Nurs. Rep., Volume 2, Issue 1 (December 2012) – 12 articles

In the period 1945-1965 most women in the state of Queensland, Australia, gave birth in hospitals and thereafter they used a variety of services and individuals for advice on infant feeding. The services available were similar throughout the period. As mothers rarely worked outside the home, being good mothers was important to their identity. In this historical study, telephone interviews and written responses involving 44 mothers and former nurses from every region of this geographically vast state were used in order to investigate sources of personal advice on infant feeding used during this period, mothers’ experience relating to this advice, and the extent to which they followed the advice. The free, nurse-run well-baby clinics and related services conducted by the state’s Maternal and Child Welfare service were the most commonly mentioned services. However, the uptake of advice from this source showed considerable variation as women also drew upon family members, their general practitioners, advice columns, radio broadcasts, other mothers and their own judgment. Only rarely was a specialist pediatrician consulted. A minority of mothers was advised by pharmacists, private baby nurses, or entered residential mothercraft facilities. An important finding is that attendance at the baby clinics did not necessarily equate with compliance, especially as mothers became more experienced. Full article

The European Year of Healthy Ageing recognizes that health care systems need to be improved and reorganized if services are to optimize the opportunities for people to stay healthy and well in their own homes for as long as possible. However, current services tend to be fragmented and insensitive to the needs of older people and their carers resulting in services being underused or refused leading to increased admissions into acute hospital care that could have been prevented. The main aim of the study reported in this paper was to identify the factors that affected older peoples’ decision and choice-making processes, when using or contemplating the use of care services. Using a constructivist methodology, this study used participant observation and 23 interviews in three study settings: an African Caribbean support service, day centers for people with memory and cognition problems and luncheon clubs for older people. An inductive analysis of the data revealed that when older community dwelling people found themselves struggling with certain aspects of their daily care needs; they used adapting, coping and seeking as strategies to manage. Additional issues of how well services were able to meet individual’s aspirations for care and support were identified through themes of match-mismatch, fair-unfair, independence-dependence. The findings reported in this study provide important insights as to how people’s needs are complex yet are negatively affected by rigid state controlled services that ultimately affect individual decisions to use or refuse services. Full article

This paper describes a malaria knowledge test (MKT) developed to evaluate a web-based game for students who increasingly travel to malaria- risk regions of the world. The 18-item MKT was structured according to the dimensions of the self-regulation model (SRM) to measure the accuracy of students’ beliefs about malaria. An experimental design was used to compare three game versions. Students (N=482) participated in 2010 by completing a pre-test, playing a Web- based game simulating student travel to malar- ia-endemic destinations, and completing a post- test. Study data support the validity and reliabil- ity of the MKT for the evaluation of malaria edu- cation interventions and for student self-assess- ment. Use of the MKT to evaluate an education- al game about malaria revealed a strong overall learning effect and discrimination by game ver- sion, travel experience, and SRM dimension. This 5-min test may also be adapted for educa- tional outreach purposes among health care providers globally, residents of malaria-endemic regions, and other high risk travel groups (e.g. , elderly, chronic health conditions, pregnant, or returning to malaria-endemic regions to visit friends/relatives). Full article

In the past, the study of old age often focused on the losses and problems associated with ageing. In recent times, the focus has been on the positive aspects, such as quality of life, inner strength, and enjoying life. The aims of this study were to highlight the ways in which chronically ill older persons experience the meaning of daily life and to understand what it means to live at home with chronic dis- ease. In-depth interviews were used to illus- trate individual experiences. The sample con- sisted of 13 chronically ill persons, aged 80 to 94 years, living at home and receiving assis- tance in the form of home nursing care. Data were analyzed using the phenomenological hermeneutical method. After a naïve reading and a structural analysis of the text, we identi- fied three themes: being insufficient, becoming dependent , and enjoying life . The comprehen- sive understanding suggested that daily life involved bad days , described as illness with dysfunctions, limited energy, and dependency on others. Daily life also had its positive aspects, described as enjoying life . Dignity was threatened by feelings of being a burden to others and was affirmed by experiencing a will to live. It was concluded that bad days with experiences of suffering and good days that provided the older with experiences of enjoy- ing life could help them meet adversity through qualities of resilience that gave mean- ing to daily life and helped them to think posi- tively in times of greater difficulty Full article

