Professor Roger Watson is a biology graduate of The University of Edinburgh, UK. Following a PhD in biochemistry from The University of Sheffield, UK he entered nursing and qualified in 1984 after studying at St George’s Hospital, London, UK. He worked in Scotland with older people and then entered academic nursing at The University of Edinburgh in 1989. His first chair was in Ireland in 1998 where he became the first Professor of Nursing in Ireland at Dublin City University. He returned to the UK in 1999 to the Chair in Nursing at The University of Hull and, in 2005, the Chair in Nursing at The University of Sheffield. Since 2003 he has been Editor of the Journal of Clinical Nursing (now Editor-in-Chief), currently rated in the top ten of world nursing journals. In 2007 Professor Watson became the first UK nurse elected Fellow of the American Academy of Nursing and in 2009 was awarded a Fellowship of the Royal College of Nursing in the UK.
Professor Watson is best known for the development of the Edinburgh Feeding Evaluation in Dementia scale which is now used in several countries, including the USA and Taiwan. His research interests are wide and he has also researched the areas of caring in nursing and work and study related stress in nurses and nursing students. He is well published in refereed journals and has several textbooks on science in nursing, accountability and research methods.
Professor Watson is a frequent visitor to Australia, China and Taiwan where he has visiting chairs.
Abstract: OBJECTIVES: To construct a training protocol for spaced retrieval (SR) and to investigate the effectiveness of SR and Montessori-based activities in decreasing eating difficulty in older residents with dementia. METHODS: A single evaluator, blind, and randomized control trial was used. Eighty-five residents with dementia were chosen from three special care units for residents with dementia in long-term care facilities in Taiwan. To avoid any confounding of subjects, the three institutions were randomized into three groups: spaced retrieval, Montessori-based activities, and a control group. The invention consisted of three 30-40 min sessions per week, for 8 weeks. RESULTS: After receiving the intervention, the Edinburgh Feeding Evaluation in Dementia (EdFED) scores and assisted feeding scores for the SR and Montessori-based activity groups were significantly lower than that of the control group. However, the frequencies of physical assistance and verbal assistance for the Montessori-based activity group after intervention were significantly higher than that of the control group, which suggests that residents who received Montessori-based activity need more physical and verbal assistance during mealtimes. In terms of the effects of nutritional status after intervention, Mini-Nutritional Assessment (MNA) in the SR group was significantly higher than that of the control group. CONCLUSION: This study confirms the efficacy of SR and Montessori-based activities for eating difficulty and eating ability. A longitudinal study to follow the long-term effects of SR and Montessori-based activities on eating ability and nutritional status is recommended. Copyright (c) 2010 John Wiley & Sons, Ltd.
Abstract: The first year post-qualifying as a nurse or midwife is often seen as a key transitional period. Flying Start NHS is the national development programme for all newly qualified nurses, midwives and allied health professionals in NHS Scotland. It is designed to support the transition from student to newly qualified health professional through supporting learning in everyday practice. It is a web-based or CD-ROM programme which seeks to increase the confidence and competence of newly qualified nurses and midwives during their first year of employment following registration. The aims of this study were to establish levels of self-report competency, self-efficacy, job demands and career intentions in newly qualified nurses undertaking Flying Start NHS programme in Scotland. The aims were met by conducting a cross-sectional survey of Flying Start NHS students. Newly qualified nurse participants (n=97) comprised a convenience sample of newly qualified nurses who were registered as undertaking the Flying Start NHS on-line programme during Autumn-Winter 2007. Most newly qualified nurses intend to remain in the NHS although a small but important number may leave.
Abstract: Symptoms of hoarseness (dysphonia) are common and often associated with psychological distress. The Voice Symptom Scale (VoiSS) is a 30-item self-completed questionnaire concerning voice and throat symptoms. Psychometric and clinical studies on the VoiSS show that it has good reliability and validity, and a clear factorial structure. The present article presents a further advance in voice measurement from the patient's point of view. To date, there has been no examination of whether voice-related symptoms form a hierarchy; that is, whether people who suffer voice problems progress through a reliable set of problems from mild to severe. To address this question, the technique of Mokken scaling was applied to the VoiSS in 480 patients with dysphonia. A strong and reliable Mokken scale--a symptom hierarchy--was found, which included 17 of the 30 items. This new information on dysphonia shows that voice symptoms progress from voice-oriented difficulties, through practical problems, to disturbances of social relationships and mood (dysphoria). The results add information about the structured phenomenology of voice problems, further establish the relationship between voice impairment and psychosocial impairment, and suggest practical applications in the assessment of dysphonic voices.
Abstract: BACKGROUND: Several behaviourally observed tools have been developed to assess pain among cognitively impaired older people with communication difficulty. However, no adequate pain observation instrument is available for this group in Taiwan. OBJECTIVE: The study was undertaken to translate the French version of the Doloplus-2 scale into Chinese and to evaluate the psychometric properties and the clinical feasibility of the translated instrument. DESIGN: A prospective, descriptive design was used. SETTINGS: Five dementia special care units in the Northern Taiwan were used. PARTICIPANTS: Two hundred and forty-one residents with dementia and 14 registered nurses in charge of these residents were recruited. METHODS: The Doloplus-2 scale was translated into Chinese using the back-translation technique and pilot testing was performed to determine the comprehensibility and the initial psychometric characteristics. Internal consistency and inter-rater reliability were evaluated by Cronbach's alpha and intra-class correlation coefficient, respectively. Based on the known correlated validity model, the association between C-Doloplus-2 and empirically supported correlates of pain such as the past pain history, the presence of pain related condition, functional disability, agitation and depression were examined using Pearson's correlation coefficient for validating the construct validity. Furthermore, factor structure was investigated using Principal Components Analysis. RESULTS: The internal consistency was adequate for the total scale (alpha 0.74) and the subscales (alpha range 0.67-0.87). The intra-class correlation coefficient of the total scale was 0.81 and of the subscales ranged from 0.60 to 0.81. The association between pain latent variable and disability or depression was demonstrated, partially supporting the construct validity. Three factors were extracted to confirm the original three-dimensional structure perfectly, accounting 65% of the total variance. CONCLUSIONS: The psychometric qualities of Chinese Doloplus-2 were supported. Further research is needed to assess the clinical value of the translated scale performed in the institutions.
Abstract: In a sample of 543 adult National Health Service (NHS) patients referred to a Psychological Therapies Service, the responses to the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) self-report questionnaire were examined using conventional principal components analysis (PCA) and a unique application of Mokken Scaling Procedure (MSP). Following the theoretical views of G. A. Foulds, it was suggested that some items more properly belong to the universe of attitudes and traits rather than that of symptoms and states. Accordingly, the analyses were carried out both with and without the CORE-OM Risk domain items. Both PCAs produced a very large first component of Psychological distress, while the small second component differs. With all items included, the second component was of Risk. With the risk items excluded, the second component was now Functioning. The MSP results, respectively, were of a five-item scale of Functioning (impaired by depression) and on the second analysis, a five-item Functioning scale (impaired by anxiety). There was discussion on the criteria for item selection, the time scale specified in questionnaire instructions and the optimum number of items required for a symptom scale. It was concluded that the CORE-OM item pool did not conform to its purported face validity domains and subdomains, but predominantly constitutes a large Psychological distress scale with considerable item redundancy.
Abstract: Background: As the number of adults in older age groups expands, difficulty performing usual activities of daily life is a rising health concern. A common exercise regimen employed to attenuate functional decline and disability has been resistance strength training. However, recent evidence suggests that functional tasks exercise may be more effective in preventing disability. Objective: Activities of Daily Living (ADL) measures are one of the most widely used tools in gerontology, and yet the full sensitivity of these instruments is often not realized. The purpose of this study is to enhance the interpretive power of ADL by formally confirming a hierarchy of decline, assessing discriminatory power, and examining option characteristic curves. Theoretically, a revised ADL instrument can improve the efficacy of functional tasks training programs. Methods: This was a cross-sectional study that employed Item Response Theory (IRT) to interpret ADL outcomes. Participants consisted of community-dwelling older adults (n = 548, aged 79) living in Scotland. Results: A Mokken scale with rho = 0.77 was obtained, indicating good reliability, and satisfying the IRT assumption that a single unidimensional scale is present. The set H coefficient of 0.48 indicated that the scale may be ordered by decreasing difficulty, with the 'Cut your own toe-nails?' item being the most difficult and 'Tie a good knot in a piece of string?' being the least difficult. Discriminatory and option characteristic parameters revealed 'Get on a bus?' to be the task most closely related to the latent construct and that item options can be used to ascertain critical thresholds for prevention type strategies. Conclusions: Examining parameters relating to difficulty, discriminatory power, and option characteristics facilitated the identification of ADL/Instrumental ADL items that may serve to enhance functional task training in community-dwelling older adults. These analyses demonstrated that functional tasks have differing levels of discriminatory power, and that a task's discriminatory power is likely to change with varying levels of disability. This observation reinforces the notion that exercises based on functional tasks may differ significantly in their therapeutic effect. Lastly, this study was able to highlight statistically meaningful cut-points relating to when older adults should begin 'prehabilitation' interventions.
