To assess and understand the barriers faced by Vietnamese marital immigrant women who do not regularly undergo cervical screenings in Southeast Taiwan.

Studies have shown a low uptake rate of preventive medical services among immigrants. As immigrant women may not be aware of the healthcare delivery system in their host country, their uptake of and access to healthcare services might be limited.

A qualitative, descriptive inquiry design was adopted.

This qualitative study employed semi-structured, individual, in-depth interviews of 17 Vietnamese immigrant women. Data were collected from February–July 2011 and analysed using content analysis.

The barriers to receiving cervical screening were lack of health literacy, lack of female healthcare providers, negative perceptions of cervical screening and personal reasons.

The results might serve as a reference for government entities and healthcare providers in Taiwan to improve cervical screening rates; this should help enhance the effectiveness of healthcare services for Vietnamese immigrant women. The findings can also provide a reference for making appropriate healthcare policies for immigrant women in other countries.

To describe a study protocol designed to explore the associations among the perceived unmet supportive care needs, quality of life and the demographic and clinical characteristics of head and neck cancer survivors.

The prognoses for people with head and neck cancer are improving with medical advances. However, studies have reported that such cancer survivors experience poor quality of life. Current studies mainly focus on Western populations and there is limited research investigating the needs of head and neck cancer survivors.

A mixed-design method is proposed, which will include two phases. Phase I will use a quantitative cross-sectional design and Phase II a qualitative descriptive approach.

The participants will be recruited from the outpatient departments of three public hospitals in Hong Kong. In Phase I, a questionnaire will be used to collect demographic and clinical characteristics, supportive care needs, necessary access to various supportive services and quality of life. Semi-structured interviews will be conducted in Phase II. The study is supported by a grant from the Health and Health Services Research Fund, Hong Kong, September 2011.

The study will generate in-depth information on the needs of head and neck cancer survivors, to help healthcare professionals allocate resources better and develop new services, which can be more person-centred, to meet the needs of the these survivors.

We examined the impact of workplace relationships (perceived organizational support, supervisor–nurse relationships and teamwork) on the engagement, well-being, organizational commitment and turnover intentions of nurses working in Australian and USA hospitals.

In a global context of nurse shortages, knowledge about factors impacting nurse retention is urgently sought. We postulated, using the Social Exchange Theory, that nurses' turnover intentions would be affected by several factors and especially their relationships at work.

Based on the literature review, data were collected via a self-report survey to test the hypotheses.

A self-report survey was used to gather data in 2010–2012 from 510 randomly chosen nurses from Australian hospitals and 718 nurses from US hospitals. A multi-group structural equation modelling analysis identified significant paths and compared the impact between countries.

The findings indicate that this model was more effective in predicting the correlations between variables for nurses in Australia compared with the USA. Most paths predicted were confirmed for Australia, except for the impact of teamwork on organizational commitment and turnover, plus the impact of engagement on turnover. In contrast, none of the paths related to supervisor–subordinate relationships was significant for the USA; neither were the paths from teamwork to organizational commitment or turnover.

Our findings suggest that well-being is a predictor of turnover intentions, meaning that healthcare managers need to consider nurses' well-being in everyday decision-making, especially in the cost-cutting paradigm that pervades healthcare provision in nearly every country. This is important because nurses are in short supply and this situation will continue to worsen, because many countries have an ageing population.

To explore the experiences of nurses providing sexual health care to adolescents with physical and/or developmental disabilities, with attention to the institutional and social discourses that shape these interactions.

Previous research has shown that nurses demonstrate a lack of attention to the impact of illness or disability on sexual health. However, in their therapeutic relationship with patients and families, nurses are in an ideal position to promote sexual health.

A critical ethnography study was conducted in an urban paediatric rehabilitative facility.

Field work occurred over 4 months (2008–2009) and data collection included interviews (n = 9), key informant discussions, collection of documentary evidence and observation of the institutional setting.

Four themes were identified (institutional space, professional interactions, engaging with sexuality, nursing experience), which revealed that nurse–patient interactions about sexual health were affected by a complex network of discourses. These encounters were shaped by practical discourses, such as time and space and by more complex discourses, such as professional relationships, normalization and asexuality.

Nurses occupy and strive to maintain, the role of a caring agent. However, aspects of the clinical, institutional and broader social environments may undermine their ability to promote sexual health. In nurses' efforts to maintain therapeutic relationships with clients, sexual health is often medicalised to legitimize it as an appropriate topic of discussion with patients and families. Facilities serving youth with disabilities should take steps to address barriers to the delivery of sexual health promotion and several solutions are proposed.

To understand the knowledge and perceptions of type 2 diabetes and to explore preferable educational strategies in the non-diabetic offspring of patients with the disease.

Type 2 diabetes is an increasingly prevalent disease with significant long-term consequences. Offspring of patients with type 2 diabetes have an increased risk of developing the disease compared with the general population. Previous studies have shown that offspring have a poor perception of their own risk.

A qualitative study was carried out using semi-structured one-to-one interviews. Analysis was completed using a structured framework approach.

Research was carried out during January–March 2011 in the north east of UK. Six offspring of patients diagnosed with the disease were interviewed.

Participants balanced positive and negative aspects of their lifestyle behaviours to estimate their own risk. They had adequate knowledge of healthy lifestyle behaviours, but were uncertain about the long-term effects and seriousness of the disease and the role of inheritance. Behavioural changes at an individual level would only be motivated by an event, which would impact on their own health. Participants believed that ‘fear’-based strategies to health promotion would be most effective to encourage behaviour change.

Knowledge of individual risk and why diabetes was serious was limited and variable. The health behaviours of this at-risk group were complex. Nurses engaged in the care of at-risk individuals must take this complexity into account when developing and implementing multi-faceted strategies to improve awareness.

This article reports on a study which examined the predictive relationship between emotional intelligence and the following programme outcomes for student nurses: clinical practice performance; academic performance and retention.

In the context of concerns about a lack of compassionate care and amid calls for values-based selection procedures, emotional intelligence is emerging as a potential factor which might help the nursing profession to address some of these concerns.

The study employed a longitudinal survey.

Student nurse applicants (n = 307) were asked to complete self-report scales to establish a total score and four subscores for emotional intelligence and these scores were matched to individual student's performance on the undergraduate programme. The scales were completed between June–September 2007 and performance data were collected up until January 2009.

A significant predictive relationship was found between emotional intelligence and all three programme outcomes: practice performance; academic performance and retention, after controlling for prior academic achievement, age and gender. There was a zero Pearson correlation between prior academic attainment and overall emotional intelligence, indicating that both predict different outcomes.

Recruitment and selection procedures should consider emotional intelligence as a legitimate additional entrance criterion for student nurses and further research is required to examine the potential relationship between emotional intelligence and compassionate care.

To explore affective and attitudinal outcomes of aspects of the psychological contract, organizational justice and negative affectivity in nursing.

Job satisfaction, mental health and commitment to organizations and the nursing profession is important for nurse retention. The psychological contract and organizational justice are related constructs that have been linked to these outcomes, as has the characteristic of negative affectivity. Rarely have the relationships between these concepts and outcomes been examined.

Cross-sectional data were collected during November, 2007.

Survey data collected on Registered Nurses and midwives from a large metropolitan hospital in Australia (n = 193, after removing missing cases and outliers) were analysed using structural equation modelling. The model used self-report measures of psychological contract obligations, fulfilment and breach, organizational justice and negative affectivity as predictors of job satisfaction, organizational commitment, career commitment and psychological distress.

Goodness-of-fit statistics confirmed a well-fitting model. The model explained 49%, 29%, 60% and 47% of the variance in psychological distress, job satisfaction, organizational commitment and career commitment respectively.

Findings support the influence of the psychological contract, fairness and individual differences on outcomes important to nurse retention. Keeping promises is more important than making promises that cannot be kept. The results support a discrepancy mechanism underlying fulfilment and breach. The impact of breach suggests that nurses take breach personally, whereas fulfilment may represent a global evaluation of discrepancies. Ultimately, fulfilling, rather than making promises, keeps nurses happy.

To explore incentives and barriers to an educational lifestyle intervention for people with severe mental illness.

Social and lifestyle factors along with long-term antipsychotic therapy contribute to poorer physical health in people with severe mental illness. Behavioural lifestyle interventions for this clinical group have shown some benefit. Evidence relating to the incentives and barriers to interventions is limited.

An ethnographic qualitative study was undertaken.

Data collection was carried out through participant observations and semi-structured interviews with eight mental health service users attending, or previously attended, a group-based lifestyle intervention. Interview data were collected between September 2008–April 2009 and observation data were collected between September–December 2009.

Participant observation highlighted environment, facilitator style, group ownership, group cohesion, information and learning, incentives and barriers as important. Participant interviews identified weight management, social networking, information and communication, role of healthcare professionals and perceived benefits as key themes.

This study provides evidence about the incentives and barriers to lifestyle interventions from service users' perspective, which should inform developments to improve the delivery of lifestyle interventions for this group.

To describe patients' experiences of bladder emptying and urinary catheterization in connection with hip surgery.

The capacity of bladder emptying in connection with hip surgery is affected by pain, medication and confinement to bed. In connection with such surgery urinary catheterization is often performed, either intermittent or indwelling. Hip surgery patients' experiences of urinary catheterization and urination have not been studied before.

A qualitative study with descriptive design was conducted among hip surgery patients.

Thirty face-to-face interviews were conducted from October 2009–March 2010 and analysed with inductive qualitative content analysis.

The main category ‘An issue but of varying impact’ illustrated the patients' experiences of bladder emptying and urinary catheterization. Five generic categories were identified: ability to urinate, catheter is convenient, bothersome bladder emptying, intrusion on dignity and concern about complications. Irrespectively of whether the patients were able to urinate or were catheterized, the bladder emptying situation was not as usual. It was described as uncomplicated and experienced as being positive if the patients were able to urinate by themselves or when catheterization was experienced as convenient. Some patients did not want to be catheterized, approving it only reluctantly. Independently of the method for bladder emptying, the patients in our study would choose the same method next time.

The patients undergoing hip surgery seem to experience bladder emptying as an issue but of varying impact. Both bladder emptying through micturition and bladder emptying through catheterization are described in positive and negative terms.

To compare the self-construal of nurses and doctors and establish whether their roles affect perceptions of independence and interdependence.

Previous research has identified that errors in patient care occur when health professionals do not work cohesively as a team and have divergent beliefs about collaboration. Thus, it is important to understand factors shaping these beliefs. Although these are usually explained by aspects of group norms, the concept of self-construal may serve as an underlying explanation.

A quasi-experimental design was used.

One hundred and two nurses and doctors working in three nursing homes in Belgium took part in this study in 2009.

Nurses' and doctors' self-construal was measured at their workplace, using Singelis' self-construal scale. Statistical differences between nurses and doctors were investigated using analysis of covariance.

Results showed statistically significant differences between doctors' and nurses' self-construal. Doctors reported higher and dominant levels of ‘independent self-construal’ compared with nurses. There were no differences between nurses and doctors for interdependence. However, gender differences emerged with male doctors reporting lower levels of interdependent self-construal than male nurses. Conversely, female doctors reported higher levels of interdependent self-construal than female nurses.

Differences in the roles and training of nurses and doctors and in knowledge of their interdependencies may explain differences in self-construal. This might be useful for understanding why nurses and doctors develop divergent attitudes towards teamwork. Training that focuses on sharing knowledge on team interdependencies may positively influence teamwork attitudes and behaviour.

To explore the experiences of family carers of people with cognitive impairment during admission to hospital.

Providing appropriate care in acute hospitals for people with co-morbid cognitive impairment, especially dementia or delirium or both, is challenging to healthcare professionals. One key element is close working with family members.

Qualitative interview study.

Semi-structured interviews with family carers of 34 older people who had been admitted to a UK general hospital and had co-morbid cognitive impairment. Interviews conducted in 2009 and 2010. Analysis was undertaken using Strauss and Corbin's framework.

The findings elaborate a core problem, ‘disruption from normal routine’ and a core process, ‘gaining or giving a sense of control to cope with disruption’. Family carers responded to disruption proactively by trying to make sense of the situation and attempting to gain control for themselves or the patient. They tried to stay informed, communicate with staff about the patient and plan for the future. The interaction of the core problem and the core process resulted in outcomes where family members either valued the support of hospital staff and services or were highly critical of the care provided.

Family carers are not passive in the face of the disruption of hospitalization and respond both by trying to involve themselves in the care and support of their relative and by trying to work in partnership with members of staff. Nurses need to foster this relationship conscientiously.

To report an analysis of the concept of acquired pharmaco-dynamic opioid tolerance.

Acquired pharmaco-dynamic opioid tolerance is a complex and poorly understood phenomenon associated with strong opioid therapy for managing pain. Critical review of the concept provides greater clarification of the attributes, assisting healthcare professionals in addressing pain and functional management of patients, particularly those with non-malignant pain.

Concept analysis.

A systematic literature search was undertaken using electronic data bases: CINAHL, British Nursing Index, EMBase, Medline, Pubmed and AMED. All literature reviewed was in English and published between 1976 and 2012. The key search terms were ‘chronic non-malignant pain’, ‘strong opioid therapy’ and ‘development of acquired pharmaco-dynamic opioid tolerance’; all possible variant terms were also searched.

The Walker and Avant approach was used to guide the concept analysis.

The concept analysis revealed four empirical referents: plasticity, drug administration, reduced analgesic efficacy and increased drug dosing. Tachyphylexia was identified as a borderline case, opioid induced hyperalgesia as a related case and pseudo-tolerance as a contrary case. The antecedent is administration of an opioid analgesic drug and the consequences, increasing opioid drug dose to maintain analgesic effect.

Untangling the antecedents, empirical referents and consequences of tolerance help healthcare professionals understand its complexities. Improved knowledge may ultimately influence patient outcomes through the construction of better monitoring systems. This concept analysis may also provide insights for policy change and give empirical direction for future research.

To identify determinants of practice nurses' intention to implement a new smoking cessation intervention and to investigate the independent value of attitude and Rogers' innovation characteristics.

While effective smoking cessation interventions exist, implementation is often suboptimal. No previous studies have disentangled the independent value of beliefs towards implementation and innovation characteristics in explaining implementation.

A cross-sectional descriptive study.

In 2010, 56 of 91 general practice nurses who participated in an intervention effectiveness trial completed an online questionnaire concerning demographics, patient population characteristics, attitude, innovation characteristics, self-efficacy, perceived social influence and intention to implement the intervention in the future. Recruitment success during the trial was defined as the number of patients participating. To detect differences between intending and non-intending practice nurses, independent sample t-tests and Chi-squared tests were conducted. Correlation coefficients were calculated to identify associations between potential determinants of intention. To identify significant determinants logistic hierarchical regression analyses were conducted.

Innovation characteristics and attitude were both significantly associated with practice nurses' intention to implement. While recruitment success showed a significant positive association with intention, perceived patient support was only a significant determinant when including innovation characteristics or attitude.

To increase new interventions' implementation rates, it is most important to convince health professionals of its beneficial characteristics, to generate a positive attitude towards the intervention, to aid practice nurses in recruiting smoking patients and to increase perceived patient support.

This article presents a discussion of the conceptual model of ethical sensitivity.

Recent research pays little attention to the tacit dimension of ethical knowledge. We focus on care practices, drawing a distinction between explicit moral knowledge and tacit moral knowing. This focus has far-reaching methodological consequences, influences the research design of empirical research and enables healthcare workers to discern both explicit and tacit knowing.

This article draws on literature about tacit knowledge, practices and ethical sensitivity, covering publications from 1958–2011. Data used in the illustrative cases were gathered in 2009 during the phenomenological phase of a multiple-case study.

Taking practices as the point of entry for exploring ethical sensitivity makes it possible to study empirically both explicit moral knowledge and tacit moral knowing. Given how relevant practical knowledge is, we aim to put forward a theoretical framework that leaves room for the discernment of this tacit moral knowing.

Creating opportunities to reflect on daily ethical concerns in an inter-professional team can contribute to improvement on quality of care.

The broadened perspective on ethical sensitivity can be used as a heuristic device to discern what both explicit and implicit moral knowledge in care are about. This empirical way of looking at care practices can enhance the awareness of the moral knowing of the professional caregiver.

To discuss the definition of spirituality and its limitations for nursing research. It proposes a definition that will capture more accurately the role of spirituality in health outcomes.

Studies have increasingly examined spirituality in nursing research as a coping mechanism attenuating the negative impact of traumatic stress on mental health. Existing definitions of spirituality in nursing research include elements of positive emotional states (meaning, purpose, general well-being) which confound mental health outcomes.

Medline and CINAHL databases were searched from 2007–2011 for research articles examining spirituality definitions and measures used by nurse researchers.

An analysis of the definitions of spirituality in nursing research reveals inconsistencies and confounding mental health concepts. The authors propose defining spirituality in the context of religious involvement when conducting research, while using a broader definition of spirituality when providing spiritual care. They argue such definition provides a more appropriate method of measuring this concept in research aimed at evaluating mental health outcomes while preserving the currently used patient-defined definition of spirituality when providing spiritual care.

A consistent definition of spirituality in nursing research evaluating mental health outcomes, distinct from ‘spiritual care’ in a clinical setting, is essential to avoid tautological results that are meaningless. Appropriate definitions will enable nursing researchers to more clearly identify resilience mechanisms and improved health outcomes in those exposed to traumatic stress.

A definition of spirituality that focuses on religious involvement provides a more uniform and consistent measure for evaluating mental health outcomes in nursing research.

To explore if and how information about a transition to a palliative care approach was communicated to patients recently discharged from hospital and who fulfilled standardized criteria for palliative care need.

Palliative care philosophy and, more recently, UK palliative care policy, endorse a context of ‘open’ awareness, where all parties openly acknowledge that the patient's death is approaching. The perceived benefits of making the patient aware of their prognosis encompass a variety of planning activities, which mean that death, when it occurs, is arguably more in keeping with the wishes of the patient.

A qualitative inductive interview study conducted in 2010–2011.

Fifteen semi-structured interviews were conducted with 15 patients and 3 family carers. All patients were identified as having palliative care needs according to standardized criteria, 3–6 months after discharge from hospital. A thematic analysis was undertaken.

Contrary to the professed ideal of ‘open’ awareness, some participants were only partially aware and others wholly unaware that they were likely to be approaching the end-of-life. Those identified as unaware were over 85. Participants displayed a reluctance to acquire knowledge which would require them to face the imminence of death.

Philosophy and policy aside, people do not always conform to the autonomy paradigm of a self-directed life followed by a self-directed death.

To elicit the strategies used by Japanese family caregivers in the community to encourage older relatives with dementia to use adult daycare and respite stays.

Older adults with dementia often require adult daycare and respite stays for their family caregivers to gain respite from care-giving. However, persons with dementia often face difficulty in new environments and timely access to sufficient services may be difficult to achieve. Few studies have examined how family caregivers encourage their service use.

A qualitative method.

Semi-structured interviews were conducted with 16 family caregivers who were caring for relatives with dementia at home between 2005–2007. Data were analysed qualitatively.

Family caregivers used various strategies to encourage older relatives to use services, allowing the older adult to decide whether to use the service, yearning and searching for the least harmful service, tailoring the service to the older adult, persuading the older adult to use the service, conforming the older adult to the service and coercing the older adult to use the service. Different strategies were used depending on factors such as desperation in needing respite, willingness to do what is best for the older adult, confidence in taking care of the older adult and the anticipated response of the older adult to services.

Nurses should carefully assess caregivers' strategies in their attempts to encourage service use and should provide adequate assistance in accordance with those strategies.

To explore individuals' stories of chronic kidney disease, particularly those aspects of experience that are difficult to discuss using language (i.e. unsayable).

Chronic kidney disease is continuous, but it is also life-threatening and sometimes people ask difficult questions about life and death that can be challenging and for some, impossible to discuss. These ‘unsayables’ are the focus of this article. The unsayable may reside both within and beyond language. Careful analysis of narratives of illness for sayable and unsayable aspects of the experience can help illuminate new areas of concern for people with chronic kidney disease.

Narrative inquiry, located in a social constructionist framework, guided this study.

Secondary data analysis was conducted with 46 in-depth interviews (collected between 2008–2011) with 14 people living with chronic kidney disease.

Through narrative thematic analysis, we identify that the unsayable includes the following five themes: living with death, embodied experiences that were difficult to language, that which was unthinkable, unknowable mystery and that which was untold/unheard. Whereas the first four themes attend to that which is unsayable for people living with chronic kidney disease, the last theme acknowledges that which is unsayable to people living with chronic kidney disease.

Not all experiences of illness can be explicitly articulated in language. Listening for both the sayable and unsayable aspects of life with chronic and life-threatening illness is an important nursing role.

To report an analysis of the concept of concordance.

Adherence-based medicines interventions are known to be of limited success. Concordance appears to offer an alternative approach consistent with person-centred approaches to decision-making. However, the application of the principle of concordance appears inconsistent. This article considers the extent to which any of this confusion may be a function of the different usage of the term concordance in the disciplines of nursing, general medicine, psychiatry and pharmacy.

