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Issue 157 - 22 October 2010

First Labour Day celebrations

The first Labour Day celebrated the struggle for an eight-hour working day. Parades in the main centres were attended by several thousand trade union members and supporters. New Zealand workers were among the first in the world to claim the right to an eight-hour day. As early as 1840 the carpenter Samuel Parnell famously won an eight-hour day in Wellington. The tradition was soon extended to other centres, but these rights were a custom, not a legal entitlement, and only applied to some groups of workers.


1. What has gone wrong with clinical chairs in nursing?
by Alison J. Tierney. Journal of Advanced Nursing, Volume 66, Number 11, November 2010: p2371

2. Psychological distress associated with the diagnostic phase for suspected breast cancer: systematic review
by  Mariann Montgomery & Susan H. McCrone. Journal of Advanced Nursing, Volume 66, Number 11, November 2010: p2372-2390
This paper is a report of a review conducted to define the manifestations that characterize psychological distress during the diagnostic phase for suspected breast cancer, define the extent of psychological distress  associated with the threat of potential cancer, and identify factors influencing psychological distress levels.
Background. Raising the possibility that a malignancy might be present is threatening. The resulting distress is believed to influence treatment outcomes in those diagnosed with cancer and result in behavioural changes in those with benign disease.
Data sources. Research papers published between January 1983 and May 2009 were identified in CINAHL, MEDLINE and PsycINFO. The search was performed using the following terms: breast cancer diagnosis, mammography, breast biopsy, breast diagnostic, anxiety, distress and uncertainty.
Review methods. A systematic review was conducted of 30 studies meeting the inclusion criteria of a quantitative design with at least one standardized measure of distress and specifically addressing distress during the  evaluation period.
Results. It is well-documented that distress, manifested as anxiety, exists. In a small cohort of women, distress levels are heightened to worrying levels that may have long-term implications. There was strong evidence for relationships among medical history, education and trait anxiety with distress. There was no substantiation of the association between younger age and increased psychological distress that has been consistently reported with other cancers.
Conclusion. It is necessary to understand the impact of factors on distress so that heightened levels can be predicted and targeted by interventions initiated at the first mention of the possibility of the presence of malignancy.

Eye irrigation for patients with ocular chemical burns: a systematic review; Effectiveness of nurse-led preoperative assessment services for elective surgery: a systematic review; The effectiveness of using human patient simulation manikins in the teaching of clinical reasoning skills to undergraduate nursing students: a systematic review; The effectiveness of educational strategies in improving parental/caregiver management of fever in their child: a systematic review.  Journal of Advanced Nursing, Volume 66, Number 11, November 2010: p2391–2397

Original Research

4. Nurses’ use of non-pharmacological methods in children’s postoperative pain management: educational intervention study.
By Hong-Gu He et al. Journal of Advanced Nursing, Volume 66, Number 11, November 2010: p2398-2409
This paper is a report of study of the impact of an educational intervention in pain management on nurses’ self-reported use of non-pharmacological methods for children’s postoperative pain relief and their perceptions of barriers that limited their use of these methods.
Background. Non-pharmacological methods have been shown to be effective in relieving pain; however, many barriers including lack of knowledge, limit nurses’ use of these methods. Pain education is a promising strategy for changing nursing practice, but only a few authors have examined the effectiveness of educational interventions for nurses to help relieve children’s postoperative pain.
Methods. A quasi-experimental one-group pre- and post-test design was used. Questionnaire surveys were conducted with a convenience sample of 108 Registered Nurses in two public hospitals in Singapore in 2008.
Results.  Statistically significant increases were found in nurses’ self-reported use of imagery, positive reinforcement, thermal regulation, massage and positioning in the postintervention survey. Before the intervention, these methods were less frequently used compared to other methods. Heavy workload/lack of time and the child’s inability to cooperate were the most commonly reported barriers at pre- and post-test.
Conclusion.  The educational intervention had a positive effect on nurses’ use of several non-pharmacological methods. Regular dissemination of updated information to nurses on these pain management methods is recommended to maintain the positive changes. Nevertheless, education alone was not sufficient to optimize nurses’ use of these methods, as various barriers limited their practice.

