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OF EUROPEAN
NURSE RESEARCHERS
2nd Open Conference
Nursing
Mirror
Ren
RESEARCH SOCIETY
25th Annual Conference
IMPERIAL COLLEGE OF SCIENCE & TECHNOLOGY
11th-13th APRIL 1984
CPHE
CONTENTS
Page Number
UK COMMITTEES
1
PROGRAMME
2-10
KEYNOTE SPEAKERS
11
ABSTRACTS
12-121
GENERAL INFORMATION
122
MAPS
123 & 124
1)
UK COMMITTEES
CORE WORKING GROUP
Jennifer Hunt
Karin Poulton
Jill David
Sulvia Lelean
Tom Keighley
SPECIALIST SUB-COMMITTEES
1)
Programme and scientific review
Chairman - Jenifer Wilson-Barnett
+ Rosemary Crow
Pam Hawthorn
Karen Luker
Sheila Harrisson
Lyn Martin
Sally Redfern
2a) Special interest session/social programme
Chairman - Lisbeth Hockey
+ Senga Bond
Barbara Wade
Sylvia Lelean
2 b)_ S po n s or;sh ip and commercial _e xh ib it ion
+ Tony Sissons
Tom Keighley
3)_ Hqspitaiity and accommodation
Chairman - Pauline Fielding
+ Una Warner
Maura Hunt
Jennifer Raiman
4)
Jha 11 __s t e va r d san dreg i s t ra t i_o n
Chairman - Sue Montague (until November 1983)
Jill Clark (from December 1983)
+ Liz Scott
Sheila Mackie-Bailey
Sue Hamer
Elisabeth Dodds
WENR STEERING GROUP
Miriam Hirschfeld
Jennifer Hunt
Rosette Poletti
Elisabeth Seidl
Maija Sorvettula
2)
TUESDAY APRIL 10TH 1984
1630
Pre-conference registration
1800
Nursing Mirror Lecture
’Priorities and progress in
nursing education research’
Baroness Caroline Cox of
Queensbury, Director of the
Nursing Education Research
Unit, Chelsea College,
University of London, UK.
1915
Nursing Mirror reception
Concourse area
Level 2
Great Hall
Junior Common Room
WEDNESDAY APRIL 11TH 1984
0830
Registration
1000
Welcome
Miss Sheila Quinn, President RCN
Introduction
Miss Kjellaug Lerheim, Norway
Miss Marjorie Simpson, RCN
Research Society
Miss Cate Campbell, Editor,
Nursing Mirror
1100
1130
Concourse area
Level 2
Great Hall
Coffee and exhibition viewing
’Nursing research: does it make
a difference?’
Miss Jennifer Hunt, Director of
Nursing Services, The Royal
Marsden Hospital, UK
Chairman - Sir Desmond Pond,
Chief Scientist, Department of
Health and Social Security
Junior Common Room
12 20
Lunch and exhibition viewing
Main Refectory
1400
Research papers - parallel
sessions
S6e pages
1530
Tea and exhibition viewing
1600
Research papers - parallel
sessions
Great Hall
THURSDAY A PR, IL _1_2 TH JT984
0930i
3)
'Obstacles and hopes for nursing
research in Southern Europe’,
Dr. Rosette Poletti, Directrice, Le
Great Hall
Bon Secours School of Nursing,
• Geneva, Switzerland
Chairman - David Rye, Director of
Professional Activities, RCN
Junior Common Room
1015
Coffee and exhibition viewing
104 5
Research papers - parallel
sessions
1220
Lunch and exhibition viewing
Main Refectory
1330
Research papers - parallel
sessions
See pages
1500
Tea and exhibition viewing
Junior Common Room
1530
Research papers - parallel
sessions
See pages
1800
'Progress in Community Care
Research’
Professor Margaret Stacey,
Department of Sociology, University
Great Hall
of Warwick, UK
Chairman - Mrs. Anne Poole, Chief
Nursing Officer, Department of
Health and Social Security, UK
FRIDAY APRIL 13TH 1984
0930
’Criteria for Evaluating Research*
Dr. Rosemary Crow, Director,
Nursing Practice, Research Unit,
Norwick Park Hospital, UK
Chairman - Miss Elizabeth Seidl,
Vienna, Austria
Great Hall
1015
Coffee and exhibition viewing
Junior Common Room
104 5
Research papers - parallel
sessions
See pages
1215
1330
1445
1530
Lunch and exhibition viewing
Research papers - parallel
sessions
'Values in Nursing Research.
A Philosophical Commentary'.
Dr. Vassiliki Lanara, Director
of Nursing Services, The
Evangelismos Medical Centre,
Athens, Greece.
Chairman - Mr. Trevor Clay,
General Secretary, Royal College
of Nursing UK
Closing ceremony
Main Refectory
See pages
Great Hall
Great Hall
WEDNESDAY HORNING 11TH APRIL 1984
PIPPARD LECTURE THEATRE
1400
1430
1500
READ LECTURE THEATRE
QUIET ROOM
DEPT. OF MATHS
ROOM 340
COMMUNITY CARE
MIDWIFERY
LONG TERM RECOVERY
AND ILLNESS
NURSES ATTITUDES
AND OPINIONS
Health visiting and
children’s health
needs - the patients
view
study of the knowledge and
practice of primipars
concerning post-partum and
the effects of a planned
education on the prevention of
post-partum complications
Specific problems
of patients with
trans-urethral
resection of the
prostate
Care-givers experience
of care of senile
demented patients in
the final stage of
disease
P. Pearson
E. Erdogan
J.M. Bret
K. Asplund S A. Norberg
Do general
practitioners and
district nurses
know what drugs
their patients are
taking?
Why does Granny know best?
Breathlessness and
psychiatric
morbidy in chronic
bronchitis and
emphysema
The administration of
infusions and gastric
tubes to dying senile
demented patients.
Interviews regarding
practice at long-stay wards
F.M. Ross
S. Shannon
A. Heslop
E. Michaelsson, A. Norberg
& B. Norberg
Eating problems
after stroke
occurrence and
course
Force -feeding of patients
at nursing homes
K. Axelsson,
K. Asplund S
A. Norberg
A. Norberg & A. Backstrom
Studies on
communication and
collaboration
between health
professionals:
physicians and
nurses: teamwork
M. Lorensen
^The evaluation of a postPasic course for antenatal
teachers - practical
problems of methodology
and organisation
P.M. Black, A. Faulkner &
A.M. Thomson
WEDNESDAY AFTERNOON 11TH APRIL 1984
1600
1635
1710
PIPPARD LECT. THEATRE
READ LECT. THEATRE
QUIET ROOM
DEPT. OF MATHS
NURSES’ ROLES AND
CAREERS
CARE OF THE
ELDERLY
PAIN
NURSES' ATTITUDES, OPINIONS
AND WORK
Clinical supervision. Role
investigation in general
hospitals in Israel
Predicting rehabili
tation success in
geriatric patients
Post-operative pain -s^A study of trained nurses'
attitudes and opinions
- nurses' perception
and practices
regarding their work on
gynaecology wards
M. Grebler
P. Fielding
K.J. Hosking
The clinical teacher - a
second class citizen in
nursing
The effects of
touch on patients'
physical and
psychological well
being: a feasibility
study to develop
methods
L. Martin
S. Redfern
B. Sofaer
Report on a study of the
career histories of
selected leading female
nurses in England and
Scotland
The nursing care
assessment model
Nursing assessment
of patients with
pain
L.K. Hardy.
K.■Poulton
G.S.A. James
ROOM 340
C. Webb
Post-operative pain ^Crisis as an agent of change:
nurses’ perception of their
management: educa
role during a physicians'
tion of staff andpatient education
strike
L. Zwanger
^The accountability and action
of nurses in patients ' care
in hospital
S. Lauri
THURSDAY HORNING 12TH APRIL 1984
1045
1135
PIPPARD LECT. THEA.
READ LED. THEATRE
HISTORICAL RESEARCH
IN NURSING
PRE-OPERATIVE
PREPARATION
History of Nursing:
How relevant?
QUIET ROOM
DEPT OF MATHS 340
DEPT OF MATHS 213
TRAINING NURSES
FOR NEW ROLES
PHYSIOLOGICAL &
TECHNICAL ASPECTS
OF CARE
COMMUNITY CARE
Pre-operative information I The use of action
giving: the implemen
research to develop
tation of research
and evaluate a
findings
training programme
for ward sisers
Day for Night:
Circadian Rhythms
in the Elderly
District nursing
outside normal
working hours in
England and Wales:
a summary of the
provision of
evening, night and
early morning
services
C. Maggs
0.0. Davis
J. Lathlean
C.A. ArmstrongEster
S. Harrisson
Research into
the history
of nursing
A randomised
controlled trial of a
new approach to pre
operative teaching and
patient compliance
The use of action
research in the
evaluation of
professional
development
schemes for newly
registered nurses
Development of
a New Indwelling
Urethral
Catheter
Utilisation of
health service
facilities by
children during
their first two
years of life
R. White
J. Wong & S. Wong
S. Bradley
A. Kennedy
A;E. While
THURSDAY AFTERNOON 12TH APRIL 1984
1330
PIPPARD LED. THEA.
READ LEO. THEA.
QUIET ROOM
ROOM 340
DEPT OF MATHS
ROOM 213
DEPT OF MATHS
MENTAL HANDICAP 5
PSYCHIATRY INTERVENTIONS
EDUCATIONAL
ISSUES
MIDWIFERY, AND
MOTHERS’
EXPERIENCE
STRESS AND
TEACHING
PATIENTS
EXTENSION
OF THE
NURSES’ ROLE
Residential practices
and skill acquisitions
in mentally handi
capped people: basic
issues & problems
^Mothers, satisfaction
Employer-employee
aspects of the nurse
with care in labour
tutor-student
and in the post
relationship
partum period
Assessment of
emotional stress
in patients
The community
nurse’s role
in the after
care of
mastectomy
patients
,R.J. Adams & Joyce
P. Stephenson
P.A. Field
V. Bishop
A. Faulkner
Locus of control in
affective disorder
Analysis of
qualitative
evaluation data in
a curriculum
development
project
Post-natal survey
- results of a
descriptive study
The need for a
nursing in
patient
education
programme
following
myocardial
infarction
Helping
people to stop
smoking: the
nurses’ role
P. Barker & M.S. Hume
A. Tomlinson &
Macleod Clark
M. Cater
V. Fletcher
S. Haverty &
Macleod
Clark
' Interaction,
between mother
and midwife
Giving advice
to patients
with cardiac
infarct in the
phase of
rehabilitation
Determination
of the time
spent off the
ward by
nursing staff
in the
Kettering Health
Authority
K. Vehvilainen
H’.M. Larsen
P. Knight, L. Goddard
J. Strangewook
■^7
1400
Evaluating the
1430
learning skills
of innumerate
learners
S.E.B. Pirie
THURSDAY AFTERNOON 12TH APRIL 1964
1530
1605
1640
PIPPARD LEO.THEA.
READ LEO.THEA.
