationship reconciliation) intervening strategies were identified. Whether the intervening strategies would be effective would depend on patients' openness and readiness; healthcare professionals' self-awareness, hopefulness, and interest in knowing the patients; and a trusting relationship between patients and healthcare professionals. A sense of peace in patients was considered a consequence of successful interventions.
Conclusion. This paper acknowledges the lack of an accepted conceptual framework of existential distress in patients with advanced cancer. It is based on healthcare professionals' views, and further studies from the perspectives of patients and their families are needed.

12. Using assistive technology services at differing levels of care: healthy older couples' perceptions. Journal of Advanced Nursing, Volume 66, Issue 7: p1523-1532
The aim of the study was to describe healthy older couples' perceptions of using assistive technology services when needing assistance with care.
Background. The use of information technology-based assistive technology services in elder care has increased as a result of an increase of care performed in private homes. The use of assistive technology services in care of older people at home has been evaluated as something positive by patients, relatives and nursing staff, while as resistance to their increased use has also been noted.
Method. Twelve healthy couples, aged over 70 years, from northern Sweden were interviewed in 2005 about their perceptions of using assistive technology services in the case of being in need of assistance with personal care. Open, individual semi-structured interviews supported by written vignettes describing three levels of caring needs were used and the data analysed with content analysis.
Findings. The findings were interpreted as one main theme with three categories: Asset or threat depends on caring needs and abilities. Three categories were identified within the theme: Assistive technology services provide an opportunity; The consequences of using assistive technology services are hard to anticipate; and Fear of assistive technology services when completely dependent on care.
Conclusion. Trust and security in the care of older people who are severely ill, dependent on care and living at home should be a hallmark in using assistive technology services. Human presence is an important dimension and must be considered when developing concepts for use of assistive technology services.

13. Infection control in clinical placements: experiences of nursing and midwifery students. Journal of Advanced Nursing, Volume 66, Issue 7: p 1533-1542
This paper is a report of a study of the experiences of nursing and midwifery students in relation to infection control in their clinical placements and how these affect their learning.
Background. Compliance with infection control precautions has been found to be low in many areas. Reasons for non-compliance include factors relevant to nursing and midwifery students, such as lack of knowledge and lack of a positive role model. However, there is little in the literature about how students experience infection control in placements and how this affects their own practice.
Methods. Semi-structured interviews were undertaken in 2009 with 40 nursing and midwifery students. Analysis of transcripts was by Framework analysis.
Findings. Students identified practices that they had observed and benchmarked these against what they had been taught at university and what was demonstrated by staff perceived as positive role models. Observing inappropriate practice affected student practice both positively and negatively. Students were reluctant to report poor practice due to fear of failing placements and not wanting to be identified negatively by staff. Students believed that  practice supported by theory was important to provide them with a rationale for their activities and to support  any complaints that they had.
Conclusion. Poor practice in clinical placements can have a negative impact on student learning and practice and may therefore have implications for the practice of future nurses and midwives. In order to maintain patient safety, there needs to be more support for students who wish to identify poor practice.

14. Breaking bad news in inpatient clinical settings: role of the nurse. Journal of Advanced Nursing, Volume 66, Issue 7: p1543-1555.
This paper is a report of an exploration of the role of the nurse in the process of breaking bad news in the inpatient clinical setting and the provision of education and support for nurses carrying out this role.
Background. The term 'breaking bad news' is mostly associated with the moment when negative medical information is shared with a patient or relative. However, it can also be seen as a process of interactions that take place before, during and after bad news is broken. Little research has been conducted exploring the role of the nurse in the process of breaking bad news in the inpatient clinical setting.
Methods. A questionnaire was developed using Likert scales and open text questions. Data collection took place in 2007. Fifty-nine inpatient areas took part in the study; 335 questionnaires were distributed in total and 236 were completed (response rate 70%).
Results. Nurses engaged in diverse breaking bad news activities at many points in care pathways. Relationships with patients and relatives and uncontrolled and unplanned events shaped the context in which they provided this care. Little formal education or support for this work had been received.
Conclusion. Guidance for breaking bad news should encompass the whole process of doing this and acknowledge the challenges nurses face in the inpatient clinical area. Developments in education and support are required that reflect the challenges that nurses encounter in the inpatient care setting.