5. Nursing care for patients requesting euthanasia in general hospitals in Flanders, Belgium
By Bernadette Dierckx de Casterlé et al. Journal of Advanced Nursing, Volume 66, Number 11, November 2010: p2410-2420
This paper is a report of a study exploring nurses’ involvement in the care process for mentally competent, terminally ill patients requesting euthanasia in general hospitals in Flanders, Belgium.
Background. International literature shows that nurses are involved in the care process surrounding euthanasia, regardless of the legal status of euthanasia in the country being studied. However, their actual involvement remains unclear.
Methods. A grounded theory approach was used. Data were collected over a 20-month period in 2005 and 2006, using individual in-depth interviews. The sample included 18 Registered Nurses employed in nine general hospitals geographically spread over the five provinces of Flanders, Belgium.
Results. The care process for patients requesting euthanasia is complex and dynamic, consisting of several stages
Major themes characterized nurses’ involvement: being on the alert for a euthanasia request; open and active listening; multidisciplinary team cooperation and analysis of the group dynamics; continuously providing maximum palliative care; multi-tasking; organizing and directing the euthanasia; and finally, providing support for the family, colleagues and oneself.
Conclusion. Nurses make a unique and indispensable contribution to making the euthanasia care process a good care process. This has to do with their specific form of knowledge, expertise and responsibilities, and their willingness to personally, continually and fully care for the patients requesting euthanasia and for their relatives.

6. What informs parents’ decision-making about childhood vaccinations?
By Astrid Austvoll-Dahlgren and Sølvi Helseth. Journal of Advanced Nursing, Volume 66, Number 11, November 2010:
This paper is a report of a study conducted to identify parents’ decision-making processes in relation to childhood vaccinations, including barriers and facilitators to searching for information.
Background. Decision-making about childhood vaccinations is complex. Access to the best available evidence and the ability to obtain and understand such information are necessary for effective participation in decision-making.
Methods. A grounded theory approach was used, with semi-structured interviews and focus groups with parents (n = 10) and public health nurses (n = 16) conducted in 2008. Data were derived through incident-to-incident and axial coding.
Findings. Being positive towards vaccination and being decided were found to be main barriers to participation and obtaining information; other factors were perceptions about own abilities and capacity. Public health nurses were the parents’ most important source of information, but tended to inform to facilitate vaccinations. Issues related to this and being inadequately informed were that some parents expressed low confidence about the decision they had made and uncertainty about their rights and responsibilities in decision-making.
Conclusion. Information delivered by public health nurses should not facilitate a specific choice but rather be balanced, explaining the benefits and harms, and accompanied by a qualified recommendation. Useful tools to improve practice may include checklists for shared decision-making and guidelines about trustworthy websites.

7. Women’s experiences of seeking reproductive health care in rural Ghana: challenges for maternal health service utilization
By Vida Nyagre Yakong et al. Journal of Advanced Nursing, Volume 66, Number 11, November 2010: p2431–2441
This paper is a report of part of a larger study exploring rural Ghanaian women’s experiences of seeking reproductive health care. The aim of this part of the study was to describe rural women’s perspectives on their experiences in seeking reproductive care from professional nurses.
Background. Nurses’ relationships with childbearing women have been linked to women’s reproductive healthcare-seeking behaviour and service utilization. However, few researchers have studied women’s perspectives on their relationships with nurses when seeking health care. In Ghana, the high rates of maternal mortality raise concerns about a number of factors, including nurses’ relational practices.
Methods. Data were collected in 2007 with a convenience sample of 27 Ghanaian women via in-depth interviews, focus groups and participant observation. Women’s ages ranged from 15 to 49 years. The translated and transcribed data were thematically analyzed.
Findings. Healthcare providers’ relational practice influenced women’s healthcare-seeking behaviours. Major themes from women’s stories were: (a) experiences of intimidation and being scolded, (b) experiences of limited choices, (c) receiving silent treatment, and experiences of lack of privacy. Women emphasized the importance of their relationships with nurses and the impact of these relationships on their healthcare-seeking.
Conclusion. Nursing education in Ghana must place emphasis on basic relational practices. Structural changes to health clinics and routine nursing practices are necessary to create conditions for privacy to address women’s health concerns. Women’s perspectives must be considered for service improvement. Further research is needed to examine nurses’ perspectives on relational care.

8. Pain management interventions with parents in the emergency department: a randomized trial
By Sylvie LeMay et al. Journal of Advanced Nursing, Volume 66, Number 11, November 2010: p2442–2449
This paper is a report of the efficacy of a parental educational intervention on children’s pain intensity and experience of pain-related unpleasantness at 24 hours post-discharge from the emergency department, and on parents’ beliefs about pain.
Background. Parents’ misbeliefs about pain management may inhibit them from managing their child’s pain  appropriately. Educating parents about pain management may increase their knowledge, dispel myths and help decrease children’s pain intensity and unpleasantness related to pain following a visit to an emergency department.
Method. A randomized design was adopted with samples of parent/child dyads. The experimental group received a bookmark, booklet on pain management and pain scale. The control group only received a pain scale. Pain intensity and unpleasantness were measured at triage and 24 hours after discharge from the emergency department. Parents’ beliefs were measured with the Pain Belief Questionnaire. Data were collected from November 2005 to May 2006.
Results. Samples of 98 (experimental) and 97 (control)children/parents were recruited. No statistically significant differences were found between both groups regarding pain intensity and unpleasantness, at triage and 24 hours post-discharge. Results for the Pain Belief Questionnaire were similar between the groups (t = 1·751, P = 0·082).
Conclusion. The interventions were not effective to reduce pain and unpleasantness related to pain, as well as to improve pain beliefs of parents. Other interventions, such as having parents participate actively in their child’s pain management, might be more effective than a passive educational intervention.