QUIET ROOM
ROOM 340
DEPT OF MATHS
ROOM 213
DEPT OF MATHS
ON NURSES ANO
STUDENTS
THE ELDERLY
MIDWIFERY
CARE OF
PREVALENCE STUDIES
AND LONG TERM
RECOVERY
The Occupation Health
of Student Nurses
Food behaviour of the q
elderly in some
conrnunes of Eastern
Finland
A randomised study
to assess the
benefits of delivery
in a birthing chair
Nursing in a
continuing care
unit
Prevalence,
distribution and
onset of
pressure sores
in an orthopaedic
population
J. Bostock & Cox
M.R. Mikkanen &
Partanen
E. Hillan
N. James
M. Versluysen
Giving up Smoking:
an exploration of
support systems for
nurses
The development of a
cassette recorded
assessment for use
by nurses in
screening the
hearing of elderly
patients/clients
Episiotomy in
normal delivery:
a randomised
controlled trial
comparing two
policies for
managing the
perinium
An invest
igation to
identify
symptoms of
distress in
the terminally
ill
Survey of
prescribed nursing
treatment for
patients with
established pressure
sores
K.Booth & A.Faulkner
M. Hunt
J.M. Sleep
J.M.Hockley
J. David
Back pain in the
nursing profession
- the need for a
systems approach
Self care and
functioning
capacity of elderly
people in Bergen,
Norway
'Evaluation of three
cord-care
procedures on
normal newborns
Families’
knowledge and
use of
resources in
meeting needs
of patients
with cancer
at home
The methodoligical
problems of
measuring the
customary physical
activity of
hospital patients
M.P. Hudson st al
E.M. Gjertsen
A. Maas
C. Hinds
J.Walker & P.J.
Hawthorne
DYING
PATIENTS
co
FRIDAY nQRNING 13TH APRIL 1984
PIPPARD LEG. THEA.
QUIET ROOM
DEPT. OF MATHS
QUALITY
MEASUREMENT
STUDENTS’ EDUCATION
AND VIEWS
The response of nurses towards
the management and teaching
of patients on continuous
ambulatory peritoneal
dialysis (CAPO)
Measurement of patient
dependency and quality
of care - their
contribution as
performance indicators:health care management
Dissatisfaction with basic
-nurse training: the
students’ view
Lukar
J.Goucher & J.Stevens
B.P. Burkey
Dynamics of quality
in nursing: a model
for evaluation
The newly graduated nurse
J.Kerr
Fagermoen & R. Nord
READ LEG. THEA.
| NURSE-PATIENT INTER
ACTION IN PSYCHIATRY NURSES' ATTITUDES
AND OPINIONS
i AND MENTAL
■ HANDICAP
10451 The contact course:
research and
intervention as
instruments of
change in nursing
mentally handi
capped people
E.Allan &
L. Goodbody
ROOM 340
Cursing education and
1120
A descriptive and
analytic study of
verbal behaviours
of nursing
students in their
relations with
psychiatric
patients
0.Bolat
students’ reactions: an
empirical study of attitudes
in basic nursing education
K. Lerheim
■■a
FRIDAY AFTERNOON 13TH APRIL 1984
n
PIPPARD LEO. THEATRE
I ISSUES IN
i NURSING RESEARCH
1330 i Nursing research - need
• it be of any use?
READ LEO. THEATRE
PHYSIOLOGICAL AND
TECHNICA.ASPECTS OF
CARE
The effect of massage
on the local skin
blood flow in areas
at risk of pressure
sores
I
I
1400
QUIET ROOM
EDUCATIONAL
ISSUES
ROOM 340
DEPT.OF MATHS
MIDWIFERY
I _________
i^The place of the
Teaching and learning i
in nursing practice
|■ traditional midwife
or traditional
J birth attendant in
i contemporary mid
wifery practice in
Eastern Nigeria
ROOM 213
DEPT.OF MATHS
SURVEYS ON
HEALTH
PROBLEMS
The Lothian and
Forth Valley leg
ulcer study
' V.Reed & P.Lyne
A.C. Ek
R.Nord & Fagermoen
N.G. Nzeribe
J.J. Dale
Teaching research:
a practical
approach
Nursing management
of passive
abdominal wound
drains
Unfitness for
nursing. Explora
tory interviews
A comparative
study on the
knowledge levels
of midwives from
3 different
districts
relating to
infant health
care
An epidemiological
study of abortion
in Bornova-Izmir
L.A. Wattley &
; Muller
R.A. Molyneux
S.WestermarK S
A. Norberg
Z. Sahar
A. Sayik
KEYNOTE SPEAKERS
ID
Miss Jennifer Hunt, Director of Nursing Services,
Royal Marsden Hospital, UK
'Nursing Research: does it make a difference?'
Dr. Rosette Poletti, Directrice, Le Bon Secours
School of'Nursing, Geneva, Switzerland.
'Obstacles and hopes for nursing research in Southern
Europe' .
Professor Margaret Stacey, Department of Sociology,
University of Warwick, UK
'Progress in community care research'.
Dr. R. Crow, Director, Nursing Practice Research Unit,
Northwick Park Hospital, UK
’Criteria for evaluation research'.
Dr. Vassiliki Lanara, Director of Nursing Services,
The Evangelismos Medical Centre, Athens, Greece
•Values in Nursing Research? A philosophical commentary’.
12)
ROUTINE RESIDENTIAL PRACTICES AND SKILL ACQUISITION IN
MENTALLY HANDICAPPED PEOPLE: BASIC ISSUES AND PROBLEMS
A wealth of literature documents the development and
application of specific intensive training programmes
by means of which people who are mentally handicapped
can be taught to acquire skills for independent living.
At the organisation level, there is also a sizeable
body of research which examines various systems of
providing care and training for this client group, It
is argued here that there is currently a dearth of
"middle-ground" research examining the ways in which
organisational and routine management practices affect
skill acquisition and that such research is vital to
proper service delivery as it is clear that most
intensive training schemes are short-lived, and that
organisation changes do not dramatically alter teaching
and training input to individual clients.
The key issues in this area of research are examined,
including:- problems of measurement; nursing staff
skills; priorities in mental handicap nursing; factors
influencing staff behaviour; problems of maintaining new
skills.
Selected findings from atcurrent1 study will
..111 1be used to
±U ~ 2
illustrate the
issues described
and ~a further paper
----- --will report on:-
(a)
a tdetailed
(b)
some approaches to develop these practices, and
(c)
some preliminary results of these interventions.
study of some aspects of routine
practices in
l.i a large mental handicap hospital,
Richard J. Adams, Principal Psychologist, Calderstones
P.F. Joyce, Lecturer in Psychology, Dept of Social
Administration, University of Lancaster
(20-minute presentation)
13)
THE CONTACT COURSE: RESEARCH AND INTERVENTION AS
INSTRUMENTS OF CHANGE IN NURSING MENTALLY HANDICAPPED
PEOPLE
The quality of care offered to mentally handicapped
people by large residential institutions has been of
considerable interest to researchers and policy makers
in recent years. This paper concentrates on one aspect
of the care environment - the social interaction and
contact that takes place between nursing staff and
residents.
Adopting the theoretical mode of applied behaviour
analysis, an extensive observational study of the
contingencies between resident behaviour and nursing
contact in living units was conducted, The results of
this study will be presented briefly to demonstrate:
(1)
the high level of neutral, unengaged behaviour
by residents
(2)
the overall low level of nursing contact
(3)
the variations in contact that take place in
relation to routine nursing duties.
Routine care and management practices were also examined.
In addition, preliminary "market research" indicated that
nurses place socialising and training residents high on
their list of priorities whilst having inadequate
opportunity to carry them out, often due to the pressure
of indirect care tasks. A training programme for nurses
on the behavioural approach to the development of
mentally handicapped people was designed to meet the needs
identified by the observational research. Its main aim
was to enhance naturally-occuring nurse-resident contact
to create an optimal environment for the learning of
independent life-skills. Staff were instructed and
rehearsed in the routine application of selective
reinforcement skills to different classes of resident
behaviour. A second objective of the course, complimentary
to improved "contact efficiency", was to increase the amount
and quality of interaction overall, with particular emphasis
upon non-task oriented periods of the day.
The methods offered to achieve this were Room Management and
several small "Contact Projects".
The course consisted of 6 weekly 1J hour units during which
a variety of pedagogic techniques were used. Each
conventional teaching unit was followed up by monitored
practical work on the living unit.
H)
The long term effects of teaching nurses how to use their
contact skills are still in the process of being examined
by a second observational study of the ethology of
residential life. However, the immediate impact of the
’’Contact Course” has been evaluated by means of a series
of pre-post training measures concerned with attitudes
towards caring for mentally handicapped people, knowledge
of behavioural principles, observation skills and consumer
satisfaction. The questionnaires were completed by the
nurses involved and a non-participant control group.
The questionnaire results are explored in relation to
institutional, practical, and motivational constraints
upon nursing behaviour. An ecological perspective upon
nursing research, intervention and implementation is
discussed, in consideration of the lack of opportunity for
nurses to benefit from the achievements of science.
E.M. Allen
Louise Goodbody
)
)
)
(30-minute presentation)
Psychology Research Team,
Calderstones
15)
DAY FOR NIGHT:
CIRCADIAN RHYTHMS IN THE ELDERLY
Elderly people frequently become confused, irrational,
incontinent and have disturbances of sleep, and these
problems seem to be exacerbated by hospitalisation.
Our hypothesis is that physiological control or
synchronisation of circadian rhythms is disturbed in many
elderly people.
In these circumstances synchronisation
is probably maintained by psychological and social cues.
These cues are disturbed and replaced by new ones when an
elderly person enters an institution or geriatric ward
and this may create anxiety and disorientation.
The research project investigates both physiological and
behavioural parameters of circadian rhythms and stress in
elderly patients. A temporal analysis is applied to
continuous 24 hour recordings of heart rate and temperature.
The results are compared to two-hourly direct observations
of behaviour and to the biochemical analysis of three
hourly urine collections. The next phase of the research,
which involves setting up a circadian activity ward for
the elderly and developing a positive rehabilitation
programme, will also be reported.
C.A. Armstrong-Esther, Ph.D., B.Sc., S.R.N., R.N.T.,
Dip.Ed., M.I.Biol.
Professor, School of Nursing,
University of Lethbridge,
Alberta, Canada
(40-minute presentation)
16)
CAREGIVERS' EXPERIENCE OF CARE OF SENILE DEMENTED PATIENTS
IN THE FINAL STAGE OF THE DISEASE
Background
In the final stage of the disease the senile demented
patient (DAT) may lie curled up like a fetus. He may
exhibit severe eating problems. At the very end stage
the caregivers will be facing the problem: Should the
patient be kept alive by tube-feeding or infusions or
should he be allowed to die? Should the caregivers go
even further using active euthanasia?