Abstract: BACKGROUND: The United Kingdom's National Health Service workforce is ageing, and the specific needs of this sector of its workforce need to be addressed. Nursing and midwifery shortage is a worldwide issue, and with increasing demands for care the retention of older nurses and midwives is crucial. OBJECTIVES: To report on the employment experiences of nurses and midwives with a particular focus on issues relating to age, ethnicity, ill-health and disability. DESIGN: The postal survey was developed following a literature review and analysis of National Health Service and Government policy documents. SETTINGS: This was a UK-wide survey of nurses and midwives working in National Health Service Trusts and Primary Care Trusts. PARTICIPANTS/METHODS: A postal survey of nurses and midwives was undertaken between May and December 2005. National Health Service Trusts and Primary Care Trusts (n=44) identified as having policies relevant to the study were contacted regarding the procedure for seeking research governance approval. Thirteen National Health Service Trusts and Primary Care Trusts participated, with 2610 surveys distributed; 510 surveys were returned (20% response rate). RESULTS: Nurses and midwives aged 50 years and over had undertaken fewer Continuing Professional Development activities than nurses and midwives under 50. Whilst not related to age, the study also found that 20% of the survey sample reported experiencing some form of discrimination. Nurses and midwives did not differ on either quality of life or psychological health using standard instruments. Having a disability did not lead to greater psychological morbidity but did have a negative effect on quality of life. Having a work-related illness had a negative impact on both quality of life and psychological morbidity. In relation to ethnicity, black nurses and midwives reported lower psychological morbidity than other ethnic groups; that is, they enjoyed a higher level of mental well-being. CONCLUSION: The nursing and midwifery workforce is ageing worldwide with a significant proportion now approaching, or having already reached, potential retirement age. With the recent introduction of the age legislation the working lives of older nurses and midwives in the National Health Service have never been more relevant. Whilst access to Continuing Professional Development is pertinent to the retention of nurses and midwives of all ages, in this study, older nurses reported less access than younger nurses.
Abstract: AIMS: The aims of this study were to investigate whether the interaction effect between restraint and functional ability, and single ability during activities of daily living can predict agitation among residents with dementia. BACKGROUND: Agitated behaviour is one of the most common symptoms of dementia and might endanger the patients themselves, caregivers and institutions. However, the prevalence of problem behaviours and its associated factors at long-term care facilities in Taiwan are less understood. DESIGN: A direct observation was used to observe the agitated behaviours of residents with dementia in special care units. METHODS: Residents of dementia special care units who were diagnosed with dementia in eight long-term care facilities were recruited. Measurements included: demographic data, the Barthel Index, the Mini-Mental State Examination and the Cohen-Mansfield Agitation Inventory. RESULTS: The number of subjects who were identified with problem behaviours was 163 (43.5%). Significant differences in sex, being restrained, restrained time, age, family visits, functional status and mental status were found between the agitated and non-agitated groups. However, mental status, family visits, walking ability, being restrained and getting in and off toilet were five independent factors associated with agitated behaviours after controlling for all other factors. CONCLUSIONS: It is recommended that strategies be constructed to encourage the family to periodically visit older residents and to develop restraint-free environments in long-term care facilities. RELEVANCE TO CLINICAL PRACTICE: Residents with dementia require significant daily living support and behaviour management as their illness progress.
Abstract: AIM: The aim of this study was to investigate how differences in life events and stress contribute to psychological distress in nurses and nursing students. BACKGROUND: Stress is an issue for nursing students and qualified nurses leading to psychological distress and attrition. DESIGN: A longitudinal study using four time waves was conducted between 1994-1997. METHODS: Measures were taken of stress, life events and psychological distress in addition to a range of demographic data. Data were analysed using descriptive statistics, linear modelling and mixed-effects modelling. The study was set in Scotland, UK and used newly qualified nurses and nursing students from four university departments of nursing over four years. The study was initiated with 359 participants (147 nurses and 212 nursing students) and complete data were obtained for 192 participants. RESULTS: Stress levels, psychological distress and life events are all associated within time and across time. At baseline, life events and stress contributed significantly to psychological distress. The pattern of psychological distress differed between the nursing students and the newly qualified nurses with a high level in the nurses after qualifying and starting their career. CONCLUSION: Stress, individual traits, adverse life events and psychological distress are all interrelated. Future lines of enquiry should focus on the transition between being a nursing student and becoming a nurse. RELEVANCE TO CLINICAL PRACTICE: Stress and psychological distress may have negative outcomes for the retention of nursing students in programmes of study and newly qualified nurses in the nursing workforce.
Abstract: The United Kingdom (UK) once led the world in nursing but because of the exigencies of the funding mechanisms of the National Health Service (NHS), it has fallen a long way behind other countries. We aim to raise awareness inside and outside the UK about the decline in nursing as a profession there. We are purposely contentious, in an attempt to raise questions, both for the UK and for countries which are recruiting British nurses who are leaving because of job losses caused by the funding crisis in the NHS. This paper discusses where the problems that have led to the decline have come from, where nursing is going and poses questions for the future. We hope that the UK government and those who influence the development of nursing will bring it back to the standard it once had.
Abstract: OBJECTIVE: To explore nurses' perceptions of the impact on clinical practice of the use of a computerised hospital information system. DESIGN: A realistic evaluation design based on Pawson and Tilley's work has been used across all the phases of the study. This is a theory-driven approach and focuses evaluation on the study of what works, for whom and in what circumstances. These relationships are constructed as context-mechanisms-outcomes (CMO) configurations. MEASUREMENTS: A questionnaire was distributed to all nurses working in in-patient units of a university hospital in Spain (n=227). Quantitative data were analysed using SPSS 13.0. Descriptive statistics were used for an overall overview of nurses' perception. Inferential analysis, including both bivariate and multivariate methods (path analysis), was used for cross-tabulation of variables searching for CMO relationships. RESULTS: Nurses (n=179) participated in the study (78.8% response rate). Overall satisfaction with the IT system was positive. Comparisons with context variables show how nursing units' context had greater influence on perceptions than users' characteristics. Path analysis illustrated that the influence of unit context variables are on outcomes and not on mechanisms. CONCLUSION: Results from the study looking at subtle variations in users and units provide insight into how important professional culture and working practices could be in IT (information technology) implementation. The socio-technical approach on IT systems evaluation suggested in the recent literature appears to be an adequate theoretical underpinning for IT evaluation research. Realistic evaluation has proven to be an adequate method for IT evaluation.
Abstract: AIMS: To explore and explain the different concepts of reliability and validity as they are related to measurement instruments in social science and health care. BACKGROUND: There are different concepts contained in the terms reliability and validity and these are often explained poorly and there is often confusion between them. DESIGN: To develop some clarity about reliability and validity a conceptual framework was built based on the existing literature. RESULTS: The concepts of reliability, validity and utility are explored and explained. CONCLUSIONS: Reliability contains the concepts of internal consistency and stability and equivalence. Validity contains the concepts of content, face, criterion, concurrent, predictive, construct, convergent (and divergent), factorial and discriminant. In addition, for clinical practice and research, it is essential to establish the utility of a measurement instrument. RELEVANCE TO CLINICAL PRACTICE: To use measurement instruments appropriately in clinical practice, the extent to which they are reliable, valid and usable must be established.
Abstract: AIM: To investigate qualified nurses' attitudes to evidence-based practice and whether this influenced their selection of wound care products. BACKGROUND: The literature shows that previous studies on attitudes to evidence-based practice tended to be part of a wider study. The general consensus was that there was a positive attitude to evidence-based practice. However, there appeared to be no published studies specifically addressing nurses' attitudes to evidence-based wound care. DESIGN: Survey design using a questionnaire completed by 156 qualified nurses working in three UK National Health Trusts. RESULTS: A statistically significant difference was seen between those nurses with a tissue viability link nurse role (p = 0.002) and those without a link nurse role; those educated to first degree (p < 0.001) and those without a first degree; and those who had received formal tissue viability training (p < 0.001) and those with informal tissue viability training. There was also a highly statistically significant relationship between the clinical grade of staff and the overall attitude to evidence-based practice (p < 0.001). CONCLUSIONS: Nurses who had attained a higher level academic qualification, had a tissue viability link nurse role and those who had received formal tissue viability training scored generally higher in the wound care knowledge tests and in attitude to evidence-based practice. RELEVANCE TO CLINICAL PRACTICE: The care received by patients in relation to wound care could be dependent upon factors that are related to the individual characteristics of the nurse providing the care and these factors, in turn, are related to education and training with respect to wound care. Better general education and better specific training in wound care could lead to better wound care.
Abstract: AIM: The aim of this paper is to consider the process of ageing, the effects of ageing and research related to ageing. BACKGROUND: In most countries of the world, the UK being no exception, the population is ageing in terms of the absolute numbers of and relative proportion of older people. This has resulted from economic, scientific and medical progress. However, it poses challenges for health and social services. METHOD: Selective review of the literature. CONCLUSION: Ageing is an inevitable part of life and, while not in itself debilitating, can be accompanied by a range of debilitating physical and mental conditions which lead to frailty and dependency. There is limited evidence that the ageing process can be alleviated, as such, but there is some evidence that choices and circumstances in early life can influence the extent to which we age successfully. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers have two responsibilities with regard to age: they are increasingly engaged in organizing care for older people in acute and long-term settings and in nursing homes and the more they need to understand the process of ageing. They also have responsibilities towards their workforce and can facilitate lifestyle choices which may help their workforce to age successfully.
