This issue of JAN

This issue is characterized by its international content, and by the number of articles that represent collaboration between authors in different countries around the world. Although the topic of shift handover practices surfaces periodically in the nursing literature, it is unusual to see such detailed investigation of practice as is presented in the first article from the UK. The author, a work psychologist from the University of Sheffield, conducted a qualitative study of 20 handovers on two paediatric wards, and also carried out individual and group interviews on the subject of handover. Findings are presented on the multiple functions of shift handover, which emerges from this study as a highly complex communication event with a range of socially and technologically distributed practices. Handover is shown to be a robust practice, able to cope with conflicting demands and intrinsic tensions on the ward. The author believes that handover should be recognized as a valuable nursing asset that at present conceals hidden expertise and knowledge. He believes that this could be exploited in terms of promoting professionalism in nursing. As is usual in ethnographic studies, generalization cannot be claimed. Nevertheless, this article takes our knowledge on the subject of nurse-to-nurse communication several stages on. Not only does the study demand replication in different contexts, its lessons can be applied both to current education, and practice.

Much of the remainder of this issue is concerned with Issues and innovations in nursing practice, with articles from authors across the world. The first paper, from The Netherlands, opens up the intriguing question of overlap between general databases (such as the International Classification of Functioning and Disability, ICIDH-2) and those specific to nursing. In two pilot studies, patient problems as defined by nurses were compared with ICIDH-2 definitions. A considerable fit was identified between nursing diagnoses and ICIDH-2, and the authors recommend that nurses should play an ongoing role in the latter’s development. We would concur, and perhaps go further. Parsimony is the essence of all good classification systems, and one has to ask why, if there is a strong correlation between the terms used in two systems, potential redundancies cannot be identified and eliminated? Greater refinement of the databases could lead to the development of one usable system that should then be shared interprofessionally.

The next article represents one of a growing number that report on cross-European studies. In this case, the authors from Finland, Germany, Spain, Greece and Scotland collaborated on a study of privacy on postnatal wards. They point out that although privacy is considered an important concept in nursing and nursing ethics, there are few empirical studies on the subject. Data on privacy on postnatal wards were collected by questionnaire from large samples of mothers (1192), and nursing staff (952). Clear differences with respect to privacy were identified by the mothers, with Finland, Germany and Scotland apparently maintaining privacy to a greater extent than in Greece and Spain. The country differences were not as clear-cut in the case of the nurses’ responses. This is a pioneering study, not only for its internationalism but also for its importance in identifying cultural differences as possible explanatory factors for the different findings. For example, privacy may mean different things in different countries; workload and shortages of nursing staff may influence nursing practice greatly; and the consideration of ethical issues and human rights may also be highly varied. Thus, studies such as these not only begin to address important practice matters, they also help to clarify the nature of international differences across a range of health care issues. Greater clarity can only add positively to debates in governments and elsewhere, on expectations for standards in health care across the European region, and the feasibility of achieving universal goals.

An author who has contributed greatly to nurses’ knowledge of medication-related issues, particularly amongst mental health patients, heads the team that carried out the next study reported from Wales. The article addresses the perennial issue of undetected adverse medication effects in patients with chronic illness. Having developed an evaluation checklist based on observations of 40 nurse–client interactions, this was tested on a further group of 20, with a similar control group. The prevalence of previously unidentified adverse drug reactions (ADRs) and related physical ill health uncovered in this study highlights not only the extent of these problems in long-term illness, but also their apparent oversight by current follow-up procedures. The authors stress that effective systems for reducing ADRs are needed urgently. However, the efficacy of checklists also needs further testing. Nevertheless, their relative economy when compared with more expensive unproven methods should encourage research funders to support larger, longitudinal studies on this important subject.

Next, we travel to Seattle on the Western seaboard of the United States of America (USA). The authors’ statement that ‘adolescent women are among the most vulnerable and medically underserved subgroups within the homeless population’ could probably apply to virtually any country. Using focus groups and individual interviews with a sample of 20 young, homeless women aged 14–23 years, the authors carried out an assessment of reproductive, health seeking behaviours, sources of advice and access to care issues. What respondents looked for in providers were trust, respect and a nonjudgemental attitude. The use of medical terminology and the giving of conflicting advice by providers were the greatest barriers to good communication, and the young women’s belief systems may not have matched the providers’ biomedical understanding of disease. There were therefore considerable power imbalances between them, and it is unsurprising that frequently clinic attendance appeared to be a ‘last resort’ when self-help had failed. Just as the study population in this study probably represented universal characteristics, so do the authors’ recommendations for practice. The need for an appreciation on the part of health care providers of lifestyle, beliefs, and adaptive attitudes in homeless young women, rather than bestowing the label of ‘deviant’, is a message that could apply to all nurses working with the homeless in any country. As Ribeiro & Trench (JAN35:1, pp. 42–29) concluded in their study of homeless street children in Brazil “(Care) represents an attitude of occupation, worry, responsibility and affective involvement with the other” (Boff 1999, p. 33). It is this broad definition that nurses must adopt if they are really to care for (the homeless) like those represented in this study.