Material and methods
Sixty registered nurses, practical nurses, mental nurses
and nurses' aids at 15 nursing homes in the County of
V’asternorrland were interviewed through a semistruetured
interview-technique. Each interviewee was shown a
videotape (32 minutes) with three senile demented patients
in the final stage of the disease who all exhibited eating
problems. Then the care of patients like these was
discussed. The discussion was taped and later typewritten.
The interviewees were 18-61 years old (md=37,Q.-Q,=27-53)/
They had worked for 2-39 years in care (md=12, Q^-Q^=6-19).
The interviewees were selected to represent the most
experienced caregivers at each nursing home.'
Results
No one of the interviewees would wish to be fed by tube
feeding were they in the same situation as the patients on
the videotape. The most common answer was that the
interviewees themselves would wish to be given no food or
fluids at all. Most interviewees also thought that the
patients should be allowed to die without any infusions or
tubes. They had been tackling the problem of active
euthanasia. However, only a minority of the interviewees
(17?o) thought that the patients should be given active
euthanasia. Most interviewees described their own feelings
when a senile demented patient in the final stage of the
disease dies, in positive terms: "It is a release", "It
is a relief". At the same time they reported that they felt
regret at the loss of the patient. Most interviewees
described a developmental process. Their first experience
in the care of senile demented patients in the final stage
of the disease had been that it was horrible, hard and
meaningless. They had however been able to adapt themselves
to this care and now they felt it meaningful to take care of
these patients.
17)
Conclusion
On basis of analysis of the interviews a hypothesis of the
development of the caregivers' attitudes to the care of
senile demented patients in the final stage of the disease
will be discussed:
(1)
The patient should be kept alive (by force-feeding,
tube-feeding, infusions...)
(2)
The patient should be allowed to die (passive
euthanasia)
(3)
The patient’s quality of life is very poor,
should be helped to die (active euthanasia)
(4)
The patient should be allowed to die but he should
also be allowed to live until he does (without
any active euthanasia).
Asplund K, RNT, Norberg A, RN, PhD,
Sidsjons’ Hospital, Department of Advanced Nursing,
Umea University, Sweden
(20-minute presentation)
He
EATING PROBLEMS AFTER STROKE
OCCURRENCE AND COURSE
18)
Introduction
Difficulties to eat is a main nursing problem after acute
stroke and influences the patient's quality of life. An
improved nursing of patients with acute stroke and eating
problems presupposes more detailed knowledge of the
occurrence, type and course of the eating problems.
Method
During the time 1/3-82--1O/6-83 all patients at the stroke
unit at the University Hospital in Umea have been observed
(random sample). Certain patients with eating problems
have been video-filmed. Those patients who had eating
problems during the acute phase have been interviewed and
observed again at approximately three month after
admission .
Results
Out of the observed 104 patients, 46 had eating problems.
Further six patients received only parenteral nutrition or
died shortly after admission (within 24 hours). Length of
stay in medical ward for the patients without eating
problems was 14 days (mean) and for the patients with eating
problems 36 days (mean). The mean age of the patients
without eating problems was 70 years, of the patients with
eating problems 72 years and of the patients with only
parenteral nutrition 75 years. The observed eating problems
were: hoarding of food in the mouth (33 patients), dysphagia
(31), leakage of food from the mouth (31), chewing problems
(31), denial of eating problems (30), anorexia (23) and sores
in the mouth (19). The weight loss during the time at the
stroke unit for the patients with eating problems was 2,6 kg
(mean) while it was 0, 1 kg for the patients without eating
problems. Ninety-eight per cent of the patients without
eating problems were discharged to their home after the stay
at the medical ward, while only 48 per cent of the patients
with eating problems were discharged to their home. Sixteen
patients were discharged to a long term ward and of these
there was only one without eating problems. All patients
with only parenteral nutrition died and so did five patients
with eating problems.
Thirty-four persons with eating problems during the acute
phase have been interviewed and observed at approximately
three month after admission. The time from admission to the
follow-up assessment was 4,2 month (R = 3,8 month). Only
three had no eating problem at all. The persons with
eating problems had less numerous problems. The weight loss
during the time from admission to the follow-up assessment
was 5, Okg (mean).
Conclusion
19)
Eating problems are frequent among patients with stroke
during the acute phase. The eating problems remain to
a great extent after discharge from the acute clinic
and add to the great need for long term care.
Karin Axelsson, RNT; Kjell Asplund, MD, PhD and
Astrid Norberg? RN, PhD
,*
Department of Medicine, University Hospital, S-901 85 Umea;
Department of Advanced Nursing, Umea University, S-901 87
Umea, Sweden
(20-minute presentation)
20)
A COMPARATIVE STUDY ON THE KNOWLEDGE LEVELS OF MIDWIVES
FROM THREE DIFFERENT DISTRICTS RELATING INFANT HEALTH CARE
Achieving the goal of "Health For All by the year 2000"
requires a health system which enable every individual to
lead a socially and economically productive life. Within
such an approach, the health personnel should be trained in
educational programmes adapted to local conditions, resources,
realities and needs of the country.
Child mortality and morbidity rates are still high in Turkey.
For this reason Front-line rural midwives should be trained
relevant to the priority health needs of community.
For the effective and efficient functioning of midwives
involved in the delivery of health care-maternal and child
health care especially, they should never be regarded as
"Finished products” and be supported by certain in-service
education programmes regularly.
For effectiveness of health care delivery to mothers and
children, it is necessary to determine the levels of
knowledge and skill of midwives, and support them for any
kind of lacks regarding their everyday practice.
This study has been designed within this general concern
and it’s objectives are specified as following:(1)
to determine and correlate the levels of knowledge
relating infact care of the midwives who work in
three different health districts Bornova (Izmir),
Etimesgut and Cubuk (Ankara). These districts are
"Research and Training Centers" which arc given
special importance. The latest is established in
recent years.
(2)
to explore variables which might influence their
knowledge relating infant care.
(3)
to measure and compare the knowledge and skill
scores of midwives by pre and post test, to
determine the efficiency of an insercivc
education programme applied to midwives of
Bornova Health Distrct.
This research was carried on 77 midwives functioning in the
field work (not in laboratories or in the district hospitals),
within the period of January-September 1982.
The strategy of this study has been a cross-sectional,
descriptive and prospective one including some analytic
methods.
Two different data gathering tools were used, and both were
developed by the researcher.
21)
The first was a questionnaire, consisted of some items
relating socio-demagraphic characteristics of midwives
and 73 questions to assess their knowledge on child health
care in order to obtain comparative data from three
different areas, this questionnaire was applied by the
researcher to the midwives of Bornova, Etimesgut and Qubuk
Health Districts.
The second tool was observation form to assess the skills
of midwives on five definite points of the physical
examination of children, such as height and weight
measurements, head circumference measurement, assessment
of congenital dislocation of the hips and fimosis.
In order to observe the above mentioned skills the
researcher made home visits together with each midwife to
the families having a male infant. Visits are repeated
one more time after the training programme ended.
To determine the efficiency of in-service education, the
questionnaires and observation forms were applied to
midwives of Bornova District in a pre and post test basis.
The findings of the study demonstrated that the
socio-demographic variables had no effect on the knowledge
levels of midwives working in Etimesgut and Qubuk Health
Districts, where in-service education programmes and
supervision being implemented regularly. But these variables
were found to have an effect on the knowledge levels of
midwives in Bornova Health District.
The findings also indicated that there werp significant
differences among the knowledge levels of midwives of three
different health districts.
It was also found a significant increase in the knowledge
and skill levels of midwives by post-training follow-up
scores in comparison to their pre-training scores.
In conclusion, these findings have confirmed the necessity
and importance of in-service education in health field
and the usefullness of the two forms developed by the
•researcher as measuring tools.
Zuhal Bahar, R.N., B.S., PhD
Ege University School of Nursing (Public Health Nursing
Division, Izmir, Turkey
(20-minute presentation)
LOCUS OF CONTROL IN AFFECTIVE DISORDER
22)
The paper is drawn from a 3-year nursing research project
which is based on a unit which specialises in the study
of the aetiology and treatment of affective disorders:
especially in women. The nursing study involves an
evaluation of the effects of two distinct forms of
psychosocial nursing on the presentation of female patients
diagnosed as suffering from manic depressive psychosis.
The subjects are allocated randomly to one or two
experimental groups: one group will receive a supportive
psychotherapy care package; the other a modified cognitive
therapy package. Each care package will be administered by
nursing teams of equivalent size and grades. Other
significant variables - such as drug therapy and staff
patient interaction time - will be strictly controlled
during the experimental phase. The first section of the
paper will review the aims of the study and will present
an overview of traditional nursing models of care relative
to this population.
The study will be evaluated using a number of standardised
measures: these will assess the patient's mood state and
overt behaviour at various stages, from admission to the
study to follow-up, 18 months after discharge. The study
is concentrating upon one aspect of the patient's
presentation: viz. how the patient views her illness, and
the definition of the kind of conceptual model which she
uses to understand her care and treatment. The nursing team
have developed an "attribution scale" which attempts to asses;
the patients attitude to her illness: what does she think
is wrong with her? What factors does she think may have
been instrumental in precipitating her breakdown? To what
extent can she control her mood state and behaviour? This
kind of measure is commonly referred to as a "locus of
control measure". Although the attribution scale described
has been developed for the manic depressive population, this
kind of measure has a wide application: especially in the
area of physical health and illness. The second section of
the paper will review briefly the use of locus of control
measures in nursing and medical settings and will discuss
their role in the planning of health care.
The "attribution scale" has been developed using patients who
are experiencing an acute phase of their illness - and are
currently hospitalised - and also "recovered" patients,
living in the community. The third section of the paper will
discuss how the scale was developed and field-tested; and
will review the picture of manic-depressive patients which
is produced.
The final section of the paper will discuss how the
attribution scale is being used in the evaluation of the stud)
and will indicate possible applications of the scale in the
planning of care for patients with affective disorder, and
other kinds of somatic disorder.
I’hil Barker and Anne Hume - Tonysidc Area Clinical Poydrology
Dept., Royal Dundee Liff 11 ospital, Dundee
(20-minute presentation)
23)
AN EPIDEMIOLOGICAL STUDY OF ABORTION IN BORNOVA-IZMIR
Abortion is widely practiced by Turkish women as a method of
terminating unwanted pregnancies. Inspite of the legal
restrictions (during the research period), the methods used
for performing induced abortion vary according to the
cultural level and socio-economic components.
A variety of hospital-based, community-based and nationwide
studies since the late 1950's have shown that induced
abortion is one of the most serious hazards to maternal health
and ’it has become a very important medical and social problem
in this country.
From the point of view of effective family planning programmes,
it is necessary to determine the women's fertility control
behavior. Recognizing the importance of the problem, and
induced abortion being most commonly resorted by the women
living in metropolises, this epidemiological field study
has been designed. Objectives of the study were as follows:
(1)
to estimate the abortion prevalence and incidence
of currently married women, fell in the fertile
age group of 15-49 years
(2.)
to determine socio-demographic variables which
might influence extent of abortion and the type
of abortion women resorted
(3)
to assess women’s latest abortion on an
epidemiological basis.