Nurses’ Quality Of Life (QOL) may be affected by many different factors that can in turn influence their job competency. The aim of this study was to assess the QOL of Iranian nurses to provide evidence to enable policy makers to take the necessary steps needed to make improvements. Using a cross-sectional study design, we evaluated the QOL of Iranian nurses by the assessment of four health indicators: physical, psychological, social and environmental. A total of 850 nurses from 17 different provinces of Iran were recruited by random sampling. They were requested to complete the World Health Organization QOL-BREF questionnaire. Data were then analyzed. Results indicated that half of the nurses scored in the moderate range, suggesting that they had a reasonably good QOL. They scored considerably higher in terms of physical health indicators and achieved significantly lower scores regarding environmental health issues. Although the χ² test did not show any significant association between the QOL indicators and different factors such as work experience, gender, job position and patients group. We found a significant association between the subject’s position at work in the hospital shift pattern and their overall QOL score. The results of our study showed that more than half the nurses evaluated their QOL to be at a moderate level. The results from this study can be used by policy makers to help make improvements to nurses’ QOL that may enhance the quality of care they deliver to their patients. Future research including a group of nurses from over the whole country is essential so that a more representative cohort can be studied. It would also pave the way for the establishment of a QOL database for nurses in Iran that could monitor changes in the nursing population. Full article

Many patients wish to discuss spiritual issues with nurses. Previous work has shown that nurses do so infrequently. A mixed meth- ods research approach was used to investigate the perceptions of spiritual care of nurses and patients. Fifty-one nurses and 75 patients of five hospital departments of a non-academic hospital in the Netherlands were surveyed in 2007. We recorded the nurses’ perception of patient wishes, perceived relevance of spiritu- al care for patients, spiritual care provided in practice, and their evaluation of the spiritual care provided for the patients. With regard to the patients the nurses cared for, we recorded their satisfaction with the information and experiences of spiritual care provided by the nurses. Furthermore, semi-structured qualita- tive interviews with eight nurses examined the nurses’ perceptions of spiritual care including perceived barriers and facilitators of spiritual care giving. The nurses generally per- ceived spiritual care as important. The quanti- tative and qualitative research indicated that time to listen, availability, empathic skills, openness to other opinions, and a good relation- ship of trust were important facilitators. Forty- one per cent of the nurses said that few patients received sufficient attention to their spiritual needs. Patients also experienced lim- itations in the support for and registration of their spiritual needs. Both nurses and patients acknowledged shortcomings in the provision of spiritual care. Even though some issues may be improved relatively easily, such as register- ing needs, in practice giving spiritual care is complex, as it requires being available and building a relationship with the patient. Full article

Chronic obstructive pulmonary disease (COPD) changes family roles and relationship dynamics and the experience of the disease is influenced by family functioning. Merleau- Ponty’s existential philosophy of the body pro- vided the framework for this Heideggerian phenomenological inquiry. Fifteen people with COPD and 14 family members engaged in 58 semi-structured interviews either face-to-face or by telephone. This study identified a differ- ence in the essence of the lived experiences between male and female carers, and between spousal and non-spousal carers in relation to severe COPD. Previous reciprocity framed the level of acceptance of the caring role and per- ception of care burden. The stories highlight the self-perceived need for women carers to be conscious micro-managers of illness. Male fam- ily members would care alongside, lending support and caring in a reactive way as specif- ic needs or crises arose. Caring in COPD required a binding vigilance ; a constant need of the carer to monitor the physical and emo- tional well-being of the sick person that bound them emotionally and cognitively to the task of caring. Carers were the managers of crises and families cared from a perspective of possible death. Family was perceived as the best thing in life. Health professionals should consider the influence of gender, family relationships and the impact of reciprocity when planning support for family caregivers. Further research is required to identify the similarities and dif- ferences in family caring between COPD and other chronic illnesses, and to further under- stand the specific needs of male carers. Full article

The Trent Universities Interprofessional Learning in Practice (TUILIP) project aimed to establish interprofessional learning (IPL) for healthcare students in clinical practice settings. Ten IPL facilitators were employed in eight varied practice setting pilot sites for up to a year to research, develop and run locally appropriate, sustainable IPL initiatives. Following the pilot phase, a qualitative evaluation was conducted in each site by means of interviews or focus groups with all key stakeholders (facilitators, clinical managers, practitioners, students, service users, carers). Data collection was guided by Kirkpatrick’s evaluation framework (1996), which focuses upon participant reactions, and their perceptions of learning, behaviour change and sustainable impact. In keeping with this framework, participants were asked to discuss their experiences of TUILIP in their placement setting (including its facilitation), and their opinions about its impact and success in terms of learning, behaviour change and sustainability. We report a subset of evaluation results relating to the roles of the facilitator, facilitation processes, experiences and challenges, personal and professional impact upon facilitators, and implications for IPL projects in practice. Facilitation tasks included preparing the ground, earning credibility, gathering ideas, researching feasibility, developing initiatives, involving service users, trialling and embedding initiatives. Facilitators were faced with challenges such as getting a focus, time limitations and dealing with logistics. They reported highs (being a fly on the wall, protected time, their educational role, and a sense of satisfaction) and lows (loneliness, frustration and fear of failure), but considered they had developed personally and professionally as a result of their experiences. Results demonstrated the complexity and demands of establishing and facilitating IPL initiatives in practice settings. Facilitation was time-consuming and effortful and did not always achieve its aims, but was a source of satisfaction and personal development. These findings suggest higher education institutions and practice settings should consider carefully the selection, preparation and support for facilitators of practice-based IPL, as well as how to engage local practitioners and service users, and embed changes in the clinical setting. Full article