9. Family caregivers’ needs predict functional recovery of older care recipients after hip fracture 
By Yea-Ing Lotus Shyu et al. Journal of Advanced Nursing, Volume 66, Number 11, November 2010: p2450–2459
This paper is a report of a study of the effect of family caregivers’ needs on the functional recovery of elders with a hip fracture during the first 6 months after discharge.
Background. Family members are closely involved in the postdischarge care of older Chinese patients. However, the influence of family caregiving-related variables, such as caregiver’s needs, on recovery after hip fracture has not been explored.
Methods. Data were collected between 2002 and 2005 with elders with hip fracture and their family caregivers at a medical centre in Taiwan. Data were collected at 1, 3 and 6 months after discharge, and 120 people completed  all follow-ups. The effect of caregiver needs on elders’ recovery was analysed using the generalized estimating equations approach.
Findings. Elders whose caregivers reported a need for information on caregiving and related health care were more likely (odds ratio = 1·93, confidence interval = 1·08–3·46) to recover their walking ability than those whose caregivers did not report such need. However, elders whose caregivers reported a need for social services were less likely to recover their walking ability (odds ratio = 0·38, confidence interval = 0·18–0·78), and activities of daily living (odds ratio = 0·40, confidence interval = 0·17–0·94) than those whose caregivers did not report such need.
Conclusion. Healthcare providers should include caregivers’ needs in their clinical assessment of Chinese elders after surgery for hip fracture. Given the rapidly increasing population of Asian elders in Western countries, the results of this study may be applicable to other countries with Chinese populations.

10. Beyond incontinence: the stigma of other urinary symptoms
By Emily A. Elstad et al. Journal of Advanced Nursing, Volume 66, Number 11, November 2010: p2460–2470
This paper is a report of a study conducted to characterize the stigma of urinary frequency and urgency and differentiate it from the stigma of incontinence and to describe race/ethnic and gender differences in the experience of stigma among a diverse sample of individuals.
Background. Lower urinary tract symptoms, including frequency, urgency and incontinence, are susceptible to stigma, but previous stigma research has focused almost exclusively on incontinence.
Method. The Boston Area Community Health Survey is a population-based, random sample epidemiological survey of
urologic symptoms (N = 5503). Qualitative data for this study came from in-depth interviews conducted between 2007 and 2008 with a random subsample of 151 black, white and Hispanic men and women with urinary symptoms.
Findings. Respondents reported stigma associated with frequency and urgency – not just incontinence. The stigma of frequency/urgency is rooted in social interruption, loss of control of the body, and speculation as to the nature of a non-specific ‘problem’. Overall, the stigma of urinary symptoms hinged upon whether or not the problem was ‘perceptible’. Men felt stigmatized for making frequent trips to the bathroom and feared being seen
as impotent. Women feared having an unclean body or compromised social identity. Hispanic people in particular voiced a desire to keep their urinary symptoms a secret.
Conclusion. The stigma of urinary symptoms goes beyond incontinence to include behaviours associated with frequency and urgency. Healthcare practitioners should assess for stigma sequelae (e.g. anxiety, depression) in individuals with frequency and urgency, and stress treatment options to circumvent stigmatization.

11. School nurses’ involvement, attitudes and training needs for mental health work: a UK-wide cross-sectional study
By Mark Haddad et al. Journal of Advanced Nursing, Volume 66, Number 11, November 2010: p2471–2480
The aim of this study was to identify school nurses’ views concerning the mental health aspects of their role, training requirements and attitudes towards depression in young people.
Background. Mental health problems in children and young people have high prevalence worldwide; in the United Kingdom they affect nearly 12% of secondary school pupils. School nurses have a wide-ranging role, and identifying and managing mental health problems is an important part of their work
Methods. A cross-sectional study was conducted using a postal questionnaire sent to a random sample of 700 school nurses throughout the United Kingdom in 2008. Questions concerned involvement in mental health work and training needs for this work. Attitudes were measured using the Depression Attitude Questionnaire
Results. Questionnaires were returned by 258 (37%) nurses. Nearly half of respondents (46%) had not received any postregistration training in mental health, yet 93% agreed that this was an integral part of their job. Most (55%) noted that involvement with young people’s psychological problems occupied more than a quarter of their work time. Staff attitudes were broadly similar to those of other primary care professionals, and indicated a rejection of stigmatizing views of depression and strong acknowledgement of the role of the school nurse in providing support.
Conclusion. Working with young people who self-harm, and recognizing and being better equipped to assist in managing depression and anxiety are key topics for staff development programmes.