15. Effects of turning on skin-bed interface pressures in healthy adults. Journal of Advanced Nursing, Volume 66, Issue 7: p1556-1564
This paper is a report of a study of the effects of lateral turning on skin-bed interface pressures in the sacral, trochanteric and buttock regions, and its effectiveness in unloading at-risk tissue.
Background. Minimizing skin-support surface interface pressure is important in pressure ulcer prevention, but the effect of standard patient repositioning on skin interface pressure has not been objectively established.
Methods. Data were collected from 15 healthy adults from a university-affiliated hospital. Mapped 24-inch × 24-inch (2304 half-inch sensors) interface pressure profiles were obtained in the supine position, followed by lateral turning with pillow or wedge support and subsequent head-of-bed elevation to 30°.
Results. Raising the head-of-bed to 30° in the lateral position statistically significantly increased peak interface pressures and total area ≥32 mmHg. Comparing areas ≥32 mmHg from all positions, 93% of participants had skin areas with interface pressures ≥32 mmHg throughout all positions (60 ± 54 cm2), termed 'triple jeopardy areas'. The triple jeopardy area increased statistically significantly with wedges as compared to pillows
(153 ± 99 cm2 vs. 48 ± 47 cm2, P < 0·05).
Conclusion. Standard turning by experienced intensive care unit nurses does not reliably unload all areas of high skin-bed interface pressures. These areas remain at risk for skin breakdown, and help to explain why pressure ulcers occur despite the implementation of standard preventive measures. Support materials for maintaining lateral turned positions can also influence tissue unloading and triple jeopardy areas.

16. Sleep quality and quality of life in female shift-working nurses. Journal of Advanced Nursing, Volume 66, Issue 7: p1565-1572
This paper is a report of a study of the factors that influence sleep quality and quality of life among shift-working nurses and the relationship between their sleep quality and quality of life.
Background. Although shift-working nurses strive to adapt their life schedules to shift rotations, they tend to suffer from severe sleep disturbances and increased rates of cancer, cardiovascular diseases, digestive disease and irregular menstrual cycles. Poor sleep is also associated with medical errors and occupational injuries.
Methods. A cross-sectional study was conducted in 2008 with a convenience sample of 435 female nurses from five regional hospitals in Taiwan. Data were collected on sleep quality and quality of life using the Pittsburgh Sleep Quality Index and World Health Organization Quality of Life Instrument-BREF Taiwan version respectively. Data were analysed using descriptive statistics, independent t-tests, analysis of variance and Pearson correlations.
Findings. The majority of female shift workers (57%) had global sleep-quality scores ≥5, indicating poor sleep and all mean scores in four domains of the quality-of-life measure were statistically significantly lower than those of females in Taiwan's general population. Scores for poor sleep quality and quality of life were related to premenstrual dysphoria, occupational injury, illness and medication use. In addition, the associations between scores on the sleep-quality and quality-of-life scales were statistically significantly inversely correlated.
Conclusion. Advice should be included in both undergraduate programmes and continuing education to help nurses to recognize and improve their own sleep quality and life quality managers should create a supportive environment to encourage shift-working nurses to engage in healthy behaviours.

17. Effect of acute and chronic job demands on effective individual teamwork behaviour in medical emergencies
Journal of Advanced Nursing, Volume 66, Issue 7: p1573-1583
This paper is a report of a study conducted to determine the combined effect of acute and chronic job demands on acute job strains experienced during medical emergencies, and its consequences for individual teamwork behaviour.
Background. Medical emergency personnel have to cope with high job demands, which may cause considerable work stress (i.e. job strains), particularly when both acute and chronic job demands are experienced to be high. This may interfere with effective individual teamwork behaviour.
Methods. A cross-sectional survey study was conducted in 2008, involving 48 members (doctors and nurses) of medical emergency teams working in the emergency department of a Dutch general hospital. Data were analyzed by means of hierarchical regression analyses.
Results. High acute job demands impeded effective teamwork behaviour, but only when they resulted in acute job strain. Acute emotional demands were more likely to result in acute job strain when chronic emotional job demands were also experienced as high. Although acute cognitive and physical strains were also detrimental, effective teamwork behaviour was particularly impeded by acute emotional strain.
Conclusion. Acute job strains impair effective individual teamwork behaviour during medical emergencies, and there is urgent need to prevent or reduce a build-up of job strain from high acute and chronic demands, particularly of the emotional kind.

