Journal of Advanced Nursing

This paper describes a participant observation study carried out on a ward for elderly functionally ill people in a large psychiatric hospital in the Midlands, England. My initial interest was in observing the process of institutionalization, and attempts made to counter this process. As the project developed I became interested in four specific cultural domains: the use of space, particularly the ward office; the relationship between ward staff and 'outsiders' or 'others'; the functions of staff handovers; and the characteristics of the physical setting. In my conclusions I describe the relationship between space and the use of space, and the structure of authority and communication on the ward and between the ward and the 'outside world'. I also discuss the functions of handover in terms of the transfer of responsibility, and the psychological process which, it seems to me, underlines the split between 'good' and 'bad' others. I suggest the possibility that this line of research might be extended, and that a synthesy between sociological insight and group dynamic theory might offer a fruitful way forward.

Nurses can play a key role in patient education, including providing patients with useful and appropriate information. Rather than focusing on the process of education or information giving by nurses, this study places emphasis on the content of that information by taking the patients' perspective and asking the patients themselves what particular types of information are perceived as important at a specific point in time. The aim of the study was to explore what particular types of information were important to women newly diagnosed with breast cancer; to enable nurses and other health care professionals to utilize their time as effectively as possible and provide a high-quality service to individuals in their care. Women with breast cancer (a mean of 2.5 weeks from diagnosis) were interviewed and asked to compare items of information. The items of information were presented in pairs and the women stated a preference for one item in that pair. Thirty-six pairs were presented in total. The analysis involved the use of a Thurstone scaling model, which allowed rank orderings, or profiles of information needs, to be developed, reflecting the perceived importance of each item. Information about the likelihood of cure, the spread of the disease and treatment options were perceived as the most important items of information at the time of diagnosis. Other information needs, in order of descending priority, included information about the risk to family, side-effects of treatments, impact on family, self-care, effect on social life and sexual attractiveness. Profiles of information needs were produced to take account of differences in age, level of education and social class.(ABSTRACT TRUNCATED AT 250 WORDS)

This study investigates the effects of hypoglycaemia on the working, social and personal lives of young people aged 16-30 years (mean age 23.9 years) who have insulin-treated diabetes mellitus. A total of 52 questionnaires were returned from a sample size of 70 subjects. Quantitative and qualitative analysis revealed that young people's lives are disrupted to varying degrees by hypoglycaemia. Hypoglycaemia and the complications of diabetes were found to be a source of concern to the subjects in the study, although 19 (36.5%) rarely carried out any self-monitoring. A more flexible approach to diabetic management is indicated, together with an agreed consensus of diabetic control between patients and professionals.

Sarrechia M., Van Gerven E., Hermans L., Deneckere S., Sermeus W., Panella M., Spitz B. & Vanhaecht K. (2012) Variation in 17 obstetric care pathways: potential danger for health professionals and patient safety?. Journal of Advanced Nursing69(2), 278–285. doi: 10.1111/j.1365-2648.2012.06004.x Aim. To report a study to determine whether or not variations exist in evidence-based key interventions in pathway documents for normal delivery across hospitals. Background. Care pathways are used worldwide to standardize and follow up patient-focused care. Minimal variations in pathway documents increase standardization and patient safety. Design. A descriptive study design using qualitative methods was used, to examine the various key interventions present in care pathway documents for normal delivery. Methods. Between January–March 2009, we evaluated the content of the care pathway document for normal delivery from 17 different hospitals. The key interventions in these pathways were compared with the 40 evidence-based key interventions of Map of Medicine®. Results. There was much variation in the characteristics and the presence of key interventions in the pathway documents. Only 6 of the 40 evidence-based key interventions (15%) were found in all 17 pathway documents and 20 of the 40 interventions (50%) were found in only 10 pathway documents. Conclusion. If variation already exists among the care pathway documents, this may lead to a high probability of variation in the actual performance of daily care. In this study is shown that, even for highly predictable medical conditions, there are huge differences in the evidence-based content and structure of pathways. Lack of evidence base could potentially endanger both patient safety and the health professional.