Abstract: BACKGROUND: Hierarchical cumulative scales are common and informative in psychology. The General Health Questionnaire (GHQ) does not appear to have been subjected to an analysis that examines the hierarchical and cumulative nature of its items. We report an analysis of data from the 30-item GHQ (GHQ-30) as part of the Health and Lifestyle Survey (HALS).METHOD: Data from 6317 participants who completed the GHQ-30 as part of the HALS were analysed using the Mokken Scaling Procedure (MSP), which is a computer program that searches polychotomous data for hierarchical and cumulative scales on the basis of a range of diagnostic criteria. RESULTS: A final scale consisting of nine items from the GHQ-30 was obtained that, according to the criteria for a Mokken scale, was a reliable and very strong scale. The least difficult item in the scale is 'been (un)able to face up to your problems?' and the most difficult item is 'felt that life isn't worth living?' CONCLUSIONS: Items from the GHQ-30 form a short hierarchical and cumulative scale. The majority of these items also appear in the GHQ-12. The nine-item GHQ shows better distribution properties than the GHQ-30 and compares very favourably with the GHQ-12.
Abstract: BACKGROUND: The worldwide shortage of registered nurses [Buchan, J., Calman, L., 2004. The Global Shortage of Registered Nurses: An Overview of Issues And Actions. International Council of Nurses, Geneva] points to the need for initiatives which increase access to the profession, in particular, to those sections of the population who traditionally do not enter nursing. This paper reports findings on the costs associated with one such initiative, the British National Health Service (NHS) Cadet Scheme, designed to provide a mechanism for entry into nurse training for young people without conventional academic qualifications. The paper illustrates an approach to costing work-based learning interventions which offsets the value attributed to trainees' work against their training costs. OBJECTIVE: To provide a preliminary evaluation of the cost of the NHS Cadet Scheme initiative. DATA SOURCE: Questionnaire survey of the leaders of all cadet schemes in England (n=62, 100% response) in December 2002 to collect financial information and data on progression of cadets through the scheme, and a follow-up questionnaire survey of the same scheme leaders to improve the quality of information, which was completed in January 2004 (n=56, 59% response). PRINCIPAL FINDINGS: The mean cost of producing a cadet to progress successfully through the scheme and onto a pre-registration nursing programme depends substantially on the value of their contribution to healthcare work during training and the progression rate of students through the scheme. The findings from this evaluation suggest that these factors varied very widely across the 62 schemes. Established schemes have, on average, lower attrition and higher progression rates than more recently established schemes. Using these rates, we estimate that on maturity, a cadet scheme will progress approximately 60% of students into pre-registration nurse training. CONCLUSIONS: As comparative information was not available from similar initiatives that provide access to nurse training, it was not possible to calculate the cost effectiveness of NHS Cadet Schemes. However, this study does show that those cadet schemes which have the potential to offer better value for money, are those where the progression rates are good and where the practical training of cadets is organised such that cadets meet the needs of patients which might otherwise have to be met by non-professionally qualified staff.
Abstract: BACKGROUND: Stress in nursing students may be related to attrition from nursing programmes and lead to a shortage of nurses entering clinical careers. In addition, stress leads to psychological morbidity which may have profound adverse consequences for individual nursing students. OBJECTIVES: To follow a cohort of nursing students from entry to their programme to the end of the first year and to study the interrelationship between a range of psychological variables including personality, stress, coping and burnout. DESIGN: Prospective, repeated measures survey using self-administered questionnaires. SETTING: A university school of nursing in Hong Kong. PARTICIPANTS: Students were selected on the basis of entry to their nursing programme in 2004; 158 students entered the study and 147 completed; 37 were male and 121 were female at entry. The mean age of the cohort at entry was 19.1 (S.D. 0.85); ages ranged from 18 to 26. METHODS: The questionnaires administered at wave 1 were: the NEO Five Factor Inventory, the Coping in Stressful Situations questionnaire, the 12-item General Health Questionnaire, the Maslach Burnout Inventory and the Stress in Nursing Students questionnaire. At wave 2 the 12-item General Health Questionnaire, the Maslach Burnout Inventory and the Stress in Nursing Students questionnaire were administered. RESULTS: Students suffered greater levels of psychological morbidity and burnout at the second time wave and this was largely explained by the personality trait of neuroticism. Stress also increased and this was largely explained by emotion-oriented coping. CONCLUSIONS: Undertaking a nursing programme leads to increased level of stress, burnout and psychological morbidity and this is largely related to individual personality and coping traits.
Abstract: AIMS: To review existing nursing research on inpatient hospitals' information technology (IT) systems in order to explore new approaches for evaluation research on nursing informatics to guide further design and implementation of effective IT systems. BACKGROUND: There has been an increase in the use of IT and information systems in nursing in recent years. However, there has been little evaluation of these systems and little guidance on how they might be evaluated. METHODS: A literature review was conducted between 1995 and 2005 inclusive using CINAHL and Medline and the search terms 'nursing information systems', 'clinical information systems', 'hospital information systems', 'documentation', 'nursing records', 'charting'. RESULTS: Research in nursing information systems was analysed and some deficiencies and contradictory results were identified which impede a comprehensive understanding of effective implementation. There is a need for IT systems to be understood from a wider perspective that includes aspects related to the context where they are implemented. CONCLUSIONS: Social and organizational aspects need to be considered in evaluation studies and realistic evaluation can provide a framework for the evaluation of information systems in nursing. RELEVANCE TO CLINICAL PRACTICE: The rapid introduction of IT systems for clinical practice urges evaluation of already implemented systems examining how and in what circumstances they work to guide effective further development and implementation of IT systems to enhance clinical practice. Evaluation involves more factors than just involving technologies such as changing attitudes, cultures and healthcare practices. Realistic evaluation could provide configurations of context-mechanism-outcomes that explain the underlying relationships to understand why and how a programme or intervention works.
Abstract: AIM: To measure competence, self-reported competence and self-efficacy; explore any differences between cohorts and student entry criteria; and explore the relationship between competence, self-reported competence, support and self-efficacy. METHOD: All students undertook a three-station objective structured clinical examination (OSCE) and had previously completed a questionnaire, which included measures of self-reported competence, support and self-efficacy. The performance of two single year cohorts enabled measurement of competence development and progression. RESULTS: Students were competent in the core generalist skills of communication and hand decontamination but demonstrated low levels of numeracy. CONCLUSION: Doubts are raised about the explanatory value or practical use of social cognitive theory in pre-registration curricula and questions are raised about the value of self-reported competence. This has implications for nursing and midwifery curricula, which emphasise the importance of self-assessment.
Abstract: BACKGROUND: There is a professional requirement for student nurses to achieve competence in the delivery of spiritual care. However, there is no research exploring students nurses perceptions of being educated in these matters. AIM: This paper explores the ethical basis of teaching student nurses about the concepts of spirituality and spiritual care by reporting the findings from the first year of a 3 year investigation. DESIGN: An exploratory longitudinal design was used to obtain student nurses perceptions of spirituality and spiritual care as they progressed through a 3 year programme. METHOD: A questionnaire incorporating the Spirituality and Spiritual Care Rating Scale was distributed to 176 pre-registration nursing students undertaking either the Advanced Diploma or Bachelor of Science degree programmes. RESULTS: A response rate of 76.7% was obtained. Findings reveal that the majority of student nurses perceived spirituality to be a universal phenomenon of a type that can be associated with existentialism. Some students were very uncertain and apprehensive about being instructed in spiritual matters. CONCLUSION: A cohort of student nurses held similar understandings of spirituality to those presented in the nursing literature. However the results also suggest an overwhelming majority felt it was wrong for spirituality to imply that some people are better than others and most were uncertain whether spirituality was related to good and evil. RELEVANCE TO NURSE EDUCATION: The investigation reveals that there are a number of ethical concerns surrounding the teaching of spirituality to student nurses that need to be resolved.
Abstract: AIMS AND OBJECTIVES: This element of the larger Scottish evaluation aimed to explore differences between access routes, cohorts and higher education institutes (HEI) (universities and colleges) in levels of self-efficacy, student support and self-reported competence in a nationally representative sample of student nurses and midwives. BACKGROUND: This paper reports findings from the National Review of Pre-Registration Nursing and Midwifery Programmes in Scotland. Fitness for practice curricula have been the heart of many recent developments in nurse and midwifery education. Fitness for practice set out to map out the future direction of preregistration nursing and midwifery education with the aim of ensuring fitness for practice based on healthcare need. There have been no national evaluations of the effectiveness of this strategic objective. Previous major evaluations in the 1990s suggested that students may not have had the skills needed to be fit for practice. DESIGN: The study design was a cross-sectional survey of a stratified random sample of student nurses and midwives (n = 777). Data collected included demographic information, generalised perceived self-efficacy, student support and self-reported competency. RESULTS: Students reported high levels of self-reported competency. There were no significant differences between two cohorts or between students with different access routes. Students rated support from family and friends highest and support from HEI lowest. There was a significant difference in support levels between HEI. Self-efficacy scores were similar to other population means and showed small-moderate correlations with self-report competence. Similarly, self-reported competency appears to be at the higher end of the spectrum, although older students may have a more realistic perception of their competence. However, support from HEI was seen as less satisfactory and varied from one institution to another. CONCLUSIONS: This study portrays a relatively positive picture of preregistration fitness for practice curricula. Questions are raised about the relative value students place on support from educationalists and mentors and whether support from family and friends and from peers needs to feature more prominently in curricula. The study provides modest support for social cognitive theory. RELEVANCE TO CLINICAL PRACTICE: The major drivers for changes in preregistration curricula stemmed from fears about the competence of students. This study did not provide support for this viewpoint, and students' self-reports suggest that curricula are, in this respect, meeting their objectives. Nevertheless support from mentors and from educational institutes may need to be improved.