Rodger's evolutionary method of concept analysis.

CINAHL, Medline, PsychINFO, Cochrane library, Psychology and Behavioural Sciences Collection were searched for publications between 2000 and 2012 with combinations of key words including concord*, adherence, compliance, medic*, psychiatr*, pharm*, nurs*.

Rodgers' evolutionary analytic method was used to identify and explore the concept of concordance across healthcare disciplines. A representative sample of papers was identified from the source disciplines. Over 500 papers were identified. Exclusion criteria limited the final sample to 60 papers in total, entailing 15 per discipline. Each discipline's papers were analysed for references, antecedents, consequences, attributes and surrogates separately. The team then worked together to cross-check these interpretations.

There was minimal agreement between the disciplines suggesting each discipline practised a different conceptualization of concordance. The main point of agreement was that better research is required to articulate the scope and value of partnership working.

The results clarified a distinct and currently missing research agenda.

To explore nursing students' perceptions of how their profession is portrayed on medical television programmes.

Recruitment and retention in nursing have been linked to the image of the profession in society. Images of nursing in popular media frequently draw on stereotypes that may damage the appeal of nursing for potential students and denigrate the value and status of the profession. A growing body of work analyses how nursing is portrayed in popular media, but less research asks nursing students themselves to reflect on this area.

Convergent parallel mixed methods.

Data were collected in 2011 from surveys of 484 undergraduate nursing students at a large university in New South Wales, Australia, that included demographic data, their viewing habits of medical television programmes and their opinions of how the shows handled nursing ethics and professionalism and the image of nursing on television and nursing role models.

Most students watch medical television programmes. Students who do not speak English at home watched fewer programmes but were more positive about the depictions of professionalism. The qualitative data showed students were concerned that television can have a negative influence on the image of nursing, but they also recognized some educational and recruitment value in television programmes.

It is important for nurses, educators and students to be critically engaged with the image of their profession in society. There is value in engaging more closely with contemporary media portrayals of nursing for students and educators alike.

Children's emergency hospital use is of concern internationally, but there has been little examination of home care by nurses.

To examine the care provided by community children's nurses during acute illness.

Triangulation of findings from case studies of three Community Children's Nursing Teams.

Parents or carers (n = 763) completed questionnaires between 2008–2010 about their contacts with nurses and satisfaction with aspects and overall assessment of nursing care provided. Eighty-one individuals participated in semi-structured interviews: 29 parents/carers described their experiences and explained their questionnaire responses in more detail; 13 children talked about their care both in hospital and at home; and 39 nurses and other healthcare providers explained how nurses supported care of children at home. Questionnaire data were analysed descriptively and interview data qualitatively. The findings were integrated by triangulation of methods (questionnaires and interviews) and of data from different informants (children, parents, healthcare providers).

Nursing care most frequently took the form of advice and education by either home visits or telephone contact. Parents and children were reassured by access to nurses and it gave them confidence to care at home. Most respondents thought that it reduced the time their children spent in hospital.

Nurses can make an important contribution to supporting parents to care confidently for their children at home to reduce or even to avoid hospitalization for acute conditions and give them confidence to manage future episodes of illness.

A synthesis of the evidence of migrant women's perceptions of their needs and experiences in relation to pregnancy and childbirth.

Despite the fact that all European Union member states have ratified human rights-based resolutions aimed at non-discrimination, there is a relationship between social inequality and access to pre-, intra-, and postpartum care.

A qualitative systematic review of studies from European countries.

A search was made for relevant articles published between January 1996–June 2010.

Data were analysed by means of thematic synthesis.

Sixteen articles were selected, analysed, and synthesized. One overall theme; ‘Preserving one's integrity in the new country’ revealed two key aspects; ‘Struggling to find meaning’ and ‘Caring relationships’. ‘Struggling to find meaning’ comprised four sub-themes; ‘Communication and connection’, ‘Striving to cope and manage’, ‘Struggling to achieve a safe pregnancy and childbirth’, and ‘Maintaining bodily integrity’. ‘Caring relationships’ was based on the following three sub-themes: ‘Sources of strength’, ‘Organizational barriers to maternity care’, and ‘The nature and quality of caring relationships’.

The results of this review demonstrate that migrant women are in a vulnerable situation when pregnant and giving birth and that their access to health services must be improved to better meet their needs. Research is required to develop continuity of care and improve integrated maternal care.

To provide a comprehensive integration of contemporary studies focusing on the relationship between obesity and asthma in paediatric populations.

The simultaneous increase in asthma and obesity prevalence has been widely discussed over the past 20 years. Although studies have discovered a positive correlation between the two, evidence-based findings are needed to develop nursing interventions.

A quantitative systematic review on the literature was conducted from June–December 2011.

An electronic database search was conducted for studies published between January 1966–May 2011. Additional articles were identified through the reference lists of reviewed papers.

Inclusion/exclusion criteria and quality appraisal were applied to ensure research primarily designed to study the relationship between obesity and asthma in children was included.

The majority of studies support a positive association between obesity and asthma in children. Among correlates recognized as important effect modifiers, gender was the most prominent, with obese girls more likely to have asthma diagnoses than obese boys. Scrutinization of covariates in selected studies revealed that most related to children's demographic characteristics and were inconsistent across the studies.

This review was designed to integrate contemporary scientific findings on the association between obesity and asthma by including a large number of studies with variant research designs. To identify high-risk groups and develop nursing interventions to help children affected by both epidemics, more interdisciplinary and well-designed investigations focusing on an expanded spectrum of correlates including demographic and behavioural factors are warranted.

In this study, we investigated the effects of group assertiveness training on assertiveness, social anxiety and satisfaction with interpersonal communication among patients with chronic schizophrenia.

Only limited studies highlighted the effectiveness of group assertiveness training among inpatients with schizophrenia. Given the lack of group assertiveness training among patients with schizophrenia, further development of programmes focusing on facilitating assertiveness, self-confidence and social skills among inpatients with chronic schizophrenia is needed.

This study used a prospective, randomized, single-blinded, parallel-group design.

This study employed a prospective, randomized, parallel-group design. Seventy-four patients were randomly assigned to experimental group receiving 12 sessions of assertiveness training, or a supportive control group. Data collection took place for the period of June 2009–July 2010.

Among patients with chronic schizophrenia, assertiveness, levels of social anxiety and satisfaction with interpersonal communication significantly improved immediately after the intervention and at the 3-month follow-up in the intervention group. The results of a generalized estimating equation (GEE) indicated that: (1) assertiveness significantly improved from pre- to postintervention and was maintained until the follow-up; (2) anxiety regarding social interactions significantly decreased after assertiveness training; and (3) satisfaction with interpersonal communication slightly improved after the 12-session intervention and at the 3-month follow-up.

Assertivenss training is a non-invasive and inexpensive therapy that appears to improve assertiveness, social anxiety and interpersonal communication among inpatients with chronic schizophrenia. These findings may provide a reference guide to clinical nurses for developing assertiveness-training protocols.

To test a model linking procedural justice, supervisor autonomy support, need satisfaction, organizational support, work satisfaction, organizational identification and job performance.

Research in industrial and organizational psychology has shown that procedural justice and supervisor autonomy support lead to positive outcomes. However, very little research related to this subject has been conducted in healthcare settings. Moreover, few studies have examined mechanisms that could account for these positive relationships.

A cross-sectional correlational design was used.

Convenience sampling was used and a sample of 500 nurses working in haematology, oncology and haematology/oncology units in France was surveyed in 2011. The final sample consisted of 323 nurses (64·6% response rate). The hypothesized model was tested using structural equation modelling.

Procedural justice and supervisor autonomy support significantly and positively influenced need satisfaction and perceived organizational support, which in turn positively predicted work satisfaction, organizational identification and job performance.

Organizations could deliver training programmes for their managers aimed at enhancing the use of fair procedures in allocating outcomes and developing their autonomy-supportive behaviours to improve nurses' work satisfaction, organizational identification and job performance.

This article is a report of an analysis of the concept of parental perception of child weight.

Perception is commonly studied, but lacks a strong conceptual definition. Concept analysis is important in providing a conceptual definition of parental perception of child weight.

Rodgers's evolutionary view of concept analysis guided this enquiry.

A search of multiple nursing and social sciences databases was undertaken, including CINAHL, Academic Search Complete, Science Direct, ProQuest, PsychINFO, Medline and SocINDEX.

Data from 2000–2012 related to the concept of interest were reviewed. Fifty-eight articles meeting the inclusion criteria were included. Key attributes, antecedent occurrences and consequences of the concept's use were identified. Thematic analysis revealed common themes related to the concept attributes, antecedents and consequences.

Five attributes were identified including: parental recognition of body size, physical appearance, functional abilities, psychosocial effects and health effects related to body weight. Antecedents of this concept are parental beliefs and values about body weight, fatalism, societal normalization of overweight, parental weight status and parental mental health status. The consequences of this concept are parental concern, increased knowledge about obesity-related health risks, motivation to make changes and family lifestyle changes. The ultimate goal is a healthy weight for the child.

A middle-range explanatory theory of parental perception of child weight was proposed. Parents who recognize child weight issues may be motivated to initiate lifestyle changes, resulting in a healthy weight for the child.

To re-examine the form of the relationships between the global distribution of health professionals (physicians and nurses), gross national product per capita, female literacy, and infant and under-5 mortality rates reported in three papers by Robinson and Wharrad using more recent data. The secondary aim was to explore prior assumptions about the quality of the data, the homogeneity of the sample, and the form of the relationship.

The analyses by Robinson and Wharrad did not take account of differences between developing and developed countries. Furthermore, the intervening years have seen changes in healthcare professional roles and their global distribution. Re-examination of these relationships is therefore timely.

A secondary analysis of routinely collected data from international databases.

A database was constructed from Organisation for Economic Co-operation and Development, United Nations and World Bank sources on 177 countries for around 2005. Regression analyses were performed first with number of physicians and of nurses per 1000 population as dependent variables and gross national product per capita, female literacy rates, and the Gini coefficient as independent variables; and second with all those variables as independent variables and infant mortality, under-5 mortality rates, and maternal mortality rates as dependent variables.

There were clear and interesting differences between richer (Organisation for Economic Co-operation and Development) countries and developing countries in the coefficients and in the power of the equations.

The importance of understanding the implications of carrying out cross-country analysis and the urgent need for standardization of definitions in datasets are emphasized.

The aim of this study was to investigate maternal–foetal attachment at 9, 12 and 20 weeks gestation and to identify factors that influenced maternal–foetal attachment in Taiwanese women who conceived by in vitro fertilization.

Development of maternal–foetal attachment is an important part of taking on the maternal role. However, evidence about maternal–foetal attachment after assisted conception is inconclusive.

A longitudinal design with repeated measures.

A prospective, longitudinal design with repeated measures was used. Over an 18-month period in 2006–2008, a convenience sample of 160 women who conceived after undergoing successful in vitro fertilization were recruited from a major infertility care centre in Taiwan. Data were collected by self-reported measures, including: (1) Maternal–Foetal Attachment Scale; (2) Symptoms Checklist; (3) Pregnancy-related Anxiety Scale; (4) Social Support Apgar; (5) Chinese childbearing attitude Questionnaire; and (6) Awareness of Foetus Scale. The selected instruments to measure each variable were administered to participants at 9, 12 and 20 weeks gestation.

Maternal–foetal attachment increased as pregnancy progressed from 9 to 20 weeks gestation. General linear mixed model showed predictors of maternal–foetal attachment included Chinese childbearing attitude, awareness of the foetus, and social support.

Health provider awareness of cultural influences on the development of early maternal–foetal attachment of women pregnant by in vitro fertilization is needed. Prenatal education in early pregnancy might incorporate more information about foetal development to allow the mother to visualize her unborn child. Providing social support for women who were conceived by in vitro fertilization is beneficial to the development of maternal–foetal attachment.

To explore parents and carers' experiences of barriers and facilitators to treatment adherence in childhood eczema

Childhood eczema is common and causes significant impact on quality of life for children and their families, particularly due to sleep disturbance and itch. Non-adherence to application of topical treatments is the main cause of treatment failure.

Qualitative interview study.

Qualitative interviews were carried out with 31 carers from 28 families of children with eczema. Participants were recruited through primary care and included if they had a child aged 5 or less with a diagnosis of eczema. Interviews were carried out between December 2010–May 2011. Data were analysed using a constant comparative approach.

Barriers to treatment adherence included carer beliefs around eczema treatment, the time consuming nature of applying topical treatments, and child resistance to treatment. Families employed a range of strategies in an attempt to work around children's resistance to treatment with varying success. Strategies included involving the child in treatment, distracting the child during treatment, or making a game of it, using rewards, applying treatment to a sleeping child or, in a few cases, physically restraining the child. Some carers reduced frequency of applications in an attempt to reduce child resistance.

Regular application of topical treatments to children is an onerous task, particularly in families where child resistance develops. Early recognition and discussion of resistance and better awareness of the strategies to overcome this may help carers to respond positively and avoid establishing habitual confrontation.

Little is known about interventions to help men and their partners cope with the after effects of prostate cancer treatment. The lack of in-depth descriptions of the intervention content is hindering the identification of which intervention (or component of an intervention) works.

To describe the development and evaluation of the content of a self-management psychosocial intervention for men with prostate cancer and their partners.

A feasibility randomized controlled trial including structure, process, and outcome analysis.

This 9-week intervention commences on completion of treatment and consists of three group and two telephone sessions. The intervention focuses on symptom management, sexual dysfunction, uncertainty management, positive thinking and couple communication. Forty-eight couples will be assigned to either the intervention or a control group receiving usual care. Participants will be assessed at baseline, immediately postintervention and at 1 and 6 months postintervention. Outcome measures for patients and caregivers include self-efficacy, quality of life, symptom distress, uncertainty, benefits of illness, health behaviour, and measures of couple communication and support. An additional caregiver assessment will be completed by the partner.

The main purpose of this feasibility study is to investigate the acceptability of the CONNECT programme to men with prostate cancer and their partners and to gain feedback from the participants and facilitators to make changes to and enhance the programme. Reasons why men do not want to participate will be collated to enhance recruitment in the future. We will also test recruitment strategies, randomization procedures, and the acceptability of the questionnaires. Ethical approval granted December 2010.

To report quantitative evidence of the effectiveness of advanced practice nursing roles, clinical nurse specialists and nurse practitioners, in meeting the healthcare needs of older adults living in long-term care residential settings.

Although studies have examined the effectiveness of advanced practice nurses in this setting, a systematic review of this evidence has not been conducted.

Quantitative systematic review.

Twelve electronic databases were searched (1966–2010); leaders in the field were contacted; and personal files, reference lists, pertinent journals, and websites were searched for prospective studies with a comparison group.

Studies that met inclusion criteria were reviewed for quality, using a modified version of the Cochrane Effective Practice and Organisation of Care Review Group risk of bias assessment criteria.

Four prospective studies conducted in the USA and reported in 15 papers were included. Long-term care settings with advanced practice nurses had lower rates of depression, urinary incontinence, pressure ulcers, restraint use, and aggressive behaviours; more residents who experienced improvements in meeting personal goals; and family members who expressed more satisfaction with medical services.

Advanced practice nurses are associated with improvements in several measures of health status and behaviours of older adults in long-term care settings and in family satisfaction. Further exploration is needed to determine the effect of advanced practice nurses on health services use; resident satisfaction with care and quality of life; and the skills, quality of care, and job satisfaction of healthcare staff.

This article reports an analysis of the concept of situational awareness in nursing.

Situational awareness is a fundamental and well-understood concept used to maintain operational safety in high reliability organizations; however, it has not been studied in nursing. Nurses play a critical role in providing vigilance in health care and what they do or fail to do is directly related to patient outcomes.

Multiple databases, including PubMed, CINAHL, JSTOR, and Google Scholar, were searched with the term, ‘situational awareness’. The primary search, used to identify all uses of the concept, did not employ date criteria. A secondary search for articles measuring situational awareness as an independent or dependent variable was completed using 2009–2011 articles.

Concept Analysis.

The concept of situational awareness was examined using Walker and Avant's eight step method of analysis.

Three defining attributes of situational awareness include perception, comprehension, and projection. Situational awareness is defined as the perception of the elements in the environment in a volume of time and space, the comprehension of their meaning and the projection of their status in the near future. Although situational awareness is related to other terms in nursing, there is increasing recognition that the concept, which is likely a consolidation of the related terms, has an impact on healthcare professionals.

Failures in perception, comprehension, and/or projection can significantly reduce the accuracy and appropriateness of patient care decisions. Therefore, as a precursor to decision making, poor or inadequate levels of situational awareness present serious threats to patient safety. Situational awareness needs to be examined in a theoretical context, studied systematically and openly recognized as a key factor in the delivery of safe patient care.

To test the situation-specific theory of heart failure self-care with structural equation modelling.

Several authors have proposed theories on heart failure self-care, but only the situation-specific theory of heart failure self-care by Riegel and Dickson is focused on the process that patients use to perform self-care. This theory has never been tested with structural equation modelling.

A secondary analysis of data from a cross-sectional study.

Patients with heart failure were recruited in 21 cardiovascular centres across Italy during 2011. Data were collected with a sociodemographic questionnaire, chart abstraction for clinical data and the Self-Care of Heart Failure Index v.6·2.

A sample of 417 participants was enrolled in the study (59% males, mean age 72 years). The following propositions were tested and supported: Symptom monitoring correlates with treatment adherence; symptom monitoring and treatment adherence have a direct, positive relationship with symptom recognition and evaluation that in turn have a direct, positive relationship with treatment implementation; treatment implementation has a direct, positive relationship with treatment evaluation. In addition, the following three relationships were found: Symptom monitoring has a direct, positive relationship with treatment implementation; symptom recognition and evaluation have direct, positive relationships with treatment evaluation and symptom monitoring correlates with treatment evaluation. [Correction added on 9th April 2013, after first online publication: ‘…symptom monitoring correlates with treatment implementation.’ has been corrected to read ‘…symptom monitoring correlates with treatment evaluation.’]

The data support the situation-specific theory of heart failure self-care with the addition of three new relationships that emerged from the analysis. Results of this study lend further support to the use of the situation-specific theory of heart failure self-care in research and practice.

To explore how families with children at home managed 4–12 months after an adult family member was discharged from the hospital to home following bone marrow or blood cell transplantation.

Studies of these families have been limited in number. The Family Management Style Framework offers a conceptual framework relevant to families with children who have an adult member who has undergone a bone marrow or blood cell transplant.

This was a descriptive, qualitative, one-point-in-time study.

Content analysis in relation to the three conceptual components of the Family Management Style Framework was employed; inductive thematic analysis determined the emergent conceptual dimensions present in the data. The sample was composed of 29 participants: 15 transplant recipients and 14 significant others who met the study criteria in 2008 and 2009. Each patient and his or her significant other were interviewed; the audio-recorded interviews were analysed after transcription.

The three conceptual components of the Family Management Style Framework: (1) definition of the situation; (2) management behaviours; and (3) perceived consequences, were validated as relevant for this sample across all participants. New conceptual dimensions were also present, inclusive of recovery view, support base, financial picture, management domains, perceived consequences to the whole family, and perceived consequences to the dyad relationships.

There are several overarching findings in this study, notably that recovery at home is a family experience. Implications for nursing practice include the need for effective transitional care for the patient and family.

To report the adaptation into Spanish and psychometric testing of the Position on Nursing Diagnosis scale.

The Position on Nursing Diagnosis is a scale that uses the semantic differential technique to measure nurses' attitudes towards the nursing diagnosis concept.

Methodological design.

The scale was cross-culturally adapted through a process including translation, comparison with versions in other languages, back-translation, review, and pre-testing. An opportunistic sample of 621 Spanish registered nurses was recruited from August–December 2011. Reliability was evaluated through internal consistency and test–retest reliability. Construct validity, using both exploratory factor analysis and the known-group technique, and concurrent validity were assessed.

The Position on Nursing Diagnosis-Spanish Version was obtained from the cross-cultural adaptation process. High internal consistency and satisfactory test-retest reliability over a two week period (n = 240) were found. In the principal component analysis, all items loaded strongly on a single-factor which accounted for adequate variance, supporting the unidimensionality of the scale. A statistically significant difference was found comparing the scores of nurses who were members of the Spanish Association of Nomenclature, Taxonomy and Nursing Diagnosis and those who were not. Concurrent validity was supported by the significant correlation found between the scores and the degree of nursing diagnosis utilization and attendance to training sessions.

The findings support the validity and reliability of the Position on Nursing Diagnosis-Spanish Version for its use among Spanish registered nurses as a measurement of their attitude towards the nursing diagnosis concept.

To demonstrate Framework Analysis using a worked example and to illustrate how criticisms of qualitative data analysis including issues of clarity and transparency can be addressed.

Critics of the analysis of qualitative data sometimes cite lack of clarity and transparency about analytical procedures; this can deter nurse researchers from undertaking qualitative studies. Framework Analysis is flexible, systematic, and rigorous, offering clarity, transparency, an audit trail, an option for theme-based and case-based analysis and for readily retrievable data. This paper offers further explanation of the process undertaken which is illustrated with a worked example.