12. Prevalence of accurate nursing documentation in patient records (pages 2481–2489)
By Wolter Paans et al. Journal of Advanced Nursing, Volume 66, Number 11, November 2010
This paper is a report of a study conducted to describe the accuracy of nursing documentation in patient records in hospitals.
Background. Accurate nursing documentation enables nurses to systematically review the nursing process and to evaluate the quality of care. Assessing nurses’ reports in patient records can be helpful for improving the accuracy of nursing documentation.
Method. In 2007–2008, we screened patient records (n = 341) from 35 wards in 10 hospitals in the Netherlands. The D-Catch instrument was used to quantify the accuracy of the (1) record structure, (2) admission data, (3) nursing diagnosis, (4) nursing interventions, (5) progress and outcome evaluations and (6) legibility of nursing reports. Items 2–5 were measured as a sum score of quantity criteria (1–4) and quality criteria (1–4), whereas
Items 1 and 6 were measured on a 4-point Likert scale that addressed only quality criteria.
Findings. The domain ‘accuracy of the interventions’ had the lowest accuracy scores: 95% of the records revealed a scale score not higher than 5. However, the domain ‘admission’ had the highest scores: 80% of the records revealed a scale score over 5.
Conclusion. Effective documentation systems that support nurses in linking diagnoses, interventions and progress and outcome evaluations could be helpful. To improve the accuracy of the documentation, further research is needed on what factors influence nursing documentation. Comparable outcomes from other studies indicate that applying our study findings to international contexts might support the development of universal criteria for accurate nursing documentation.

13. Community care assessment of exacerbations of chronic obstructive pulmonary disease
By Anastasia F. Hutchinson et al. Journal of Advanced Nursing, Volume 66, Number 11, November 2010: p2490–2499
The aim of this study was to develop a clinical algorithm to assess chronic obstructive pulmonary disease exacerbation severity in a community setting.
Background. An important aspect of community management of exacerbations is assessing patient safety. Although researchers have investigated risk factors for rapid deterioration, there is a lack of evidence validating clinical measures of exacerbation severity.
Methods. This was a prospective, community-based cohort study of patients enrolled in the Melbourne Longitudinal Chronic Obstructive Pulmonary Disease Cohort. The outreach team collected data on symptom severity at baseline and exacerbation onset using the Medical Research Council Dyspnoea Scale, St George Quality-of-Life Questionnaire and Symptom Severity Index.
Results. Ninety-two patients were monitored from 2003 to 2005. There were 148 exacerbations: 121 (82%) were treated at home and 27 (17·5%) required hospitalization. An ordinal logistic regression model demonstrated that a combination of chronic obstructive pulmonary disease severity with dyspnoea and wheeze severity at exacerbation onset could differentiate severe from milder episodes [(OR 7·69, 95%CI: 3·9–11·5, P < 0·01), area
under the receiver operating characteristics curve 0·75 (95%CI: 0·65–0·86)].
Conclusion. The majority of chronic obstructive pulmonary disease exacerbations can be safely managed in a community setting, but clinical assessment alone may not be sufficient to identify all patients who will develop complications such as respiratory failure. Further research is needed to validate clinical assessment and decision-making algorithms for community-management of chronic obstructive pulmonary disease exacerbations.

14. Laparoscopic surgery for endometrial cancer: a phenomenological study
By Cathy Hughes et al. Journal of Advanced Nursing, Volume 66, Number 11, November 2010: p2500–2509
This paper is a report of a study of women’s perspectives on the experience of laparoscopic surgery for endometrial cancer.
Background. Laparoscopic surgery is increasingly used to treat early endometrial cancer. It is associated with low levels of morbidity and is considered safe as cancer surgery, but research on quality of life and women’s experiences is limited.
Method. Heideggerian hermeneutic phenomenology was used to explore the experiences of 14 women who had undergone the procedure in two English cancer centres between February 2008 and July 2009. In-depth interviews were taped, transcribed and analysed using Colaizzi’s framework.
Findings. A phenomenological description was produced from five identified themes: having cancer, transfer of responsibility to the surgeon, information and support, independence, and normality. The experience of aparoscopic surgery was overshadowed by the presence of cancer. Fear and lack of knowledge played an important role in entrusting the surgeon with the responsibility for decision-making. Individual, unmet information needs focused on the practicalities of treatment and being in an unfamiliar situation and environment. Loss of control and vulnerability were associated with illness and surgery, but early postoperative mobility and reduced pain, facilitated rapid return to independence and maintained a sense of normality.
Conclusion. Healthcare professionals should deliver care in early endometrial cancer in a way that recognizes the significance of the cancer diagnosis, the role of the surgeon in decision-making and the need for practical information. Women with endometrial cancer should have access to treatments that reduce dependency and maintain normality.