Abstract: AIM: This paper is a report of an assessment of the construct validity of the Chinese version of the Edinburgh Feeding Evaluation in Dementia scale. BACKGROUND: The Edinburgh Feeding Evaluation in Dementia scale has previously been translated and back-translated and to determine the equality of the Chinese and English versions. However, the construct validity of the Chinese version has not been investigated. METHODS: Participants (n = 477) were selected from residents with dementia in licensed long-term care facilities in Taiwan in 2006-2007. Data collectors received training before observing feeding for 2 days during lunch and dinner. Data were analysed using principal component analysis, Mokken scaling and correlation. FINDINGS: A two-factor structure was demonstrated for the 11 items of the Chinese version of the scale and six items conformed to a Mokken scale. The Chinese version of the scale correlated with external constructs such as weight and body mass index, as predicted by the unmet needs model. CONCLUSION: A confirmatory factor analysis is needed to confirm that the Chinese version measures the same qualities, in the same proportions, and with the same factor structure as the original Edinburgh Feeding Evaluation in Dementia scale.
Abstract: Recently we have witnessed several significant changes to the nursing curriculum in the United Kingdom (UK). This review forms part of a larger study evaluating the 'fitness for practice' elements of the nursing curriculum in Scotland. Systematic review methods were used including the following databases: CINAHL and BNI. Twenty six papers were retrieved and 14 remained after applying the review criteria, the main rationale being the empirical focus. It appears that there is a paucity of research in this area in the UK and papers dealt exclusively with either content, process or outcome evaluation of the nursing curriculum. National, well funded, multi-centre studies tended to be more rigorous. Results, where they were positive about curricular changes, tended to be limited. There is clearly a need for rigorous research into curriculum evaluation, both at the micro and macro level, which investigates content, process and outcome. Without such research, curriculum change will be uninformed.
Abstract: This paper examines the typical and varying routes to doctoral degrees in the UK and other developed countries. It raises the important question of whether university schools of nursing should offer a whole range of options with the potential for sub-optimal higher degree training and therefore "mediocre" academics, or resist the "path of least resistance" and offer more limited pathways that ensure that only the highest quality training and candidates are associated with what should be the pinnacle of the profession. As such, it seeks to clarify which of the commonly offered routes to doctoral degrees might be most suited to the academic integrity and value of the profession to our patients and the health care system.
Abstract: AIM: To examine the employment experiences of older nurses and midwives working in the NHS. METHOD: A total of 27 semi-structured telephone interviews were conducted with nurses and midwives to identify positive and negative aspects of their working lives in the NHS. The interviewees were selected from a potential pool of 87 nurses and midwives who had consented to be involved in an earlier part of the study. Data were analysed using QSR NVivo 7.0. FINDINGS: Positive and negative issues were identified as having an impact on the quality of working life. These included: access to training, change and Agenda for Change (AfC), quality of management, work demands, patient/colleague contact and nursing and midwifery as a career. CONCLUSION: This study highlighted a number of issues relevant to older nurses and midwives that warrant further study and attention. These include access to training and continuing professional development, issues relating to change and AfC, and general work demands including workload, resources and morale. The ability of staff to remain healthy, committed and able to deliver quality care can be compromised in cases where the staff experience is negative.
Abstract: Nurse education is now almost wholly situated within universities internationally. However, issues such as the necessity of higher education for what is seen as a practical occupation and the question of whether or not nursing is a profession arise. Newman viewed universities as places where training was given but character was also formed and self-awareness was developed through exposure to a wide range of disciplines and this type of education has helped to shape other professions. If nursing fulfills the criteria for a profession then it requires nurses to be properly educated in higher education. Poor media images of nursing, opposition from within and outside of the profession and poor funding for research, especially in the UK, where most nurses still do not enter the register with a degree, mean that the place of nursing in higher education remains on the periphery. Nurses must be competent to practice and higher education is not incompatible with the development of competent practitioners. However, higher education should take competent practitioners to a higher level whereby they become capable: able to respond appropriately in unfamiliar situations and to unfamiliar events. This paper argues for the role of higher education for nurses in terms of developing capability.
Abstract: AIMS: This paper reports a study testing the reliability and validity of the Emotion and Health Scale and to check convergent and discriminant validity against the Hospital Anxiety and Depression Scale. BACKGROUND: Reactions to illness are often measured in the narrow terms of anxiety and depression. Primary emotions are claimed by the functionalist school of psychology to be adaptive and to produce specific behaviours for survival. The functionalist theory requires testing in the context of health threat and adaptation. This paper is concerned with the development of a 24-item self-assessment scale of eight primary emotions. METHODS: A healthy cohort of 150 university students was enrolled to complete the Health and Emotion Scale. A cohort of 80 first-time myocardial infarction patients was enrolled to complete the Emotion and Health Scale and the Hospital Anxiety and Depression Scale four days after the onset of myocardial infarction or when symptoms were controlled. The data were collected in 2002. RESULTS: The Emotion and Health Scale was shown to have acceptable internal consistency. Significant differences were observed between the healthy and myocardial infarction cohorts in illness attributed sadness, anger, disgust and surprise. Healthy men had significantly more health fear than women. CONCLUSIONS: The Emotion and Health Scale is a valid and reliable instrument that could be used to study emotion and illness. This line of enquiry may improve understanding of illness reactions and the role primary emotions exert on adaptation to health change.
Abstract: AIM: This paper reports a systematic review of the literature on interventions to promote oral nutritional intake of older people with dementia and feeding difficulty between 1993 and 2003. BACKGROUND: Older people with dementia commonly experience difficulty with feeding, especially in the later stages of the condition. This topic and related nursing care was reviewed in 1993 and the conclusion was that there was little research into interventions that nurses could use to alleviate feeding difficulty. METHOD: A systematic review of the literature was carried out using the CINAHL, Medline, EMBASE and Cochrane databases and the search terms 'feeding', 'eating' and 'dementia' combined as follows: '(feeding or eating) and (dementia)'. A second search was carried out combining the search terms 'mealtimes' and 'dementia' as follows: 'mealtimes and dementia'. The literature search was carried out on 1 December 2003 and papers were included in the review if retrieved by 31 December 2003. English language papers only were retrieved. RESULTS: Sixty-seven papers were retrieved, of which 13 addressed interventions aimed at helping older people with dementia to feed. All studies reported positive outcomes but only one randomized controlled trial was reported. Music was the most common intervention but there were no standardized interventions or outcomes across the studies and none reported the use of power analysis to decide on sample size. There were problems in some studies with confounding variables. CONCLUSIONS: Further research is needed into interventions aimed at how nurses can help older people with dementia to feed. There are some promising lines of enquiry, with music being one of these, but future studies need to use adequate samples and to use power calculations and account adequately for confounding variables. There is also a need to standardize interventions and outcomes across such studies to facilitate meta-analysis.
Abstract: AIM: This paper reports a literature review to examine the range of published tools available for use by nurses to screen or assess nutritional status of older adults, and the extent to which validity, reliability, sensitivity, specificity and acceptability of the tools has been addressed. BACKGROUND: The incidence of malnutrition in older adults is high. One method by which malnutrition or risk of malnutrition can be detected is by the use of nutritional screening or assessment tools. METHODS: A comprehensive literature review methodology was employed. A variety of electronic databases were searched for the period 1982-2002. Search terms incorporating nutrition, screening, validity, reliability and sensitivity and specificity were combined to retrieve relevant literature. In addition, manual searches were conducted and articles retrieved from those listed in key papers. In this paper, nutritional screening or assessment tools are described as tools which use a questionnaire-type format containing more than one risk factor for malnutrition, and give a quantitative or categorical assessment of risk. RESULTS: Seventy-one nutritional tools were located, 21 of which were identified as designated for use with an older population. A wide variety of risk factors for malnutrition are used with the tools, ranging from objective measurements to subjective assessment. Some tools identify an action plan based on the score obtained. Many tools appear not to have been subjected to validity and/or reliability testing but are used clinically. CONCLUSIONS: As malnutrition is present in the older adult population, nutritional assessment and screening tools can be useful to highlight those in need of a nutritional care plan. However, many have not been subjected to evaluation and consequently may not demonstrate sensitivity and/or specificity in clinical use. The decision to use a particular tool should therefore be considered carefully.