Average dietary calcium intake and energy intake of 113 18-year-old university students in Western Australia was examined. Four-day, weighted diet records, including 1 weekend day, were completed by the subjects. A large proportion of the students (68%) had an average daily calcium consumption below the 800 mg recommended by the National Health and Medical Research Council of Australia. A strong positive association was also found between dietary calcium and dietary energy intakes. Many young women on self-imposed energy reduction diets are at risk of a dietary calcium intake deficit at a time when it should be enhanced. These findings are significant for nursing practice as they indicate the need for further health education concerning the importance of dietary calcium in young women.

Nursing staff in lunatic asylums provided the day-to-day care and containment of patients and were the direct occupational ancestors of today's mental health nurses. This study explores (1) How was asylum nursing seen by asylum nurses themselves and by others, particularly other healthcare workers? (2) What were the demographic characteristics of those who became asylum nurses and what were their patterns of employment? Information regarding contemporary views of asylum nursing were gathered through searching a range of contemporary journals and other publications. Statistical information regarding patterns of employment was gathered from asylum records and census data. During the period from 1890 to 1910 the image of asylum nursing was poor. Allegations of brutality continued to effect its image, despite claims by asylum nurses and medical superintendents that such generalizations were unfair and that asylum nursing was at least as valuable as any other from of nursing. The middle class leadership of voluntary hospital general nursing was particularly critical. At the Three Counties Asylum in Southern England, the majority of asylum nurses came from unskilled or semi-skilled backgrounds. 43% were recruited locally; 43% of nursing staff left after less than a year, and less than a quarter remained after 3 years. Even those individuals thought to be suitable by prior experience, such as ex-servicemen, often did not stay long. Dismissals were common, especially amongst male staff (22%). The discipline was hard, hours long and the work often unpleasant. For asylum nurses conditions were poor, the work difficult and their public image negative. The reality was that people from working class backgrounds entered asylum nursing at a relatively young age, often travelling some distance to do so, and then many only stayed for short periods. However, some women were able to take advantage of the possibilities offered by asylum work to develop a career for themselves in the absence of other opportunities.

This paper is a report of a test of the psychometric properties of a 19-item version of the Clinical Learning Environment Inventory. Although the clinical learning environment provides the 'real-life' context essential for preparing nursing students for their professional role, the quality of student learning is influenced by the quality of the clinical placement. Nursing students completed an abbreviated (19-item) form of the Clinical Learning Environment Inventory to rate their perception of the clinical learning environment. Descriptive statistics, principal component analysis, discriminant validity and Cronbach's alpha reliabilities were computed. Between March and December 2009, 231 online surveys were submitted. The mean age of participants was 30.3 years (sd: 10.4) and 87% were female. All 19 items loaded on two factors, 'Clinical Facilitator Support of Learning' and 'Satisfaction with Clinical Placement', with factor loadings above the 0.4 threshold. Cronbach's alpha coefficient was 0.93 for the total Clinical Learning Environment Inventory-19, with subscales ranging from 0.92 to 0.94. Multiple regression uncovered that participants who engaged in health-related paid work were independently and significantly more positive on the 'Clinical Facilitator Support of Learning' subscale, whereas those who worked >16 hours a week, or allocated the afternoon shift were independently and significantly more negative on the 'Satisfaction with Clinical Placement' subscale. Providing an effective and productive clinical experience is vital in preparing nursing students to become competent clinicians. The Clinical Learning Environment Inventory-19 offers a useful measure to explore nursing students' satisfaction with two aspects of this clinical experience--clinical facilitator support of learning and the clinical learning environment.