15. Everyday ethics: ethical issues and stress in nursing practice
By Connie M. Ulrich et al. Journal of Advanced Nursing, Volume 66, Number 11, November 2010: p2510–2519
This paper is a report of a study of the type, frequency, and level of stress of ethical issues encountered by nurses in their everyday practice.
Background. Everyday ethical issues in nursing practice attract little attention but can create stress for nurses. Nurses often feel uncomfortable in addressing the ethical issues they encounter in patient care.
Methods. A self-administered survey was sent in 2004 to 1000 nurses in four states in four different census regions of the United States of America. The adjusted response rate was 52%. Data were analysed using descriptive statistics, cross-tabulations and Pearson correlations.
Results. A total of 422 questionnaires were used in the analysis. The five most frequently occurring and most stressful ethical and patient care issues were protecting patients’ rights; autonomy and informed consent to treatment; staffing patterns; advanced care planning; and surrogate decision-making. Other common occurrences were unethical practices of healthcare professionals; breaches of patient confidentiality or right to privacy; and end-of-life decision-making. Younger nurses and those with fewer years of experience encountered ethical issues more frequently and reported higher levels of stress. Nurses from different regions also experienced specific types of ethical problems more commonly.
Conclusion. Nurses face daily ethical challenges in the provision of quality care. To retain nurses, targeted ethics-related interventions that address caring for an increasingly complex patient population are needed.

16. Professional autonomy and job satisfaction: survey of critical care nurses in mainland Greece.
By Katerina K. Iliopoulou and Alison E. While. Journal of Advanced Nursing, Volume 66, Number 11, November 2010:
This paper is a report of a study conducted to describe Greek critical care nurses’ views on professional autonomy and its relationship with job satisfaction and other work-related variables.
Background. Professional autonomy is generally considered a highly desirable nursing attribute and a major factor in nurse job satisfaction. In the critical care environment, a high level of accountability, responsibility and autonomy are required to optimize outcomes of critically unstable patients.
Method. A questionnaire survey was conducted with a convenience sample of Greek critical care nurses (n = 431; response rate 70%) in 2007. Data were collected on professional autonomy, job satisfaction, role conflict and role ambiguity.
Results. Overall, nurses reported acting moderately autonomously. Younger nurses reported statistically significant lower levels of autonomy. Higher levels of autonomy were reported by female nurses. Multiple logistic regression revealed that appointment level, type of critical care unit and registration with a professional organization were independently associated with autonomy. A positive moderate association was found between reported autonomy, job satisfaction, role conflict and role ambiguity, but there was no relationship between job satisfaction and reported role conflict and role ambiguity.
Conclusion. Further education, role enhancement and support are required for nurses working in critical care in Greece if they are to achieve the maximum potential of their professional role. Failure to address the perceptions of professional autonomy may have an impact on staff retention, because of job dissatisfaction.

17. Motivation for entry, occupational commitment and intent to remain: a survey regarding Registered Nurse retention
By Kathleen M. Gambino. Journal of Advanced Nursing, Volume 66, Number 11, November 2010: p2532–2541
This paper is a report of a study of the relationships between Registered Nurses’ motivation for entering the profession, occupational commitment and intent to remain with an employer until retirement.
Background. Identifying and supporting nurses who are strongly committed to their profession may be the single most influential intervention in combating the nursing shortage. An understanding of the characteristics these individuals possess could lead to a decline in the high attrition rates plaguing the profession.
Method. Using a survey design, Registered Nurses enrolled at the school of nursing and/or employed at the associated university medical centre of a large, not-for-profit state university were polled in 2008. Logistic regression analysis was used to determine how the variables of motivation for entry and occupational commitment could indicate intent to remain.
Results. The strongest indicators of intent to remain were normative commitment and age, with a 70% average rate of correctly estimating retention. Exp(B) values for normative commitment (1·09) and age (1·07) indicated that for each one-point increase on the normative commitment scale or one-point increase in age, the odds of remaining with an employer until retirement increased by 1·1%.
Conclusion. Transformational changes in healthcare environments and nursing schools must be made to encourage
loyalty and obligation, the hallmarks of normative commitment. Retention strategies should accommodate mature nurses as well as promote normative commitment in younger nurses.