325 women constituted the sample were, identified by
stratified proportional random sampling and, they were
interviewed by the investigator. The study was conducted in
1982.
Since the general strategy of this study was cross-sectional,
it was included some descriptive and analytic methods,
together.
The findings of the study have demonstrated that 45.8 percent
of women had had a history of an abortion of any type at
least for once. The mean number of abortion was 0.9 per
women. The proportion of women with induced abortion was
30.1 percent. The number of abortions per 100 live births
was found to be 37.2, the number of abortions per 100
pregnancies was found to be 26.3.
The study also indicated that women with more living children,
and more pregnancies and more parity, reported more induced
abortions than others. There was also a positive
correlation with the number of induced abortion and the age
of women, duration of marriage, and the age at first marriage.
24)
Women with higher education status had more induced
abortions. Women preferred physicians to traditional
methods in abortion induction and 81.2 percent of abortions
took place in the first three months of pregnancy.
Women were motivated for limiting the family sizee, but use
of modern contraception was only 28.0 percent. Withdrawal
I.
was the most commonly used contraceptive method.
On post abortion follow up, it was found that women
increased their contraceptive practices specially after
their induced abortion and the findings demonstrated a
significant difference.
Consequently, these findings indicate the need to intensify
family planning educational programmes and necessity of
distribution of effective contraceptives. Nurses and
midwives should be trained as educators, counsellors and
informers and they should be allowed to insert intrauterine
devices considering the realities and health needs of the
country. Their roles should be defined and they must
occupy a unique place in the delivery of family planning
services. (Induced abortion under certain circumstances
has been legalised in Turkey in 1983. Some further
researches will be necessary in order to assess the outcomes
of this fact in the coming years).
Ayla Bayik, R.N., B.S. PhD.
Ege University School of Nursing (Public Health Nursing
Division), Izmir, Turkey
(20-minute presentation)
25)
THE EVALUATION OF A POST BASIC COURSE FOR ANTENATAL
TEACHERS - THE PRACTICAL PROBLEMS OF METHODOLOGY
AND ORGANISATION
This paper will give a brief outline of the provision of
antenatal education in the U.K. and the results of
research over the last 30 years, showing the problems
with the organisation and teaching styles, which have led
to poor attendance and dissatisfaction among parents.
The initiatives used by two different centres to improve
the situation will be discussed, with the strategies
adopted to establish in-service training for their staff.
A teaching package, which had been developed to meet the
needs of staff in one Health Authority, was used and
adapted by the two study centres to help their staff
improve their teaching and group work skills.
The design and establishment of a method of evaluation
will be discussed in detail, highlighting the practical
problems of permission, consent and access. The
solutions adopted will be explored with particular
reference to the impact of the constraints on the
research design.
Patricia M. Black, Department of Nursing,
University of Manchester
(30-minute presentation)
ASSESSMENT OF EMOTIONAL STRESS IN PATIENTS
26)
This paper describes a pilot study which was designed to
establish the attitudes of patients towards clinical
research and to assess how much anxiety, if any, is
induced in patients when they are asked to participate
in a clinical research investigation. This was
particularly relevant to the author who is the sister
in a research department which frequently involves
volunteer patients in clinical studies.
The study entailed the use of two separate methods of
measurement, one which measured the physiological changes
at specific times and one which involved the use of a
questionnaire. Physiological responses to emotional
stimuli are endocrine and autonomic in origin and the
variables measures in the physiological study were changes
in heart-rate and in palmar sweat as both can be measured
quickly and easily without invoking further stress. A
specially designed questionnaire was used to assess the
cognitive, affective and behavioural attitudes of each
participant towards clinical research. Overall results,
which are remarkedly varied and relatively unpredictable,
are discussed.
In spite of the shortcomings of this investigation
potential areas of study which have been neglected by
previous investigators in the field of emotional stress
have been revealed. While emotional stress in patients
awaiting surgery has been well documented (Janis 1958 ,
Egbert et al 1964, Hayward 1975, Wilson-Barnett 1976)
there is less information about the components and degree
of stress. On the basis of this pilot study it is
planned to carry out an investigation involving the
subjective and objective evaluation of stress provoked
in patients about to undergo surgery, and in particular
to assess the contribution of anaesthesia to that response.
References
Egbert et al (1964). Reduction of post-operative pain by
encouragement and instruction of patients.
New England Journal of Medicine 270 825-827.
J. Hayward (1975).
Information - a prescription against
pain. The Study oif Nursing Care.
RON London.
Psychological stress.
I.L. Janis (1958).
John Wiley and Sons. New York.
J. Wilson-Barnett (1976).
Patients' emotional responses to
hospi tai isat ion.
Ph. I), thesis. London University.
Veronica Bishop, Research Sister, Department of Anaesthetics
T-he
._9.f.._?.9.r.8.9.9.P.?.!—.
(20-minute presentation)
27)
A DESCRIPTIVE AND ANALYTIC STUDY OF VERBAL BEHAVIORS
OF NURSING STUDENTS IN THEIR RELATIONS WITH PSYCHIATRIC
PATIENTS
Nursing care is a largely used concept that signifies the
unique function of the nurse. Although the necessity to
acquire the adequate knowledge and skills in nursing is
well known today, there seems inadequacy in performing
this function.
For the improvement of the professional nursing role, the
educators emphasize the responsibility of the nursing
students to recognize the emotional problems and the needs
of the patients. But if the nursing student has personal
fears, to what extent she will be successful in meeting this
responsibility?
During theoretical psychiatric nursing training, we
observed that the students had personal fears and anxieties
about their success in their relations with psychiatric
patients. In discussion with the students it was seen that
they knew theoretically how to relate effectively. So to
plan more systematic and effective training objectives in
psychiatric nursing practice, it seemed necessary to
determine the factors that affect face-to-face relationship.
In this respect, the objectives of the study were as follows:
(1)
to determine the quality of the verbal behaviors
of the students
(2)
to discuss the factors that could affect the
effectiveness of the verbal behaviors of these
students
All of the 49 students in the highest class in Ege University
School of Nursing constituted the sample. The study included
some descriptive and analytic methods together. The verbal
behaviors were taken from the notes of the students written
word by word in their relations with patients. Determining
the quality of these behaviors, Binary method in content
analysis was used. Also it was asked by the investigator,
if the students had any fears and anxieties prior to their
relations. In order to determine what they felt and thought
after the termination of the relationship, the students
filled "Patient Rating Scale".
The findings of the study revealed that the 51.02% of the
students got person-positive score. None of them got the
score of person-centeredness. The 29.27% of the verbal
behaviours, was found as being in the person-positive
category, which directed the patient to talk about his
objective world.
28)
The only factor found as significant, affecting the
quality of the students' verbal behaviors, was the period
spent in psychiatry.
Consequently it was said that there was a need for the
improvement of the quality of the verbal behaviors. In
meeting this need, active training techniques such as
role-playing and dramatization could be used. Also the
period found as a significant factor, seemed as emphasizing
this need.
CJigdem Bolat, RN. , B.S., PhD
Ege University School of Nursing (Psychiatric Nursing
Division),1zmir, Turkey
(30-minute presentation)
GIVING UP SMOKING:
FOR NURSES
AN EXPLORATION OF SUPPORT SYSTEMS
29)
This Paper will describe a study, funded by the Health
Education Council, exploring the thoughts and feelings
of nurses in training about smoking. An account will be
given of the analysis-of questionnaire data, with special
reference to the two hundred student and pupil nurses who
smoke (thirty-seven per cent of the sample). This material,
together with follow up data from twenty in-depth
interviews, has been the basis of an exploration of various
issues concerned with the smoking debate.
These issues, nurses' views of themselves, their responses
to those with whom they live and work, their weight
management, and responses to difficult situations, will be
described. The data will be utilised to design support
systems for those who wish to stop smoking, taking into
account those activities and materials which nurses
perceive to be most helpful, especially the ideas and
experiences of the sample's ten per cent of ex-smokers.
The concept of stress as applied to nursing has been
described by other workers, and this Paper will address
this issue by describing those situations in which nurses
report increases in their cigarette consumption. The style
and structure of the support to be offered as a consequence
of this work will be described, and there will be a
discussion of the work's implications.
Katie Booth, B.Sc., SRN, HV Cert.
Ann Faulkner, M.A., M.Litt., SRN, RCNT, Dip.Ed
University of Manchester, Oxford Road, Manchester MIS 9PT
(30-minute presentation)
30)
THE OCCUPATIONAL HEALTH OF STUDENT NURSES
There is much evidence to support the view that nursing
is a "stressful” occupation, (Menzies, 1960; Holsclaw,
1965; Gardam, 1960; Kornfield et al, 1968; Birch, 1975;
Stehle, 1981; Stewart et al, 1980; Parkes, 1980).
However, these studies used different approaches and
methodologies and it is clear that a theoretical framework
needs to be used, from which hypotheses may be forwarded
and tested.
The present study was based upon the transactional model
of stress developed by Cox and Mackay (1976, 1981).
Eighty-five student nurses completed questionnaires
concerning their perceptions of the task involved in
nursing, the demands of the job and its workload, and the
social support they received at work. They were also
required to describe if and how nursing affected their
social lives and the commitment they thought was required.
The students also answered questions which provided
measures of general well-being (Cox, Mackay, Thirlaway
and Gotts, 1980) and mood (Mackay et al, 1978).
The following hypotheses were generated from the
transactional model and tested - (1) the more demanding the
job was perceived to be, the greater would be the experience
of stress; (2) the perception of the demands of the job
would be buffered by positive factors, such as social
support; (3) if stress was perceived as high, a reduced
feeling of general well-being would result.
The findings from the present study supported these
hypotheses. Ninety-one per cent of the sample felt nursing
to be "very demanding" or "demanding" and the more demanding
the job was perceived to be, the more likely was the
experience of stress. Twenty-seven per cent of the students
felt that they had "more work than they could manage" and
for those nurses who reported having "just enough work to
do", social support appeared to alleviate the perception
of the demands of the job. The experience of stress was
significantly associated with impaired well-being.
Comparisons were made between the 44 first year students
and the 41 second year students in the sample. The second
year students perceived the job more negatively in terms
of work load and the amount of social support they
received. However, there were no obvious differences in
the psycholigical stress and well-being of the two groups.
These findings have implications for the development of the
recruitment and training of nurses, as we need to understand
the nature of the demands perceived by the students whether they are ’’role-related” or ”task-re la ted" - and how
these are associated with the coping resources available
31)
to the students. A clarification of the structure of
the job may enable action to be taken that would lessen
these demands, increase the available social support and
thus stress and impaired well-being might be reduced.
The enhanced quality of working life for student nurses
may not only improve their psychological health and
well-being, but also their optimum job performance, and
hence the overall cost effectiveness of health care
provision would also benefit.