Data were collected from 31 nursing students in 2009 using semi-structured interviews.

The data collected are not reported directly here but used as a worked example for the five steps of Framework Analysis. Suggestions are provided to guide researchers through essential steps in undertaking Framework Analysis. The benefits and limitations of Framework Analysis are discussed.

Nurses increasingly use qualitative research methods and need to use an analysis approach that offers transparency and rigour which Framework Analysis can provide. Nurse researchers may find the detailed critique of Framework Analysis presented in this paper a useful resource when designing and conducting qualitative studies.

Qualitative data analysis presents challenges in relation to the volume and complexity of data obtained and the need to present an ‘audit trail’ for those using the research findings. Framework Analysis is an appropriate, rigorous and systematic method for undertaking qualitative analysis.

To compare the effectiveness of care delivered by nurses to the usual care delivered by general practitioners, in adult patients requesting same day appointments in primary care practices in Catalonia (Spain).

Same day appointments conducted by nurses are characterized by high patient satisfaction and a high resolution index. The profile of nursing and the organization of primary care services in our country differ from other countries.

Multicentre, randomized, unblinded clinical trial with two parallel groups.

Patients were randomized to an intervention group (seen by nurses trained to respond to low complexity problems) or a control group (seen by the general practitioner) using an automatic probabilistic function. Setting: 38 primary care practices in Catalonia, 142 general practitioners and 155 nurses participated. Population study: ≥ 18-year-old patients who requested a same day consultation. Recruitment period: January–May, 2009. Of the 1,461 randomized patients, 92·5% completed the study. Main outcome measures: resolution of symptoms and patient satisfaction 2 weeks after the visit.

Seven hundred and fifty-three patients were assigned to the intervention group and 708 to the control group. Nurses successfully solved 86·3% of the cases. We did not observe any differences in resolution of symptoms or patient satisfaction between the groups.

Nurses trained specifically to resolve acute health problems of low complexity give comparable quality of care to that provided by general practitioners in terms of resolution of the problem 15 days after the visit and in patient satisfaction with the visit.

To aggregate, interpret and synthesize findings from qualitative studies of patients' experiences on being transferred/in transition from one hospital to another or from one ward to another.

Studies about patients' experiences of transfer focused on concepts such as transfer stress, transfer anxiety, and translocation syndrome; however, a meta-synthesis on experiences of transition across different patient populations was lacking.

The meta-synthesis approach was based on the guidelines by Sandelowski and Barroso.

Six electronic databases were searched for articles published between the years 1999-2011, based on the target phenomenon: patients' experiences of transition after transfer between hospitals or units. Reference lists of included articles were screened for eligible papers.

Data were analysed into meta-summary and meta-synthesis. The qualitative content analysis process started with a search for common themes, concepts, and metaphors.

Fourteen qualitative studies were included. Three main categories were identified: transfer as unpredictable, scary and stressful; transfer as recovery and relief; and transfer as sliding into insignificance. The meta-synthesis showed patients' experiences of transitions as critical events where nurses need to focus on patient outcome of transfer as safe, predictable, and individual.

It was difficult for patients to leave their experiences behind when feeling unimportant. Evidence existed for clinical nurses to continue the development of care quality and safety for patients in transfer/transition. Intervention studies and policy development to improve transfers and transitions for patients are recommended.

To increase understanding of women's decision-making process concerning the medication use for anxiety and/or depression while pregnant.

Anxiety and depression affects many pregnant women, yet the decision to take psychotropic medication is complex and possibly subject to social oppression.

Cross-sectional descriptive survey design.

A web-based survey was used to collect data from a convenience sample of 143 pregnant women over 3 months beginning in early 2011. An independent t-test was conducted to determine differences in satisfaction between women with high and low levels of emancipated decision-making (EDM). A multiple regression analysis was conducted to determine which subscales of the emancipation scale best predict level of satisfaction with the decision.

The majority of respondents were White, between 25–34 years of age. The group with lower levels of emancipation reported lower mean satisfaction scores compared with those with higher levels of emancipation. Regression analysis showed that the three subscale emancipation model was a statistically significant predictor of satisfaction with the decision and accounted for 54% of the variance in satisfaction. The subconcept of personal knowledge was most predictive of satisfaction with decision.

Women may be able to overcome oppressive forces by using an EDM process. EDM allows them to make a decision that feels right for them and to feel satisfied with the decision.

This paper is a report on the effectiveness of a self-management programme based on the self-efficacy construct, in older people with heart failure.

Heart failure is a major health problem worldwide, with high mortality and morbidity, making it a leading cause of hospitalization. Heart failure is associated with a complex set of symptoms that arise from problems in fluid and sodium retention. Hence, managing salt and fluid intake is important and can be enhanced by improving patients' self-efficacy in changing their behaviour.

Randomized controlled trial.

Heart failure patients attending cardiac clinics in northern Taiwan from October 2006–May 2007 were randomly assigned to two groups: control (n = 46) and intervention (n = 47). The intervention group received a 12-week self-management programme that emphasized self-monitoring of salt/fluid intake and heart failure-related symptoms. Data were collected at baseline as well as 4 and 12 weeks later. Data analysis to test the hypotheses used repeated-measures anova models.

Participants who received the intervention programme had significantly better self-efficacy for salt and fluid control, self-management behaviour and their heart failure-related symptoms were significantly lower than participants in the control group. However, the two groups did not differ significantly in health service use.

The self-management programme improved self-efficacy for salt and fluid control, self-management behaviours, and decreased heart failure-related symptoms in older Taiwanese outpatients with heart failure. Nursing interventions to improve health-related outcomes for patients with heart failure should emphasize self-efficacy in the self-management of their disease.

To assess the economic impact of increased nursing hours of care on health outcomes in adult teaching hospitals in Perth, Western Australia.

Advancing technology and increased availability of treatment interventions are increasing demand for health care while the downturn in world economies has increased demand for greater efficiency. Nurse managers must balance nurse staffing to optimize care and provide efficiencies.

This longitudinal study involved the retrospective analysis of a cohort of multi-day stay patients admitted to adult teaching hospitals.

Hospital morbidity and staffing data from September 2000 until June 2004, obtained in 2010 from a previous study, were used to analyse nursing-sensitive outcomes pre- and post-implementation of the Nurse Hours per Patient Day staffing method, which remains in place today. The cost of the intervention comprised increased nursing hours following implementation of the staffing method.

The number of nursing-sensitive outcomes was 1357 less than expected post-implementation and included 155 fewer ‘failure to rescue’ events. The 1202 other nursing-sensitive outcomes prevented were ‘surgical wound infection’, ‘pulmonary failure’, ‘ulcer, gastritis’, ‘upper gastrointestinal bleed’, and ‘cardiac arrest’. One outcome, pneumonia, showed an increase of 493. Analysis of life years gained was based on the failure to rescue events prevented and the total life years gained was 1088. The cost per life year gained was AUD$8907.

The implementation of the Nurse Hours per Patient Day staffing method was cost-effective when compared with thresholds of interventions commonly accepted in Australia.

To report a concept analysis of nursing overtime.

Economic constraints have resulted in hospital restructuring with the aim of reducing costs. These processes often target nurse staffing (the largest organizational expense) by increasing usage of alternative staffing strategies including overtime hours. Overtime is a multifaceted, poorly defined, and indiscriminately used concept. Analysis of nursing overtime is an important step towards development and propagation of appropriate staffing strategies and rigorous research.

Concept analysis.

The search of electronic literature included indexes, grey literature, dictionaries, policy statements, contracts, glossaries and ancestry searching. Sources included were published between 1993–2012; dates were chosen in relation to increases in overtime hours used as a result of the healthcare structuring in the early 1990s. Approximately 65 documents met the inclusion criteria.

Walker and Avant's methodology guided the analysis.

Nursing overtime can be defined by four attributes: perception of choice or control over overtime hours worked; rewards or lack thereof; time off duty counts equally as much as time on duty; and disruption due to a lack of preparation. Antecedents of overtime arise from societal, organizational, and individual levels. The consequences of nursing overtime can be positive and negative, affecting organizations, nurses, and the patients they care for.

This concept analysis clarifies the intricacies surrounding nursing overtime with recommendations to advance nursing research, practice, and policies. A nursing-specific middle-range theory was proposed to guide the understanding and study of nursing overtime.

To report the expectations and experiences of general practitioners and practice nurses regarding the U-CARE programme, to gain a better understanding of the barriers and facilitators in providing proactive, structured care to frail older people and to determine whether implementation is feasible.

Care for older patients with complex care needs in primary care is fragmented, reactive and time consuming. A structured, proactive care programme was developed to improve physical functioning and quality of life in frail older patients.

An explanatory mixed-methods study nested in a cluster-randomized trial.

The barriers to and needs for the provision of structured, proactive care, and expectations regarding the U-CARE programme were assessed with pre-questionnaires sent to all participating general practitioners (n = 32) and practice nurses (n = 21) in October 2010. Postquestionnaires measured experiences with the programme after 5 months. Twelve months later, focus group meetings were conducted.

Practice nurses and general practitioners reported that it was difficult to provide proactive and structured care to older patients with multi-morbidity, different cultural backgrounds and low socioeconomic status. Barriers were a lack of time and financial compensation. Most general practitioners and practice nurses indicated that the programme added value for the coordination of care and allowed them to provide structured care.

This explanatory mixed-methods study showed that general practitioners and practice nurses perceived the U-CARE programme as feasible in general practice. A transition was made from reactive, ad hoc care towards a proactive and preventive care approach.

To develop a framework to evaluate the impact of nurse consultants on patient, professional and organizational outcomes and identify associated indicators of impact.

Since nurse consultants were introduced into the UK in 2000, there has been growing interest in demonstrating their impact, although robust evidence of impact is lacking. Existing frameworks for evaluating the impact of advanced practice roles do not cover the four dimensions of the nurse consultant role sufficiently.

Multiple case study.

Individual case studies of six nurse consultants in England were undertaken between December 2009–October 2010. Each case study involved interviews with the nurse consultant, healthcare staff, managers, patients and carers. Interviews explored participants' perceptions of the impact of the nurse consultant and indicators of actual and/or potential impact. Data were analysed using framework approach.

Three domains of impact of nurse consultant roles were identified: clinical significance, professional significance and organizational significance. Each domain included three to four indicators of impact. All nurse consultants showed some evidence of impact in all three domains although the primary focus varied across the different nurse consultants. Due to the wide diversity in nurse consultant roles there was little commonality in the specific indicators of impact across all nurse consultants.

The framework for capturing the impact of nurse consultants could be used by researchers and by nurse consultants to demonstrate their impact. Further research is required to assess the suitability of the framework for capturing the impact of other advanced practice roles.

To test the selected propositions of the middle-range theory of nursing intellectual capital.

The nursing intellectual capital theory conceptualizes nursing knowledge's influence on patient and organizational outcomes. The theory proposes nursing human capital, nurses' knowledge, skills and experience, is related to the quality of patient care and nurse recruitment and retention of an inpatient care unit. Two factors in the work environment, nurse staffing and employer support for nurse continuing professional development, are proposed to influence nursing human capital's association with patient and organizational outcomes.

A cross-sectional survey design.

The study took place in 2008 in six Canadian acute care hospitals. Financial, human resource and risk data were collected from hospital departments and unit managers. Clearly specified empirical indicators quantified the study variables. The propositions of the theory were tested with data from 91 inpatient care units using structural equation modelling.

The propositions associated with the nursing human capital concept were supported. The propositions associated with the employer support for nurse continuing professional development concept were not. The proposition that nurse staffing's influences on patient outcomes was mediated by the nursing human capital of an inpatient unit, was partially supported.

Some of the theory's propositions were empirically validated. Additional theoretical work is needed to refine the operationalization and measurement of some of the theory's concepts. Further research with larger samples of data from different geographical settings and types of hospitals is required to determine if the theory can withstand empirical scrutiny.

To report an analysis of the concept of perinatal bereavement.

The concept of perinatal bereavement emerged in the scientific literature during the 1970s. Perinatal bereavement is a practice-based concept, although it is not well-defined in the scientific literature and is often intermingled with the concepts of mourning and grief.

Concept Analysis.

Using the term ‘perinatal bereavement’ and limits of only English and human, Pub Med and CINAHL were searched to yield 278 available references dating from 1974–2011. Articles specific to the experience of perinatal bereavement were reviewed. The final data set was 143 articles.

The methods of principle-based concept analysis were used. Results reveal conceptual components (antecedents, attributes and outcomes) which are delineated to create a theoretical definition of perinatal bereavement.

The concept is epistemologically immature, with few explicit definitions to describe the phenomenon. Inconsistency in conceptual meaning threatens the construct validity of measurement tools for perinatal bereavement and contributes to incongruent theoretical definitions. This has implications for both nursing science (how the concept is studied and theoretically integrated) and clinical practice (timing and delivery of support interventions).

Perinatal bereavement is a multifaceted global phenomenon that follows perinatal loss. Lack of conceptual clarity and lack of a clearly articulated conceptual definition impede the synthesis and translation of research findings into practice. A theoretical definition of perinatal bereavement is offered as a platform for researchers to advance the concept through research and theory development.

This paper presents a discussion of the advantages and disadvantages of redefining human papillomavirus-related anal intraepithelial neoplasia as a problem of sexually active people by using Kingdon's Multiple Streams Theory to examine possible policy solutions for increasing anal cancer screening.

Human papillomavirus is the most common sexually transmitted infection worldwide. Anal cancer associated with human papillomavirus infections is increasing in incidence in both men and women. The prevalence of anal cancer does not decrease with age.

Pubmed was searched for articles and internet references from 1995–2012.

Although a large body of literature suggests that human papillomavirus-related anal intraepithelial neoplasia is a problem, no effective policy solutions have emerged. However, as almost the entire sexually active population is exposed to human papillomavirus, it should be thought of as every person's problem. This suggests that human papillomavirus-related anal intraepithelial neoplasia calls for different types of problem definitions and policy solutions to address the disease. The issue of anal cancer is typically defined as a problem of HIV-positive individuals.

Nurses are focused on improving patient outcomes. We play a key role in helping to identify problems, moving problems onto policymaker's agendas, and influencing the creation of new healthcare policies.

Human papillomavirus-related anal intraepithelial neoplasia demands attention and the development of national level policies to ensure public health and safety. Kingdon's Multiple Streams Theory has provided a pragmatic framework to evaluate the problem.

To examine the long-term effects of fixed/individualized spaced retrieval combined with Montessori-based activities on nutritional status and body mass index and nutritional improvement's moderating effect on depressive symptoms for people with dementia during a specific follow-up period.

The decrease in food intake, often combined with poor nutrition, may induce depressive symptoms in people with dementia.

A single-blind, quasi-experimental study with repeated measures.

Twenty-five fixed group participants received spaced retrieval combined with Montessori-based activities over 24 sessions. Thirty-eight individualized group participants received the same intervention with different sessions, which was adjusted according to each participant's learning response. Twenty-seven control group participants just received routine care. The Chinese version of the Mini-Nutritional Assessment and Cornell Scale for Depression in Dementia scores and body mass index were recorded at pre-test, posttest and 1-, 3- and 6-month follow-ups. Data were collected between July 2008–February 2010.

The Mini-Nutritional Assessment scores and body mass index of the fixed and individualized groups could be significantly increased over time. Additionally, the Cornell Scale for Depression in Dementia scores could be significantly reduced as a result of the improvement of the Mini-Nutritional Assessment scores arising from the individualized intervention.

The depressive symptoms of residents with dementia could be moderated by the individualized intervention through nutritional improvement. Trained clinical nurse specialists can use this individualized intervention for residents with dementia who also have poor nutrition and depressive symptoms.

This paper reports a study testing the content and face validity and internal consistency of the Dutch version of the Aging Sexual Knowledge and Attitudes Scale.

The ability of older residents to sexually express themselves is known to be influenced by the knowledge and attitudes of nursing home staff towards later-life sexuality. Although the Aging Sexual Knowledge and Attitudes Scale is a widely used instrument to measure this, there is no validated, Dutch translation available.

Instrument development.

Following a standard forward/backward translation into Dutch, the scale was further adapted for use in Flemish nursing home settings. Content and face validity and user-friendliness were assessed. The psychometric properties were determined by means of an exploratory study. Data were collected from March–April 2011 at eight Flemish nursing homes. Reliability was assessed using internal consistency and item–total correlations.

Both subscales of the Flemish adaptation showed acceptable content validity. The face validity and user-friendliness were deemed favourable with hardly any remarks given by the expert panel. The Cronbach's α was 0·80 and 0·88 for the knowledge and attitude subscales, respectively. The item–total correlations ranged from 0·21–0·48 for the knowledge section and from 0·09–0·68 for the attitude subscale.

We conclude from our study that the Dutch version of the scale has acceptable to good psychometric properties. The Flemish adaptation therefore seems to be a valuable instrument for studying nursing staff's knowledge and attitudes towards aged sexuality in Flanders.

To report a concept analysis of oral hygiene care.

Oral hygiene care, as it is provided to older patients in hospital and long-term care settings by nurses and their delegates, has the potential to contribute to the oral health of patients while preventing aspiration pneumonia as well as periodontitis, which itself has been associated with several systemic diseases. However, the state of oral cleanliness in such patients tends to be poor and despite the existence of guidelines, nursing care practices may be inadequate and not reflective of recent advances in knowledge.

Concept analysis.

A search of electronic databases (2002–2012), use of internet search engines, and hand searching yielded an international data set of 66 research studies, reviews, and practice guidelines.

The concept analysis method of Walker and Avant was used to explore the concept of oral hygiene care in the context of frail older patients.

Oral hygiene care involves approaches informed by knowing the patient, inspecting the oral cavity, removing plaque, cleansing the oral tissues, decontaminating the oral cavity, using fluoride products and maintaining oral tissue moisture. Those attributes, along with their antecedents and consequences, form a conceptual framework from which a middle-range theory of nurse-administered oral hygiene care is derived that could be tested, evaluated, modified, and translated into practice.

Clarity around the concept of oral hygiene care as a nursing intervention could enable nurses to impact oral health outcomes and possibly prevent systemic diseases in older patients.

To explore experiences of the diagnosis and management of tuberculosis from the perspective of Somali patients and healthcare professionals involved in their care.

The Somali population has the third highest incidence of tuberculosis occurring in persons born outside the UK. Tuberculosis is a disease with sociocultural as well as physical consequences. Nurses should understand how the disease is experienced by people from different ethnic backgrounds to implement strategies for prevention and management of tuberculosis.

A focused ethnography.

Individual interviews with 14 Somali patients and 18 healthcare professionals with experience of providing care to Somalis were undertaken in 2008–2009. Interviews explored the patient experience from onset of symptoms to completion of treatment. Data were analysed using Framework approach.

Despite presenting in primary care early, patients experienced diagnostic delays due to low clinical suspicion of tuberculosis among general practitioners. Although patients reported felt and enacted stigma, it did not adversely affect concordance with treatment. Patients were reticent about sharing their diagnosis among wider networks due to perceived stigma. Psychological support from families and specialist nurses was valued highly. Healthcare professionals perceived that stigmatization of tuberculosis was diminishing among Somalis leading to improved management of tuberculosis. Patients and healthcare professionals raised concerns about the longer term physical and psychosocial implications of tuberculosis once treatment was completed.

Nurses have a role in promoting early presentation, timely diagnosis, and treatment adherence through supporting Somali patients and raising awareness of the disease among primary care practitioners.

To report a study of emergency nurses' experiences of caring for survivors of intimate partner violence.

Emergency nurses have the opportunity to intervene during the period following exposure to intimate partner violence when survivors are most receptive for interventions. The confrontation with the trauma of intimate partner violence can, however, affect emergency nurses' ability to engage empathetically with survivors, which is fundamental to all interventions.

The research was guided by the philosophical foundations of phenomenology as founded by Husserl.

A descriptive phenomenological inquiry grounded in Husserlian philosophy was used. The phenomenological reductions were applied throughout data collection and analysis. During 2010, concrete descriptions were obtained from interviewing 11 nurses working in emergency units of two public hospitals in an urban setting in South Africa. To arrive at a description of the essence, the data were analysed by searching for the meaning given to the experience of caring for survivors of intimate partner violence.

Emergency nurses in South Africa are often witnesses of the emotional and physical effects of intimate partner violence. Exposure to the vulnerability and suffering of survivors elicits sympathy and emotional distress. Emergency nurses are left with the emotional impact and disruptive and recurrent memories.

Exploring the tacit internal experiences related to caring for survivors of intimate partner violence revealed emergency nurses' vulnerability to the effects of secondary traumatic stress. The findings generated an opportunity to develop guidelines through which to support and empower emergency nurses.

This article is a report of the psychometric testing of the five-item English Language Acculturation Scale, an indicator of English language usage as reported by first-year undergraduate nursing students.

Nursing students who have English as an additional language can struggle clinically and academically due to low levels of English language proficiency. A self-report screening tool may provide early identification of nursing students at risk of underperformance.

Prospective correlational survey design.