18. Research citation analysis of nursing academics in Canada: identifying success indicators
By Thomas F. Hack et al. Journal of Advanced Nursing, Volume 66, Number 11, November 2010: p542–2549
This article is a report of a citation analysis of research publications by Canadian nursing academics.
Background. Citation analysis can yield objective criteria for assessing the value of published research and is becoming increasingly popular as an academic evaluation tool in universities around the world. Citation analysis is useful for examining the research performance of academic researchers and identifying leaders among them.
Methods. The journal publication records of 737 nursing academics at 33 Canadian universities and schools of nursing were subject to citation analysis using the Scopus database. Three primary types of analysis were performed for each individual: number of citations for each journal publication, summative citation count of all published papers and the Scopus h-index. Preliminary citation analysis was conducted from June to July 2009, with the final analysis performed on 2 October 2009 following e-mail verification of publication lists.
Results. The top 20 nursing academics for each of five citation categories are presented: the number of career citations for all publications, number of career citations for first-authored publications, most highly cited first-authored publications, the Scopus h-index for all publications and the Scopus h-index for first-authored publications.
Conclusion. Citation analysis metrics are useful for evaluating the research performance of academic researchers in nursing. Institutions are encouraged to protect the research time of successful and promising nursing academics, and to dedicate funds to enhance the research programmes of underperforming academic nursing groups.

19. Effect of patient coping preferences on quality of life following renal transplantation (pages 2550–2559)
By Ciara White and Pamela Gallagher. Journal of Advanced Nursing, Volume 66, Number 11, November 2010
This paper is a report of a study investigating the relationships between quality of life, patient coping preferences, and desire to be actively involved in care following renal transplantation.
Background. While the general consensus is that quality of life is improved greatly by kidney transplantation, it is apparent that it is not uniformly a positive experience in this regard. There is a need to identify individual difference factors that influence quality of life following renal transplantation.
Method. A correlational study was conducted in the national referral centre for renal transplantation in the Republic of Ireland in 2006 with a sample of 172 transplant recipients. Data were collected using a questionnaire composed of standardized instruments to measure the key concepts.
Results. Participants perceived that they had good quality of life, and used more problem-solving than avoidance coping strategies. Avoidance coping strategies were associated with statistically significantly lower quality of life following transplantation. Being younger, attaining a higher education level, being in employment and being married were associated with higher quality of life following transplantation.
Conclusion. Assessment of coping strategies among the transplant population should be further explored in clinical practice, and steps employed to promote the use of positive coping strategies in order to maximize quality of life after transplant.

Research Methodology
20. The HIV Medication Taking Self-efficacy Scale: psychometric evaluation
By Judith A. Erlen et al. Journal of Advanced Nursing, Volume 66, Number 11, November 2010: p2560–2572
This paper is a report of an examination of the psychometric properties of the HIV Medication Taking Self-efficacy Scale.
Background. Self-efficacy is a critically important component of strategies to improve HIV medication-taking; however, valid and reliable tools for assessing HIV medication-taking self-efficacy are limited.
Method. We used a cross-sectional, correlational design. Between 2003 and 2007, 326 participants were recruited from sites in Pennsylvania and Ohio in the United States of America. Six self-report questionnaires administered at baseline and 12 weeks later during ‘Improving Adherence to Antiretroviral Therapy’ were used to examine the variables of interest. Means and variances, reliability, criterion, and construct validity of the HIV Medication Taking Self-efficacy Scale were assessed.
Findings. Participants reported high self-confidence in their ability to carry out specific medication-related tasks (mean = 8·31) and in the medication’s ability to effect good outcomes (mean = 8·56). The HIV Medication Taking Self-efficacy Scale and subscales showed excellent reliability (α = 0·93∼0·94). Criterion validity was well-established by examining the relationships between the HIV Medication Taking Self-efficacy Scale and selected physiological and psychological factors, and self-reported medication adherence (r = −0·20∼0·58). A two-factor model with a correlation between self-efficacy belief and outcome expectancy fitted the data well model χ2 = 3871·95, d.f. = 325, P < 001; CFA = 0·96; RMSEA = 0·046).
Conclusion. The HIV Medication Taking Self-efficacy Scale is a psychometrically sound measure of medication-taking self-efficacy for use by researchers and clinicians with people with HIV. The findings offer insight into the development of interventions to promote self-efficacy and medication adherence in persons with HIV.