J. Bostock and T. Cox
Department of Psyclingtry, Medical School,
Queens Medical Centre, Nottingham
(30-minute presentation)
SCHEMES FOR NEWLY REGISTERED NURSES
32)
This paper describes the use of action research to
evaluate experimental schemes for the professional
development of newly registered nurses. Three pilot
schemes have been established in 3 health districts as
a result of discussions which suggested that newly
registered nurses would benefit from further preparation
for their role as staff nurses.
An action research strategy has been selected which allows
for the monitoring and modification of an innovation as it
progresses. This method entails the collection of data,
the assessment of situations, recommendations for change
and modification, followed by further assessment and
modification. Parallel to this staged evaluation, overall
evaluation of the whole programme is undertaken. The
methods of data collection being used include interviews,
questionnaires, observation and documentary analysis.
The evaluation of the schemes commenced in May 1983 and is
due for completion in May 1986. Although the research is
in its early, exploratory stage it is useful to take a
prospective view of the project and in particular, to
discuss the issues and problems that emerge from the use of
action research. These include: the subjective nature of
the action research approach compared to the so-called
objectivity of the experimental approach; qualitative
versus quantitative data; transferability of the findings;
the roles and relationships of the researchers with their
clients and their involvement in decision-making.
The action research approach in the evaluation of
experimental schemes enables change and modification to
take place at an early stage of an innovation. The data
emerging from the evaluation of the professional
development schemes for newly registered nurses will be
used.to illustrate the use’of action research in nursing
practise and the way in which it can make a difference.
Susan Bradley/Gilliam Smith
Nurse Education Research Unit,
Chelsea College1, London
(40-minute presentation)
SPECIFIC PROBLEMS OF PATIENTS WITH TRANS-URETHRAL
RESECTION OF THE PROSTATE
33)
The rapid development of this procedure (327 such operations
at our institution during the past year) has greatly
changed the follow up of patients after surgical treatment
of prostatic adenoma by reducing the duration of
’’ w the,recovery
■*
j a part of the
hospitalization and* making
fact to be taken
and to
convalescence, a fv^L
t-!— in
-- consideration
-be well known by the nurses.
udy, two groups of patients were investigated:
In this study
patients
- group I : 82 r
---- - were interviewed on the day of
hospital discharge and then, 8 days later at home, in order
to know if their initial apprehensions were still a
reality. These patients were selected according to the
localization of their home, to make the second interview
easier;
- group II : a questionnaire was sent to 60 patients to
appreciate the quality of the follow up at longer term
(6 to 14 weeks) .
ANALYSIS OF 16 INTERVIEWS
The mean age was 70 years and the length of hospitalization
was 5 to 8 days for 6 patients (more than 8 days for 2
patients). 7 patients went back home after discharge, 1
patient was referred to a convalescence home. The patients
mentioned some differences between what they had expected
and reality.
Urinary problems
- pain, especially for the first urination was more
important than expected; - difficulties for passing urine
was less important; - patients were worried about urine
coloration; - transitory incontinence more important than
expected under-lined the necessity of giving a specific
information on protective devices.
General problems
- tiredness appeared as the first concern for 7 of 8
patients.
Psychological problems
- 7 of 8 patients were anxious about what could happen;
- 3 of 8 patients did not remember quite well the
informations given to them before leaving the hospital;
- 4 of 8 patients were reassured by the visit of the nurse.
ANALYSIS OF THE QUESTIONNAIRE
47 answers could be used (78’o) . The mean age was 70, 2
years. The length of hospitalization was less than 5 days
34)
for 7 patients. 27 patients stayed from 5 to 8 days. 13
patients stayed more than 8 days. 24 patients had surgery
less than 9 weeks ago. 23 patients had surgery more than
9 weeks ago. 39 patients went back home after discharge
from the hospital. 8 patients were referred to a
convalescence home. The analysis showed:
Urinary problems
. pain 31/47;
. incontinence 26/47, but for 17 it was a transitory
incontinence;
. 18 patients were worried about the aspect of urine;
. frequency dysuria were marked at the beginning;
. sexual problems were mentioned by 5 patients.
General problems
. tiredness in 8 of 47 patients;
. various other problems were mentioned.
Psychologicals
. 26/47 - 55 $ think that the given informations were adequate
. 21/47 - 45 $ think that the given informations were
inadequate.
(Whatever the person giving this information : doctor, nurse,
general practitioners), out a choice of 9 words to qualify
their feelings:
- 30 happiness, security, serenity;
- 27 apprehension, anxiety, unsafety;
- 7 anguish, fear, forsaking.
12 patients choosed words in the 2 first categories. The
comparison between the results of the interviews and of the
questionnaires, allowed us to say that while some problems
disappeared during the convalescence, others occured, this
giving us an overview of the evolution of the main symptoms.
The patients have shown a great interest for the data
collection.
In conclusion, a better and more formal
information of the patients
is needed.
Propositions for action : we are preparing printed documents
for the nurses and for the patients to be given in complement
of oral explanations.
J.M. Bret - Nurse Supervisor, Service d'Urologie, Hospital
Edouard Herriot, Lyon, France.
(20-minute presentation)
35)
DISSATISFACTION WITH BASIC NURSE TRAINING : THE STUDENTS'
VIEW
•
This paper focuses on a study which was concerned with
twelve students and how they perceived their training for
registration. By using a qualitative research method, thestudy gave some insight into (a)
how the students learned the art of nursing, and
(b)
what they found good and bad in terms of experience
and to whom they turned for support.
The data was collected by the use of tape recorded informal
interviews which gave a wealth of information about nurse
training from the students’ point of view.
The field work method is discussed in terms of its
suitability for this type of research, together with the
problems encountered. Analysis of the data was based on
the work.of Glaser and Strauss (1967) and three conceptual
categories emerged.
The category "Hanging On" is discussed with the aid of
original data. It highlights the students' dissatisfaction
with their training and how they are "hanging on" despite
the many stressful experiences they have encountered. Many
of the students suggested that with hindsight they would not
have chosen nursing as a career.
Standards of nursing care are severely criticised,
particularly on two long-stay geriatric wards and the
relevant socialogical literature is referred to in an attempt
to explain the reason for this type of care continuing.
The support systems used by the students is discussed and
whilst these were varied, neither the ward sister or nursing
officer were consulted for a variety of reasons. The main
person to emerge outside the students’ own peer group was an
educationalist who appeared to "recharge batteries" and
motivate them to "hang on".
Barbara P. Burkey
(30-minute presentation)
36)
POST-NATAL SURVEY
RESULTS OF A DESCRIPTIVE STUDY
The modern preoccupation with antenatal care and the
technology associated with delivery has meant there has
been a relative lack of interest in the puerperium by
obstetricians. The post-natal care of women largely still
remains the province of midwives. Recent years have seen
the advent of consumer groups challenging current obstetric
practice, including the use of episiotomy and the often
resulting problems of pain and discomfort following it.
The study was designed to elicit mothers' views and evaluate
their experiences and expectations associated with this
aspect of childbirth.
The aims of the study were:
to see whether or not patients experience pain in
the perineum following vaginal deliveries.
(1)
(2)
,
to assess the severity and duration of any
perineal pain post-delivery.
(3)
to compare the levals of discomfort between
patients with intact perineums, following perineal
tears or episiotomy.
(4)
to identify if differences exist between
primigravid/multigravid patients, normal delivery/
instrumental delivery, and social classes.
(5)
to examine the relationships between mothers'
experiences of pain during labour and delivery
with experiences of post-natal pain and discomfort.
(6)
to evaluate mothers’ experiences with expectations
and knowledge of perineal pain and episiotomy.
(7)
to assess her evaluation of analgesic drugs and
other measures currently in use to alleviate
discomfort.
(8)
to place in context the problem of perineal pain
and discomfort with other types of post-natal
discomfort.
From September 1982,
1982 a questionnaire survey was undertaken of
450 consecutive patients, who were subdivided into 3 groups;
those who had (i) an episiotomy, (ii) sustained a
laceration, and (iii) delivered with the perineum intact.
Questionnaires were given personally to mothers on the
morning following a vaginal delivery of a healthy child,
for seif-completion on their 1st and Sth days postnatally. Coding of the questionnaire produced 123 variables.
The Statistical Package for Social Scientists was used for
producing descriptive statistics, measures of association
and tests of statistical significance.
3 7)
The paper will discuss the results and their implications
related to midwifery practice and health education. The
question "Does it make a difference to how the patient
feels after delivery if she receives an episiotomy or not?"
is answered.
M. Cater BA, SRN, SCM, RCNT
Nursing Studies Unit/Department of Obstetrics & Gynaecology
Medical School, Queen's Medical Centre, Nottingham
(20-minute presentation)
THE LOTHIAN AND FORTH VALLEY LEG ULCER STUDY
38)
A nursing survey in Lothian (population 750,000) during
1979 revealed that 500 patients were being treated in the
community, mainly by District Nurses, for chronic
ulceration of the leg. Four hundred and fifty one hours
per week were spent in treating the patients. In many
cases the causes of ulceration were not clear, and there
was a wide variety of treatments in use. As a result of
these findings, a joint nursing and medical project was
funded by the Scottish Home and Health Department. The
aims were to identify as many patients in two Health
Board Areas (population one million) as possible and
examine those who were willing to be seen in order to
study the natural history, aetiology, treatment and use of
resources. Nearly 1500 patients were identified, 600 were
examined and District Nurses reported on 379 patients
currently in their care. The information collected will
provide a data base for further research.
This is an example of a project, originally carried out as
a monitoring exercise by nursing management, which has
inspired research of major importance.
J.J. Dale
Senior Nursing Officer (Services Development),
Lothian and Forth Valley Leg Ulcer Study,
40 Clinton Road, Edinburgh
(20-minute presentation)
.39)
SURVEY OF PRESCRIBED NURSING TREATMENT FOR PATIENTS WIT ’ll
ESTABLISHED PRESSURE SORES
Previous surveys of patients with pressure sores have
calculated prevalence, provided data on patient
characteristics and divided sores into grade according
to severity. To date no widescale information has been
collected concerning the nursing care of patients with
pressure sores or the treatment of their sores. The
purpose of this survey is to define patient characteristics
in nursing terms, to record sore treatment and assess the
state of the sores. This will provide baseline data for
further research on the efficacy of pressure sore treatment.
The sample comprised hospital patients drawn nationally,
and for convenience Health Districts were the primary
sampling units. All wards in selected Districts (excluding
maternity, paediatric and psychiatric) were visited and
notification of patients with pressure sores requested,
In
all, 961 patients were notified (prevalence 6.65°&), data
was collected on 885 of these by interview with the nurse
responsible for care. The patients were generally elderly
(85$ over 65) and immobile, 50$ able to sit in a chair but
not to walk. Hospital admissions were chiefly for
orthopaedic, cardiovascular or undiagnosed conditions,
though when reported 47$ of patients were in geriatric
units. Descriptions of 1506 sores were obtained including
location, tissue damage and condition (eg. necrosis,
infection). Most sores (67$) were pelvic, in 58$ only the
skin was broken but in 23$ deeper tissues were involved.
A total of 18 preparations were prescribed to clean the
sores, soap and water being most popular (331 sores).