Abstract: AIM: This paper reports a review analysing the use of factor analysis in papers in Journal of Advanced Nursing. BACKGROUND: Factor analysis is a multivariate statistical method for reducing large numbers of variables to fewer underlying dimensions. There are several methods of factor analysis with principal components analysis being the most commonly applied. Factor analysis has been used by researchers in nursing for many years but the standards for use and reporting are variable. METHOD: Papers using factor analysis in Journal of Advanced Nursing were retrieved from 1982 to the end of 2004. The search term 'factor analysis' was used in the CINAHL database and applied specifically to Journal of Advanced Nursing in December 2004. Retrieved papers were included in the review if they came from Journal of Advanced Nursing and used factor analysis as part of the method of the reported study. RESULTS: One hundred and twenty-four papers were retrieved as a result of the initial search criteria of which 116 were from Journal of Advanced Nursing. Screening of papers for the use of factor analysis left 100 papers for review. Principal components analysis was the most commonly used method of factor analysis; Eigenvalues greater than one was the most commonly applied criterion for selecting the number of factors followed by orthogonal rotation to achieve simple structure. The majority of papers did not report the whole factor solution and there were papers that did not specify anything beyond the fact that they carried out factor analysis. Confirmatory factor analysis was rarely used and exploratory methods other than principal components analysis were also rarely used. CONCLUSIONS: Factor analysis is quite commonly used in nursing research reported in Journal of Advanced Nursing. While some papers are exemplary there is room for improvement in the reporting of all aspects of factor analysis.
Abstract: AIM: To evaluate the quality assurance model for nursing education in the United Kingdom (UK) for the first nine months after the inception in 2002 of the Nursing and Midwifery Council (NMC). METHOD: A specially designed questionnaire was administered to representatives of higher education institutions where nurse education took place and representatives of the NMC in all four countries of the UK. RESULTS: Quality assurance activity had taken place across the UK, mostly in the shape of validation events. Quality assurance events proceeded largely as expected by higher education and NMC representatives. There was a statistically significant trend towards greater preparedness and knowledge for validation and satisfaction with the new quality assurance procedures in Scotland, Wales and Northern Ireland compared with England. CONCLUSION: At the time of this study the new quality assurance procedures were less than 12 months old and there may have been resistance to change in England where the changes were greatest.
Abstract: This paper describes recent reforms of quality assurance (QA) for the education of nurses, midwives and health visitors and reports qualitative findings from a study of how they are working out in practice. This study reported whether the stakeholders consider the system to be adequate for the principal aim of public protection. Using a postal survey and interviews, QA in nursing, midwifery and health visiting is compared and contrasted in the four countries of the United Kingdom. Issues of subjectivity versus objectivity in decision making over QA of nursing, midwifery and health visiting education and the extent to which these processes are rigorous arose. There is an inverse relationship between the number of higher education institutions in a country and the extent to which nursing, midwifery and health visiting QA personnel, responsible for conducting QA events, become involved with those institutions in offering advice and support. Generally speaking, where the changes have been greatest, satisfaction with the QA processes is lowest. Dissatisfaction was only expressed with processes and most likely arose from resistance to change but these are early days in the operation of the new QA procedures.
Abstract: AIM: The aim of this paper is to report a study investigating the extent to which National Health Service cadet schemes widen access to professional health care education. BACKGROUND: Cadet schemes have been reintroduced in the United Kingdom to increase recruitment of nurses and other health care staff to the National Health Service and also to widen access and increase participation in professional health care education by groups poorly represented in such education, including minority ethnic groups. METHODS: A questionnaire survey of all cadet schemes (n = 62) in England at the time of the study was carried out, and the respondents were cadet scheme leaders (n = 62) and cadet students (n = 411). The questionnaires to scheme leaders enquired about when the schemes were established, what the schemes were preparing cadets for, modes of delivery and entry qualifications. The questionnaires to cadets enquired about age, gender, family circumstances, prior experience and ethnic background. FINDINGS: The majority of schemes had been established since the health service reforms of 1999 and most were preparing cadets to enter professional nurse education programmes. Very few provided opportunities for part-time study and some asked for entry qualifications. Cadets were younger on entry than a comparator group of student nurses, fewer were married, fewer had previous employment or health-related employment and a lower percentage of cadets were white. CONCLUSION: Cadet schemes have the potential to widen access to professional health care study, but there is only limited evidence that they are doing so. In particular there was a lack of mature entrants to health care professional education via the schemes. However, the majority of schemes offered a route into professional education for students who did not hold sufficient educational qualifications for direct entry to professional health care education. It is encouraging that cadet schemes appear to be attracting a significantly greater proportion of students from Black and minority ethnic groups than preregistration nursing programmes overall.
Abstract: AIM: This paper aims to explore the influences on employment related decision making in respect of nurses over 50 in the United Kingdom. It investigates the retirement and labour market relationship through the diverse experiences of older nurses and stakeholders in nursing. BACKGROUND: The ageing of the United Kingdom nursing workforce constitutes a potential challenge for the National Health Services. There is evidence of increasing efforts to address this issue by encouraging older nurses to remain in the profession, dissuading early retirement and attracting nurses who have retired to return to nursing. However, decision-making by older nurses is influenced by a wide spectrum of factors and perceived employment options. BACKGROUND: The paper is based on research commissioned by the Joseph Rowntree Foundation as part of its Transitions Over 50 programme. It derives from concern about inadequate knowledge of, and under-developed policy responses to, the ageing United Kingdom workforce and the specific implications of this age shift for the nursing labour market. The research consisted of interviews with nurses over 50 and key stakeholders in nursing in the United Kingdom. Stakeholders included employers, advisers and policy makers in nursing. METHOD: Interviews with older nurses and stakeholders in nursing were conducted over a period of 12 months. They included face-to-face and telephone semi-structured interviews with 84 nurses over 50 and 18 key stakeholders in nursing in the United Kingdom. Stakeholders included employers, advisers and policy-makers. FINDINGS: Employers, policy makers and advisers and older nurses all identified a range of influences on nurses' employment decisions including a lack of flexible hours, the stress of work, pension-related expectations and the pace of change. Some of these related to negative aspects of work that led nurses to leave ('push' factors), and others to the presence of positive factors in nursing or in pension options ('pull' factors). CONCLUSION: The study highlighted the need for increased implementation of more flexible hours of work and greater availability of part-time hours for older nurses. It revealed the salience of improved pay, adequate and flexible pensions provision, and opportunities for continued professional development to the recruitment and retention of older nurses.
Abstract: In this paper, four experienced researchers from the UK, China and Australia offer guidance in research supervision based on their experiences and the recent document, Improving standards in postgraduate research degree programmes [Higher Education Funding Council for England, 2003. Improving standards in postgraduate research degree programmes. Formal consultation. Department for Employment and Learning, Northern Ireland, Higher Education Funding Council for England, Higher Education Funding Council for Wales, Scottish Higher Education Funding Council, HEFCE, London]. Supervision is an important aspect of not only the development of the neophyte researcher, but of academic staff and research activity in general. With increased academic accountability, good supervision should be an integral component of a quality research governance framework and resourced as such. Recommendations include: adoption of these standards; rigorous selection of research students and supervisors and development of projects; development of departmental procedures for monitoring, feedback and intellectual property; and transparency, rigour and fairness in examination procedures.
Abstract: AIM: This paper reports a literature review describing the range of published tools available for use by nurses to screen or assess nutritional status of patients/clients, and to examine whether the validity, reliability, sensitivity, specificity and acceptability of the tool have been investigated. Tools developed specifically for use with older adults are not considered in this review. A screening/assessment tool is described as a tool that uses a questionnaire-type format, contains more than one risk factor for malnutrition and gives an assessment of risk. BACKGROUND: The incidence of malnutrition in people cared for by nurses is high and screening or assessment tools are often used to identify those with, or at risk of, malnutrition. METHODS: A comprehensive literature review methodology was employed. A range of electronic databases was searched from 1982 to 2002. Search terms incorporating "nutrition", "screening", assessment, feeding, instrument, tool, validity, reliability, sensitivity and specificity were combined. Manual searches were also conducted. RESULTS: Seventy-one nutritional screening/assessment tools were identified of which 35 were reviewed. Tools not reviewed included those which incorporated significant use of biochemical measures (8), included complex anthropometric measures (3), were concerned specifically with ingestion (4) or were designated for use with an older population (21). The tools reviewed use a wide variety of risk factors for malnutrition, varying from anthropometric measurements to socio-cultural aspects of eating behaviour. Some identify an action plan based on the score obtained. Many have not been subjected to validity and/or reliability testing and yet appear to be in use in clinical practice. The sensitivity, specificity and acceptability of the tools are often not investigated. CONCLUSION: There are many published nutritional screening/assessment tools available for use by nurses to screen or assess the nutritional status of patients/clients. Many have not been subject to rigorous testing. Future work should consider a more standardized approach to the use of these tools.
Abstract: AIM: To identify what decisions nurses make in medical, surgical and critical care areas and compare the results. METHOD: A clinical decision-making questionnaire (CDMQ) consisting of 15 statements was developed. A total of 60 nurses completed the questionnaire: 20 from each of three clinical areas. RESULTS: Most nurses, in all specialties, regularly made clinical decisions on direct patient care, which included providing basic nursing care and psychological support, and teaching patients and/or family members. Although nurses in all specialties regularly managed the work environment, they did not make decisions on the ward or unit budget, supervise junior staff or mentor student nurses. Critical care nurses regularly made decisions on their extended roles, such as acting in emergency situations and deciding to change patient medication, while medical and surgical nurses only did this occasionally. Length of clinical experience is significantly related to the frequency of decision-making. CONCLUSION: The decisions nurses make are directly related to the clinical areas in which they work. However, it would be interesting to know if nurses showed particular aptitudes for different types and levels of decision-making and if this is related to other factors such as personality, education and experience in nursing.