21. Metacognitive Inventory for nursing students in Taiwan: instrument development and testing
By Li-Ling Hsu. Journal of Advanced Nursing, Volume 66, Number 11, November 2010: p2573–2581
This paper is a report of the development and testing of an instrument that measures metacognitive abilities of nursing students.
Background. Metacognition refers to an individual’s knowledge, awareness and command of thinking and learning strategies. Nursing students are challenged to think and learn in ways that will prepare them for practical work in a complex healthcare environment. Nursing educators have the responsibility to produce graduates who possess and use metacognitive skills to facilitate the solving of ill-structured problems using a variety of mental processes, such as reasoning, judgment and creativity.
Methods. In 2007, the Metacognitive Inventory for Nursing Students was developed, based on previous instruments, and administered to a sample of 802 senior nursing students in two nursing colleges and a university in Taiwan. Principal axis factor analysis and other statistical tests were performed to test the psychometric properties of the questionnaire.
Results. Preliminary analysis reduced the original 40 items to 28. Five factors were retained, accounting for 53·09% of the variance, and these five factors were identified as self-monitoring, self-modification, self-awareness, effective learning and problem-solving. The resultant Metacognitive Inventory achieved good internal consistency reliability, with a Cronbach’s alpha coefficient of 0·94 and the coefficient for the five factors ranged from 0·73 to 0·90.
Conclusion. Nurse educators in Taiwan could use the Metacognitive Inventory for Nursing Students to assess students and facilitate metacognitive skill development in classrooms and in practice settings.

22. Center for Epidemiologic Studies Depression Scale for Children: psychometric testing of the Chinese version
By Ho Cheung William Li et al. Journal of Advanced Nursing, Volume 66, Number 11, November 2010:p2582–2591
This paper is a report of psychometric testing of the Chinese version of the Center for Epidemiologic Studies Depression Scale for Children.
Background. The availability of a valid and reliable instrument that accurately detects depressive symptoms in children is crucial before any psychological intervention can be appropriately planned and evaluated. There is no such an instrument for Chinese children.
Methods. A test–retest, within-subjects design was used. A total of 313 primary school students between the ages of 8 and 12 years were invited to participate in the study in 2009. Participants were asked to respond to the Chinese version of the Center for Epidemiologic Studies Depression Scale for Children, short form of the State Anxiety Scale for Children and Rosenberg’s Self-Esteem Scale. The internal consistency, content validity and
onstruct validity and test–retest reliability of the Chinese version of the Center for Epidemiologic Studies Depression Scale for Children were assessed.
Results. The newly-translated scale demonstrated adequate internal consistency, good content validity and appropriate convergent and discriminant validity. Confirmatory factor analysis added further evidence of the construct validity of the scale.
Conclusion. Results suggest that the newly-translated scale can be used as a self-report assessment tool in detecting depressive symptoms of Chinese children aged between 8 and 12 years.

23. Joint or clinical chairs in nursing: from cup of plenty to poisoned chalice?
By Philip Darbyshire. Journal of Advanced Nursing, Volume 66, Number 11, November 2010: p2592-2599
This paper presents a discussion of the current state of joint chair or clinical chair positions in nursing.
Background. Joint chair positions in nursing or midwifery have been popular approaches to developing clinical research and to bridging the ‘theory-practice gap’. Recent personal observations and commentaries in the literature suggest that the service-academy consensus that underpinned such positions may be crumbling.
Data sources. This paper is based on 13 years’ experience of holding a joint chair position, an extensive review of the professional literature (up to and including 2009 sources), and conversations and discussions with many professorial and joint chair colleagues.
Discussion. Despite its demonstrated success, the joint chair position may be under threat from competing and unrealistic demands from partner organizations and from changing understandings of the essential role and nature of a professor. The situation may be exacerbated by appointing inexperienced or unsuitable applicants to such key posts.
Implications for nursing. The joint chair position was a powerful initiative in nursing and midwifery with real potential. In the current climate, this potential is unlikely to be realized and nursing will be the poorer.
Conclusion. If joint chair positions are still valued and seen as key roles in developing clinical research and university-service partnerships, then serious consideration needs to be given to the current state of position. I argue for a return to trust and what Onora O’Neill calls ‘intelligent accountability’ rather than the micromanagement that is so prevalent in both the health and academic industries

Journals Table of Contents

24. From Employment Today, September/October 2010, Issue 150
Feature articles
24A. On the road to a great future

Auckland-based Urgent Couriers is keeping its foot on the gas, while making sure its business is both economically and environmentally sustainable. HR manager Sue Bonnici-Carter tells Lyndsey Swan about a rapidly changing industry.

24B. Short stories … but true
Stories are central to influencing and inspiring change, says Paul Stewart. They stimulate the imagination and are a source of real organisational knowledge. He explains how to use your success stories to inspire employees and depict the value your organisation aims to create for others.