In addition, 98 different preparations were prescribed to
be left in contact with 1109 sores, povidone iodine (175
sores) and eusol mixtures (147) the most, commonly used.
Opsite dressing was prescribed to treat 100 sores, with
heat or light treatments carried out by physiotherapits on
107 sores.
• An enormous variation in patient problems, nursing care and
preparation use was recorded; many preparations, pressure
relieving aids and methods of treatment were encountered
only once, with others used in only one Unit visited. The
need for rationalisation of treatment is apparent, this
would involve a thorough scientific appraisal of treatment
and the subsequent dispersal of the information to the
profession.
This paper presents a section of the results from a DI1SS
sponsored survey.
J.A. David, R.G. Chapman, E.J. Chapman and B. Lockett
Nursing Practice Research Unit, Northwick Park Hospital
and Clinical Research Centre, Harrow
(30-minute presentation)
THE EFFECT OF MASSAGE ON THE LOCAL SKIN BLOOD FLOW IN
AREAS AT RISK FOR PRESSURE SORE
10)
The purpose of this study was to study the effect of massage
on the local skin blood flow in normal skin and in skin
with discolouration (red or reddish blue) in long-term care
patients.
Ten patients 7 women, 3 men with normal skin were studied.
They were all older than 60 years of age (mean 84.8+ 5.6).
The patients with skin discolouration had a red or reddish
blue pressure injury of the skin. These patients were
younger and older than 60 years of age (mean 77.1+ 10.2).
They suffered from cerebral haemorrhage, senile dementia,
arteriosclerosis, diabetes, rheumatoid arthritis,
Parkinson’s disease, fractures and tetraplegia. The
patients had either no drugs or drugs necessary for their
disease states.
By massage we mean small circulating movements with the
fingertips from the periphery to the center for 3 minutes
using liniment. The skin blood flow was measured with a
laser-Doppler flowmeter. This technique measures the
velocity of moving red cells; it does not give a direct
measure in ml/min/ tissue weight but rather in millivolts.
The laser-Doppler flowmeter that measures to a depth of
1-1.5 mm is a noninvasive technique. The skin temperature
was measured simultaneously with a thermistor temperature
probe. The patients with normal skin were measured 20 days
each, five days before and five days after a ten day period
of massage implemented two times a day, in the morning and
in the evening. The measurements before and after were
done at ambient temperature (2O-24°C) and at increased
temperature (40 C). For the ten day period of massage the
measurement were done before and after the massage in the
morning. The patients with skin discolouration were
measured once at the center of the injured skin and on the
normal skin 10 cm from the edge of the skin discolouration
before and after massage was carried out.
The results from normal skin over <a ""
’
' ' indicated
20 day
period
noochanges in the ability to increase skin blood flow at
40 C after 10 days of massage. Some of the patients
increased their blood flow significantly immediately after
the massage was done while some of the patients did not.
The results from the injured skin indicated a very high
blood flow in the center of the injury. Immediately after
the massage was carried out the blood flow decreased
dramatically.
Anna-Christina Ek R.N. B.A.
Department of Social Medicine, University Hospital, Sweden
(20-minute presentation)
41)
A STUDY OF THE KNOWLEDGE AND PRACTICES OF PRIMIPARS
CONCERNING POST-PARTUM CARE, AND THE EFFECTS OF A
PLANNED EDUCATION ON THE PREVENTION OF POST-PARTUM
COMPLICATIONS
This study was planned to examine how the application of
an organized training about post-partum care affects
puerperae, who had their first delivery, in respect of
their knowledge of the subject and the prevention of
post-partum complications.
The research was carried out at Ege University Gynocology
Department between July-December 1982 on a group consisting
of 120 primipar puerperae. Experimental and control groups
were formed by matching puerperae according to their
educational levels.
The researcher has developed a special training programme
with the consideration that it is important for puerperae
to know post-partum care and its benefits in preventing
post-partum complications. In this training programme, the
contents of post-partum care and its application have been
established.
Pre-test forms were handed out to the puerperae in this
group in order to determine their knowledge on post-partum
care while 60 puerperae forming the experimental group were
given the programmed training. To determine the efficiency
of the programmed training the puerperae were asked to fill
post-test forms 40 days after the delivery, which is the
termination of puerperium.
After the assessment of pre-test forms, the puerperae have
been found to be lacking in efficiency with regards to their
knowledge and application of post-partum care. The increase
in the knowledge of trained mothers with regards to
post-partum care has also been observed to be relatively
more and the rate of incident of complications in this group
relatively lower.
As a conclusion, it has been suggested that a programmed
training is an efficient way of increasing puerperae’s
knowledge in this respect, and that it is therefore of great
benefit to both puerperae and pregnants to have an applied
pre and post-partum training course in which nurses arc to
take an active and effective part.
Elcin Erdogan, RN., B.S., PhD.
Ege University School of Nursing (Division of Obstetric
and GynocOlogycal Nursing), Izmir, Turkey
(20-minute presentation)
THE NEWLY GRADUATED NURSE - A CORRELATIONAL ANALYSIS
BETWEEN EXPERIENCES IN NURSING EDUCATION AND ATTITUDES
TOWARD NURSING AUTONOMY, PATIENTS’ RIGHTS AND THE
NURSE ROLE
42)
Background
This study examines experiences of nurses graduated in 1980
in relation to the educational programme just completed.
This programme structure reflected different medical
specialities (surgical
internal
psychiatric care etc.)
in contrast to a new programme structure reflecting
different levels of self-care (healthy, risk-groups,
acutely and chronically ill).
Ihe purpose was to gather base-line data for outcome
control and retest 5 year after a change in nursing
education had been introduced. The assumption was that
nurses educated within the new programme will have a stronger
nursing identity than nurses educated before the change due
to the new emphasis on nursing philosophy and thinking.
Nursing identity was operationalized as comprised of three
attitudes: nursing autonomy and advocacy, patients' rights
and rejection of traditional role limitations.
Method
A questionnaire with open-ended and closed questions was
distributed to a random sample (n=133) graduated in Norway
during 1980. Attached to the questionnaire was Pankratz
and Pankratz' instrument (Norwegian translation) on Nursing
Autonomy and Patients’ Rights (1).
Findings
More than 3/4 of the sample (78%) were working
i
in acute care
settings. 121 were working in long-termi care, 5$ in
district-hursing and the remaining 51 were (either unemployed
or working in nursing education. Fifty-nine nurses (44’0)'
planned to change their place of work. Of these 47°6 wanted
to work in district-nursing while 38’0 planned to work in
acute care.
It is a disturbing fact that few of the new
graduates work or want to work in long-term care while at
the same time there is a shortage of nurses in this area
with an increasing number of patients in need of such care.
In this study a number of nurses reported the transition
from student-role to the role of the nurse as being
"difficult”, "exhausting” etc. They expressed that what
they had learned in nursing theory was not reflected in
practice, however, they said the holistic approach to
patient care was necessary to provide the best possible care.
The role expectations related to the team-leader role i. e.
independent dec is ion-making, collaboration and being
responsible for nursing care, were mentioned most often a s
transitional problems. The education was said to provide
43)
insufficient preparation for this role. The nurses
suggested that necessary changes in nursing education
should include better preparation for the teamleader role,
a more independent student role, less use of lectures
with more group-discussions and seminars and more frequent
guided learning experiences in the practice setting with
emphasis on holistic nursing.
Pankratz and Pankratz' instrument consists of 47 statements
designed to elicit information about nurses’ attitudes
toward their professional role and patients' rights. Our
sample had higher scores on the attitudes compared with
four different groups of American nurses with only a group
of nurse-leaders scoring higher (2).
Multivariate analysis revealed three variables, sex, age
and workplace to be related to scores on the attitude-scale.
On the attitude "nursing autonomy and advocacy" men
scored higher than women and younger women (25 years and
younger) higher than older while the opposite was true for
male nurses. On the attitude "patients' rights" older
nurses tended to have higher' scores than younger nurses and
men higher scores than women. On the attitude "rejection
of traditional role limitations" men had higher scores than
women. Nurses working in long-term care had higher scores
than those working in the acute care setting. One has to
be cautious to draw conclusion in regard to the effect of
sex on these variables due to the uneven distribution of
men (18) and women (115) in this sample.
1) Pankratz, L./D. Pankratz, 'Nursing Autonomy and Patients'
Right Questionnaire', in Instruments for Measuring Nursing
Practice and Other Health Care VariabTes. tilfkW puBTication
Ro‘.
^rj‘."7c7ArTiKa^n“(eds.) Vol. 2.
2) Pankratz, L. and Pankratz, D. 'Nursing Autonomy and
Patients' Rights: Development of a Nursing Attitude Scale',
Journal of Health and Social Behavioury 1974, pp. 211-216.
May Solveig Fagermoen, RN, MA, Lecturer, AHS, University
of Tromsd, Norway.
Randi Nord, RN, MA, Lepturer, The School of Advanced Education
in Nursingt Oslo, Norway
(30-minute presentation)
44)
THE COMMUNITY NURSES' ROLE IN THE AFTERCARE OF
MASTECTOMY PATIENTS
This Paper will describe research in which Community
Nurses (both District Nurses and Health Visitors) were
asked to monitor mastectomy patients' physical, social
and psychological state following discharge from hospital
after mastectomy.
Nurses in the study were asked to make a total of three
visits to each patient, and to fill in a standard
assessment form. Each assessment was to be tape recorded
to allow feedback discussions to take place.
Results will be discussed under the following headings:-
(1)
nurses' willingness to take part in monitoring
mastectomy patients
(2)
nurses' ability to interview and assess
mastectomy patients
(3)
Attitudes of Nursing Management and General
’ Practitioners
Inferences will be drawn from the study, and discussed in
respect to the Community Nurse v the Specialist Nurse, and
in respect to the role of the Health Visitor v District
Nurse, in giving emotional care to clients.
Ann Faulkner, M.A., M.Litt., S.R.N., R.C.N.T., Dip.Ed.
Lecturer in Nursing, University of Manchester
(20-minute presentation)
45)
MOTHERS' SATISFACTION WITH CARE IN LABOUR AND IN THE
POST-PARTUM PERIOD_____________
This research study focussed on the satisfaction of a
selected group of mothers with the birth and post-partum
experience in one maternity unit. One half of the mothers
delivered in a traditional setting, the other half in the
birthing room, The same medical and nursing staff served
both settings, Semi-structured interviews were conducted
on the post-partum floor 1-3 days post-delivery and at
home 15-21 days post-delivery. One quarter of the subjects
were observed during labour and the observations were
used to verify the mothers recall of the events during
labour and delivery. A content analysis of the data was
undertaken and categories developed. These were verified
with previous literature and the reliability validated
by two content experts.