Abstract: In common with the nursing workforces of the developed world, the NHS nursing workforce is ageing. Community nurses, in particular, tend to be older than their acute counterparts and this ageing could have a greater impact on this section of the workforce than on nurses in other sectors. This article reports on a study into the options, decisions and outcomes for nurses over the age of 50 years in the NHS. The study was funded by the Joseph Rowntree Foundation as part of a larger programme of work. Older nurses are a valuable part of the NHS workforce, being a repository of skill and wisdom. While this is generally recognized, and there are policies to support this, there is little recognition or action within the NHS. This study found that older nurses would like to see greater flexibility being shown towards them, in terms of their working hours and conditions of work, without harming their pension prospects. They would like to see return to practice courses and continuing professional development more geared towards their needs. Furthermore, they would like more information about their options. The article includes the experiences of some older nurses working in the community who remain, have left or have returned to the NHS.
Abstract: Eating and drinking difficulties are common in people with dementia and yet some health staff are inclined to neglect this important area of care. This article explores how, combined with the skills of nurses, the experiences of those caring for relatives with dementia can help potential problems to be avoided.
Abstract: The aim of the present paper was to compare and contrast perceptions of caring in nursing between Spanish and UK nurses. There are no previous studies comparing directly the perceptions of caring across cultures in nursing. A survey method was used employing the 25-item Caring Dimensions Inventory. Data were Mokken scaled for comparison with data from a previous study and scores for common items on the 25-item Caring Dimension Inventory for Spanish and UK nurses were correlated. There were similarities and differences between Spanish and UK nurses' perceptions of caring: many similar items were incorporated into Mokken scales but the endorsement of items did not correlate. The present work demonstrates that it is possible to measure differences and similarities in perceptions of caring. The study design could be improved and such work could be valuable in cross-cultural work with nurses.
Abstract: BACKGROUND: People with dementia encounter problems in eating and these have been reported in various studies. Many of these studies focus on individual difficulties and neglect the social, environmental and cultural aspects of meals and eating. Studies often centre on the problems of providing food instead of the experience of those receiving food. Less is known of the perspectives of family carers and residential or domiciliary care staff than of nurses' perceptions. Only recently are the perspectives of family carers and people with dementia joining nurses' discussions. AIM: The present paper considers feeding and eating in the context of enhancing support of life for people with dementia. Drawing on a range of literature, it highlights themes that are well developed and aims to identify areas of little knowledge and potential investigation. CONCLUSIONS: In the United Kingdom, the areas of feeding and eating are likely to assume greater importance in attempts to promote rehabilitation, in moves to offer training to unqualified staff and in enhanced vigilance of the experience of people with dementia. Their problems with respect to food and its consumption need to be interrogated and informed by interventions that are ethical, socially inclusive and acknowledge the importance of food to well-being.
Abstract: AIM: To investigate the options, decisions and outcomes for nurses aged over 50 in terms of remaining in, retiring from, or returning to, work in the NHS. METHOD: Interviews were conducted with 18 employers, advisers and policy makers linked to the nursing labour market. They were conducted by telephone (n = 14) or face to face (n = 4), recorded (with consent), transcribed and analysed thematically. Interviews were also held with 84 older nurses who were remaining in nursing, had retired or had returned to nursing. One focus group was held with older nurses who 'remained' in Scotland (n = 11) and the rest of the data were collected in face-to-face and telephone interviews (n = 73). Again, interviews were recorded (with consent), transcribed and analysed thematically. RESULTS: There is a gap between the rhetoric of policy and the implementation of practice in the employment of older nurses. CONCLUSION: Older nurses could continue to make a valuable contribution to the NHS, especially in light of the shortage of nurses, but their value is not always recognised. If older nurses are to continue making a contribution then they need good advice about employment, retirement and pension options.
Abstract: This paper describes a study of perceptions of nursing by nursing students, qualified nurses (United Kingdom and Spain), patients and non-nursing students. A survey method was used with a longitudinal panel element incorporating a 35-item version of the Nursing Dimensions Inventory translated into Spanish. Data were analysed using principal component analysis, congruence analysis, Mokken scaling, correlation, ANOVA, t-test and Cronbach's alpha. Patients may perceive nursing differently from nursing students, nurses (in the UK and Spain) and non-nurses. These findings are discussed in the context of nurse education and patient care.
Abstract: BACKGROUND: It is well-established that stress is likely to contribute to attrition in nursing students. Attrition from nursing programmes and retention of nurses in the profession are international concerns and steps are currently being taken in the United Kingdom to tackle these issues. AIM: The aim of this study was to investigate prospectively the determinants of, and relationships among, stress, burnout and attrition in nursing students. METHOD: A longitudinal design involving a complete cohort of nursing students was employed, using a battery of instruments to measure personality, intelligence, psychological morbidity, stress, coping and burnout. Data were gathered on entry, at 12 and 24 months, and at the end of the nursing programme. FINDINGS: Students experienced increasing levels of stress and use of negative coping mechanisms as the programme progressed and psychological morbidity increased. Positive aspects of personality were more likely to lead to aspects of burnout, and personality was a more important indicator of attrition than cognitive ability. CONCLUSIONS: Stress, burnout and attrition may not be directly linked. Personality factors at course entry contributed significantly to the prediction of burnout and programme completion, but the relationships were not strong enough to be practically useful.
Abstract: AIMS: To describe the methods of measuring progress in achieving competence of preregistration nursing and midwifery students used by institutions of higher and further education in Scotland and to describe the philosophy and approaches to competence assessment in each institution. BACKGROUND: Institutions of higher and further education in Scotland operate a variety of schemes to assess the clinical practice of student nurses. These are based on different philosophies and practices and this raises the question of which are valid and reliable. METHODS: All institutions in Scotland providing validated Diploma of Higher Education programmes for preregistration nursing and midwifery participated in this study. Data were collected by postal questionnaire, review of programme documentation and supplemented with interviews with key stakeholders. The directors of the 13 programmes (seven nursing and six midwifery programmes) were surveyed and also 12 group interviews with students (six nursing and six midwifery student groups) from seven institutions. Students from all four branches were represented and 72 students (36 nurses and 36 midwives) were interviewed. RESULTS: Four key findings were identified and related to competence assessment methods, preparation of practice assessors, consequences of failure to meet expected level of outcome and students' views. CONCLUSIONS: There has been a change in theoretical frameworks of assessment instruments used since the 1992 programmes commenced and only a limited number of approaches to clinical assessment are used in Scotland. Students' views suggested that they had little confidence in methods of clinical competence assessment and there was no formal validity and reliability testing within institutions. A lack of consistency in the training of student assessors in the clinical areas was identified. Some of these issues may be resolved with the development of a national instrument for competence assessment.
Abstract: This paper reports findings from a study funded by the National Board for Nursing, Midwifery and Health Visiting for Scotland to test selected nursing and midwifery clinical competence assessment tools for reliability and validity. The study, which took place over two years from July 1997, involved comparing items in the selected tools with statutory competencies for nurses and midwives, collecting assessment data from a sample of 257 nursing and 43 midwifery students in four educational institutions and administering additional assessment measures (the Nursing Competencies Questionnaire (NCQ) (Bartlett et al., An evaluation of pre-registration nursing education: a literature review and comparative study of graduate outcomes, Oxford Centre for Health Care Research & Development, Oxford Brookes University, Oxford, 1998) and the Key Areas Assessment Instrument-KAAI) to the total student sample (and to their lecturers and practice assessors) at two time points which were six months apart. Our focus was the programme-specific clinical competence assessment tools but by testing these tools we also provide evidence on the validity of other methods of competence assessment. Validity of the methods was assessed, primarily, by calculating multivariate and univariate correlation coefficients between them. The NCQ and KAAI were analysed for internal consistency. The NCQ and the versions of KAAI for lecturers and practice assessors were found to have good internal consistency. The version of the KAAI tool developed for students showed reasonable internal consistency for nursing students, but less consistency for midwifery students. Correlational analysis of data collected on students showed that there is little or no relationship between most of the clinical competence assessment methods in current use, or between these methods and those introduced by the research team. This finding supports previous research, particularly in medical education and confirms that the different methods address different abilities.A clear finding from this study is that no single method is appropriate for assessing clinical competence. A multi-method UK-wide strategy for clinical competence assessment for nursing and midwifery is needed if we are to be sure that assessment reveals whether or not students have achieved the complex repertoire of knowledge, skills and attitudes required for competent practice.
Abstract: Difficulty with feeding is a common problem among people with dementia and may pose ethical problems for the care team if decisions about continued feeding arise. Thorough assessment can help with successful management and a team approach, with the full involvement of relatives, is advocated.