24C. Ticking the boxes
Professional development courses have been trimmed down, toned up and they’re performing better than ever, reports Jackie Brown-Haysom.  She finds businesses are taking a more considered approach to their executive learning programmes and ensuring the right people get the right training.

24D. Kiwi companies show leadership in literacy
Staff from two of New Zealand’s largest infrastructure companies are getting hooked on learning. Jacqui Gibson checks out the workplace literacy programmes at Fulton Hogan and Downer and finds they have lifted people’s confidence and benefited company culture.

24E. The power of conflict coaching
People problems are time-consuming, energy-sapping and often hard to resolve. What’s more, they can have a profound effect on an organisation’s bottom line. But with the right approach, conflict can also provide an opportunity to build understanding, bring about change, and promote innovation, says Gabrielle O’Brien.

24F. The strategic employee survey
If you or your management team see employee surveys as an unnecessary add-on, then it may be time to reconsider the role that measuring employee attitude and opinion can play in driving your organisation’s success—and how you go about it, says Dr Neal Knight-Turvey.

24G. Learning on the job
Professor Paul Kirkbride, a keynote speaker at the recent HRINZ 2010 Conference, looks at emerging trends in organisational learning and executive education, and at the challenges for the next decade and beyond.

24H. Secret ballots for strike action
A private member’s bill currently before Parliament will make secret ballots for strike action compulsory. Susan Hornsby-Geluk and Chloe Luscombe outline the proposed changes and discuss the implications.

24I. Getting down to business
The transformation of HR professionals from their traditional roles to strategic business partners has been slow, says Clare Parkes. She examines the issue of HR business partnering and explains how to put HR at the centre of business strategy.

24J. Sustainable business: Corporate responsibility signals a smart approach

Forging a business path by specialising in corporate social responsibility has been a successful formula for Nikki Wright, who explains her central philosophy.

24K. Remuneration remedies: Under pressure
As the economy recovers, there is growing pressure from the workforce for solid pay increases. Susan Doughty provides a low-down on wages and salaries in the year ahead and how to deal with employee and union expectations.

24L. HRINZ news: Honestly, what do you think?
Surveys are an important part of organisational functioning and HR activity—but how useful are they, and what should HR professionals consider when implementing them, asks Bev Marshall. She outlines ways to ensure you get real value from your surveys.

24M. Recruitment: New recruitment DNA
The recruitment industry is undergoing massive change and must become more fully engaged with candidates, says Jane Kennelly. She looks at the skills those in the recruitment function of tomorrow will require in order to stay ahead of the game and add value.

24N. Public sector: He’s back
Reinstatement is the primary remedy under the Employment Relations Act. However, as Paul Robertson explains, if there is a
 potential for reinstatement to open old wounds and create disruption and conflict, then the practical solution is for the person to move on.

Conferences, seminars and Courses

25. Medical Sciences Congress
The Theme for the 2010 meeting is: “A New Decade of Discovery”

The conference will focus on the latest breakthroughs in the fields of bio-imaging, inflammatory bowel disease and gut permeability, neuroendocrinology, cardiovascular monitoring, and muscle wasting in addition to more general aspects of physiology, endocrinology, immunology and anaesthesia research
Dates: 30th November to 3rd December 2010
Venue: Millennium Hotel, Corner Frankton Road & Stanley Street
More information:

News - National

26. Nurses support Minister’s statement on unions
Thursday, 21 October 2010, 4:58 pm
Press Release: New Zealand Nurses Organisation 
Nurses support Minister’s statement on health union rights

The New Zealand Nurses Organisation (NZNO) supports Health Minister, Tony Ryall’s statement that he will not reconsider the rights of health unions to take strike action. He has said that laws allowing medical workers to take strike action will neither be reviewed nor changed. “Health workers never take strike action lightly, and when action is taken they comply with self-imposed obligations under the Health Sector Code of Good Faith to
work with service providers to ensure arrangements are in place to provide for patient safety by ensuring that life preserving services are available to prevent a serious threat to life or permanent disability,” says NZNO president Nano Tunnicliff.

27. EDITORIAL: Unions take a stand
The Timaru Herald - 21 October 2010
OPINION: From a public sympathy point of view, the combined union rally on Timaru's piazza yesterday could certainly have been better timed. It coincided with the rostering home of year 9 students as part of the Post Primary Teachers Association's ongoing pay dispute with the Education Ministry, an action that has not been universally popular, particularly among parents. But it would be wrong for those upset by that situation simply to tar those rallying yesterday with the same brush, because the point of the rally on the piazza was not about asking for more money. It was about planned changes to the Holidays and Employment Relations Acts, and the effect those changes could have. And they are changes which could affect all workers, whether unionised or not.



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