18. Autonomy, evidence and intuition: nurses and decision-making. Journal of Advanced Nursing, Volume 66, Issue 7: p1584-1591
This paper is a report of a study conducted to examine how nurses represent professional clinical decision-making processes, and to determine what light Jamous and Peloille's 'Indeterminacy/Technicality ratio'
concept can shed on these representations.
Background. Classic definitions of professional work feature autonomy of decision-making and control over the field of work. Sociologists Jamous and Peloille have described professional work as being high in 'indeterminacy' (the use of tacit judgements) relative to technicality (activity able to be codified). The rise of the evidence-based practice movement has been seen as increasing the realm of technical decision-making in healthcare, and it is relevant to analyse nurses' professional discourse and study how they respond to this increase.
Method. Three focus groups with qualified nurses attending post-qualifying courses at a London university were held in 2008. Participants were asked to talk about influences on their decision-making. The discussions were tape-recorded, transcribed and subjected to discourse analysis.
Findings. Participants described their decision-making as influenced by both indeterminate and technical features. They acknowledged useful influences from both domains, but pointed to their personal 'experience' as the final  arbiter of decision-making. Their accounts of decision-making created a sense of professional autonomy while at the same time protecting it against external critique.
Conclusion. Pre- and post-registration nurse education could encourage robust discussion of the definition and roles of 'irrational' aspects of decision-making and how these might be understood as components of credible professional practice.

19. Job stress, achievement motivation and occupational burnout among male nurses. Journal of Advanced Nursing, Volume 66, Issue 7: p1592-1601
This paper is a report of an exploration of job stress, achievement motivation and occupational burnout in male nurses and to identify predictors of occupational burnout.
Background. Since the Nightingale era, the nursing profession has been recognized as 'women's work'. The data indicate that there are more female nurses than male nurses in Taiwan. However, the turnover rate for male nurses is twice that of female nurses. Understanding the factors that affect occupational burnout of male nurses may help researchers find ways to reduce the likelihood that they will quit.
Method. A survey was conducted in Taiwan in 2008 using a cross-sectional design. A total of 121 male nurses participated in the study. Mailed questionnaires were used to collect data, which were analysed using descriptive statistics and stepwise multiple regression.
Results. The job stress of male nurses was strongly correlated with occupational burnout (r = 0·64, P < 0·001). Stepwise multiple regression analyses indicated that job stress was the only factor to have a statistically significant direct influence on occupational burnout, accounting for 45·8% of the variance in this. Job stress
was comprised of three dimensions, of which role conflict accounted for 40·8% of the variance in occupational burnout.
Conclusion. The contribution of job stress to occupational burnout of male nurses was confirmed. As occupational burnout may influence the quality of care by these nurses, nurse managers should strive to decrease male nurses' job stress as this should lead to a reduction of negative outcomes of occupational burnout.

20. Identifying attitudes, beliefs and reported practices of nurses and doctors as immunization providers.
Journal of Advanced Nursing, Volume 66, Issue 7: p1602-1611
This paper is a report of a study conducted to examine the attitudes, beliefs, behavioural intentions and self-reported behaviour of nurses and physicians relating to key immunization behaviours and compare the findings for nurses and physicians.
Background. Immunization is an important and effective public health intervention. Understanding immunization providers' attitudes and beliefs toward immunization has the potential to improve educational efforts and lead to behavioural change.
Method. A postal survey was conducted with all immunization providers in British Columbia, Canada, in 2005. The  survey elicited data on demographics, practice characteristics, attitudes, perceived social norms and perceived behavioural control related to key immunization behaviours.
Results. Responses were received from 344 nurses and 349 physicians. The response rate was 67% for nurses and 22% for physicians. More nurses than physicians thought that administering all recommended vaccines at one visit was important (89·2% vs. 63·2%P < 0·001); nurses felt more pressure from parents to administer all recommended vaccines (82·4% vs. 48·7%P < 0·001), and nurses were also more likely to intend to give all recommended vaccines at one visit (98·8% vs. 73·8%P < 0·001). Both nurses and physicians thought that their own receipt of influenza vaccine each year was important (88·9%, 87·1% respectively P = 0·65).
Conclusion. The foundational work done to develop the survey tool can be used to modify it so that survey findings can be validated according to the Theory of Planned Behaviour. The results could inform the development of behavioural change interventions targeting the identified determinants of immunization provider behaviour.