Abstract: AIM: Health related quality of life is impaired in patients suffering from inflammatory bowel disease. Although counselling directed towards physical and psychological morbidity is assumed to improve health related quality of life, this has never been demonstrated. METHODS: Physical and psychological well-being were assessed using questionnaires administered to 100 out-patients in the United Kingdom suffering from inflammatory bowel disease, 50 subjects not suffering from inflammatory bowel disease and a disease control group comprising 28 patients with psoriatic arthritis. A specific nurse led counselling package was given to half the inflammatory bowel disease group and health related quality of life was assessed at baseline, 6 and 12 months. RESULTS: Inflammatory bowel disease and psoriatic arthritic patients had a range of physical disease activity, although none were severely ill during the course of the study. Medical therapy was similar in both groups throughout the duration of the trial. The mean Short Form 36 (SF-36) scores for mental health were low in inflammatory bowel disease patients; 62.9 +/- 9.1 (SD) in ulcerative colitis, 60 +/- 9.8 (SD) in Crohn's disease, compared with 72.4 +/- 7.2 (SD) in healthy controls (P < 0.05). Mean SF-36 scores for social function were also reduced in Crohn's disease patients; 68.4 +/- 10.1 (SD) in Crohn's disease, compared with 87 +/- 10.1 (SD) in healthy controls (P < 0.05). As expected, the mean SF-36 scores in psoriatic arthritic patients were significantly low 61.9 +/- 1.5 (SD) compared with 82.4 +/- 14 (SD) in healthy controls (P < 0.05). Crohn's disease patients were significantly more anxious than the other groups, mean HAD score was 10 +/- 3.7 (SD) in Crohn's disease patients and 6.86 +/- 3.5 (SD) in healthy volunteers (P < 0.05), although mean HAD scores for depression were similar in all groups. Maladaptive coping mechanisms were present in a significant proportion of Crohn's disease patients. At follow-up all aspects of psychological morbidity returned to the normal range in the Crohn's disease patients without significant change in the mean physical disease index. CONCLUSION: Health related quality of life can be improved over 6 months by provision of a nurse led counselling service but the effects are not sustained for 12 months.
Abstract: BACKGROUND: Contemporary research into caring in nursing was criticized in the pages of this journal by John Paley. He charged that the study of caring has not been advanced by research which, he reckoned, merely generates endless lists of terms to describe caring. He also argued that research in the field was largely flawed by confusion over the difference between things said about caring and the act of caring itself. THE PRESENT PAPER: We have analysed Paley's criticism. Essentially, he is criticizing the whole field of survey research. The scientific process is underpinned by the implicit understanding that any field moves forward cautiously. In the social sciences multiple perspectives enrich understanding of phenomena and often confirm previous perceptions. The lack of any alternative approach from Paley is evident. Examples from psychology, where seemingly endless lists of descriptors have led through rigorous concept and statistical analysis to genuinely useful psychological and clinical data, are expounded. In contrast to Paley's assertions, the study of caring in nursing to date has also produced information which is useful within nurse education and practice. CONCLUSION: There is no confusion concerning the things said about and the things done in the name of caring in our minds. We acknowledge that studying the actual phenomena of caring is difficult. However, in the absence of definitive descriptions of caring and precise methods to study it, the search for perfection has not paralysed action. Much has been learned about caring and much remains to be learned.
Abstract: BACKGROUND: In response to the policy initiatives in England to secure recruitment and retention in the nursing and midwifery professions, strategies to improve and extend access to preregistration education and training in England have been developed. The relatively recent development of modern cadet schemes is an example of such a strategy. Despite the increasing interest in and proliferation of cadet schemes, there is as yet little evidence for their effectiveness. Reporting on an evaluation of a scheme in England, this paper makes some contribution to this evidence. AIMS AND OBJECTIVES: The project explored former nurse cadets' experiences of the cadet scheme 9 months after their transition to nurse education. The aims of the project were to evaluate the extent to which former cadets and university staff considered the scheme to prepare students effectively for access to university nurse education. METHODS: The first cohort of former cadets entered nurse education in September 2000. After 9 months they were invited to contribute to an evaluation of the cadet scheme and their present experience. The evaluation consisted of a structured questionnaire sent to all the former cadets, a focus group interview with the former cadets, informal discussions with university staff and brief documentary analysis. CONCLUSION: Tensions were apparent between the worlds of education and clinical practice: the cadets felt better prepared clinically than academically and found an element of repetition in the nursing programme. They valued their preparation, which they felt put them at an advantage over other nursing students. However, some of them experienced difficulties in the transition to higher education and further review is therefore required to establish the success of cadet schemes.
Abstract: Clinical competence assessment has been a feature of nurse education in the United Kingdom for about 20 years but has really moved to centre-stage since the nurse education reforms of 1999. Clinical competence is a controversial issue and there are problems with assessment and the relationship between the practical and educational aspects of nurse education programmes. The present paper explores the origins of clinical competence assessment, presents some of the problems associated with the adoption of clinical competence in nurse education and reviews some literature in this area. In so doing the paper refers to two research studies commissioned in the United Kingdom into the educational preparation of nurses in which the measurement of clinical competence has been an issue. This paper is based on the Winifred Raphael Memorial Lecture delivered by the author on behalf of the Royal College of Nursing Research Society at the Royal College of Nursing Congress in Harrogate, England on 23 May 2001. The views expressed are those of the author and not necessarily, those of the Royal College of Nursing or the Royal College of Nursing Research Society.
Abstract: BACKGROUND: The assessment of clinical competence has returned to centre stage of nurse education. However, there is little evidence to support the use of clinical competence and a wide variety of methods for its use. RESEARCH QUESTION: The present study was designed to investigate the evidence for the use of clinical competence assessment in nursing. DESIGN: A review using systematic methods of literature pertaining to clinical competence in nursing was conducted using defined dates, databases and search terms. RESULTS: There is still considerable confusion about the definition of clinical competence and most of the methods in use to define or measure competence have not been developed systematically and issues of reliability and validity have barely been addressed. CONCLUSION: The assessment of clinical competence remains almost universally accepted in the nurse education literature as a laudable pursuit yet there are aspects of it that remain at odds with the higher education of nurses.
Abstract: Public expectations of the success of resuscitation have been raised in recent years. However, reality does not always match these expectations. Media attention has highlighted the fact that decisions about resuscitation have, in the past, sometimes been ad hoc and not backed by strict protocol. This article draws attention to the issues and suggests how nurses may improve their skills in helping patients and families decide whether a resuscitation attempt is appropriate.
Abstract: This paper discusses the use of portfolios in nursing education and sets this in an international context. It argues that the assessment of clinical competence in the practice setting is inherently problematic, as recognized in certain recent policy documents, and evaluates the role that portfolios can play. A number of theoretical approaches to the definition and use of portfolios are discussed, and particular attention is paid to their reliability and validity as assessment tools. The paper concludes by arguing that there is a need for further research into the credibility, reliability and validity of this approach to the assessment of nurses' competence.
Abstract: The present study was designed to investigate the perceptions of caring among student nurses and how these develop throughout the course of a programme of pre-registration nurse education. A 35-item version of the caring dimensions inventory was administered to a cohort of nursing students in a department of nursing in Scotland at entry to the programme, after 12 months and after 24 months on the programme. Caring was largely perceived through a technical dimension, demonstrated by factor analysis, but other dimensions such as intimacy, support and unnecessary and inappropriate aspects of nursing also became apparent as students progressed through the programme.
Abstract: A longitudinal study involving student nurses' responses to the Caring Dimensions Inventory (CDI) was carried out to investigate the development of perceptions of caring. This study continues previously reported work in which the development of the CDI was described. The current study was designed to see if the CDI could detect changes in perceptions of caring among student nurses as they progressed through their training. Data were collected on the same subjects at three points, each a year apart, throughout the study. A cohort of 168 student nurses entering training was recruited into the present study and data from the CDI was analysed using exploratory factor analysis. A four factor structure for perceptions of caring throughout the study was supported, with some evidence for a five factor structure at 24 months into the programme of nurse education. A professional and technical factor increased in congruence with a similar factor, identified in a previous study, throughout the present study and was used to provide factor scores for individual students. There was a statistically significant and moderately sized correlation between the score on this factor and the age of the student nurses. The five factor solution yielded a factor of accountability. Professional and educational consequences of the study are discussed along with the problem of attrition in longitudinal studies.
Abstract: A longitudinal study of a cohort of student nurses was undertaken in order to investigate whether changes in perceptions of nursing and caring take place and how perceptions of nursing and caring are related. The Caring Dimensions Inventory (CDI) and the Nursing Dimensions Inventory (NDI) were employed for data collection at entry to nurse education and after 12 months. There were significant changes in the scores of a range of items in both inventories which suggested that student nurses lose some of their idealism about nursing and caring after 12 months in nurse education. While the overall ranking of items in the inventories was very similar, it was possible to distinguish between the inventories at entry to training and to observe a change, particularly in the CDI, over time by means of Mokken scaling. Nursing and caring would appear to become more synonymous to the student nurses after 12 months in nurse education. Factors scores, for factors identified in the CDI in a previous study, were used to investigate whether these scores changed at 12 months into nurse education compared with entry. No significant changes were detected.
Abstract: The dimensions underlying the perceptions of caring among nurses were investigated using the Edinburgh Caring Dimensions Inventory (CDI). Exploratory and confirmatory factor analysis techniques were used. While there was a general caring factor on which the majority of the items in the CDI loaded, there were two separable major dimensions to caring, namely 'psychosocial aspects' and 'professional and technical aspects'. In addition, two smaller dimensions were identified that were both related to self-giving, and it is postulated that these refer, respectively, to appropriate and inappropriate self-giving in nursing.