The study used a prospective, correlational survey design. In 2010 and 2011, 1400 commencing nursing students were surveyed about their English language usage using the English Language Acculturation Scale. In addition to descriptive statistics, exploratory and confirmatory factor analyses and Cronbach's alpha reliabilities, the relationship between English Language Acculturation Scale score and Grade Point Average at the end of first year was computed.

Results show good reliability and construct validity of the English Language Acculturation Scale. Principal component analysis yielded only one component in which all five items loaded highly. This was further supported by confirmatory factor analysis, with standardized factor loadings ranging from 0·79 to 0·90. The results also showed strong association between English language use and academic performance; students in the high English Language Acculturation Scale score group were most likely to be in the high Grade Point Average group at the end of first year.

Language screening tools can be an important strategy to identify nursing students at risk of underperforming in their studies. The English Language Acculturation Scale has the potential to be a useful brief self-report measure for commencing nursing students.

To investigate the relationship between three types of organizational resources (job control, social support and organizational justice) and the impact of job demands on nurse's well-being and attitudes towards their work.

The negative impact of work-related stress on nurse's health and attitudes towards their work has been established. Increasingly, research is focusing on the role of organizational resources in reducing the impact of work-related stress.

Cross-sectional survey.

Data collected in November 2008 from 226 Australian nurses and midwives were analysed using the full Job Strain Model with the addition of organizational justice variables. Multiple regression analyses explored the relationships among job control, job demands, three sources of social support and four types of organizational justice on well-being and work attitudes.

The overall regression models explained a significant amount of variance in well-being, job satisfaction and organizational commitment. Significant main effects were evident for support variables and organizational justice variables on well-being and job satisfaction. Interactions between job control and supervisor support and between job demands and supervisor support were evident for job satisfaction.

Supervisor support and organizational justice have significant relationships with nurses' well-being and job satisfaction. More broadly, the findings suggest that, in the triple-matching approach from a work-stressor to a resource to a work outcome, personal, supervisory and organizational resources may be substitutable. These findings provide nurse management with empirical endorsement for the development and delivery of the organization's resources for nursing staff.

To examine the effects of nursing tasks (including their physiological and psychological demands, and the moderating effects of reward and control) on distress and job performance in real time.

Nurses working in hospital settings report high levels of occupational stress. Stress in nurses has been linked to reduced physical and psychological health, reduced job satisfaction, increased sickness absence, increased staff turnover, and poorer job performance. In this study, we will investigate theoretical models of stress and use multiple methods, including real-time data collection, to assess the relationship between stress and different nursing tasks in general medical and surgical ward nurses.

A real-time, repeated measures design.

During 2011/2012, 100 nurses from a large general teaching hospital in Scotland will: (a) complete self-reports of mood; (b) have their heart rate and activity monitored over two shifts to obtain physiological indices of stress and energy expenditure; (c) provide perceptions of the determinants of stress in complex ward environments; and (d) describe their main activities. All measures will be taken repeatedly in real time over two working shifts.

Data obtained in this study will be analysed to examine the relationships between nursing tasks, self-reported and physiological measures of stress and to assess the effect of occupational stress on multiple work outcomes. The results will inform theoretical understanding of nurse stress and its determinants and suggest possible targets for intervention to reduce stress and associated harmful consequences.

To present a case of knowledge translation in nursing education and practice and discusses mechanisms relevant to bringing knowledge into action.

The process of knowledge translation aspires to close the gap between theory and practice. Knowledge translation is a cyclic process involving both the creation and application of knowledge in several phases. The case presented in this paper is the translation of the Model of Practical Skill Performance into education and practice. Advantages and problems with the use of this model and its adaptation and tailoring to local contexts illustrate the cyclic and iterative process of knowledge translation.

The cultivation of a three-sided relationship between researchers, educators, and clinical nurses was a major asset in driving the process of knowledge translation. The knowledge translation process gained momentum by replacing passive diffusion strategies with interaction and teamwork between stakeholders. The use of knowledge creates feedback that might have consequences for the refinement and tailoring of that same knowledge itself. With end-users in mind, several heuristics were used by the research group to increase clarity of the model and to tailor the implementation of knowledge to the users.

This article illustrates the need for enduring collaboration between stakeholders to promote the process of knowledge translation. Translation of research knowledge into practice is a time-consuming process that is enhanced when appropriate support is given by leaders in the involved facilities.

Knowledge translation is a time-consuming and collaborative endeavour. On the basis of our experience we advocate the implementation and use of a conceptual framework for the entire process of knowledge translation. More descriptions of knowledge translation in the nursing discipline are needed to inspire and advise in this process.

To report a study that explored the experiences of night-shift nurses, focusing on employee interrelationships and work satisfaction.

Night-shift nurses are a critical component in hospital care making it essential to understand the experiences that give meaning to their work and understand how these nurses and the organization can benefit from their contribution to hospital care. A literature review revealed minimal research in this area.

Qualitative case study.

A qualitative case study using semi-structured interviews and self-completed diaries was conducted in 2010 in regional public hospitals in Australia. Participants were 14 nurses working nights half or more of their shifts in medical or surgical wards.

Thematic analysis identified four major areas of concern: work relationships, work environment, work practices and lifestyle impact. Notably, work relationships were most meaningful for nurses on the same shift; night-shift nurses experienced working conditions inferior to their daytime counterparts including a perception of minimal leadership. Despite limited education opportunities, night shift provided opportunity for professional growth for some nurses with a slippage in skills for others; night shift provided flexibility for family and social activities, yet impeded these same activities, primarily due to pervasive fatigue. Night-shift nurses considered their role critical, yet believed that they were poorly regarded.

The strong interpersonal relationships developed between night-shift workers need to be capitalized on whilst developing a more effective leadership model, improved work environment, more equitable professional development, and genuine recognition of the critical role of night nurses.

To describe the research protocol that will be used to investigate factors contributing to effective interprofessional practice in a rural context in Australia.

Interprofessional practice is a key strategy for overcoming rural health challenges; however, our knowledge of interprofessional initiatives and consequences in rural areas is limited.

A modified realistic evaluation approach will be used to explore the structures, systems, and social processes contributing to effective interprofessional outcomes. This ‘context–mechanism–outcome’ approach provides a useful framework for identifying why and how interprofessional practice works in rural contexts.

Initial propositions regarding the factors that explain effective collaborative practice will be generated through interviews with lead clinicians, policy-makers, and clinician managers. Clinician interviews, document analysis, and multi-participant focus groups will be used as evidence to support, refine, or redevelop the initial propositions. This will allow the development of a model of rural interprofessional practice that will explain how and why collaborative approaches work in rural environments. This study is funded by an Institute of Rural Clinical Services and Teaching grant (January 2010).

Rural healthcare challenges are well documented; however, studies investigating the nature of interprofessional practice in rural contexts are not common. Rural contexts also present research design, particularly data collection, challenges. This proposed research is one of the first to identify the factors that facilitate or constrain effective interprofessional work in rural settings. This is particularly important, given the continuing workforce shortages and maldistribution and poorer health outcomes in rural communities globally.

To compare the effectiveness of alternating pressure air mattresses vs. overlays to prevent pressure ulcers in mechanically ventilated patients in intensive care units.

Pressure ulcers prevention is an important issue in the nursing of critically ill patients. It is not clear whether alternating pressure air mattresses are more effective than overlays to prevent pressure ulcers.

Prospective quasi-experimental study.

A prospective quasi-experimental study was conducted among patients in the medical–surgery intensive care unit of a university hospital on mechanical ventilation ≥24 hours during two time periods (2001 and 2006). Overlays were used in 2001 and mattresses in 2006. Primary outcome was the incidence of pressure ulcers grade ≥II (according to the European Pressure Ulcer Advisory Panel) during intensive care unit stay.

The study included 221 patients (116 in 2001 and 105 in 2006). Baseline characteristics were similar between groups except for a higher Acute Physiology and Chronic Health Evaluation III score, total and first-day respiratory Sequential Organ Failure Assessment Score on day 1 in overlay group. There was significantly lower incidence density in the mattress vs. overlay group (12·41 cases/1000 days vs. 18·67 cases/1000 days of stay). The multivariate analyses showed the use of the mattress to be a protective factor against pressure ulcer onset.

This quasi-experiment study that alternative pressure air mattresses were more effective than alternating pressure air overlays in preventing pressure ulcers in mechanically ventilated critical care patients.

To report an analysis of the concept of self-advocacy among individuals with cancer to clarify its meaning, to differentiate this meaning with related concepts, and to unify understanding of the concept in cancer research and practice.

Cancer survivors are increasingly required to assume an active role in their health care. A thorough analysis of how survivors advocate for themselves is a crucial aspect in supporting survivors' ability to engage and manage their care throughout all stages of cancer survivorship.

Walker and Avant's eight-step process of conducting a concept analysis was used.

PubMed, PsycINFO, and CINAHL databases were searched for articles, reviews, editorials, and grey literature directly addressing self-advocacy.

A broad inquiry into the literature from 1960 to 2012 that produces a definition of self-advocacy. Model and contrary cases of self-advocacy demonstrate the concept's application and intricacies.

Antecedents to self-advocacy include particular personal characteristics, learned skills, and attainable support. The essential element of self-advocacy and what differentiates it from related concepts, is the internalization of these antecedent resources into self-advocacy thoughts and actions while incorporating personal values and priorities in a way that upholds the survivors' goals and beliefs. A full realization of self-advocacy facilitates a cancer survivor attaining a strong self-concept, sense of control, and adaptation to a life with cancer.

Self-advocacy is a process of internalizing skills and resources to act in a way that supports survivors' needs and goals.

To describe the tasks and the roles of nurses and midwives in Sub-Saharan African health services.

The current roles of nurses and midwives in the African region of the World Health Organization have not been empirically established, with only studies from two countries found (South Africa and Mozambique). This makes it difficult to establish whether current nursing/midwifery education programmes and regulations adequately address the needs in the health services.

A descriptive quantitative study.

A survey questionnaire was administered to ambulatory and hospital services. Data were collected between June–December 2010, with completed responses from 734 nurses from nine African countries (five Anglophone and four Francophone).

The highest reported role functioning in both settings was for ‘General Care and Treatment’. The lowest role functioning reported in both settings was in the role ‘Maternal and Child Health’ and in ‘The Provision of Mental Health Care’. The reported role performance in Anglophone countries was significantly greater than in Francophone countries.

The development of competency in nursing/midwifery roles other than medical surgical roles (general assessment and care) should receive more attention in curricula. Special attention needs to be given to Francophone countries, where the professions of nursing and midwifery are poorly developed.

To report a study of the relationship between person-centred care and ability to perform activities of daily living, quality of life, levels of pain, depressive symptoms, and agitated behaviours among residents with dementia in residential care facilities.

Standardized measurements of person-centred care have not previously been used to investigate the relationship between person-centred care and well-being for residents with dementia in residential aged care units.

This study had a cross-sectional design.

Staff and resident surveys were used in a sample of 1261 residents with dementia and 1169 staff from 151 residential care units throughout Sweden. Valid and reliable scales were used to measure person-centredness and ability to perform activities of daily living, quality of life, levels of pain, depressive symptoms, and agitated behaviours in residents. All data were collected in May 2010.

Person-centred care was correlated with residents' ability to perform activities of daily living. Furthermore, residents in units with higher levels of person-centred care were rated as having higher quality of life and better ability to perform activities of daily living compared with residents in units with lower levels of person-centred care.

There seems to be a relationship between person-centredness, residents' ability to perform activities of daily living, and residents' quality of life. Further studies are needed to explain the variation of person-centredness between units and the extent and ways this might impact on the quality of life and well-being of frail older residents with cognitive impairments in clinical practice.

To describe and compare the outcomes of a nurse practitioner-managed cardiac surgery follow-up model of care with the standard model of primary care provider follow-up for coronary artery bypass graft surgery patients.

Advances in healthcare have had a favourable impact on length of stay following cardiac surgery; however, the shorter length of stay has not been accompanied by enhanced support to bridge the gap between acute care and the community setting.

Prospective (2009–2010) randomized study.

Elective cardiac surgery patients (N = 200) were randomly assigned to the nurse practitioner follow-up intervention or to the standard model of follow-up care. The main outcomes were health-related quality of life, patient satisfaction, symptoms, and health resource use. Outcome data were elicited via telephone interviews at 2 and 6 weeks postdischarge.

Baseline differences between the two groups were non-significant; however, at 2 weeks postdischarge, the intervention group reported significantly fewer symptoms and higher physical functioning status. At 2 and 6 weeks postdischarge, the intervention group was significantly more satisfied with the amount of help, as well as the quality of the services received. Differences in healthcare resource use were not statistically significant.

This evidence suggests that the nurse practitioner-managed model of follow-up care effectively bridges the gap between institutional and primary care in the cardiac surgery population.

To examine the role of two personal resources (active, problem-focused coping; self-efficacy beliefs) in the relation between job demands and strain.

Evidence suggests that healthcare staff in general and nurses in particular, are at a high risk of suffering from high levels of job strain. In addition to often examined job-related resources (such as control and social support), personal resources are expected to moderate (i.e. buffer) the relation between job demands and indicators of strain, particularly when there is a functional match between the type of demands and resources.

Cross-sectional questionnaire survey.

A cross-sectional questionnaire survey was conducted (February–April 2010) among staff members of three nursing homes of a municipal organization for residential elderly care located in an urban area of Western Germany. A total of 145 of 251 employees responded to the invitation to participate in the study (57·8% participation rate). Data were analysed by hierarchical moderated regression analyses.

Increasing job demands (quantitative and qualitative workload) had adverse effects on emotional exhaustion, psychosomatic complaints, and turnover intentions, whereas nurses’ self-efficacy beliefs exerted beneficial effects on all outcomes. Furthermore, findings revealed that active, problem-focused coping interacts with job demands in the prediction of job strain.

Both research and practice should focus on a closer match between personal resources and job demands to prevent nurses from being strained.

To report a qualitative study which explores registered nurses' views on the issue of time in the workplace.

There is a worldwide shortage of healthcare workers, subsequently time as a healthcare resource is both finite and scarce. As a result, increased attention is being paid to the restructuring of nursing work. However, the experience of time passing is a subjective one and there exists little research which, over a prolonged period of time, describes nurses' experiences of working in time-pressurized environments.

A narrative inquiry.

Five registered nurses were individually interviewed a total of three times over a period of 12 months, amounting to a total of 15 interviews and 30 hours of data. Data were collected and analysed following a narrative enquiry approach during the period 2008–2010.

Participants describe how attempts to work more effectively sometimes resulted in unintended negative consequences for patient care and how time pressure encourages collegiality amongst nurses. Furthermore, the registered nurses' account of how they opportunistically create time for communication with patients compels us to re-evaluate the nature of communication during procedural nursing care.

Increasingly nursing work is translated into quantitative data or metrics. This is an inescapable development which seeks to enhance understanding of nursing work. However, qualitative research may also offer a useful approach which captures the otherwise hidden, subjective experiences associated with time and work. Such data can exist alongside nursing metrics, and together these can build a better and more nuanced consideration of nursing practice.

To determine the effect of a nurse telephone follow-up on paediatric post-tonsillectomy pain intensity, complications, and use of other healthcare services.

After tonsillectomy, children experience moderate-to-severe pain for days. Parents tend to give insufficient analgesia, with resulting increases in pain and postoperative complications. In adults, nurse telephone follow-up for ambulatory surgeries reduces postoperative pain.

The study design was a randomized clinical trial.

In this trial, children aged 4–12 years undergoing elective tonsillectomy in June–October 2010 were assigned to a nurse telephone follow-up with parents on postoperative days 1, 3, 5 and 10, or standard care with no follow-up but data collection. Outcomes included pain intensity, analgesics administered, complications, and healthcare use.

Of 45 participants, the intervention group (n = 24) received more analgesics on postoperative days 1 and 3, increased their fluid intake at days 1 and 3, but had more constipation at day 3 than the control group (n = 21). There was no significant difference regarding pain intensity or use of healthcare resources.

Nurse telephone follow-up was beneficial for some pain management and prevention of complications, although better analgesic treatments are needed. The intervention was simple, safe, and appreciated by parents.

To report observational data collected as part of a multi-phased study examining violence in the health sector. The findings presented detail the nature of verbal abuse experienced by nurses during their everyday interactions with patient, their families, or companions.

Nurses have unacceptably high levels of exposure to violence, which commonly includes verbal abuse. However, relatively little is known about the nature of verbal abuse against nurses.

Observational design.

During 2010, 1150 hours of observation resulted in data on 220 patients displaying cues for physical violence and 210 qualitative observational notes. These observational notes constitute the data for this paper and reveal the nature of verbal abuse experienced by nurses in their everyday work.

A mosaic of abuse was revealed through three major categories: a discourse of gendered verbal abuse that was largely: sexual; insults, ridicule, and unreasonable demands; and hostility, threats, and menacing language.

For the nurses observed in this study, everyday nursing practice occurred in a backdrop of verbal abuse and hostility, which had a strong theme of gendered and sexualized overtones. We recommend that interventions that target verbal abuse should address the gendered and sexualized nature of the abuse experienced by nurses.

To quantify the risk of death associated with Clostridium difficile infection, in an Australian tertiary hospital.

Two reviews examining Clostridium difficile infection and mortality indicate that Clostridium difficile infection is associated with increased mortality in hospitalized patients. Studies investigating the mortality of Clostridium difficile infection in settings outside of Europe and North America are required, so that the epidemiology of Clostridium difficile infection in these regions can be understood and appropriate prevention strategies made.

An observational non-concurrent cohort study design was used.

Data from all persons who had (exposed) and a matched sample of persons who did not have Clostridium difficile infection, for the calendar years 2007–2010, were analysed. The risk of dying within 30, 60, 90 and 180 days was compared using the two groups. Kaplan–Meier survival analysis and conditional logistic regression models were applied to the data to examine time to death and mortality risk adjusted for comorbidities using the Charlson Comorbidity Index.

One hundred and fifty-eight cases of infection were identified. A statistically significant difference in all-cause mortality was identified between exposed and non-exposed groups at 60 and 180 days. In a conditional regression model, mortality in the exposed group was significantly higher at 180 days.

In this Australian study, Clostridium difficile infection was associated with increased mortality. In doing so, it highlights the need for nurses to immediately instigate contact precautions for persons suspected of having Clostridium difficile infection and to facilitate a timely faecal collection for testing. Our findings support ongoing surveillance of Clostridium difficile infection and associated prevention and control activities.

To describe how patients adapt to living with a mechanical aortic heart valve.

Aortic valve replacement with a mechanical prosthesis is preferred for patients with life expectancy of more than 10 years as they are more durable than bioprosthetic valves. Mechanical valves have some disadvantages, such as higher risk of thrombosis and embolism, increased risk of bleeding related to lifelong oral anticoagulation treatment and noise from the valve.

An explorative design with a phenomenographic approach was employed.

An explorative design with a phenomenographic approach was applied. Interviews were conducted over 4 months during 2010–2011 with 20 strategically sampled patients, aged 24–74 years having undergone aortic valve replacement with mechanical prosthesis during the last 10 years.

Patients adapted to living with a mechanical aortic heart valve in four ways: ‘The competent patient’ wanted to stay in control of his/her life. ‘The adjusted patient’ considered the implications of having a mechanical aortic valve as part of his/her daily life. ‘The unaware patient’ was not aware of warfarin–diet–medication interactions. ‘The worried patient’ was bothered with the oral anticoagulation and annoyed by the sound of the valve. Patients moved between the different ways of adapting.

The oral anticoagulation therapy was considered the most troublesome consequence, but also the sound of the valve was difficult to accept. Patient counselling and adequate follow-up can make patients with mechanical aortic heart valves more confident and competent to manage their own health. We recommend that patients should participate in a rehabilitation programme following cardiac surgery.

To report the psychometric testing of the Household Risk Perception and Self-Efficacy in Environmental Risk Reduction instruments using principal components analysis.

There are limited instruments available to test household risk perception and self-efficacy related to environmental health behaviours. The Household Risk Perception instrument was developed to measure personal perceptions of household environmental health risks. The Self-Efficacy in Environmental Risk Reduction instrument was designed to measure caregivers' confidence in taking steps to reduce household risks.

An exploratory analysis of previous data was undertaken.

Baseline data from 235 caregivers enrolled in a randomized clinical trial testing a healthy housing intervention were collected between 2006–2009. Principal components analysis was used to determine principal components from measured responses to each instrument.

Components were explored and compared to constructs used to design the original instruments. A five-component structure showed the simplest solution and explained 65% of variance in the Household Risk Perception analysis. Cronbach's alpha values indicated satisfactory internal consistency for four of five identified components. Risk perception varied according to available sensory input of the specific risk. A four-component structure explained 64% of the variance in the Self-Efficacy in Environmental Risk Reduction analysis. Cronbach's alpha values were satisfactory. Items mapped to steps in an action-oriented process vs. agent-specific actions. Results from both analyses suggest that environmental tobacco smoke is perceived differently than other household risks.

Previously, both instruments relied on item reliability and content validity testing. This study provides a basis for further instrument revision and theoretical testing.

This article is a report of the development and testing of the hypothetical model that illustrates relationships between treatment adherence and its psychosocial influencing factors and to elucidate the direct and indirect (mediating) effects of factors on treatment adherence.