Our global journey takes us next to Uganda for the second article to be published in JAN from the Department of Nursing, University of Mbarara (see JAN33:1, pp. 8–12). Here, a study is reported by American and Ugandan authors on the phenomenon of ‘waiting to know’ for contacts with Ebola haemorrhagic fever. To be confirmed as infected would almost certainly have meant the prospect of imminent death, and this study identifies the salient characteristics of this experience such as fear of premature death and helplessness, combined with anguish over losing close family or colleagues, lack of trust and hopelessness. I reflected that nursing as such an incredibly high-risk occupation is thankfully rare in today’s world of antibiotics and immediate response. Perhaps in the West, the most recent universal experience of similar proportions was the pandemic of acute anterior poliomyelitis during the 1950s. Fear of biological warfare brings this awful reality closer, although even this cannot compare with the emergence of a lethal infectious disease, apparently from nowhere. Here is a sober, thought-provoking paper, which could usefully be discussed in classes on ethics.

Moving across Africa to Tanzania, Swedish and Tanzanian authors report on a comparative study of self-reported health and glycaemic control in their respective countries. Tanzanian patients differed markedly from their Swedish counterparts in several important respects; they had poorer health when compared with the general population of their respective countries. They also had poorer glycaemic control, and Tanzanian patients in this group had significantly poorer reported health in the mental health domain than the Swedish sample. Detailed studies of this kind must surely represent the ‘thin end of the wedge’ in beginning to explain unacceptable differences in morbidity and life expectation found between Western and African populations. The implications go beyond the measurement of health, to questions of resource availability and access to health facilities for those with chronic diseases, such as diabetes. Recent initiatives, for example by the World Health Organisation, in bringing essential drugs to countries who cannot afford Western prices (see, for example, Current issues and forthcoming events, JAN35:4, p. 474) can only be welcomed, whilst also recognizing that issues such as patient and professional education must play a substantial role in bringing about improvements in population health.

South Australia was the venue for the next study reporting on patients’ preferences for a male or female nurse in four different clinical situations. The findings confirmed that the degree of intimacy involved in a clinical procedure was predictive of same-gender preferences. Importantly, experience with male nurses was limited and not predictive of patient preferences or attitudes. The authors compared their findings with those of a study carried out in 1984, and found no significant differences. One might be tempted to argue that choice of the sex of the attending nurse is a luxury that cannot be afforded in many of the situations described in papers in this issue. Nevertheless, cultural aspects of patients’ preferences are also found to be extremely important if services are to be accessed successfully. Studies such as this therefore help us to consider what types of intervention, and by whom, are likely to be cost-effective.

A paper written jointly by English and Australian authors concludes those in the practice section. Concerned with the important area of complementary therapy in the management of coronary heart disease, this small comparative study found one significant effect (on calm scores) following postsurgical foot massage. Although no significant differences between physiological parameters were found, there was a clear trend across all psychological variables for both foot massage, and guided relaxation to improve psychological well-being. Non-invasive techniques such as these may prove to be cost-effective ways of improving the psychological health of patients undergoing major surgical interventions. Further, large-scale research is clearly indicated.

An important conceptual analysis of Infant Feeding Responsiveness, follows, written by authors from the USA. Like many concepts used in daily nursing practice, infant responsiveness in the past has been understood implicitly to mean many different things but, until now, has never been defined adequately. As in so many of the conceptual analyses published in JAN, the authors perform an extremely valuable service in providing nurses with, at least, a provisional definition. The section on the relevance of their findings to nursing practice is extremely important. Faced with negative behaviours in response to feeding attempts, parents may feel rejected by their infant and experience confusion and frustration. Knowledge of infant responsiveness can help nurses to foster care-giver-infant reciprocity, and thereby facilitate more effective, family-centred care. Thus, once again, a detailed academic paper provides practical advice of immense use to nurses in their day-to–day interactions with parents. That further refinement is advocated is an additional challenge to be taken up by children’s nurses.

A contribution to JAN Forum responding to an earlier critique concludes the issue. We always welcome dialogue of this kind and hope that the author may write more for JAN on the differences between the paradigms to which she refers in this communication.