The authors aimed to evaluate the Safe Harbors Youth Intervention Project inter-sec- toral collaboration to improve continuity and appropriateness of services for sexually exploited children and adolescents. The study was carried on through an intensive, single case study, drawing on interviews and focus groups with experiential youths (n=125) and multi-sectoral stakeholders (n=196), docu- mented activities, and repeated interviews with collaborating team members (n=29), teen clients (n=46) and parents (n=22). The collab- oration was designed around an eight-step process for creating victim-centered protocols within and across organizations, altering serv- ices to bridge gaps in care, and creating train- ing tools for the different sectors. The results of the study showed an initial needs assess- ment documented fragmented care and prob- lematic communication across departments and sectors. The shared protocol development among decision makers from each agency, focused on best practices and evidence-based interventions, fostered trusting relationships, improved awareness of different roles and services, and speeded practice changes to remove barriers to care for sexually exploited youths. A task-focused collaboration with a shared community-wide protocol, increases transparency between services, and ongoing inter-sectoral training helps healthcare team foster a meaningful response to sexually exploited youths. Full article

Medication errors compromise patient safety and cost £500m per annum in the UK. Patients who forget the name of their medication may describe the appearance to the doctor. Nurses use recognition skills to assist in safe administration of medications. This study quantifies healthcare professionals’ accuracy in visually identifying medications. Members of the multidisciplinary team were asked to identify five commonly prescribed medications. Mean recognition rate (MRR) was defined as the percentage of correct responses. Dunn’s multiple comparison tests quantified inter-professional variation. Fifty-six participants completed the study (93% response rate). MRRs were: pharmacists 61%; nurses 35%; doctors 19%; physiotherapists 11%. Pharmacists’ MRR were significantly higher than both doctors and physiotherapists (P<0.001). Nurses’ MRR was statistically comparable to pharmacists (P>0.05). The majority of healthcare professionals cannot accurately identify commonly prescribed medications on direct visualization. By increasing access to medication identification resources and improving undergraduate education and postgraduate training for all healthcare professionals, errors may be reduced and patient safety improved. Full article

In collaboration with Age Concern UK, older people were invited to participate in action learning groups to explore how they adapt to change. Themes for discussion were initially identified using a nominal focus method. Discussions identified actual and desired methods of coping with changes in later life. A series of weekly meetings with three cohorts of urban, rural and sheltered accommodation participants with an average age of 81 years revealed that they were concerned with having to cope with and adapt to a wide range of experiences. These included the loss of sharing and reduced sociability, reduced mobility, bereavement, physical changes, having to move house and/or location, having to retire, and having to deal with outside agencies. In order to cope with these experiences, participants engaged in a range of activities that centered on aspects of communication and social networking. Participants talked to each other socially and informally, exchanging information and advice. When able, they also participated in more structured but non-specific social events during which time they also had the opportunity to support each other. Participants suggested that there was a role for statutory and nonstatutory bodies and professions such as mental health and community adult nursing, occupational therapy and social work to provide more formal social networking and information exchange opportunities. Full article

While women who informally shared breast- feeding or breastmilk (also called cross-nurs- ing or co-feeding) in the latter part of the twentieth century were often reluctant to dis- close this practice, media attention in the last few years has resulted in this practice being discussed more. Nurses may, therefore, encounter mothers who have shared or are sharing breastfeeding or their breastmilk at least once. This paper is the second of two to explore the experiences of mothers co-feeding in a variety of situations. Twenty-two mothers who had co-fed, and the coordinator of an online milk-sharing network, were recruited from online breastfeeding discussion net- works, personal contacts and word of mouth. Sampling stopped when eight countries were included. Respondents came from a range of cultures and gave different reasons for this practice. They could choose whether to respond to a set of open-ended questions by e- mail or telephone. A number of different situa- tions were identified in which the women had cross-fed on one or more occasions. Cultural issues, including milk siblingship in Islamic and other cultures, were explored. Consent was important, but fully informed consent was not necessarily obtained. Although no formal screening was conducted, it was clear that the women informally screened those with whom they shared their milk. In this study, sharing of breastfeeding or breastmilk mostly occurred in kinship or close female relationships, or at least between women with similar lifestyles and values, and seldom through casual con- tacts. In most cases, there was informal screening and the women would not have cross-fed indiscriminately Full article