Poor adherence has been consistently reported in haemodialysis patients. Much research has showed various influencing factors of adherence, but these studies have failed to identify consistent influencing factors.

This study was performed using a non-experimental, cross-sectional design.

The study subjects were 150 end-stage renal failure patients on haemodialysis at a university hospital located in Incheon, South Korea. Data were collected over 10 months (June 2010–April 2011).

The hypothetical model provided a good fit with data. Haemodialysis-related knowledge, perceived barrier to adherence, self-efficacy on adherence, and healthcare provider support had significant effects on adherence. Self-efficacy was found to mediate barrier–adherence and family support–adherence relationships. Self-efficacy in combination with barrier, family support, and healthcare provider support was found to mediate the depression–adherence relationship.

Strategies aimed at the development of successful adherence interventions should focus on reducing perceived barriers and enhancing self-efficacy and knowledge. It can be suggested that efforts to improve the healthcare provider–patient relationship would enhance adherence. In depressive patients, strategies that promote self-efficacy and the support of family or healthcare providers could diminish the negative impact of depression on adherence.

To develop a theory to guide the recovery process of a recent suicide attempt.

Suicide is one of the 10 leading causes of death in many countries. Many nations have set targets to reduce the high incidence of suicide by aiming to prevent people from taking their own lives and also providing care to promote the healing of those who attempt suicide.

A qualitative grounded theory approach was used.

Data were collected in 2011–2012 in a Taiwanese hospital until data saturation occurred. Twenty participants were interviewed, comprising patients who recovered from suicide attempts (N = 14) and their caregivers (N = 6). Data were analysed using open, axial, and selective coding and using the constant comparison technique.

A substantive theory was formulated to guide the recovery process of people who have recently attempted suicide. The core category that emerged from the data collected was ‘Striving to accept the value of self-in-existence’. Other key categories linked to and embraced in this core category were: becoming flexible and open-minded, re-building a positive sense of self, and endeavouring to live a peaceful and contented life.

Nurses could use this theory as a theoretical framework to guide people who are recovering from a suicide attempt by affording them the opportunity to grow and heal, and facilitating the re-building a positive sense of self, acknowledging the uncertainties of life, and inspiring hope.

To determine which method of intermittent urinary catheterization, sterile with a catheterization-set or the no-touch method, offers the most advantages for caregivers in a hospital setting

The no-touch catheter is assumed to decrease the risk for infection and increase the comfort for caregivers due to its construction, however, evidence is lacking

A cross-over experimental study was carried out from October until December 2009, 100 nurses and 71 nursing students participated.

Every participant had to catheterize as well according to the no-touch method as to the standard intermittent catheterization method. A randomization programme determined whether the subjects had to catheterize a male or female simulation model.

Multiple regression analysis shows that nurses and nursing students appear to make on average two more errors with the sterile intermittent catheterization method with set than with the no-touch method. The duration of the no-touch method is 92 seconds less than the classical catheterization method. On a scale with 10 points for comfort, the classical sterile method with set scored on average two points lower than the no-touch method, as well for the nurses as for the students.

Compared with the classical method, both students and nurses spend less time on performing the no-touch method, less sterility errors are made and a higher score is assigned to the no-touch method. Also classical catheterization of men implies higher costs compared with the no-touch method. No-touch intermittent catheterization is thus expected to be preferred above the gold standard catheterization method.

Structural equation modelling tested hypothesized causal relationships between age, gender, pain, depression, self-efficacy, outcome expectations, functional status and quality of life in older Australians postorthopaedics surgery across three stages of their rehabilitation.

Self-efficacy is important in forming personal beliefs about capabilities to perform functional activities, which is believed to maintain individual's quality of life. Research examining how efficacy beliefs influence functional status in older people following orthopaedic events is limited.

A descriptive, longitudinal method was used for this study.

A convenience sample of 101 older people with orthopaedic surgery to lower extremities was recruited from private rehabilitation units in Brisbane, Australia. Data were collected from September 2008–November 2009. Standardized questionnaires were used to measure efficacy beliefs, functional status, and quality of life.

Structural equation modelling revealed that depression, efficacy beliefs, age, and gender significantly influenced quality of life, as self-efficacy and gender have a direct relationship on functional status. Across three stages in the model, outcome expectation at stage 2 was the most significant predictor of functional recovery after discharge. Older men with higher quality of life at admission was positively related to self-efficacy and negatively associated with depression at stage 2: quality of life influenced outcome expectations and pain positively at stage 3.

Rehabilitation programmes play a significant role in assisting older people in resuming functional activities and quality of life following orthopaedic surgery. Enhancing self-efficacy may facilitate older people's participation and adher-ence to rehabilitation programmes during hospitalization and following discharge.

To report a study protocol to explore the experience of cancer screening from the perspective of ethnic minorities in Hong Kong

Cancer is a major health problem, but screening can be effective in decreasing the incidence and mortality rates. Providing information on how to participate in recommended preventive measures and on accessibility to these services is a crucial step in promoting healthy behaviour. Ethnic minorities in Western countries are found to be less likely to use preventive services and encounter more barriers in doing so than the general population.

A mixed-method design with two phases has been chosen to meet the aims and objectives of the study, with Phase 1 using a self-reported survey and Phase 2 involving focus-group interviews.

A convenience sample of 1540 South Asians (770 in each gender) will be recruited from community centres for the Phase 1 survey in 2013–2014, of whom 72–96 will be invited to participate in the Phase 2 interviews. The Survey and Behavioural Research Ethics Committee of the local university approved the study in March 2012.

The findings will provide detailed information on the use of cancer screening and the barriers that this minority population faces in Hong Kong. The findings will inform the government and policy-makers on the implementation of culture-specific interventions, so as to increase the screening uptake rate of this ethnic minority.

To explore caring and coping among carers of stroke survivors and identify factors that had an impact on their lives.

Informal carers carry the main responsibility for the care of stroke survivors in the community, which can have a detrimental effect on the health and well-being of carers. However, the circumstances of caring differ for each carer: this study identifies the diverse factors that can cause caring to be burdensome for some carers and less so for others.

Qualitative descriptive study.

A convenience sample of 30 carers of stroke survivors were interviewed in 2008–2010, following hospital discharge of the stroke survivor.

The impact that the stroke event had on the participants of this study varied enormously. Not only did the health status and well-being of the stroke survivors vary greatly but it was also clear that many different factors had an influence on the impact of the stroke on the carer and on how each of them coped. Nine thematic categories were identified, which fell into three broad categories: (1) the impact of the stroke event on the carer; (2) the extrinsic factors that support the caring scenario; and (3) the intrinsic factors that help a carer to cope with the new role.

This study provided an insight into the circumstances where caring for stroke survivors takes place. These factors that have an impact on caring and carers should inform the nursing assessment of needs of carers of stroke survivors in the community.

This article is a report of a study of informed consent in people with a learning disability. The aims of the study were to explore the information needs of people with mild-to-moderate learning disabilities with respect to consent for blood tests and to identify ways of facilitating informed consent.

The recent political agenda for social change in the UK has emphasized the right of people with a learning disability to have more autonomy and make their own decisions. As in other countries, there has also been a shift towards shared decision-making in healthcare practice.

Qualitative study using an ethnographic approach.

An ethnographic approach was used for this qualitative study. Phase 1 involved observation of six participants with a learning disability having a routine blood test in general practice, followed by semi-structured interviews with 14 participants with a learning disability in Phase 2. Data were collected between February 2009–February 2010.

The data showed that consent procedures were often inadequate and provision of information to patients prior to a blood test was variable. People with a learning disability expressed clearly their information requirements when having a routine blood test; this included not wanting any information in some cases.

Healthcare practitioners and people with a learning disability need to be familiar with current consent law in their own country to facilitate valid consent in the healthcare context. This study demonstrated the value of qualitative research in exploring the knowledge and attitudes of people with learning disability.

To report an analysis of the concept of humour in adult cancer care.

Humour is a form of communication which is present in the adult cancer setting. Numerous studies show the multi-dimensional value of humour in cancer care. A clear conceptual understanding, however, of what it represents is lacking.

Walker and Avant's framework was used to guide this concept analysis.

Literature searches included bibliographic databases, internet, and manual searches.

Literature published from 1990 to the present was reviewed. Thematic analysis was carried out to identify critical attributes and antecedents.

Based on the analysis, a definition of humour in adult cancer nursing is proposed. Humour is a subjective emotional response, resulting from the recognition and expression of incongruities of a comic, absurd and impulsive situation, remark, character, or action, which enhances feelings of closeness or togetherness when shared in the context of trust between the patient and nurse and may be used as a coping mechanism in a stressful situation such as the adult cancer care setting.

The analysis provides an understanding of the concept of humour in the adult cancer setting and includes a theoretical illustration of its critical attributes. This concept analysis provides a forum for discussion with reference to the use of humour in adult cancer nursing care. Further exploration is recommended to determine the meaning of humour and its nature across different care settings.

To explore and to identify the possible need for psychological communicative support in men undergoing fertility treatment.

Male infertility affects many aspects of a man's life and may cause a life crisis. Although infertility treatment is now commonplace in men, they often feel remote and disconnected from the treatment process.

A descriptive survey.

A questionnaire with structured and open-ended questions was completed by 210 Danish men undergoing fertility treatment. The questionnaire covered three issues: individual perception of male infertility, gender equality issues, and communication with health professionals in the clinic. Data were collected during 2008.

Of the participants, 28% believed that their reduced sperm quality affected their perception of masculinity. 46% stated that equal involvement between partners was a very important element of the treatment; however, 63% said that the health professionals communicated primarily with their female partner. Finally, 62% found that there was a need for a deeper dialogue with the nurses concerning male infertility and 72% lacked information about the psychological consequences of male infertility. In general, participants wanted a more open and balanced dialogue about infertility treatment and the role of the male partner during this process.

Infertile men want health professionals to view them on equal terms with their partner. When treating the infertile man, there is a further need to develop more inclusive communication skills.

To explore fatigue, the impact it has on daily life and the strategies used to ameliorate the symptom, as described by people with inflammatory bowel disease.

Fatigue is the most troublesome symptom during remission of inflammatory bowel disease. Fatigue affects people's daily functioning, impacting on quality of life. There is limited understanding of the nature of and the ways fatigue in inflammatory bowel disease is experienced and managed in everyday adult life.

An epistemological interpretive approach to understand participants' self-reported experiences of disease-related fatigue.

A convenience sample of 46 participants was recruited from the Crohn's and Colitis UK member database. Five focus group interviews (November 2008–February 2009) were conducted, audio-recorded, transcribed, and analysed using an inductive thematic framework.

Five themes were identified: the experience of fatigue, causes of fatigue, managing fatigue, consequences of fatigue, and seeking support. Fatigue had a debilitating effect on the social and emotional well-being of participants and limited their employment opportunities. People used a range of strategies to cope and reported that fatigue-related issues seemed to be poorly understood by clinicians and were not addressed in medical consultations.

Fatigue was an inextricable part of daily life for some people with inflammatory bowel disease. Specialist nurses and medical colleagues need to address the personal, social, and economic consequences of fatigue, whilst further nursing research would improve understanding of the impact of fatigue and help develop appropriate intervention strategies for people with inflammatory bowel disease.

To explore moral distress in relatives doctors and nurses, in end-of-life care decision-making, in the adult intensive care unit.

Many deaths in intensive care involve decisions about withholding and withdrawing therapy, potentially triggering moral distress. Moral distress occurs when individuals feel constrained from acting in accordance with moral choice, or act against moral judgement, generating painful, unresolved emotions, and problems that continue long after an event. Prior research has focused mainly on nurses; less is known about doctors' experiences and occurrence and impact on relatives is unknown.

A narrative inquiry case study approach, funded by a Northern Ireland Health and Social Care Doctorate Fellowship Award (April 2011).

In-depth digitally recorded interviews will be conducted with relatives, doctors, and nurses involved in end-of-life cases comprising: (1) withdrawal of therapy, including circulatory death organ donation; (2) non-escalation of therapy; and (3) brain stem death with a request for organ donation. Relatives will be offered the opportunity to share their experiences on ‘Healthtalkonline’ by copyrighting audio-visual interviews to the Health Experiences Research Group, Oxford University. Research Ethics Committee approval was obtained (April 2012).

This is the first time that moral distress is explored, in a case approach, among relatives, doctors, and nurses intimately involved in end-of-life decisions in intensive care. Dissemination of findings will make a large contribution to international knowledge and understanding in this area and alert healthcare professionals and relatives to an otherwise under-recognized, but potentially detrimental, experience. Findings will inform education, practice, and policy.

To report a programme theory for pre-natal home visiting by nurses in the context of a sustained nurse home visiting programme by exploring pre- and postnatal outcomes and characteristics of the intervention that may have contributed to the outcomes.

Studies have shown sustained nurse home visiting commencing pre-natally to be effective. Few studies have explored the processes by which pre-natal activities by nurses contribute to achieving effective outcomes.

Process evaluation.

Process and outcome data from a randomized controlled trial of sustained nurse home visiting in an area of socioeconomic disadvantage in Western Sydney between 2005–2008 were collated. The pre-natal intervention focused on improving transition to parenting by supporting mothers through pregnancy. Health and service use outcome data were analysed for 208 women (111 intervention; 97 comparison receiving usual care). Five nurses delivering the intervention completed checklists detailing activities undertaken.

Nurses provided information, psychosocial support, and health promoting activities for families. Intervention mothers had a higher rate of unassisted vaginal births than the general population. Compared with comparison mothers, intervention mothers at 4–6 weeks postnatally reported better general health and felt significantly more enabled to cope with and understand their baby and to care for themselves and their baby.

Comprehensive support, in a context of enabling client-nurse relationships and continuity of carer are the ways by which antenatal nurse home visiting achieves benefits for women and infants, having an impact on both clinical outcomes such as rates of normal vaginal delivery and maternal service engagement.

To test a model that delineates advanced practice nursing from the practice profile of other nursing roles and titles.

There is extensive literature on advanced practice reporting the importance of this level of nursing to contemporary health service and patient outcomes. Literature also reports confusion and ambiguity associated with advanced practice nursing. Several countries have regulation and delineation for the nurse practitioner, but there is less clarity in definition and service focus of other advanced practice nursing roles.

A statewide survey.

Using the modified Strong Model of Advanced Practice Role Delineation tool, a survey was conducted in 2009 with a random sample of registered nurses/midwives from government facilities in Queensland, Australia. Analysis of variance compared total and subscale scores across groups according to grade. Linear, stepwise multiple regression analysis examined factors influencing advanced practice nursing activities across all domains.

There were important differences according to grade in mean scores for total activities in all domains of advanced practice nursing. Nurses working in advanced practice roles (excluding nurse practitioners) performed more activities across most advanced practice domains. Regression analysis indicated that working in clinical advanced practice nursing roles with higher levels of education were strong predictors of advanced practice activities overall.

Essential and appropriate use of advanced practice nurses requires clarity in defining roles and practice levels. This research delineated nursing work according to grade and level of practice, further validating the tool for the Queensland context and providing operational information for assigning innovative nursing service.

This study reports the prevalence of malnutrition (according to body mass index and malnutrition universal screening tool) and the prevalence of health problems that may influence the development of malnutrition in Austrian hospitals. Screening routines and nutrition-related interventions on patient level and quality indicators on ward and facility levels were also investigated.

Malnutrition is an undesirable condition of care-dependent patients and can increase morbidity and mortality of those affected; it is therefore required to screen every patient to detect people at risk and treat them early. Only little data are available on the prevalence of the underlying causes and on the extent of nutrition-related interventions.

A cross-sectional multicentre study in 11 Austrian hospitals (n = 2,283) in 2009.

Every patient was assessed by two trained nurses. Data were collected using a standardized validated questionnaire.

The prevalence of malnutrition according to the malnutrition universal screening tool was 15·7% (high risk) and 8·3% (middle risk). A body mass index <20·0 kg/m² was found in 12·0% (6% <18·5 kg/m²). Main problems were loss of appetite (56·6%), acute disease (38·6%), and nausea (22·3%). About 70% of the patients were screened on admission. Patients at risk were referred to a nutritional expert (7–28·7%), received protein-energy-enriched diets (2·5–15·1%) or snacks (5·1–17·4%). A dietician was available in all hospitals; 8/11 hospitals had fixed criteria for assessing malnutrition; guideline policy varied among the facilities.

The majority of wards acted in compliance with clinical guidelines; nevertheless, there are still some facilities that do not screen and weigh their patients in a standardized manner and do not treat high-risk patients adequately.

To explore the effect of diverse types of women's physical activity on menopausal symptoms among multiethnic groups of midlife women in the USA.

Although physical activity is one of the most widely used non-pharmacological methods for managing menopausal symptoms, there is a paucity of clinical guidelines for women and healthcare providers because the relationship between physical activity and menopausal symptoms has been found inconsistent in previous studies.

A secondary analysis of the data from a lager Internet survey study conducted in 2008–2010.

A total of 481 midlife women among four ethnic groups were selected from the original study. The data were collected using the Kaiser Physical Activity Survey and the Midlife Women's Symptom Index. Bivariate correlation analyses and hierarchical multiple regression analyses were used to analyse the data.

The household/caregiving activity index was positively associated with the prevalence scores of the psychological symptoms in both non-Hispanic Asians and non-Hispanic African Americans. The increased sports/exercise activity index was negatively associated with the severity scores of the physical symptoms in both Hispanics and non-Hispanic Whites. The occupational activity index and the active living activity index significantly predicted the severity scores of the psychosomatic symptoms in Hispanics and non-Hispanic African Americans, respectively.

Nurses who take care of multiethnic groups of midlife women who experience menopausal symptoms should be aware of diverse types of women's physical activities within the cultural context.

This article is a report of a study that explored the perceptions of patients as they experienced their diabetes illness trajectory, and their initial decisions to undergo dialysis, in an effort to provide further complementary guidance for nurses and healthcare practitioners.

Diabetes leads to higher morbidity and mortality when patients develop renal failure resulting from diabetic nephropathy. An effective self-care regimen and multidisciplinary team approach are required to avoid or delay the serious chronic complications of the disease. Patients and healthcare practitioners must be aware therefore of psycho-physiological adjustment when seeking to delay the onset of complications.

A qualitative design was used for data collection through semi-structured interviews.

Data were analysed using content analysis. Participants were 25 diabetes patients undergoing initial haemodialysis who were recruited from diabetes and nephrology wards at a medical centre in northern Taiwan. Data were collected from December 2010–August 2011.

The core theme describing the illness trajectory derived from face-to-face interviews with people undergoing hemodialysis was ‘from silence to storm’. There emerged also five phases of patient experience that resulted from the development of diabetic nephropathy: (1) diabetes onset stage; (2) stable stage; (3) burden stage; (4) shock stage; and (5) coping stage.

Patients suffer with diabetic nephropathy for a long-term period. Our findings may enhance the understanding of nurses regarding the experiences of patients with diabetic nephropathy, and will help them provide diabetes care that promotes healthy life for those individuals.

To explore the impact of being a family carer to patients with stage 5 chronic kidney disease managed without dialysis.

Increasing numbers of patients with renal disease worldwide are making the decision not to embark on dialysis. This group has significant physical and psychological symptom burdens similar to or greater than those in advanced cancer patients. Little is known about the impact on family carers.

Exploratory, qualitative design.

The study was undertaken with 19 carers caring for patients managed in a Renal Supportive Care Service in the UK between 2006–2008. Sixty-one semi-structured interviews and detailed field notes inform the analysis.

‘Caring from diagnosis to death’ was the overarching theme illustrated by three sub-themes: (i) Caregiver's plight – making sense of the disease and potential deterioration; (ii) Having to care indefinitely; and (iii) Avoiding talk of death. ‘Caring from diagnosis to death’ coincides with an original concept analysis of renal supportive care, which is considered an adjunct to the management of patients with renal disease at all stages of their illness.

There is a clear need for further research internationally and theory-based nursing interventions to support carers of patients managed without dialysis. The development of a holistic, integrated care pathway based on carer perspectives, which includes identification of information needs related to original diagnosis, associated comorbidities, treatment options, prognosis, and assistance in developing strategies to manage communication with patients as the end of life approaches, is required.

To examine Chinese mothers' experience of caring for their hospitalized sick child.

Engaging the mother in providing care for a hospitalized sick child is considered one of the key elements for high-quality care in advanced paediatric nursing. There is evidence that a mother's belief in her capacity to manage stressful situations could improve the nurse–parent relationship because they might play an important role in protecting mothers against heightened stress during crisis situation.

An interpretive phenomenological approach involving semi-structured interview and thematic analysis was used.

Fifteen interviews were conducted in Hong Kong, China from April 2009–January 2010, with 15 mothers caring for their hospitalized sick children with acute injury or illness. Crist and Tanner's circular process of hermeneutic interpretive phenomenology was chosen to guide the data analysis.