This paper is a report of a study examining the influence on how nursing and nurses are portrayed in feature films made between 1900 and 2007, with a nurse as their main or a principle character and a story-line related specifically to nursing. Nurses and the nursing profession are frequently portrayed negatively or stereotypically in the media, with nurses often being portrayed as feminine and caring but not as leaders or professionals capable of autonomous practice. A mixed method approach was used to examine feature films made in the Western world. Over 36,000 feature film synopses were reviewed (via CINAHL, ProQuest and relevant movie-specific literature) for the keywords 'nurse'/'nursing'. Identified films were analysed quantitatively to determine their country of production, genre, plot(s) and other relevant data, and qualitatively to identify the emergence of themes related to the image of nurses/nursing in films. For the period from 1900 to 2007, 280 relevant feature films were identified. Most films were made in the United States of America or United Kingdom, although in recent years films have been increasingly produced in other countries. Early films portrayed nurses as self-sacrificial heroines, sex objects and romantics. More recent films increasingly portray them as strong and self-confident, professionals. Nurse-related films offer a unique insight into the image of nurses and how they have been portrayed. Nurses need to be aware of the impact the film industry has on how nurses and nursing are perceived and represented in feature films.

This paper is based on the nursing lecture delivered on the occasion of the Royal College of Nursing's Diamond Jubilee Year Annual General Meeting, 24 November 1976. The history of the first sixty years of the college is recorded and discussed and its national and international contributions to the nursing profession and the art and science of nursing are documented. The College's pioneering role in nursing research and post-basic nursing education are also considered as are its influences on the development of the National Health Service and its significant role in representing nurses.

Recent research into the Development of the British Poor Law Nursing Service has thrown up interesting attitudes towards the registration of nurses and the delay in achieving this until 1919. These allow a wider understanding of the political considerations surrounding the setting up of the General Nursing Council and the factors which influenced the acceptance of the Syllabus of Examinations and the rejection of the Syllabus of Training as a mandatory instrument. The Poor Law Nursing Service is described as the major section of British nursing during the 1920s which out-numbered the voluntary nursing sector by about 2 : 1 and cared for 75% of the hospital patients at that period.

Nurses' struggle to attain educational parity with other professional groups is closely aligned with the struggle of women for social equality within Canadian institutions. The attempts of nursing educators to shift their perspective from social reform to educational reform and to develop nursing scholarship has been restricted by the cultural views of women. Consequently, nurses' gains in attaining higher education have been realized by reforms in social and health care policies thought suitable for women. With advancement in university nursing education closely tied to social reform, nurses were not expected, nor did they expect, to pursue scholarly enquiry or develop research endeavours. This paper suggests that the feminist movement offers nurses a social and psychological basis from which to complete the educational reform of nursing.

This paper reports one aspect of a larger study. The aim of this aspect was to explore the role of the "welfare officer" in promoting the health of cotton mill workers during this period. The paper considers one element of a broad exploratory study of the health of women cotton mill workers in the North West of England. The original purpose of the study, which was conducted in 2002 in two towns, Oldham and Ashton-under-Lyne, was to explore the women's own perceptions of the impact of their work on their health, and to find out what, if any, help and support they obtained. During the course of the study it was discovered that "welfare officers", some of whom were trained nurses, had an important role in promoting the health of these workers. The study was therefore expanded to incorporate data obtained directly from interviews with a small sample of welfare officers. The present paper focuses on the issue of sanitary reform and considers the role of the "welfare officer" in promoting public health in the workplace. The study employed a combination of archive searches and oral history interviewing. In total, 31 interviews were undertaken between June 2001 and October 2002. The interpretive process focussed both on the ideological power structures which influenced the perspectives of participants, and on evidence for those aspects of participants' experiences which impacted on their health. In considering their health, female cotton-mill workers recalled that the poor sanitary conditions in their workplaces during the middle years of the 20th century had been a source of some concern to them. They also observed that mill welfare officers took a hand in promoting improvement in available facilities. Welfare officers themselves recounted their own concern regarding the poor sanitary conditions in the mills, and their efforts to improve conditions for the mill workers. The paper demonstrates the role of a little-known group of health workers in the middle years of the 20th century, and demonstrates the importance of oral history work in re-capturing elements of nursing work and experience, which do not appear extensively in the written record. The study's relevance to contemporary practice lies in the insight it offers into the autonomy with which these occupational health workers defined their roles and performed their work.