Early findings indicate that satisfaction occurs when
perceived care and expected care are congruent. In labour,
the attitude of the nurse to the mother is an important
source of satisfaction. The setting per se is not
important once the mother is in labour, but privacy is an
important factor for the mother. On the post-partum floor,
factors that detract from satisfaction appear to be a lack
of personalized care, sleep interruptions and lack of
cleanliness in the environment. Satisfaction appears to
be related to appropriate teaching, physical comfort
measures and an empathetic response from the nurse. These
findings are based on the initial categorization and a
comparison between the responses of the groups delivered
in the two settings has not yet been completed.
nN, SCM
Peggy Anne rielu,
Field, 3
SRN,
SCM , PhD,
of Nursing, University of Alberta,
Professor, Faculty
f
Edmonton, Canada
(20-minute presentation)
46)
PREDICTING REHABILITATION SUCCESS IN GERIATRIC PATIENTS
During the past 20 years, in the field of rehabilitation,
there has been a move away from a concentration on the
patient’s pathology to a consideration of his functional
ability. This has particular relevance for those working
within a multidisciplinary team and provides a focus for
inter-professional co-operation leading to realistic goal
setting in patient care.
Functional assessment has also been used to predict
recovery and identify those patients on whom scarce
resources should be expended. The present study, which is
now in progress, is an attempt to use a functional scoring
system to select patients for admission to a
rehabilitation ward in a geriatric unit. Patients scoring
within a previously identified optimal range are selected
for admission to the rehabilitation ward. Their functional
progress is assessed throughout their course of treatment
and scores are related to ultimate placement on discharge
from the ward.
The feasibility of predicting recovery on the basis of
functional assessment will be discussed, the methodology
outlined and preliminary results presented.
Dr. Pauline Fielding B.Sc. Hons., S.R.N.
Senior Nurse, Geriatric Unit, The Middlesex Hospital, London
(30-minute presentation)
THE NEED FOR A NURSING IN-PATIENT EDUCATION PROGRAMME
FOLLOWING MYOCARDIAL INFARCTION
47)
The aim of this study was to apply a modified programme of
health education to a selected number of patients admitted
to the Coronary Care Unit following primary uncomplicated
myocardial infarction. It was hoped to promote physical,
mental and social wellbeing amongst these patients in an
attempt to limit the extent of their illness.
Risk factor profiles were studied in 20 patients admitted
to the Coronary Care Unit following primary uncomplicated
myocardial infaction. An individualised comprehensive
teaching programme was c.arried out over four sessions by
a senior nurse aimed at a simple understanding of the
pathophysiology of myocardial infaction and its
causitive factors prior to discharge.
Patient group consisted of 18 males and 2 females (age
range 31-59 years) who were allocated randomly either to
the teaching programme or as control. Evaluation was by
a combined questionnaire and scoring system, initially at
four days and again at two months post infaction.
Adequate understanding of their illness was demonstrated
in lOO’o of patients included in the teaching programme as
opposed to 201 of control. Dietary habits were favourably
modified in 70$ of patients in the teaching programme as
compared to 10$ of the control group, and weight was
reduced towards ideal in four of the five in whom this was
required. Smoking in the controls was virtually unchanged
- a mean of 34 and at two months 23 per day. In the
study group this was reduced from a mean of 32 cigarettes
per day to five. All patients in the study group took
regular dynamic exercise compared with 20$ of control.
Unsolicited patient comments suggested reduced anxiety in
the patients and relatives included in the teaching
programme.
In conclusion, a comprehensive individualised teaching
programme administered by a senior nurse prior to discharge
from hospital is an effective method of reducing multiple
overt risk factors in the post-myocardial infarct patient.
Valerie Fletcher, University Department of Medical Cardiology,
Royal Infirmary, Glasgow
(20-minute presentation)
48)
SELF CARE AND FUNCTIONING CAPACITY OF ELDERLY PEOPLE IN
BERGEN, NORWAY
Introduction
This is a partial report of a research project in progress
to meet the requirements for the degree of doctor of
philosophy under the faculty of medicine at the University
of Bergen.
The purpose of the study was to explore the functional
level and self care capacity of elderly people (67 years
of age and older) in the municipality of Bergen, Norway.
Further, to assess to what extent private care affects
the total life situation of the elderly.
Method
A number of 431 elderly people were chosen by random
sampling technique. Group I: Elderly people receiving
nursing care while at home (198 persons). Group 2: Elderly
people living in nursing homes (94 persons). Group 3:
Healthy elderly people living at home, not receiving any
type of nursing care provided by the public health service
(131 persons). The data were obtained through personal
interviews. Three different types of forms were used,
number 1: The socalled "Hesp”, an instrument measuring
health and self care deficit. Number 2: A social network
questionnaire. Number 3: A form registering specific
nursing care data. Groups 1 and 2 were tested with all the
three forms, while group 3 was tested with forms one and
two only.
Findings
The self care capacity and functional level of the three
groups were registered.
‘
A comparison of the self care
capacity and functioning level of the three groups was
undertaken. Hypothesis I: Elderly people receiving nursing
undertaker..
care at home and with a strong social network have a
higher degree of functioning disability and lower self care
capacity than nursing home patients with a weak social
network. Hypothesis 2: Nursing home patients with a weak
social network have a higher level of self care capacity
and less functional deficit than elderly people receiving
nursing care at home and with a strong social network. The
final results of the study will be available at the time of
the presentation of this report.
Esther Margrethe Gjertsen, R.N., Cand.Polit., Assistant
Professor, University of Bergen, Norway, Institute of
Nursing Science
(30-minute presentation)
49)
’’CLINICAL SUPERVISOR” ROLE INVESTIGATION GENERAL HOSPITALS
IN ISRAEL
This research deals with the role investigation of the
Clinical Nurse Supervisor in General Hospitals in Israeli
reality.
In Nursing hierrarchy it is a role between the Director of
Nursing Services in the hospital, and the Head Nurse in a
patient’s ward or other unit. The research focuses on
description and analysis of the role by four main
objectives:
(1)
description and analysis of Role Perception by
the Supervisor herself (focus person), and her
main role senders (Director of Nursing and Head
Nurses).
(2)
description and analysis of several types of
Role Conflict, and Role Ambiguity.
(3)
description and analysis of the Supervisor’s
feelings as outputs of the Role Conflict and
Amb igu ity.
(4)
description of the appreciation the role merits
on the Nursing hierrarchy. The extent of
explotation of the role potentiality according
to other roles in the Nursing hierrarchy.
Field research was carried out in seven General Hospitals
and/or Medical Centers all over the country. The sample
__ 1.
’ii— •__
included seven Directors of Nursing services, th
29 /-Clinical
Supervisors, 71 Head Nurses. The subjects answered a self
report questionnaire.
The Clinical Supervisor’s role was described from three
points of view:
(1)
the activities she is expected to do or actually
does (desired, existed).
(2)
responsibility she expected to bear or actually
has (desirable, existed).
sources of authority and responsibility she has
in her role.
(3)
decisions she is expected to make or actually
does (desirable, existed).
All these in three areas: Team, Patients, Organization.
As expected, a difference in role perception was found
between the focal person and the role senders, mainly
when related to the Clinical Supervisor’s role and the
50)
Head Nurse. A tendency of gap was found between the
Director of Nursing and the Head Nurse.
Role conflict that was expressed by three types of conflict:
as expected gaps between expectations of the
Director of Nursing and the Clinical Supervisor,
the Head Nurses and the Clinical Supervisor.
What indicates person role conflict.
gap between senders which indicates inter sender
conflict, meaning between the Director of
Nursing and the Head Nurse.
gap between the supervisor’s expectations and
her actual experience as expected, was found
and indicated the role conflict.
The Supervisor is of opinion that she is not expected to
deal with activities, nor is she expected to be responsible
in three main areas explored: Team, Patients and
Organizational problems. But, she is of opinion that she is
expected to a great deal of decision making in these three
above mentioned areas, As expected, a great deal of role
ambiguity was found.
Looking for her resources for responsibility and authority
we found differing opinions and it seems to be that she has
no resources of responsibility and authority.
As to the Clinical Supervisor’s feelings as outputs to role
conflict and ambiguity we found, as expected, a great deal
of feelings of frustration, dissatisfaction. Although, most
of the supervisors adjusted to their role and stayed in the
system. The reason that was mainly found is their personal
relationship and a great deal of co-operation with Head Nurses.
The appreciation the role gains in relationship to other
nursing roles was found, as expected, low. So was found low
explotation of the role potential relating to other nursing
roles.
In general, the research results suggest that it’s first
conclusion is that the role of the Clinical Supervisor in
Israel is nor similar to the Nurse Clinical Specialist in the
United States, though there is a tension to compare them.
This is one of the first systematic research in this subject.
There is a need for further researches, so as to reinforce
the main findings and come to apply the conclusion.
By identifying the needs of every hospital we shall be able
to determine why and how to employ the role and by whom.
according Lu Lhe managciial behavioui oL inu UuecLoi ul
Nursing, needs and abilities of the Head Nurses.
51)
Mainly, we should take in account the General Organizational
design of the whole hospital.
Malca Grebler R.N.N.A.
Director of Nursing Services, Geriatric Medical Centre,
''Shmue1 Harofe" Hospital, Beer Ya'acov 70300, Israel
(30-minut’e presentation)
52)
REPORT ON A STUDY OF THE CAREER HISTORIES OF SELECTED
LEADING FEMALE NURSES IN ENGLAND AND SCOTLAND
The paper reports on a study which took the form of an
exploratory and descriptive survey of the career histories
of 36 leading female nurses in England and Scotland.
Theoretical views of careers have been formulated
primarily from the male career experience. Whether or not
these views have validity for the female career experience
was questioned.
The subjects, selected by reputational method, completed a
lengthy questionnaire and 35 of the 36 were interviewed.
The methodological triangulation produced1 a massive amount
of rich data.
The paper groups the findings under three headings: demo
graphic profile, early lives and career period. First, the
profile is drawn of 1981 demographic features such as age
(they averaged 56.5 years), marital status C92% were single)
family background (86% had fathers engaged in white collar
occupations), professional education and official recognition
of contributions to the discipline of nursing.
Second, the early lives of the subjects are examined. The
data revealed that the subjects, in general, were advantaged
socially, academically able and very active in school and
extra cirricular areas. Three quarters of them had attended
single sex schools. Despite this early promise, few
received career counselling. Nursing, for the most part,
was not seen as a desirable profession by parents and
teachers. Many of the subjects came into the profession by
default: when other plans failed, with the direction of
labour in WW II, and with the occurrence of familial
financial constraints such as those brought on by the death
of fathers.
The third major area presented is the career period. This
was found to separate into two distinct stages. The first
included, on average, nine years in which a "Lateral
Movement Syndrome'’ was manifested. Here occupational
mobility (or side-stepping) rather than career mobility
(progressive stepping) was the major feature. Eventual
career mobility (in the second career phase) began, for 60$
of the subjects, with the help of a mentor, a senior nurse
who, in some way, suggested or created opportunity for
promotion.
The paper concludes with a discussion of the relevance of
this kind of historical perspective to Nursing to-day, the
topic of mentoring and the need for comprehensive programmes
of career counselling based on a multifactorial approach.