The prevailing concept identified through analysis was the ‘constant vigilance’ that mothers developed. Interpretation of data resulted in the identification of four key themes: ‘being sensitive to others’, ‘providing helping hands’, ‘monitoring health conditions’, and ‘maintaining dialogues’. The findings highlight Chinese mothers' desire for participation in caring for their hospitalized child, their unexpressed needs for communication, and concern about being uncared by the busy health professionals, which affect their care for the child's health outcomes.

The findings facilitate the development of family-centred care focuses on partnership of care between the nurse and family to enhance the Chinese family's active and participatory role.

To report a study of the negotiation practices of neurorehabilitation nurses with one another and with allied health professionals to understand nursing relations.

Negotiated order theory offers a promising theoretical lens with which to explore negotiation between nurses and other professionals. This study is the first to apply the perspective to nurse–nurse and nurse–allied health professional relations.

The study is a secondary analysis of findings from a multi-site arts-based intervention to improve patient-centred neurorehabilitation practice.

Interviews and ethnographic observations were conducted (2008–2011) in two neurorehabilitation units in Ontario, Canada. Participants (n = 31) included registered and practical nurses, nurse leaders, and allied health professionals from physical, occupational, and recreational therapy, speech language pathology, and social work.

Neurorehabilitation nursing is characterized by heavy workload, high patient acuity, and poor interprofessional collaboration. This practice context was negotiated by nurses through two strategies: (1) intraprofessional collegialism, accomplished through tactics including task and knowledge sharing, emotional support, coercive threats, and suppression of dissension; and (2) vying for an autonomous essential nursing role in interprofessional practice, accomplished by claiming unique nursing knowledge based on 24/7 nursing proximity, the expansion of the division of professional labour with allied health professionals and modifying physical therapy care plans.

The intraprofessional context and negotiations therein were linked in significant ways to interprofessional negotiations. Understanding this complexity has important implications for improving patient safety and interprofessional practice interventions.

To report a study of the relationship between variables at the group and individual level with nurses' intention to leave their unit.

Workplaces are collective environments where workers constantly interact with each other. The quality of working relationship employees develop at the unit-level influences both employee outcomes and unit performance by shaping employee attitudes.

The study was a cross-sectional design with self-administered questionnaires.

A questionnaire including measures of leader–member exchange and nurse–physician collaboration analysed at group-level and affective commitment and turnover intention analysed at individual level, was administered individually to 1018 nurses in five Italian hospitals. Data were collected in 2009.

A total of 832 nurses (81·7% response rate) completed questionnaires. The results showed that affective commitment at individual level completely mediated the relationship between leader–member exchange at group-level and nursing turnover intention. Furthermore, the cross-level interaction was significant: at individual level, the nurses with high levels of individual affective commitment towards their unit showed low levels of turnover intention and this relationship was stronger when the nurse–physician collaboration at group-level was high.

This study showed the importance for organizations to implement management practices that promote both high-quality nurse–supervisor and nurse–physician relationships, because they increase nurses' identification with their units. Individual affective commitment is an important quality for retaining a workforce and good nurses' relationship at group-level relationships with both supervisors and physicians are instrumental in developing identification with the work unit. Thus, the quality of relationship among staff members is an important factor in nurses' decision to leave.

To present the operationalization of concepts in the nursing intellectual capital theory and the results of a methodological study aimed at empirically validating the concepts.

The nursing intellectual capital theory proposes that the stocks of nursing knowledge in an organization are embedded in two concepts, nursing human capital and nursing structural capital. The theory also proposes that two concepts in the work environment, nurse staffing and employer support for nursing continuing professional development, influence nursing human capital.

A cross-sectional design.

A systematic three-step process was used to operationalize the concepts of the theory. In 2008, data were collected for 147 inpatient units from administrative departments and unit managers in 6 Canadian hospitals. Exploratory factor analyses were conducted to determine if the indicator variables accurately reflect their respective concepts.

The proposed indicator variables collectively measured the nurse staffing concept. Three indicators were retained to construct nursing human capital: clinical expertise and experience concept. The nursing structural capital and employer support for nursing continuing professional development concepts were not validated empirically.

The nurse staffing and the nursing human capital: clinical expertise and experience concepts will be brought forward for further model testing. Refinement for some of the indicator variables of the concepts is indicated. Additional research is required with different sources of data to confirm the findings.

This paper assessed the reliability and construct validity of the new version of a patient classification instrument.

In the development of patient classification instruments, monitoring validity and reliability is essential to assure that patient care requirements and nursing staff workload are appropriately measured.

The sample included 194 patients (construct validity test) and 60 patients (inter-rater reliability test) at medical, surgical, and specialized wards of a teaching hospital in the south east of Brazil. The study was conducted in 2009–2010. For analysis purposes, Spearman's correlation and Cronbach's alpha (internal consistency) were used, and weighted kappa (inter-rater reliability), factor analysis with principal axis factoring extraction method (construct validity) and ordinal regression (instrument's predictive ability).

A high level of inter-rater agreement was found. The importance of all care areas and their contribution to distinguish patient care needs and category in the new instrument were demonstrated. Results also showed the instrument's high predictive ability (99·6%).

The findings give the evidence that the new scale is a reliable and valid tool to assess patient care needs and care category and that it can be used to guide nursing management practice in determining the nursing staff workload.

The aims of this study were to explore: (1) the prevalence and predictors for hazardous alcohol-drinking problems; and (2) previous assessments and interventions for alcohol-drinking problems in hospitalized Chinese patients.

Alcohol is legally accessible and widely used in Taiwan, but few studies have addressed alcohol-drinking problems in hospital settings.

A cross-sectional design was used.

Self-report data were collected in 2009 from 484 patients at five randomly selected general teaching hospitals.

The prevalence of hazardous alcohol-drinking problems was 19·2%. Logistic regression analysis revealed that predictors for hazardous drinking problems were being male, smoking, and chewing betel quid. Only 29·1% of participants had been assessed for drinking problems in the past year. Only 38·7% of participants with drinking problems had received a drinking intervention in the past year.

These findings suggest that alcohol problems in Taiwanese general teaching hospitals are insufficiently assessed and targeted with interventions. Targeting high-risk groups in general teaching hospitals is important to prevent patients' drinking problems.

This paper presents a discussion of historical scholarship published in the Journal of Advanced Nursing.

The Journal of Advanced Nursing provides a forum for disseminating high-quality research and scholarship. For over 35 years, scholars have used the Journal of Advanced Nursing to disseminate research into aspects of nursing, including nursing history.

The data source was Wiley Online electronic database for the Journal of Advanced Nursing for the period 1976–December 2011.

Relative to other academic concerns, nursing history represents a topic of limited concern to nursing scholars, as evidenced in published scholarship in the Journal of Advanced Nursing. The trends in historical scholarship in the journal have been on disciplinary development, the place and context of practice, and gendered relationships. While these are legitimate academic concerns, they suggest a lack of attention to clinical practice in historical research, that which confers social legitimacy on the discipline.

Nursing derives its social legitimacy, in part, through its history, including reliable accounts of the legacy of nursing work in the development of healthcare systems. Disciplinary development in nursing is advanced by giving greater prominence to nursing history in nursing scholarship, including the history of nursing practice

Relative to other academic concerns, nursing scholarship affords little prominence to the topic of nursing history and less still to the history of practice, as evidenced in the outputs of one of nursing's major organs of scholarship. Not to assign due importance to the history of nursing and its practice demonstrates nursing's lack of disciplinary maturity.

To report an analysis of the concept of respite for older people.

Respite is an important support strategy for family carers of older people. However, there is considerable confusion in the literature about the nature, scope, and outcomes of respite services.

The data source for the concept analysis was a review of literature addressing respite for older people. There were no publication date restrictions for the review and literature was searched up to 2010.

Concept analysis that was informed by the work of Dubin and the operationalization of Dubin's work by Holton and Lowe.

A review of the literature was undertaken to better understand the nature of respite for older people. The review investigated the views of respite from the perspective of the service provider, family carer, and care-recipient. A conceptual model of respite was developed using a four-step approach: gaining an understanding of the phenomenon; identifying and retrieving relevant studies; analysing the construct; and developing the conceptual model.

The conceptual model that emerged from this process consisted of three attributes, Partnership, Service, and Respite. The attribute of Partnership concerned the relationship between the service provider, carer and care-recipient. The attribute of Service concerned what the provider offered and focused on two important areas, assistance and engagement. The attribute of Respite concerned the outcomes that the family carer and care-recipient gained from respite and focused on freedom, support, and connection.

The conceptual model provides a framework to assist in the development of respite services.

This article reports results of a study of contributing factors and associated behaviours in specific clinical areas to resistance to care episodes.

Resistance to Care has previously been studied in aged care settings, and previous studies have reported patient behaviours and appropriate responses. Resistance to Care is a defensive response by patients towards healthcare staff and is demonstrated in various non-compliant behaviours.

Cross-sectional study.

A cross-sectional survey of a representative sample of nurses (n = 5044), who were members of the New South Wales Nurses' Association in Australia, was conducted in 2008–2009.

Resistance to Care episodes occur in various clinical settings and may be precipitated by a range of clinical diagnoses and symptoms. They may also be triggered during various nursing activities that nurses recognize as high-risk for these episodes.

The reported Resistance to Care behaviours are similar to those reported in studies of aggression and violence; however, they require a substantially different response by nurses in various clinical contexts.

To explore the level of nurses' job satisfaction and compare the differences between critical care nurses and general ward nurses in Mainland China.

Hospitals continue to experience high nurse turnover. Job satisfaction is a key factor to retain skilled nurses. The differences in job satisfaction among critical care nurses and general ward nurses are unknown.

A cross-sectional design was selected for this descriptive correlation study.

Cross-sectional study of critical care nurses (n = 446) and general ward nurses (n = 1118) in 9 general hospitals by means of questionnaires that included the Chinese Nurses Job Satisfaction Scale and demographic scale. The data were collected from June 2010–November 2010.

Chinese nurses had moderate levels of job satisfaction, were satisfied with co-workers and family/work balance; and dissatisfied with pay and professional promotion. Critical care nurses were younger; less educated and had less job tenure when compared with nurses working on general wards. Critical care nurses were significantly less satisfied than general ward nurses with many aspects of their job.

Levels of nurses' job satisfaction can be improved. The lower job satisfaction of critical care nurses compared with general ward nurses should warn the healthcare administrators and managers of potentially increasing the critical care nurses turn over. Innovative and adaptable managerial interventions need to be taken to improve critical care nurse' job satisfaction and retain skilled nurse.

This protocol outlines a review and qualitative study to determine the models and effectiveness of Advanced Practice Nursing developed for the health care of people over 65 years in different settings (hospital care, home care, outpatients' care, and nursing homes) and to identify the ingredients of the interventions developed by Advanced Practice Nursing in the field of geriatric care.

Numbers of nurses in advanced roles have increased internationally in conjunction with research to determine their effectiveness. Nevertheless, in older people, evidence of advanced practice roles remains scattered, and there is little synthesis of evidence, and therefore it is not easy to visualize the different practice models, their components, and their impact.

Study protocol with two phases: a systematic review and a qualitative study.

First phase: Depending on comparability of studies, meta-analysis will be undertaken. If so, results will be summarized in relative and absolute measures or mean difference, depending on the type of outcome. Sensitivity and heterogeneity analyses will be performed. Second phase: a content analysis will be carried out of the interventions identified in the systematic review, and they will be contrasted with the contents of the Nursing Interventions Classification. Finally, this matching will be submitted to expert consensus using a Delphi technique. Approval from the Ethics Committee was obtained in July 2010 and funding was obtained in March 2011.

The identification of components of Advanced Practice Nursing models and evidence of their effectiveness will contribute to designing more grounded nursing services for older people. Additionally, the categorization of Advanced Practice Nursing interventions through Nursing Interventions Classification would permit comparisons to be made between settings or between healthcare systems.

To report an analysis and comparison of the concepts centring and opening meditation processes in health care.

Centring and opening meditation processes are included in nursing theories and frequently recommended in health care for stress management. These meditation processes are integrated into emerging psychotherapy approaches and there is a rapidly expanding body of neuroscience research distinguishing brain activity associated with different types of meditation. Currently, there is a lack of theoretical and conceptual clarity needed to guide meditation research in health care.

A search of healthcare literature between 2006–2011 was conducted using Alt HealthWatch, CINAHL, PsychNET and PubMed databases using the keywords ‘centring’ and ‘opening’ alone and in combination with the term ‘meditation.’ For the concept centring, 10 articles and 11 books and for the concept opening 13 articles and 10 books were included as data sources.

Rodgers' evolutionary method of concept analysis was used.

Centring and opening are similar in that they both involve awareness in the present moment; both use a gentle, effortless approach; and both have a calming effect. Key differences include centring's focus on the individual's inner experience compared with the non-dual, spacious awareness of opening.

Centring and opening are overlapping, yet distinct meditation processes. The term meditation cannot be used in a generic way in health care. The differences between centring and opening have important implications for the further development of unitary-transformative nursing theories.

To report a study of the lived experience of being a close relative to a patient with colon cancer participating in a fast-track programme.

Studies have documented that postoperative recovery can be accelerated and that hospitalization can be reduced through fast-track programmes. Due to the early discharge and the increasing demands on patients for self-care, patients' relatives seem to play a pivotal role in fast-track programmes. However, research is limited into how patients' close relatives are affected by and involved in the postoperative recovery process.

A descriptive phenomenological approach using Reflective Lifeworld Research.

The study was carried out within the descriptive phenomenological framework of Reflective Lifeworld Research. Data were collected in 2008 from in-depth interviews with twelve relatives.

Relatives experienced a huge responsibility for both the patient's well-being and for the patient's compliance with the daily regimen. Relatives were caught in a conflicting double role. They were the extended arm of the health professionals but also the caring, supporting partner. A tension arose between relatives' desire to help the patient by taking an active part in the recovery process and the feelings of not always having the resources needed.

Relatives seem to suffer in silence as they bear the burden of the patient's diagnosis, the disruption of life, and the taken-for-granted responsibility for the patient's recovery process. From an existential perspective, this caring responsibility can be understood as ethical pain. Relatives should be seen as a distinct group with special caring needs of their own.

To report a study that investigated the career development, aspirations, and choices of undergraduate students and graduates of nursing double degree programmes.

Over one-third of Australian undergraduate nursing students study by double degree mode. Their career destinations will have an impact on the availability of graduates in a time of nursing shortages, but little is known about why nursing students choose double degrees or take up a career in nursing vs. the other specialization.

A qualitative study using two longitudinal methods.

The study was conducted in 2008–2009 with 68 participants from an Australian regional university offering double degrees in nursing. A time series method involved interviews with 12 first year students followed by focus group interviews with 22 final year students. A longitudinal method involved repeated interviews with 34 graduates. Interview transcripts were analysed thematically.

Enrolment in a double degree was influenced by advice from significant others; previous experiences of health care; and the anticipated rewards associated with a choice of two careers. Career development and decisions of undergraduates were influenced by intrinsic and extrinsic rewards distinctive to each area of specialization and marketing and job availability. For graduates, the impact of workplace experiences such as prior practicums and past and present workplace support were foremost.

This study provides previously unknown information about double degree nursing students' and graduates' career development and career choices over time. A socio-ecological framework adapted to nursing enabled a broad understanding of the many environments and contexts that confirm or discourage a nursing career.

To report a study of the effects of protein-energy malnutrition on the functional recovery of older people with hip fracture who participated in an interdisciplinary intervention.

It is not clear whether protein-energy malnutrition is associated with worse functional outcomes or it affects the interdisciplinary intervention program on the functional recovery of older people with hip fracture.

A randomized experimental design.

Data were collected between 2002–2006 from older people with hip fracture (N = 162) in Taiwan. The generalized estimating equations approach was used to evaluate the effect of malnutrition on the functional recovery of older people with hip fracture.

The majority of older patients with hip fracture were malnourished (48/80, 60% in the experimental group vs. 55/82, 67% in the control group) prior to hospital discharge. The results of the generalized estimating equations analysis demonstrated that subjects suffering from protein-energy malnutrition prior to hospital discharge appeared to have significantly worse performance trajectories for their activities of daily living, instrumental activities of daily living, and recovery of walking ability compared with those without protein-energy malnutrition. In addition, it was found that the intervention is more effective on the performance of activities of daily living and recovery of walking ability in malnourished patients than in non-malnourished patients.

Healthcare providers should develop a nutritional assessment/management system in their interdisciplinary intervention program to improve the functional recovery of older people with hip fracture.

(1) To explore ‘successful ageing’ strategies in terms of selection, optimization and compensation in nursing; (2) To develop a scale that measures these strategies in nursing; (3) To investigate the association between these strategies in nursing and work ability of nurses and the moderating effects of age on this relationship.

Studies indicate impaired work ability of older nurses. Research is needed to examine if ‘successful ageing’ strategies can promote the work ability especially in older nurses.

The investigation applied a mixed method design: Study (1) Semi-structured interviews were conducted to explore selection, optimization and compensation in nursing; (Study 2) A cross-sectional survey was used to test the association between selection, optimization and compensation in nursing and work ability.

Data were collected in 2010 and 2011. Study 1: 17 nurses ≥45 years were interviewed; Study 2: 438 nurses (21–63 years) participated. A selection, optimization and compensation-in-nursing-scale was applied that was developed on the basis of study 1. Work ability was measured with the Work Ability Index (Dimension 1).

Study 1, the majority of reported ageing strategies were identified as selection, optimization and compensation in nursing. Study 2, selection, optimization, and compensation in nursing was positively related with work ability. The positive relationship was stronger for older nurses.

Selection, optimization and compensation in nursing contributes positively to work ability, particularly in older nurses. This finding is relevant for the development of measures that promote work ability of nurses over the course of their professional careers.

To explore the influence of the haemodialysis regimen on African Americans' perceptions of sexuality.

Sexuality is defined as the quality of humans as males or females. Sexuality concerns are commonly reported for individuals receiving haemodialysis; yet, sexuality-related research for this population has been limited to a focus on altered physical sexuality characteristics.

Qualitative descriptive study.

This qualitative descriptive study used a middle-range model derived from Roy's adaptation model to explore a holistic viewpoint of African Americans' perceptions of physical sexuality, personal sexuality identity, family/social roles, and intimate/personal relationships since being on dialysis. Data were collected over a 9-month period in 2008–2009.

Semi-structured interviews were conducted with 19 African American men (N = 12) and women (N = 7) who were receiving haemodialysis treatment (mean age = 49·95 years). Perceptions of diminished sexuality were most associated with altered relationships, family and social roles for most participants, and were suggested to negatively influence adaptive processes. Perceptions of personal sexuality identity in male participants were found to be greatly influenced by endorsement of traditional masculinity ideology. In contrast, female participants' perceptions of sexuality were found to be influenced by multiple meanings of their identity as Black women.

These findings suggest that diminished perceptions of sexuality may negatively influence adaptive processes for patients receiving chronic treatment such as dialysis. In addition, findings support further research and the development of instruments to assess sexuality from a more holistic viewpoint.

To explore the unregistered healthcare worker's role and influence on student nurses' clinical learning experience.

Across the developed world, the role of the unregistered worker is exceeding its traditional boundaries. Evidence suggests that this includes the day-to-day mentoring of pre-registration student nurses. However, no research to date has explored reasons as to why this is occurring, what types of tasks are taught, and the consequence of this.

A sequential exploratory mixed method research design was adopted.

Reporting on the final qualitative phase of a mixed method sequential research study, semi-structured interviews were undertaken with 59 unregistered healthcare workers across four hospitals in Northern Ireland. Transcriptions were analysed using a content analysis approach; all data were collected in 2010.

Findings show the diversity of the unregistered healthcare workers' roles and confirm that they play a major part in the education of student nurses with regards to basic, clinical, and non-clinical tasks, with and without the approval of registered staff. However, their involvement did not reflect their levels of expertise as evidenced by certified training. Their participation was justified based on mentor unavailability, their closeness to the student and the patient. While some did raise concerns, they recommended that these workers be formally involved in nurse education.

Mechanisms of workforce planning need to pay particular attention to the expanding role of unregistered healthcare workers as ‘role drift’ has the potential to alter patterns of work and affect current educational approaches impacting on the acquisition of clinical skills. Further research is recommended in this domain.

To assess the association between attendance at antenatal education sessions and breastfeeding during the first year of life.

Although there is evidence that antenatal education encourages breastfeeding, the size and duration of its effect remain unclear.

A prospective cohort study.

The study was conducted in Bizkaia (North of Spain) between May 2005–June 2007 with a consecutive sample of 614 primiparas. Women were classified into three groups according to whether they had received antenatal education and, if so, how many classes (0, 1–4, or 5 or more). Telephone interviews at 1·5, 3, 6 and 12 months were used to estimate the risk of cessation of any breastfeeding and to compare the groups with Cox proportional hazards regression models adjusted for potential confounders.

Initially, 90% of women breastfed their infants, with no differences between the groups. During the first month, the risk of cessation of any breastfeeding was three times as high among non-attendees and twice as high among women who attended 1–4 classes compared with those who attended 5 or more classes. The risk was, however, similar in the three groups from the end of first month onwards.

The results suggest that though antenatal education may be associated with higher rates of breastfeeding in our setting this is only the case for the first month after the birth. Further research is necessary to optimize this beneficial effect to achieve long-term continuation of breastfeeding.