The introduction of 'open' visiting and family involvement in the care of hospitalized children created a revolution in the care of children in hospitals. This historical study utilized the situation at the Hospital for Sick Children, Toronto (HSC), as a case study illustrating change. Although psychological research provided a strong rationale for including families in the care of hospitalized children, change occurred slowly. In this regard, HSC was typical of many children's hospitals. However, there seemed to be a significant failure to learn from innovations elsewhere. Paediatric nurses, in particular, were slow to encourage family visiting and participation in care.

To explore the nursing role in the use of insulin coma therapy for schizophrenia in Britain, 1936-1965. The only history of mental health nursing in Britain published to date gives a minor role to insulin coma therapy and emphasizes nursing opposition to it. An historical study using documentary and oral history sources obtained in 2003-2008 and supplemented by material drawn from interviews in 2010. Historical method was used involving the collection and analysis of primary documentary and oral history material, together with relevant secondary sources. A range of contemporary sources suggest that nurses in Britain were generally supportive of this treatment regime. The scope for using physical nursing skills was particularly attractive, while the emphasis on close interaction with patients also laid the foundation for later developments in social therapy. The debates surrounding its evidence base are also examined. Faced with a lack of rigorous research findings, clinicians preferred to rely on their clinical judgement. The issue of whether the treatment was abandoned as worthless or merely superseded by still more effective regimes is also explored. A nuanced account of the rise and fall of insulin coma therapy provides a lens through which to examine the development of mental health nursing and a case study of the challenges involved in implementing care based on the best evidence.

This article explores the care British nurses provided to victims of typhus during the Second World War. Typhus is associated with poverty and overcrowding. During wars in the pre-antibiotic era, civilians were particularly susceptible to epidemics, which military governments feared would spread to their troops. This discussion paper draws on archival data from three typhus epidemics in the Second World War to examine the expert work of British nurses in caring for victims during these potential public health disasters. The published sources for the paper include material from nursing and medical journals published between 1940-1947. Archival sources come from the National Archives in Kew, the Wellcome Library and the Army Medical Services Museum, between 1943-1945. Of particular interest is the correspondence with Dame Katharine Jones from nurses on active service overseas. Whilst epidemics of typhus are now rare, nurses in the present day may be required to care for the public in environments of extreme poverty and overcrowding, where life-threatening infectious diseases are prevalent. This article has demonstrated that it is possible for expert and compassionate nursing to alleviate suffering and prevent death, even when medical technologies are unavailable. Expert and compassionate care, adequate nutrition and hydration and attention to hygiene needs are crucial when there are limited pharmacological treatments and medical technologies available to treat infectious diseases. The appreciation of this could have implications for nurses working in current global conflicts.

The author concludes that since the British National Health Service is the product of a complex history, it is impossible th start again: however, the removal of three factors and the development of one would greatly improve it. The factors to be removed are: (i) the witch hunt against management, which has become the scapegoat for other ills; (ii) the medical model of health care, which is no longer relevant or practical; (iii) the industrial model, which has forced the NHS into an inappropriate style of management, trade unionism and employment patterns. The factor to be developed is the clinical skill of the nurse; such development requires improved educational opportunities and a clinical career structure.

The paper discusses the findings of a survey of the career progress of graduates of certificate courses in nursing administration and education, between 1958 and 1975, at the Department of Nursing Studies, University of Edinburgh. Five sections are presented: age, sex, career patterns, educational attainments and scholarly work. Issues arising within these sections are discussed.

This paper describes the educational activity of a group of 149 nurse teachers and administrators following completion of the nursing education and nursing administration certificate courses of the University of Edinburgh (1958-1975). The data were obtained by a postal questionnaire and three particular types of courses reported by the respondents are discussed. Emphasis is given to the analysis involving degree courses as this was a prominent educational activity, especially among nurse teachers. The conclusion discusses the potential of an all graduate nurse teacher group and suggests some implications for the nursing profession.