Abstract: The latent structure of feeding difficulty in elderly patients with dementia was investigated using multivariate statistical techniques including exploratory and confirmatory factor analysis. A survey design of 345 elderly patients with the diagnosis of dementia using a questionnaire completed by key workers and primary nurses, was used in local psychogeriatric and continuing care of the elderly facilities. Feeding difficulty and nursing intervention were estimated followed by fitting of latent variable models of feeding difficulty to the data using structural equation modelling. Three models of feeding difficulty in elderly patients with dementia, with 2, 3 and 4 factor structures respectively were compared. All three models showed a good fit to the data as assessed by several standard criteria. The 3 and 4 factor models, however, showed significantly better fit than the 2 factor model. The 4 factor model introduced a latent variable of "oral difficulty" with feeding which merits further investigation. This study demonstrates the possibility of developing reliable and validated scales for the assessment of feeding difficulty in elderly patients with dementia.
Abstract: Caring is an elusive phenomenon but this should not prevent the development and validation of reliable quantitative tools for studying this concept in large samples of nurses. The present paper reports on the content analysis of a questionnaire called the Caring Dimensions Inventory (CDI). The CDI was content validated in terms of existing conceptualizations of caring and research in this area and also in terms of a nursing taxonomy and its representation in popular United Kingdom nursing publications. The CDI was administered to a large sample of nurses working in Scotland and data were obtained from 1430 qualified and student nurses. The internal consistency of the CDI items related to perceptions of caring was established and the scalability of a sub-set of CDI items was demonstrated. The CDI scale was related to the constructs of age and sex of respondents. Possibilities for further analysis and development of the CDI are discussed.
Abstract: Structural equation modelling has already been used to study the relationship between feeding difficulty and nursing intervention in elderly people with dementia. Four models were tested and one provided an acceptable fit to the data. However, there were limitations in terms of sample size and the scales used to measure the variables related to feeding difficulty and nursing intervention. In the present study the sample size has been increased and the scaling of variables has been improved and an additional model has been tested. The best fitting model introduces a latent state variable to explain the relationship between feeding difficulty and nursing intervention. In order to study this relationship further several lines of investigation are suggested, including trait validation and state experimentation. These will be explained in the paper.
Abstract: A selected review of the literature on caring in nursing is presented. The review relies on the work of the major theorists in this area. The major conceptualizations of caring are compared and contrasted, along with some of the research approaches which have been applied to investigate the phenomenon of caring in nursing. The outcome of quantitative and qualitative research on caring is described and the justification for an extension of the quantitative work, through the development of an appropriate inventory and the application of multivariate statistical analysis, is discussed.
Abstract: The phenomenon of loneliness occurs in people of all ages but may be a particular problem in the elderly. It is acknowledged that loneliness is not a necessary accompaniment to ageing and that ageing is not solely responsible for the development of loneliness in elderly people. However, there is a relationship between ageing and loneliness. Four major theories of loneliness are reviewed and their utility for application to research in the elderly is examined along with a consideration of the ways in which loneliness can be measured. While causal relationships are difficult to determine, there is evidence that loneliness is associated with a number of physical and psychological pathologies and the relevance of these to nursing is discussed. There is a growing awareness of the phenomenon of loneliness in elderly people in the nursing literature and some evidence that nursing intervention can be beneficial in this regard both at alleviating loneliness and reducing some of the adverse effects of loneliness. Finally some directions for nursing research are presented which are aimed at improving the assessment and nursing intervention for loneliness in elderly people.
Abstract: Feeding difficulty increases as the condition of dementia progresses. Compensating for this difficulty in feeding is time consuming for lay and professional carers and is the cause of many practical and ethical problems. The current work reports on an analysis by means of Mokken scaling, of the pattern of accumulation of feeding difficulty--described as obstinacy or passivity--in a sample of 182 elderly people with dementia in a psychogeriatric setting. The existence of a cumulative, unidimensional scale was demonstrated which may have some clinical value. Further lines of investigation to validate the scale are suggested.
Abstract: A study was conducted in order to replicate a scale which was previously reported for assessing the feeding difficulty of elderly patients with dementia. The clinical significance of the scale was also investigated. It was demonstrated that the scale was replicable in two separate nursing units. Also, it was demonstrated that, according to criteria such as its correlation with levels of nursing intervention, for example physical help, and with an indicator of feeding difficulty, namely leaving food on the plate at the end of a meal, the scale was clinically significant. The consequences and limitations of the present investigation are discussed and recommendations for future lines of enquiry are suggested. Specifically, the possibility of analysing data from such studies by the use of multivariate statistical techniques is raised.
Abstract: The feeding difficulty of 196 elderly people with dementia was investigated by means of an 11-item questionnaire administered to nursing staff. The questionnaire was analysed by means of multivariate statistics, namely factor analysis. The factor analysis demonstrated that the original items could be reduced to three factors. These three factors were named: (a) patient obstinacy or passivity; (b) nursing intervention; and (c) indicator of feeding difficulty. This quantitative analysis confirms a previous qualitative distinction between items in the questionnaire and suggests avenues of research into the relationship between the factors.
Abstract: Feeding difficulty in elderly people with dementia is well documented and the need for research in this area of nursing care has been raised by several authors. One hundred and twelve elderly people with dementia were entered into a study of feeding difficulty. Data were gathered by means of a questionnaire administered to the nurses caring for the patients. The aspects of feeding difficulty which were investigated were based on reports of relevant behaviour in the literature and included refusal to eat, turning the head away, refusing to open the mouth, spitting, allowing food to drop out of the mouth and not swallowing. It was possible to arrange these different aspects of feeding difficulty under three headings: (a) refusal to eat, (b) spitting, and (c) inability to swallow, and to analyse the pattern of accumulation of these feeding difficulties by means of Guttman scale analysis. According to this analysis, the feeding difficulties investigated form a cumulative and unidimensional pattern. The implications of this pattern and the possibilities for further research are discussed.
Abstract: The feeding problems of demented elderly people are well documented and the need for research into the assessment of feeding difficulty and intervention by nurses has been raised. The present paper reviews the literature in this area of care and outlines the problems which exist in attempting to investigate the feeding difficulty of demented patients. Demented elderly people display a range of behaviours related to feeding including excessive eating in the early stages of dementia and then difficulty with feeding, refusal to eat and, finally, inability to self-feed at all. The problems with research in this area revolve around the issue of measurement of feeding difficulty. There are problems in deciding what to measure and in how measurements should be made which are clinically meaningful. A possible strategy for investigating the feeding difficulty of demented elderly patients is suggested which includes the design of a tool for measurement and the application of single-case studies. Any tool which is used for measurement should enable researchers, in the first instance, and then clinicians to categorize the feeding difficulty of individual patients. Moreover, such a tool should also be sufficiently sensitive to respond to change in feeding ability. The single-case methodology is considered to be the most ethically and statistically appropriate for research with this particular group of patients.
Abstract: Nurses working with elderly people, and students considering the specialty as a career option, may develop negative attitudes about the value of the work they do. These often derive from the perception that their efforts do not improve patients' problems, and a misconception that what they do is intuitive rather than based in research. Such tensions can lead to the development of 'burnout' and the rapid demoralisation of the workforce. Roger Watson shows how nursing elderly people, particularly those with dementia who live in continuing care settings, calls on high degrees of technical and interpersonal skills, and demonstrates how the roots of the specialty are deeply entrenched in research.
Abstract: In posing the question that forms the title of this article, the author seeks not to provide a definitive answer, but to raise the issue in nursing literature. Through this, he suggests, nurses will become aware of the controversy that surrounds the diagnosis, or even existence, of Alzheimer's disease. His objective is to bring the nursing profession more fully into the arena where decisions are made about the future of research into the disease and appropriate strategies for the care of elderly people with dementia.
Abstract: A quasi-experimental trial, yielding 30 data points per system, was carried out to investigate the influence of component parts on the overall performance of urinary sheath systems. Information was obtained on the effect of changing both the sheath and leg-bag. Data from the trial was supported by accurate stock-taking analysis over two periods of 4 weeks' duration when alternative systems were used in a clinical setting. Results suggest that leg-bag design profoundly influences the performance of urinary sheaths. A significant difference in the performance of two urinary sheaths in the presence of the same leg-bag was also observed. The significance of the findings for nursing practice is discussed since the optimum performance, from the components tested, was a 'hybrid' system. A continuing line of investigation is suggested whereby improvements in the composition of urinary sheath systems could be made from nursing research.
Abstract: This paper evaluates a policy for treating patients with established pressure sores. The results show that excellent nursing care has a significant effect on the rate of healing.
Abstract: An investigation was carried out on six hospitalized elderly male urinary incontinent patients for 21 days to test three urinary sheath systems by means of a quasi-experimental trial, incorporating crossover. Observations were made, and recorded, of detachment or leakage in systems and of skin condition round the shaft of the penis. Results suggest that two of the systems differ significantly in their performance and that performance of the urinary sheath was probably the limiting factor in overall performance. Incidence of skin problems, and other problems within systems, were minimal. It was also observed that patients differ significantly in their suitability for the application of sheath systems. This observation was made at two time intervals. A further line of investigation is suggested to test the effect of components, other than sheaths, on performance of systems.