To report a study in Australian operating theatres of compliance by the anaesthetic team with best peripheral arterial catheter practice for blood gas sampling and infection prevention. Comparisons are made with research recommendations and Centres for Disease Control Guidelines.

There is wide global usage of peripheral arterial catheters in the operating theatre for haemodynamic monitoring and blood gas analysis. Frequent blood sampling from arterial catheters can lead to statistically significant blood loss and provide an infective potential. Evidence-based research and clinical guidelines prescribe best practice.

Cross-sectional descriptive survey

Data were collected in 2009 from 64 major Australian hospitals using a self-designed internet survey.

Hand hygiene prior to catheter insertion was the only infection prevention practice entirely adherent with guidelines. The recommended ratio of discard to dead space volume of 2:1 to decrease unnecessary blood loss during blood gas sampling was reported by only 11 (17%) respondents. Less than 32 (50%) respondents used the preferred solution, chlorhexidine to disinfect the insertion site. Access ports were reported as ‘never disinfected’ before use by 30 (47%) respondents.

The complex operating theatre environment presents barriers, which contribute to non-adherence with guidelines. These barriers need to be identified to plan strategies for improvement. A quality audit tool is proposed for development by nurses in collaboration with the anaesthetic team, providing a needed method to assess ongoing compliance with best peripheral arterial catheter care. Further international research would test the generalizability of our Australian findings.

To test alternatives to the current research and clinical practice of assuming that married or partnered status is a proxy for positive social support.

Having a partner is assumed to relate to better health status via the intermediary process of social support. However, women's health research indicates that having a partner is not always associated with positive social support.

An exploratory post hoc analysis focused on posttraumatic stress and childbearing was conducted using a large perinatal database from 2005–2009.

To operationalize partner relationship, four variables were analysed: partner (‘yes’ or ‘no’), intimate partner violence (‘yes’ or ‘no’), the combination of those two factors, and the woman's appraisal of the quality of her partner relationship via a single item. Construct validity of these four alternative variables was assessed in relation to appraisal of the partner's social support in labour and the postpartum using linear regression standardized betas and adjusted R-squares. Predictive validity was assessed using unadjusted and adjusted linear regression modelling.

Four groups were compared. Married, abused women differed most from married, not abused women in relation to the social support, and depression outcomes used for validity checks. The variable representing the women's appraisals of their partner relationships accounts for the most variance in predicting depression scores.

Our results support the validity of operationalizing the impact of the partner relationship on outcomes using a combination of partnered status and abuse status or using a subjective rating of quality of the partner relationship.

To determine the factors affecting the prevalence of metabolic syndrome in younger and older Koreans.

Metabolic syndrome, in combination with other, interrelated predisposing factors, is a risk factor for cardiovascular disease. In Korea, the prevalence of this syndrome, like those of other chronic diseases, has increased continually in recent years.

This is an analytic, descriptive cross-sectional study.

This survey targeted 690,283 examinees that had undergone a medical examination on a life transition period performed by the National Health Insurance Corporation from January–December 2008. For the purpose of this study, the diagnosis of metabolic syndrome was based on the criteria of the American Heart Association and the Heart, Lung, and Blood Institute. The relationship between the risk factors and prevalence rate was shown using a multiple logistic regression model.

The prevalence of metabolic syndrome was 24·8% in the 40 year olds and 40·8% in the 66 year olds. Among the younger adults, the prevalence in women was only 0·57 times that in men. A multiple logistic regression analysis demonstrated that heavy obesity and family history of cardiovascular disease are the strongest independent predictors of metabolic syndrome among younger and older Koreans.

As a management strategy, a nursing intervention strategy for the improvement of lifestyle factors including self-care through proper diet and exercise should be developed and implemented.

This article is a report on a case study that described and analysed the collaborative process among nurse practitioners and registered nurses in oncology outpatient settings to understand and improve collaborative practice among nurses.

Changes in the health system have created new models of care delivery, such as collaborative nursing teams. This has resulted in the increased opportunity for enhanced collaboration among nurse practitioners and registered nurses. The study was guided by Corser's Model of Collaborative Nurse-Physician Interactions (1998).

Embedded single case design with multiple units of analysis.

Qualitative data were collected in 2010 using direct participant observations and individual and joint (nurse dyads) interviews in four outpatient oncology settings at one hospital in Ontario, Canada.

Thematic analysis revealed four themes: (1) Together Time Fosters Collaboration; (2) Basic Skills: The Brickworks of Collaboration; (3) Road Blocks: Obstacles to Collaboration; and (4) Nurses' Attitudes towards their Collaborative Work.

Collaboration is a complex process that does not occur spontaneously. Collaboration requires nurses to not only work together but also spend time socially interacting away from the clinical setting. While nurses possess the conceptual knowledge of the meaning of collaboration, findings from this study showed that nurses struggle to understand how to collaborate in the practice setting. Strategies for improving nurse–nurse practitioner collaboration should include: the support and promotion of collaborative practice among nurses by hospital leadership and the development of institutional and organizational education programmes that would focus on creating innovative opportunities for nurses to learn about intraprofessional collaboration in the practice setting.

To explore the relationship between personal characteristics and smoking initiation among adolescents in Hong Kong.

Adolescents have been initiating cigarette smoking at an increasing rate in recent years. Preventing tobacco use among young children has become one of the most effective strategies to reduce the harmful effects of tobacco use.

A cross-sectional study.

Secondary students were recruited by convenience sampling from schools in the New Territories of Hong Kong in 2010. Questionnaires were used to collect information relating to their demographic and personal characteristics, including behavioural control, coping styles, sociability, locus of control, rebelliousness, self-esteem, emotional distress, and intention to smoke.

A total of 644 secondary students were recruited. The prevalence of having ever tried smoking was 19·4% and that of regular smoking was 3·9% among these students. The results of this study show that secondary students who were living in public housing and had lower behavioural control and higher smoking intention were more likely to have tried smoking or to be regular smokers, indicating that these factors contribute to smoking initiation among secondary students.

The personal characteristics of secondary students do play a role in smoking initiation. Parents and school personnel should work together to help young people to improve their self-esteem and behavioural control and to overcome their rebelliousness. The causes of smoking intention should also be explored to stop young people from picking up their first cigarette.

This paper introduces the concept of acceleration-related demands in the care of older adults. It examines these new demands and their relation to cognitive, emotional, and physical job demands and to employee well-being.

Various changes in the healthcare systems of Western societies pose new demands for healthcare professionals' careers and jobs. In particular today's societal changes give rise to acceleration-related demands, which manifest themselves in work intensification and in increasing requirements to handle new technical equipment and to update one's job-related knowledge. It is, therefore, of interest to investigate the effects of these new demands on the well-being of employees.

Survey.

Between March–June 2010 the survey was conducted among healthcare professionals involved in care of older adults in Austria. A total of 1498 employees provided data on cognitive, emotional, and physical job demands and on acceleration-related demands. The outcome variables were the core dimensions of burnout (emotional exhaustion and depersonalization) and engagement (vigour and dedication).

Hierarchical regression analyses show that acceleration-related demands explain additional variance for exhaustion, depersonalization, vigour, and dedication when controlling for cognitive, emotional, and physical demands. Furthermore, acceleration-related demands associated with increasing requirements to update one's knowledge are related to positive outcomes (vigour and dedication). Acceleration-related demands associated with an increasing work pace are related to negative outcomes such as emotional exhaustion.

Results illustrate that new demands resulting from social acceleration generate potential challenges for on-the-job learning and potential risks to employees' health and well-being.

This paper is a report of the development and psychometric testing of the Swedish version of the Body Awareness Questionnaire to measure bodily focus of attention.

The Body Awareness Questionnaire has been identified as an instrument with excellent psychometric properties within the concept of body awareness. It has been used in both research and clinical settings in different contexts. However, a validated Swedish version is not available.

A cross-sectional design was applied for adaptation of the Body Awareness Questionnaire and psychometric validation. Data were collected between autumn 2009 and spring 2011 from 120 patients diagnosed with rheumatoid arthritis, and from 120 students. The ‘concurrent think aloud’ method was used in a pre-test to determine the usability of the questionnaire. Cronbach's alpha was used to test the internal consistency, and confirmatory factor analysis was performed to test the construct validity.

According to the confirmatory factor analysis, neither the one-factor model nor the four-factor model tested in this study fulfilled the pre-specified criteria in accordance with the Comparative Fit Index, Standardized Root Mean Squared Residual and the Root Mean Square Error of Approximation. The value of Cronbach's alpha for the Swedish version of the Body Awareness Questionnaire was satisfactory.

Our results indicate that the two models tested in this study do not provide a good fit to the observed data. Further refinement and testing of the Swedish version of the Body Awareness Questionnaire is therefore required. The concept of body awareness may be useful in the management of chronic disease and can be addressed in nursing.

Internet use became an integral part of the healthcare relationship. Literature indicates that the illness trajectory plays a role in the use of Internet as a health information tool. This study focuses on infants admitted to a neonatal intensive care unit.

This study aims to understand how the illness trajectory triggers the use of Internet by parents of infants admitted to a neonatal intensive care unit, using a conceptual framework influenced by Corbin and Strauss' illness trajectory.

This study was based on a qualitative longitudinal multiple-case study design.

From July 2007–August 2008 and from June 2009–May 2010, parents with newborns were prospectively interviewed over a period of 10 months. Parents were recruited in four neonatal intensive care units. The interviews were subject of a thematic content analysis.

The multi-layered illness trajectory triggers Internet use. Parents' online health information behaviour interacts with other information channels too (such as interaction with healthcare professionals). Parents accumulate knowledge along the illness trajectory affecting their information needs. The sickness trajectory helps to understand the complexity of the information behaviour. Labels have a major impact on the effectiveness of search strategies.

Nursing and other healthcare professionals should become more aware about the complex relationship between information needs and Internet use along the illness trajectory of an infant. As such, they will be more able to assist parents in finding and evaluating high-quality online information at the right time.

This article presents a discussion on the role of family interventions in HIV/AIDS disease prevention and care.

Although HIV/AIDS epidemic and its impact on the society traditionally has been measured in terms of individual risk behaviours and individual-level HIV prevention, HIV/AIDS family-focused prevention and management strategies are increasingly becoming a priority. However, little is known as to what constitutes a HIV/AIDS family intervention.

The search was limited to English and published literature starting in the year 1983 to date. CINAHL and PubMed were emphasized using a combination of text words and subject headings. Cochrane Library, PsycInfo, Scopus, and the ISI Web of Science databases were also searched using keywords and in the case of PsycInfo, subject headings were used. The main keywords were ‘nurse’, or ‘nursing’, ‘HIV/AIDS’, ‘family interventions’, ‘family support’ and ‘family education’, and/or ‘family subsystems’.

The process of theorizing about ‘family interventions’ and ‘HIV/AIDS-family interventions’ is critical for putting forth essential components unique for designing culturally specific HIV/AIDS family interventions. In addition, any proposed design of HIV/AIDS family intervention should consider the impact of HIV/AIDS on the family across the family life span, disease trajectory, and from an interdisciplinary perspective.

Training needs of family nurses should be met when designing multidisciplinary HIV/AIDS-FIs. Furthermore, nurses should be proactive in advocating for HIV/AIDS family intervention and HIV/AIDS family policies to improve outcomes in family functioning, processes, and relationships. More needs to be done in regard to research on families, family interventions, effectiveness, and cost of family-focused approaches.

To evaluate the clinical appropriateness and safety of nurse and midwife prescribing practice.

The number of countries introducing nurse and midwife prescribing is increasing; however, concerns over patient safety remain.

A multi-site documentation evaluation was conducted using purposeful and random sampling. The sample included 142 patients' records and 208 medications prescribed by 25 Registered Nurse Prescribers.

Data were extracted from patient and prescription records between March–May 2009. Two expert reviewers applied the modified Medication Appropriate Index tool (8 criteria) to each drug. The percentage of appropriate or inappropriate responses for each criterion was reported. Reviewer concordance was measured using the Cohen's kappa statistic (inter-rater reliability).

Nurse or midwife prescribers from eight hospitals working in seventeen different areas of practice were included. The reviewers judged that 95–96% of medicines prescribed were indicated and effective for the diagnosed condition. Criteria relating to dosage, directions, drug–drugs or disease–condition interaction, and duplication of therapy were judged appropriate in 87–92% of prescriptions. Duration of therapy received the lowest value at 76%. Overall, reviewers indicated that between 69 (reviewer 2)−80% (reviewer 1) of prescribing decisions met all eight criteria.

The majority of nurse and midwife prescribing decisions were deemed safe and clinically appropriate. However, risk of inappropriate prescribing with the potential for drug errors was detected. Continuing education and evaluation of prescribing practice, especially related to drug and condition interactions, is required to maximize appropriate and safe prescribing.

To study the relationships between nurse practice environment, workload, burnout, job outcomes and nurse-reported quality of care in psychiatric hospital staff.

Nurses' practice environments in general hospitals have been extensively investigated. Potential variations across practice settings, for instance in psychiatric hospitals, have been much less studied.

A cross-sectional design with a survey.

A structural equation model previously tested in acute hospitals was evaluated using survey data from a sample of 357 registered nurses, licensed practical nurses, and non-registered caregivers from two psychiatric hospitals in Belgium between December 2010–April 2011. The model included paths between practice environment dimensions and outcome variables, with burnout in a mediating position. A workload measure was also tested as a potential mediator between the practice environment and outcome variables.

An improved model, slightly modified from the one validated earlier in samples of acute care nurses, was confirmed. This model explained 50% and 38% of the variance in job outcomes and nurse-reported quality of care respectively. In addition, workload was found to play a mediating role in accounting for job outcomes and significantly improved a model that ultimately explained 60% of the variance in these variables.

In psychiatric hospitals as in general hospitals, nurse–physician relationship and other organizational dimensions such as nursing and hospital management were closely associated with perceptions of workload and with burnout and job satisfaction, turnover intentions, and nurse-reported quality of care. Mechanisms linking key variables and differences across settings in these relationships merit attention by managers and researchers.

To evaluate the effects of a self-care promoting problem-based learning programme for people with rheumatic diseases in terms of health-related quality of life, empowerment, and self-care ability.

Individuals with rheumatoid arthritis express a great need for education and support in adapting to the disease, but the average qualities of studies about patient education interventions are not high. There is no evidence of long-term benefits of patient education.

Randomized controlled trial.

A randomized controlled design was selected with test at baseline, 1-week and 6-month post-interventions after completed the 1-year programme. The tests consisted of validity and reliability tested instruments. The participants were randomly assigned in spring 2009 to either the experimental group (n = 54) or the control group (n = 148). The programme was running alongside the standard care the participants received at a rheumatology unit. Parametric and non-parametric tests were used in the analyses.

The participants in the experimental group had statistically significant stronger empowerment after participation in the self-care promoting problem-based learning programme compared with the control group, at the 6-month post-intervention. Approximately, two-thirds of the participants in the experimental group stated that they had implemented lifestyle changes due to the programme.

The self-care promoting problem-based learning programme enabled people with rheumatic diseases to improve their empowerment compared with the control group. It is important to continue to develop problem-based learning in patient education to find the very best way to use this pedagogical method in rheumatology care.

To test the effect of a nurse-led intervention on weight gain in people with serious mental illness prescribed and taking second generation antipsychotic medication.

Weight gain and obesity has reached epidemic proportions in the general population with the prevalence of Metabolic Syndrome reaching 20–25% of the global population. People with serious mental illness are at even higher risk, particularly those taking second generation antipsychotic medication.

An experimental randomized controlled trial was undertaken.

The control group received a 12-week healthy lifestyle booklet. In addition to the booklet, the intervention group received weekly nutrition and exercise education, exercise sessions, and nurse support. Participants (n = 101) were assessed at baseline and 12 weeks. Data were collected between March 2008–December 2010. Seven outcome measures were used: body measurements included girth (cm), weight (kg), height (cm), and body mass index (kg/m²); questionnaires included the medication compliance questionnaire, the Drug Attitude Inventory, the Liverpool University Neuroleptic Side Effect Rating Scale, and the Medical Outcomes Study Short Form 36. Differences in primary outcome measures between baseline and 12 weeks follow-up were compared between intervention and control groups using standard bi-variate statistical tests. The study was conducted between 2008–2010.

The analysis of outcome measures for the control group (n = 50) and intervention group (n = 51) was not statistically significant. There was a mean weight change of −0·74 kg at 12 weeks for the intervention group (n = 51), while the control group (n = 50) had a mean weight change of −0·17 kg at 12 weeks.

The results were not statistically significant.

This article reports a study exploring nursing practice of monitoring in-hospital patients including intra- and interprofessional communication and collaboration.

Sub-optimal care in general in-hospital wards may lead to admission for intensive care, cardiac arrest, or sudden death. Reasons may include infrequent measurements of vital parameters, insufficient knowledge of their predictive values, and/or sub-optimal use of Medical Emergency Teams. This study was designed to improve understanding of nursing practice and to identify changes required to support nursing staff in improving standards of clinical monitoring practice and patient safety in general in-hospital wards.

The study was designed as a qualitative descriptive clinical study, based on method triangulation including structured individual observations and semi-structured individual interviews.

In the spring of 2009, structured observations and semi-structured interviews of 13 nurses were carried out at a university hospital in Copenhagen, Denmark. The observational notes and interview transcriptions were analysed using content analysis.

One theme (Professionalism influences nursing monitoring practice) and two sub-themes (Knowledge and skills and Involvement in clinical practice through reflections) were identified. Three categories (Decision-making, Sharing of knowledge, and Intra- and interprofessional interaction) were found to be associated with the theme, the sub-themes, and with each other.

Clinical monitoring practice varies considerably between nurses with different individual levels of professionalism. Future initiatives to improve patient safety by further developing professionalism among nurses need to embrace individual and organizational attributes to strengthen their practice of in-hospital patient monitoring and management.

To present an overview of UK National Health Service nurse staffing changes across the last 10 years.

National Health Service funding is now being constrained as part of the overall measures to reduce UK public expenditure. This has implications for future staffing levels and deployment. Government and professional associations are disagreeing about the current extent of actual and likely National Health Service nurse staffing decline.

The paper reviews ‘official’ data and evidence on National Health Service staffing to assess actual National Health Service nurse staffing trends in recent years, highlights the results of scenario modeling of future National Health Service nursing numbers and relates this to national policies on staffing.

The available evidence now points to nurse staffing growth having tailed off and a likely pattern of overall decline in National Health Service nurse staffing is emerging. This is a policy concern in the UK, but also in many other countries.

Whilst there has been a ‘recession benefit’ to the UK nursing labour market, this supply side boost cannot continue indefinitely. Any continued trend towards reduced intakes to training and reduced staffing levels will intensify the debate about the appropriate staffing levels and skills mix.

We have seen significant National Health Service nurse staffing growth in the last 10 years, which is likely now to reverse. The real measure of the effectiveness of local and national National Health Service nursing workforce policy is not how many nurses are employed, it is that sufficient are deployed to provide safe care.

To examine and critique how the phases of the 4D cycle (Discovery, Dream, Design, and Destiny) of appreciative inquiry are implemented in a healthcare context.

Appreciative inquiry is a theoretical research perspective, an emerging research methodology and a world view that builds on action research, organizational learning, and organizational change. Increasing numbers of articles published provide insights and learning into its theoretical and philosophical underpinnings. Many articles describe appreciative inquiry and the outcomes of their studies; however, there is a gap in the literature examining the approaches commonly used to implement the 4D cycle in a healthcare context.

A methodological review following systematic principles.

A methodological review was conducted including articles from the inception of appreciative inquiry in 1986 to the time of writing this review in November, 2011. Key database searches included CINAHL, Emerald, MEDLINE, PubMed, PsycINFO, and Scopus.

A methodological review following systematic principles was undertaken. Studies were included if they described in detail the methods used to implement the 4D cycle of appreciative inquiry in a healthcare context.

Nine qualitative studies met the inclusion criteria. Results highlighted that appreciative inquiry application is unique and varied between studies. The 4D phases were not rigid steps and were adapted to the setting and participants.

Overall, participant enthusiasm and commitment were highlighted suggesting appreciative inquiry was mostly positively perceived by participants. Appreciative inquiry provides a positive way forward shifting from problems to solutions offering a new way of practicing in health care and health research.

To explore if young people with higher and lower levels of metabolic control of type 1 diabetes have different perceptions about their lives and illness.

Adolescence through emerging adulthood is a developmental stage made more challenging when the person has type 1 diabetes. Little research has investigated if individuals with high and low levels of metabolic control in this age group perceive their disease differently.

Qualitative descriptive.

In this study, 14 participants, ages 11–22 years were interviewed in 2008 about their perceptions of living with type 1 diabetes. Through a process of induction, major themes were identified.

Participants with high and low metabolic control levels reported similar themes related to reactions of others, knowledge about type 1 diabetes, and believed healthcare providers used authoritarian interactions. However, high metabolic control level participants believed type 1 diabetes would be cured; had negative initial responses to being diagnosed; rarely received parental support in managing their diabetes; and were negligent in self-care activities. Participants with low metabolic control levels did not believe a cure was imminent or have negative responses to being diagnosed; received parental support in managing diabetes; and were diligent in self-care activities.