21. Spiritual health, clinical practice stress, depressive tendency and health-promoting behaviours among nursing students. Journal of Advanced Nursing, Volume 66, Issue 7: p1612-1622
This paper is a report of an exploration of the association of spiritual health with clinical practice stress, depressive tendency and health-promoting behaviours among nursing students.
Background. Several studies in western countries have demonstrated an association between spirituality and health.
Spirituality-related research in eastern countries, however, is still in its infancy.
Methods. A cross-sectional design was adopted and structured questionnaires were used for data collection. We adopted the Probability Proportional to Size cluster sampling method to recruit nursing students in senior grades. Data were collected in 2005 using the Spiritual Health Scale, Perceived Clinical Practice Stress Scale, Beck Depression Inventory-II and Health Promotion Behaviours Scale.
Results. A total of 1276 nursing students with an average age of 20·1 years (sd = 1·6 years) participated in the study. Spiritual health was negatively associated with clinical practice stress (r = −0·211, P < 0·001) and depressive tendency (r = −0·324, P < 0·001) and positively associated with health-promoting behaviours (r = 0·611, P < 0·001). Using hierarchical regression analysis to control for demographic factors, spiritual health was found to be an important
predictive factor for clinical practice stress, depressive tendency and health-promoting behaviours.
Conclusion. These results are consistent with research findings from western countries. Educators should develop strategies to address nursing students' spiritual health. This may help nursing students to manage their stress,to reduce depressive symptoms and to enhance health-promoting behaviours.


22. A mixed-mode approach to data collection: combining web and paper questionnaires to examine nurses' attitudes to mental illness. Journal of Advanced Nursing, Volume 66, Issue 7: p1623-1632
This paper is a report an evaluation of the use of a sequential mixed-mode approach to data collection in a study of attitudes to mental illness and people with mental health problems held by Registered Nurses working in adult acute inpatient and psychiatric intensive care settings.
Background. The use of electronic tools for data collection is becoming increasingly common in nursing research. Currently there is a lack of reports of the use of mixed-mode designs featuring both web and paper questionnaires. The efficacy of this approach remains unclear.
Method. Web and paper versions of a questionnaire including the Community Attitudes towards the Mentally Ill scale were distributed in 2007 to all 148 Registered Nurses working in acute care settings in an English mental healthcare organization.
Results. The mixed-mode design was successful in increasing overall response rate. Data collection mode was indicative of statistically significantly different response rates, but had no impact on differences in nurses' socio-demographic characteristics or attitudes to mental illness. The use of email reminders had a positive impact on the web questionnaire return rate.
Conclusion. Future nursing studies could benefit from a mixed-mode study design to attain increased response rates and reduce non-response bias, although further research should be undertaken with larger groups of nurses to verify consistently the absence of mode effect on study outcomes.

23. Coping behaviour checklist for Chinese children: development and psychometric testing.
Journal of Advanced Nursing, Volume 66, Issue 7: p1633-1643
This paper is a report of development and psychometric testing of the coping behaviour checklist for Chinese children.
Background. An understanding of the coping behaviour of children is an essential prerequisite for the design of an appropriate psychological intervention to enhance children's ability to cope with stressful medical procedures and hospitalization. Review of literature reveals that there is lack of child-sensitive measurement tools in the Chinese culture for assessing coping behaviours of children with good psychometric properties.
Methods. An instrument development and validation study was conducted. Phase 1 was designed to develop a checklist of coping behaviour for Chinese children, while in phase 2 the psychometric properties of the new scale were tested. A total of 168 (phase 1) and 236 (phase 2) children between the ages of 7 and 12 years, were invited to participate in this study in 2008 and 2009, respectively; 228 completed both phases of data collection.
Results. On the basis of the results of qualitative interview data, the coping behaviour checklist for Chinese children was developed. The newly developed scale had adequate internal consistency reliability and test–retest reliability, high content validity and appropriate construct validity. Confirmatory factor analysis further added evidence of the construct validity of the scale.
Conclusion. The instrument can be used to identify the coping behaviour of Hong Kong Chinese children aged between 7 and 12 years. Knowing the coping behaviour of children in advance can help nurses to shape and design appropriate psychological interventions that can help children better cope with stressful medical procedures and hospitalization.