Five hundred and two items about community psychiatric nursing have been located and classified. The data indicate a continuing rising trend in the number of publications on this subject. The majority of the literature is about the clinical role of the community psychiatric nurse (CPN) and is descriptive/analytical in nature. The second largest proportion is research, the third largest topic is management and administration and the fourth largest is CPN education. The amount of 'clinical' literature as a proportion of the whole has been in decline since the mid-1970s. The majority of papers cannot be classified by the specialism of community psychiatric nursing to which they relate, but a small and significant number have been written about the care of the elderly mentally ill. Overall, the practising CPNs have been the most prolific writers, followed by academic nurses and then nurse managers. Contributions from other professions are miniscule. Over recent years the contribution of nurse managers has declined, and that of academic nurses has risen. The contribution of practising CPNs remains robust. Research publications also continue to rise, the majority being produced by academics, but large contributions are also being made by nurse managers and practising CPNs. In the early years nearly all publications of articles were in populist nursing magazines. In recent years the spread of journals in which items about community psychiatric nursing appear has widened considerably.

The United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) recently undertook a major project aimed at identifying the most appropriate future nurse staffing patterns. The results presented here were produced at the request of the UKCC in order that the recommendations stemming from their deliberations could be set against a wider backcloth. It proved possible to secure nurse staffing data from three of the countries of the United Kingdom, namely, England, Wales and Scotland. Most were secured from government publications but the appropriate government agencies also provided valuable assistance. The main trends emerging from a processing of the data are a steadily falling ratio of student nurses and midwives to their qualified counterparts and a steadily increasing contribution by state enrolled nurses. A number of other ratios are presented pictorially accompanied, where appropriate, by a commentary. The actual growth in whole time equivalent nurses is seen to be somewhat less than many people imagine when account is taken of the reduction in both the number of weeks and the number of hours per week worked. Indeed, there has been a levelling off of this last figure over the past few years.

Head nurses and faculty members have their own beliefs on and attitudes towards the process of selecting candidates to schools of nursing. Many times these are based on impressions and/or everyday experiences that might have a crucial influence on perception of the issue. These impressions are not always verified when a study is conducted. This article reports on some of the issues and findings regarding attrition in one school for registered nurses in Israel during the years 1968-1974. It also describes what head nurses and faculty members thought to be valid criteria in the selection process, though findings revealed that things are not always as they are believed to be. For example, psychological tester recommendations were thought to be crucial in selecting candidates and preventing attrition, but no significant correlation was found between the recommendations and attrition. Head nurses thought that the main reason for attrition was dissatisfaction, although this was not found to be a stated reason. This belief of the head nurses should evidently be investigated. Findings support the author's belief that local studies are important and that faculty members and head nurses should communicate on the issue of student nurse selection and education.

To explore from a personal and historical perspective key career trends of UK graduate nurses qualifying between 1970 and 1989. During the 1970s and 1980s, graduate nurses qualifying from UK academic institutions with nursing and degree qualifications were a controversial minority. Concerns about their practical ability and role resulted in considerable quantitative research about graduate nurse careers. Whilst such research identified key graduate nurse career trends, these trends have yet to be explored from a qualitative perspective. This descriptive study used a phased approach: first, a literature review of earlier studies to identify key career trends of UK graduate nurses qualifying between 1970 and 1989, and second, an exploration of these trends from the perspective of six graduate nurses qualifying during this period using semi-structured interviews. Third, archival material was used to set career trends and interview data within their historical context. The literature indicated that most graduate nurses remained clinically based, especially in community and intensive care, with few in senior posts above charge nurse/health visitor level (G-grade). Analysis of interview data revealed four major themes significantly influencing graduate nurse careers: wanting to be clinical nurses, the effect of organizational structures and systems, being a woman, and careers by accident not design. Graduate nurses interviewed aspired to clinical posts, yet this was not what some in nursing expected of them during the 1970s and 1980s. The ability of these graduate nurses to fulfil personal career aspirations and develop their careers depended on many factors, not fully acknowledged in earlier studies. For example, organizational structures and systems often delayed fulfilment of career aspirations. Significantly, gender issues embedded within nursing adversely affected career progression of those interviewed, even in the 1990s. In particular, although nurses can combine work and family commitments, for those interviewed this was often at the expense of their career development.