Nurses should give information to young people with type 1 diabetes beyond initial diagnosis and help and support this age group learn appropriate ways to manage their disease, develop positive relationships with healthcare professionals, and participate in interactions with others their age successfully managing type 1 diabetes.

This article reports experiences of Brazilian physicians and nurses caring for women with postpartum depression in primary healthcare settings.

Prevalence of postpartum depression in Brazil ranges from 12–37%, which fits with international claims about differences in the magnitude of the problem and consistency of screening.

Qualitative descriptive.

This study was situated in health units of the Family Health Strategy in Campina Grande, Brazil. Data were collected from September 2010–January 2011 through open-ended interviews with ten nurses and seven physicians, observations, and field diary records. Inductive content analysis was used to develop categories.

Three categories: (1) Limited professional exposure to postpartum depression; (2) Postpartum depression as the domain of psychiatry; and (3) Challenges dealing with postpartum depression demonstrated that few professionals felt postpartum depression merited their attention. Women, with signs of postpartum depression, were usually identified by family members who noticed behaviours that seemed abnormal. Care providers indicated they had inadequate time and access to screening techniques to identify women with depression attending unit-based pregnancy and postpartum groups. When identified, women were referred directly to psychiatric care.

Without consistent screening and diagnostic techniques, Brazilian health professionals are insecure about identifying and treating cases of postpartum depression. Referring women to psychiatric units entail more time for women to be diagnosed and treated and increased costs for health services. Primary healthcare professionals require training to screen, identify, and treat postpartum depression in primary healthcare settings.

To compare home care nursing services use by community-dwelling older people from urban and rural environments in Poland.

In the current literature, there is a lack of data based on multidimensional geriatric assessment concerning the provision of care delivered by nurses for older people from urban and rural environments.

Cross-sectional random survey.

Between 2006–2010, a random sample of 935 older people (over 65 years of age) from an urban environment and 812 from a neighbouring rural environment were interviewed in a cross-sectional survey.

The rural dwellers (82·8%) nominated their family members as care providers more often than the city inhabitants (51·2%). Home nursing care was provided to 4·1% of people in the city and 6·5% in the county. Poststroke condition, poor nutritional status, and low physical activity level, as well as low scores for activities of daily living, instrumental activities of daily living, and Mini-Mental State Examination values, were all determinants of nursing care, both in urban and rural areas. In the urban environment, additional predictors of nursing care use were age, presence of ischaemic heart disease, diabetes and respiratory disorders, number of medications taken, and a high depression score.

Poor functional status is the most important determinant of nursing care use in both environments. In the urban environment, a considerable proportion of community-dwelling elders live alone. In the rural environment, older people usually have someone available for potential care services. The main problem seems to be seeking nursing care only in advanced deterioration of functional status.

This article is a report of a study of lesbian co-mothers' experiences of UK maternity healthcare services.

With the increase in fertility provision to lesbian couples, maternity healthcare services are increasingly coming into contact with lesbian co-mothers. Literature highlights the need to investigate donor-conceived lesbian families and an absence of research focusing on the unique experiences of co-mothers in the maternity process.

The study followed a qualitative design and interpretative phenome-nological analysis methodology.

A qualitative study was carried out involving ten lesbian co-mothers, whose children were conceived via anonymous donor insemination to their partners. Data collection took place between May–September 2009.

Interpretative phenomenological analysis revealed two main types of co-mothers' experiences, those connected with maternity service structures and interpersonal experiences with maternity care staff. Co-mothers felt excluded by heterocentric organizational service structures. However, the co-mothers' overwhelming experiences with staff were positive and inclusive. Despite this, co-mothers reported that any ambiguous or non-inclusive experiences with professionals left them questioning whether these experiences were due to homophobic attitudes or professional incompetence.

The results indicate that these lesbian co-mothers felt predominantly included and accepted by maternity services. Ambiguous interpersonal experiences, however, evoked doubts in this regard. In addition, organizational heterocentric structural barriers remain. Structural service delivery changes could facilitate co-mothers' feelings of inclusion and highlight the important role practitioners have in contributing to co-mothers' experiences.

To determine the effectiveness of the ‘sleep enhancement’ nursing intervention (Nursing Interventions Classification) in patients hospitalized with mental illness and having a disturbed sleep pattern and to identify the possible effect of psycho-active medications on this disturbed sleep pattern.

A quasi-experimental pretest-posttest type study without control group.

The study was conducted in all patients admitted to the mental health inpatient unit of University Hospital of Spain from 1 March 2007–31 May 2008. The effectiveness of the ‘sleep enhancement’ nursing intervention was measured using the Oviedo Sleep Questionnaire score and Nursing Outcome Classification sleep scores at admission and discharge. Psycho-active medication was considered an intervening variable and data were analysed by multivariate analysis of variance for repeated measures.

The study included 291 patients. Consumption of psycho-active medications did not change between admission and discharge and was not statistically significantly different in the multivariate analysis of variance. Oviedo Sleep Questionnaire and Nursing Outcome Classification sleep scores at admission and discharge demonstrated significant sleep improvement after the nursing intervention.

This nursing intervention could be implemented in patients admitted to a mental health inpatient unit with disturbed sleep pattern, regardless of their consumption of psycho-active medications.

To report a study undertaken to explore the underlying factors influencing e-learning adoption in nurse education.

Despite e-learning's high profile it has not been readily integrated into teaching practice in nurse education. Previous research has identified generic, cross-disciplinary factors but has left out ‘soft’ factors.

The study adopted an exploratory descriptive design.

Q-methodology was used to explore e-learning adoption in a Division of Nursing located in an institution of Higher Education in the UK. Between September–December 2009, 38 participants were recruited to participate in Q-sorts and post-sort interviews. The Q-sort data were factor analysed and the interviews were coded to their respective factors to develop in-depth narratives.

Four factors were identified: ‘E-learning advocates’ saw e-learning's potential to improve nurse education and prepare future nurses for their evolving role; the ‘Humanists’ had avoided e-learning because they valued human interaction; the ‘Sceptics’ doubted that technology could improve learning outcomes; and the ‘Pragmatics,’ only used e-learning as a tool to post lecture notes online to supplement what they covered in class.

The findings point to the variety of responses existing among nurse academics faced with integrating e-learning into their teaching. Moving beyond the binary labels commonly attributed to those considered either ‘early adopters’ or ‘laggards,’ the findings contribute to the literature by revealing a wider breadth of views and responses towards technology. Acknowledging these views can inform future e-learning strategies and lead to improvement in e-learning use in nurse education.

To investigate whether the psychological well-being of care workers in the Danish eldercare services mediated the association between experiences of acts of offensive behaviour and actual turnover.

Research suggests that experiences of acts of offensive behaviour are associated with risk of turnover. However, little is known about the longitudinal associations between experiences of different types of offensive behaviour (threats, violence, bullying, and unwanted sexual attention) and risk of actual turnover.

A prospective cohort study.

The study was conducted among employees in the eldercare services in Denmark. Employees aged 55 or more and non-care staff were excluded from the study. Employees who were working in eldercare at baseline (2005) and no longer worked in eldercare at follow-up (2006) were interviewed through questionnaires. Respondents to this questionnaire were coded as cases of turnover (N = 608) and were compared with employees who had not changed jobs during follow-up (N = 4330). Data on experiences of acts of offensive behaviour and well-being were measured at baseline. Data were analysed using logistic regression analysis.

Frequent and occasional experiences of bullying and threats and occasional experiences of unwanted sexual attention at baseline entailed a significantly increased risk of turnover at follow-up. Further analyses showed that psychological well-being significantly reduced the risk of turnover and that well-being partially mediated the association between bullying and turnover and fully mediated the association between threats, unwanted sexual attention, and turnover.

Prevention of threats, unwanted sexual attention and – especially – bullying may contribute towards improving well-being and reducing turnover among eldercare staff.

To identify predictors of successful transition from undergraduate student to registered nurse and to identify whether any particular pre-registration paid employment choice impacted on transition.

Nursing students in Australia and internationally, engage in a variety of paid employment whilst completing their university studies. However, there is little empirical evidence about the different types of employment chosen by students and any relationship to graduate nurse transition.

A descriptive questionnaire survey.

This cross-sectional study was conducted with newly graduated nurses throughout Australia. The survey data were collected over 4 months in 2011, with 392 registered nurses completing a questionnaire.

Respondents were categorized into four groups, according to their chosen work type (hospitality/retail, enrolled nurse, other healthcare worker, and non-worker) and transition scores were identified. Transition scores were significantly higher for undergraduates who were employed compared with non-workers. Postregistration institutional work factors appeared to be stronger predictors of successful transition than pre-registration employment factors. Assistance in dealing with complex patients, orientation to a new environment, and respect from colleagues were the best predictors for successful transition.

Engaging in some form of paid employment in the final year of undergraduate university study is beneficial. However, it is not pre-registration employment choice per se that is the best predictor of successful transition, but the influence of work factors which new graduates experience in their first year of practice.

To report a study designed comparing the roles, responsibilities, and perceived outcomes of Clinical Nurse Specialists, Clinical Midwife Specialists, and Advanced Nurse Practitioners in Ireland.

A clinical career pathway that encompasses progression from staff nurse or midwife through clinical specialist to advanced practitioner level was introduced in Ireland in 2000. Such roles are common internationally, but little evaluation has been conducted and few comparisons have been made between roles.

A mixed-method case-study design was used.

Following Research Ethics Committee Approval, data were collected in 2009–2010, using non-participant observation (92 hours) of 23 Clinical Specialists and Advanced Practitioners, interviews with 21 clinicians and 13 Directors of Nursing or Midwifery. A survey was completed by 154 service-users.

A clear difference was seen between Clinical Specialist and Advanced Practitioners, with advanced practice roles providing improved service delivery, greater clinical and professional leadership, increased research, and a clear governance and accreditation structure. Clinical Midwife Specialists were rated at a similar level to Advanced Nurse Practitioners for certain aspects and rated more highly for ‘continuity of care and carer’.

Advanced Practitioners do give a higher level of care, particularly at a strategic level. Existing Clinical Specialists should therefore be encouraged to develop their skills and education to achieve advanced practice level and more specialist and advanced practice posts should be instituted.

To validate, clinically, the defining characteristics for the nursing diagnoses of Impaired Tissue Integrity and Impaired Skin Integrity in patients subjected to heart catheterization and to validate acute pain, haematoma, bleeding, redness, and heat as additional characteristics.

In clinical practice, an applicable nursing diagnosis for patients subjected to diagnostic heart catheterization has not been well-defined.

Cross-sectional.

This clinical validation study using Fehring's model was performed at a Brazilian general hospital between November 2009–November 2010. This study included 250 patients who received elective femoral artery catheterization. Each patient was identified as having two characteristics of Impaired Tissue Integrity and three characteristics of Impaired Skin Integrity, according to NANDA-I nursing diagnoses. Due to certain postprocedure events, five additional characteristics were added to be validated in this setting. In addition to Fehring's reliability rating, the kappa coefficient was used to evaluate inter-rater agreement during the clinical evaluation.

The defining characteristic of damaged tissue was validated for Impaired Tissue Integrity and the defining characteristics of the invasion of body structures and the disruption of the skin surface were validated for Impaired Skin Integrity. Although the five characteristics that were added to the investigated diagnoses were not validated because of their low rate of occurrence in this setting, the measurements of acute pain, haematoma, bleeding, redness, and heat each had excellent inter-rater agreement.

The validation of characteristics from both of these diagnoses suggested that these criteria could be utilized for clinical practice in a diagnostic setting. Moreover, additional characteristics should also be observed to better guide nursing intervention.

To report a study conducted to describe the determinants of Turkish school-aged children's dietary habits and body mass index.

Over the past two decades, children's unhealthy dietary habits and obesity have increased rapidly. Nurses have an essential role in minimizing health-risk behaviours and promoting healthy lifestyles. Using the Interaction Model of Client Health Behavior to measure children's dietary habits and body mass index values helps to prepare health-promotion interventions.

A descriptive, correlational study.

The study was conducted, based on a sample of 420 fifth-grade students and their parents in one city in Turkey. The data were collected during 2007 using a questionnaire designed to assess the dietary habits and anthropometric indices. Data were analysed using quantitative analysis to identify key variables.

The girls scored healthier on dietary habits than did the boys. Although dietary self-efficacy was statistically significant as an explanatory variable of dietary habits for both genders, the dietary attitude was the only explanatory variable of dietary habits for the girls. No difference was detected in the prevalence of overweight between boys and girls.

Nurses are well-situated to give children dietary self-efficacy improvement, dietary attitude enhancement, and family-centred and school-based intervention programmes to reduce their unhealthy dietary habits. The model guides researchers to identify the background characteristics of children that result in the body mass index.

To explore the experience of young adults growing up and living with HIV in urban Sweden.

HIV has become a widespread pandemic. Effective antiretroviral treatment has dramatically increased the survival rate of infected individuals, such that HIV infection is currently considered a chronic disease where treatment is available. Data concerning the experience of living with HIV since early childhood is scarce and more empirical knowledge is needed to direct the development of adequate care and interventions for this growing demographic.

Exploratory qualitative study.

Semi-structured interviews were conducted with ten HIV-infected young adults over the period from January–August 2008. Transcripts of the interviews were analysed using qualitative content analysis.

The analysis revealed five categories illustrating the experiences of growing up and living with HIV in Sweden: (1) to protect oneself from the risk of being stigmatized; (2) to be in control; (3) losses in life, but HIV is not a big deal; (4) health care/healthcare providers; and (5) belief in the future.

It is essential to offer a safe, trustworthy, and professional healthcare environment during the upbringing of HIV-infected children. Evidence-based interventions are needed to improve care and support, particularly about the handling of stigma and discrimination.

To report a study of processes used by women to disclose intimate partner violence to healthcare professionals in urban emergency department settings.

Women seek emergency care for impairment related to intimate partner violence yet face barriers non-judgmental and supportive care.

A two-phase sequential explanatory mixed methods study.

The study was conducted in Ontario, Canada (May 2006–December 2007). In a sub-analysis of quantitative data with 1182 participants, 15% of women patients reported intimate partner violence, but only 2% disclosed to a healthcare professional. To understand these results, grounded theory with 19 participants was completed.

Participants identified that the basic social problem was the violence ‘being found out’ by healthcare professionals while receiving care. To address this problem, women undertook a process to minimize intrusion including: deciding to seek care, evaluating the level of trust with the presenting healthcare professional, and establishing personal readiness to disclose. The trajectory of this process was different for each participant with some negotiating all phases leading to violence disclosure. The length of time it took for participants to move through each phase varied across all participants. Common to all participants was the anticipation and the actual experience of intrusion and its influence on women's willingness to disclose intimate partner violence.

The results suggest nurses may be able to facilitate disclosure of intimate partner violence through limiting intrusion. This can include assessment in a private setting, and fewer professionals who interact with the client.

The purpose was to examine the effects of non-commercial music on quality of sleep and relaxation indices, including heart rate, mean arterial pressure, and respiratory rate in patients in intensive care units.

There is currently insufficient scientific knowledge for the effects of music on quality of sleep in critically ill patients.

A randomized controlled trial.

Between January–December 2010, 28 patients aged 39–78 years were randomly assigned to music and control groups. Participants in the music groups listened to non-commercial music for 45 minutes at nocturnal sleep time. In the control group, participants slept with no music. Participants were assessed using vital signs monitors, standardized questionnaire, and polysomnography. Polysomnography sleep was recorded for the first 2 hours of the nocturnal sleep. General estimating equation was applied to analyse data.

Participants in the music group had shorter stage N2 sleep and longer stage N3 sleep in the first 2 hours of the nocturnal sleep and improved self-reported sleep quality, compared with those in the control group. The music group patients also had significantly lower heart rates than those in the control group. The intensive care units patients experienced fragmented sleep with a high frequency of awakenings and severe reduction in random eye movement sleep during the first 2 hours of the nocturnal sleep.

The findings provided evidence for nurses to use soothing music as a research-based nursing intervention for intensive care unit patients' sleep improvement.

To gain an increased understanding of fathers' experiences during their child's stay in hospital as an unplanned admission for acute illness or injury.

Family-centred care is promoted in children's nursing as providing high quality care but internationally, research has in the main focused on mothers whilst fathers' contribution to care remains relatively under explored.

A qualitative field study.

The study was conducted from August 2009–December 2010 involving 150 hours of ethnographic observation on two children's wards and interviews with 12 fathers and seven qualified children's nurses.

Fathers wanted to be with their sick child in hospital and made essential contributions to the whole family's experience. Three aspects of the fathers role in caring for their sick child in hospital were identified which included: protecting, providing for the family, and participating in care.

Fathers, no less than mothers, want to be with and care for their sick child in hospital, yet they face challenges in doing so. The working practices of children's nurses and other healthcare professionals must take into account that fathers play a significant role in caring for their sick child in hospital but may do this alongside paid work and caring for well siblings.

To expand our understanding of the experience of social role strain in the context of diabetes care among middle-aged married Korean women with type 2 diabetes.

Diabetes remains an international concern. There are special challenges experienced by middle-aged married women who may not prioritize self-care and disease management. These challenges may be heightened in certain cultures due to traditional female and family roles along with other social norms and values.

Descriptive qualitative study.

This qualitative descriptive study involves in-depth interviews conducted between January–February 2007 with ten middle-aged married Korean women purposively selected to represent both higher and lower levels of role strain as measured by the measure of role gratification and strain instrument from the companion study, which was conducted simultaneously.

Korean women in this study reported ‘resentment regarding previous role strain’. This psychosocial burden was heightened by a noted pattern of ‘sacrificing self in favour of others’, which complicated both their personal lives and their ability to take care of themselves physically. Added to this were feelings of guilt related to their diabetes and the requirements of day-to-day management expressed as, ‘my diabetes makes me a liability’.

The women's role-strain experience related to their diabetes was intertwined with their past and current daily life. Further explication and interventions to address and manage role strain could potentially improve women's disease management and overall quality of life.

To test the psychometric properties and evaluate the German version of the Nurse Competence Scale.

Nursing competence is an important factor for high-quality healthcare. However, there are only few instruments available, which try to assess nurse competence and there is limited knowledge about the psychometric quality of any of these instruments.

A cross-sectional survey of 679 nurses was used.

Analysis of the psychometric properties of the 73-item Nurse Competence Scale was undertaken using confirmatory factor analyses and Rasch modelling with data generated in a study in 2007.

The 7-factor model of the Nurse Competence Scale could not be confirmed. However, six scales consisting of 54 items demonstrated adequate fit to the Rasch model. The six subscales could also be combined into an overall competence scale.

There are concerns about the psychometric properties of the Nurse Competence Scale. The reduced set of items removes redundancy among items, is free from item bias and constitutes six unidimensional scales.

This article is to report the development and psychometric testing of the Hospital Aggressive Behaviour Scale – Users.

Workplace violence is present in many work spheres, but in the healthcare sector, nurses in particular are at more risk due to the close contact they maintain with users and clients and the special characteristics of this relationship.

Using qualitative and quantitative methodology, an instrument was applied to a sample of 1,489 nurses from 11 public hospitals. Data collection was carried out in 2010 and 2011.

Exploratory factor analysis yielded a 10-item instrument distributed in two factors (non-physical violence and physical violence), which was validated by means of confirmatory factor analysis. Both the resulting questionnaire and the factors identified present high internal consistency and adequate external validity, analysed by means of statistically significant correlations between the Hospital Aggressive Behaviour Scale and job satisfaction, burnout components, and psychological well-being.

The results indicate that, in nursing personnel, higher exposure to user violence leads to lower job satisfaction, more emotional exhaustion and more cynicism, and to a lower level of psychological well-being.

The instrument developed in this study may be very useful in the sphere of assessment and prevention of psychosocial risks for the early detection of the problem of user violence in its two facets.

Our purpose in this paper is to propose a new method for extracting findings from research reports included in mixed-methods mixed research synthesis studies.

International initiatives in the domains of systematic review and evidence synthesis have been focused on broadening the conceptualization of evidence, increased methodological inclusiveness and the production of evidence syntheses that will be accessible to and usable by a wider range of consumers. Initiatives in the general mixed-methods research field have been focused on developing truly integrative approaches to data analysis and interpretation.

The data extraction challenges described here were encountered, and the method proposed for addressing these challenges was developed, in the first year of the ongoing (2011–2016) study: Mixed-Methods Synthesis of Research on Childhood Chronic Conditions and Family.

To preserve the text-in-context of findings in research reports, we describe a method whereby findings are transformed into portable statements that anchor results to relevant information about sample, source of information, time, comparative reference point, magnitude and significance and study-specific conceptions of phenomena.

The data extraction method featured here was developed specifically to accommodate mixed-methods mixed research synthesis studies conducted in nursing and other health sciences, but reviewers might find it useful in other kinds of research synthesis studies.

This data extraction method itself constitutes a type of integration to preserve the methodological context of findings when statements are read individually and in comparison to each other.