24. Facing up to 'challenging behaviour': a model for training in staff–client interaction. Journal of Advanced Nursing, Volume 66, Issue 7: p1644-1655
This paper draws on theory and evidence to develop a conceptual staff training model for the management of 'challenging behaviour'.
Background. Staff working with clients who are experienced as challenging commonly report negative feelings such as anxiety, anger, guilt, fear, self-blame and powerlessness, as well as dissatisfaction with their jobs. Current training programmes in challenging behaviour offer a 'smorgasbord' of content, without a clearly defined conceptual framework.
Data sources. Medline and PsychInfo were searched for papers in English from 1998 to 2008, linking 'nurs*' to'challenging behaviour' and its related terms. Additional hand-searching identified informative papers from disciplines outside nursing older than the search period.
Discussion. We developed an applied model for training educators in respect of challenging behaviours. The model directs educators to consider: the influence of the nurse, including their values, emotional processes and behavioural skills; features of the client; and features of the situation in which the behaviour occurs,
including its culture and working practices and physical environment.
Implications for nursing. The most striking implication of the model is that it explicitly recognizes the importance of domains of learning other than skill. This enables educators to find educationally appropriate responses to resource limitations that inevitably constrain training.
Conclusion. Challenging behaviour should be considered as a product of several intertwined factors: the actors involved – nurses, clients and others – and the situation in which the behaviour occurs, including its culture and working practices and physical environment.

Journals Table of Contents

25. From Nursing Times 29 June - 5 July 2010
No opt-out: nurses told of 'moral duty'to save money
Clinical Indicators coming to A&E; Rehabilitation care will boost senior nurses' role; 'Ridiculous' sexy\nurse advert inflames Unison
25C. NMC behind fitness cases; DH: be systematic about terminal care; More allergy specialists required as demand rises
25D. Join us to show your commitment to the eight high impact actions: variations in practice must be eliminated to drive up quality care and cut costs. Nurses are ideally charged to lead this challenge.
25E. Exploring the principles of best practice discharge to ensure patient involvement
25F. Why do patients with complex palliative care needs experience delayed hospital discharge?
25G. Using an accreditation scheme to demonstrate quality in mental healthcare settings
25H. Dementia care 2: exploring how nursing staff manage challenging behaviour
25I. NHS evidence helps you to provide cost effective care
25J. Why understand if you can just point the finger?

Conferences, Training, seminars

26. Trans-Tasman Law and Legal Practice Conference
Staged by the University of Canterbury School
of Law and the New Zealand Australia Research Centre
Date: 27-28 August, 2010
Venue: Christchurch
More info:

27. Company Law - challenges for SMEs and their advisers
Dunedin 13 September, 2010
Christchurch 14 September, 2010
Auckland 15 September, 2010
Hamilton 16 September, 2010
Wellington 21 September, 2010
More information:

28. 2nd Annual Total Safety Culture: From compliance
to complete participation
Date: 28-29 September 2010
Venue: Crowne Plaza, Auckland
To register:
More info:

29. Reducing Drug & Alcohol Risk in the Workplace
Interactive workshop

Date: 30 September 2010
To register:
More info:

News – National

30. Pay dispute could lead to emergency department delays
Northern Advocate - 13th Jul 2010
Emergency department patients at Northland's public hospitals could experience some delays from today as hospital laboratory workers start industrial action for better pay.

31. Patients quizzed on safety
Manawatu Standard - 14 July, 2010
Asking patients whether they're being abused at home is becoming routine practice at MidCentral Health. About 12 children each month who have been hurt or are in danger are being referred to Child Youth and Family services from Palmerston North and Horowhenua.

News - International

A new federal government Website managed by the U.S. Department of Health & Human Services

33. Registered Nurse Safe Staffing Bill Introduced in Congress
Direct Care Nurses Would Drive Staffing Plans to Ensure Patient Safety
SILVER SPRING, MD – The American Nurses Association (ANA) applauds the introduction of federal legislation that empowers registered nurses (RNs) to drive staffing decisions in hospitals and, as a result, protect patients and improve the quality of care. On the heels of the introduction of the Registered Nurse Safe Staffing Act of 2010 (S. 3491/H.R. 5527), hundreds of registered nurses from across the country flocked to Capitol Hill last month to meet with their congressional representatives, emphasizing that insufficient nurse staffing can be a life-or-death issue for patients and that federal legislation is needed to ensure that hospitals don’t limit
resources in a way that harms patient outcomes.



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