Dr. Leslie K. Hardy, Associate Professor, School of Nursing
University of Lethbridge
(30-minute presentation)
53)
DISTRICT NURSING OUTSIDE NORMAL WORKING HOURS IN ENGLAND
AND WALES: A SUMMARY OF THE PROVISION OF EVENING, NIGHT
AND EARLY-MORNING SERVICES
The paper summaries the main findings of a DHSS-funded
three-stage survey of all Health Districts in England
and Wales which investigated the range and scope of
services provided by district nursing services outside
normal working hours, the allocation of resources, the
reasons for which such services were established and their
relationship with other community-based support. Stages
1 and 2 were postal surveys of all district nursing offices
(Stage 1) and randomly selected samples of district nurses
and general practitioners (Stage 2). Stage 3 was a single
Region interview survey of district nursing officers,
district nurses, general practitioners and home-help
supervisors. The paper will give an overview of reasons
for establishing services, common types of care provided,
visiting frequency, methods and levels of staffing, costs
and methods of monitoring services.
Sheila Harrisson, University of Durham, Health Care Unit,
Durham
(30-minute presentation)
54)
HELPING PEOPLE TO STOP SMOKING
THE NURSES ROLE
This paper will describe a research project concerned
with the nurses health education role. Special information
packs were designed to help nurses educate their patients
about smoking.
The impact of these materials has been assessed in terms
of:
(a)
nurses’ knowledge levels about smoking before
and after receiving the packs and
(b)
the acceptability of the packs to nurses
A sample of 430 nurses (SRN, SEN, students, pupils, midwives,
district nurses and health visitors) from 3 health districts
completed a questionnaire (A) covering all aspects of
smoking, prior to receiving an information pack. A second
questionnaire (B) was completed by the same sample a few
months later, after receipt of the pack. A sample of
"Control” group nurses from 3 different health districts
completed questionnaire B only.
Additional data on acceptability of the material was
obtained through a postal survey of individuals who had
independently requested the smoking pack.
Findings from the research will be discussed:
(a)
in relation to nurses’ knowledge levels about
smoking before and after receiving the pack
and
(b)
nurses’ responses to the pack and overall
acceptability of the materials.
Sheila Haverty, BA, SRN
Jill Macleod Clark, PhD, BSc, SRN,
Department of Nursing Studies, Chelsea College, London
(20-minute presentation)
55)
BREATHLESSNESS AND PSYCHIATRIC MORBIDITY IN CHRONIC
BRONCHITIS AND EMPHYSEMA: A STUDY OF PSYCHOTHERAPEUTIC
MANAGEMENT
This paper describes a «study of the outcome of psychotherapy
with patients disabled by dyspnoea
\ .
i as a consequence of
COAD.
Hypothesis
The principal hypothesis was that a combination of
psychotherapy and medical treatment is more effective than
medical treatment alone in relieving the dyspnoea of
patients with COAD. Some other hypothesis tried to
enquire the effect of different types of psychotherapy on
dyspnoea, psychiatric symptoms and psychodynamic change.
Background
Dyspnoea is a distressing sympton and is difficult to treat.
Its physiological mechanisms are not fully understood.
Work has been done using anxiolytic drugs such as
benzodiazepines, phenothiazines, alcohol or opiates to
relieve dyspnoea in COAD with some value. However, large
doses are hazardous. Psychotherapy has been used to
relieve dyspnoea in rehabilitation programmes for patients
with COAD. More recently it has been shown that brief
interpretative psychotherapy may benefit patients with
various physcial illnesses.
Method
Sample: patients with dyspnoea due to COAD were screened in
the clinics, but 70$ of them were excluded from the study
as certain criteria were not met. For example, they had
other illnesses causing dyspnoea, did not speak English
and were demented. Sixty-five patients were allocated at
random to slots specififed by the experimental design.
Equal numbers of men and women received each of four
different treatments.
Treatment
With the consent of the patients and the agreement of their
general practitioners, patients received medical treatment
for COAD and some other intercurrent conditions from the
hospital physician while participating in the study.
Psychotherapy consisted of eight individual forty-five
minute sessions over a period of eight weeks. Patients
were encouraged to discuss any topic and express their
feelings.
56)
Treatment groups were as follows:
The analytical group who received treatment from one of
two experiencedpsychoanalysts making liberal use of
transference interpretations.
The supportive group received treatment from the same two
psychoanalysts who were withholding tranference
interpretations.
The nurse * s group received treatment from an experienced
medical nurse with no formal psychotherapeutic training.
She reported her sessions to a nurse familiar with
psychotherapy and to a psychiatrist, but was not advised
on theory or technique. She talked with her patients
on how they managed their lives with the disabling
disease, explored these problems and endeavoured to find
solutions with her patients. She offered practical
advice and discussed medical treatment.
All therapies were focal. A central problem was defined
and criteria by which this could be judged to have been
resolved were specified in advance.
The control group had no psychotherapy but had weekly
laboratory tests.
Before and after the eight week period of psychotherapy,
the patients had lung function tests and blood gas
measurements, also some lung function tests after each
session. Six months after the psychotherapy, the patients
had further lung function tests and blood gas measurements.
Results
Patients treated by a medical nurse experienced sustained
relief of dyspnoea, but tended to undergo less
psychodynamic change. Psychiatric symptoms were reduced
n those receiving supportive, but not analytical,
psychotherapy. 77*& of control patients were admitted to
the medical wards during the eight months of their
participation in the study. The corresponding figure for
patients who received psychotherapy was 31I.
In conclusion, the psychosomatic mechanisms involved,
the implications for medical and nursing practice, and
the value of liaison psychotherapy need to be considered.
Mrs. A. Heslop, Department of Medicine, Nursing and
Psychiatry, Charing Cross Hospital and Cassel Hospital,
London
(20-minute presentation)
57)
RANDOMISED STUDY TO ASSESS THE BENEFITS OF DELIVERY
IN A BIRTHING CHAIR
Five hundred mothers participated in this study of the
influence of their position during the second stage of
labour on their delivery performance. All had previously
agreed to random allocation to delivery in the
conventional recumbent position in bed or in a squatting
position in a birthing chair. The instrument used was
the E-Z Birth Chair (Century Manufacturing Company Ltd.)
The randomisation was determined by an envelope drawn
towards the end of the first stage of labour.
The duration of the second stage and the time spent
actively bearing down were shorter in the chair patients
than in the bed patients. There was a significant
difference in the overall rate of forceps delivery between
the two groups, and this was especially marked in
primigravidae with epidural analgesia who required less
instrumental intervention if they delivered in the chair.
The blood loss was greater among the chair patients:
atonic post-partum haemmorhage appeared commoner and
bleeding from perineal tears and episiotomies was more
profuse, probably because of increased venous pressure
when the perineum is the most dependant part of the trunk,
this did not reach statistical significance. However,
in a significantly great number of the chair patients
the perineum was either intact or only superficially
damaged. There was no difference in the condition of the
neonates in the two groups.
Edith M. Hillan M.Sc.,
I.JL., U.LOL.,
D.LSc., IV.U.IN.,
R.G.N. R.S.C.N., S.C.M.,
Research Sister, Glasgow
C*
, Royal Maternity Hospital, Glasgow,
Scotland
(30-minute presentation)
58)
FAMILIES' KNOWLEDGE AND USE OF RESOURCES IN MEETING
NEEDS OF PATIENTS WITH CANCER AT HOME
Forty-three male and 40 female family members providing
care to patients with cancer were interviewed at home.
The purpose of the investigation was: 1) to identify needs
perceived by families; 2) to determine how families were
meeting care requirements; 3) to identify deficits in
outside resources; 4) and to determine resources which a re
available but not used.
Study participants were selcted from a stratified random
sampling of out-patients receiving treatment at a local
Cancer Clinic. Stratification was by site of disease
and sex of patient. Day of the week was used as a proxy
measure for site of cancer. The proxy measure was
necessary since site of disease was not indicated on the
daily lists of clinic attendance from which the sample
of patients was drawn. Patients visits were usually
scheduled such that certain sites were seen on certain
days of the week.
Findings indicated that there were unmet needs related
to the physical care of the patient and also in the
psychosocial realm. Only 23% of the family members were
aware of services that could assist them with patient
care. The Victorian Order of Nurses and the Visiting Home
Makers services were the two resources most frequently
mentioned. The results also showed that only eight
percent of the study sample had received assistance from
available services.
Generally families relied mainly on their own resources
and the support of relatives, friends and neighbours in
meeting patient care requirements. Not all family
members interviewed had access to informal sources of
support.
Cora Hinds, R.N., B.Sc.N., M.Sc.N.,
Assistant Professor Nursing, University of Ottawa, Canada
(30-minute presentation)
59)
AN INVESTIGATION TO IDENTIFY SYMPTONS OF DISTRESS IN
THE TERMINALLY ILL PATIENT AND HIS/HER FAMILY IN THE
GENERAL MEDICAL WARD
A small descriptive study identifying the distressing
symptoms of 26 terminally ill patients dying from
malignant as well as non-malignant disease was carried
out. Twenty of the patients' relatives and 52 nurses
were also included in the study and were interviewed
individually to elicit the care given within the general
hospital setting.
Patients were selected consecutively over a three month
period from three consultant physicians' case-load which
involved five different wards between two hospitals.
A number of tools were compiled, namely a four degree
rating chart with 16 distressing physical symptoms and
a mood chart to establish the general condition of the
patient, completed by the researcher (for the patient),
nurse and doctor. A semi-structed interview was used
with the relatives and nurses. The nurses' opinions
were taped. The relatives were also asked to fill in a
mood adjective check list previously used on mastectomy
patients to establish how they were reacting, and the
nurses had a self rating question on stress to complete.
The study showed that certain distressing symptoms were
present, namely, anorexia, sleeplessness, mouth
infections, pain, pressure sores and depression being
the most common. Psycho-social care of the patient and
relative was often hampered because of lack of teaching,
lack of time and lack of continuity of care due to
rapid changeover of staff. Nurses found caring for the
terminally ill patient rewarding but first year nurses
learners found coping with their own emotions difficult.
The senior nurses would have liked more teaching on pain
control and care of relatives. Support of nursing
staff was seen to be better on wards where the nursing
process was being practised.
Looking after the terminally ill patient and his/her
family on an acute medical ward is not easy with all the
other pressures. However, more attention must be given
to the specific details of symptom control and
psycho-social aspects of care for both patient and family.
Good contact with the family before and after the death
must be more strongly encouraged.
Mrs. Josephine Hockley, St. Bartholomews Hospital, London
(30-minute presentation)
60)
POST OPERATIVE PAIN
NURSES PERCEPTION AND PRACTICES
Major surgery is frequently associated with pain. Patients
are normally prescribed narcotic analgesics for pain relief
post-operatively and it is usually the nurse who decides
when prescribed analgesia is offered, given or withheld.
This study was designed to test the knowledge and
practices of nurses of various grades in relation to post
operative pain and the use of analgesics.
75 nurses of 5 grades working on surgical wards of a
teaching hospital completed a questionnaire. Questions
relating to the understanding of narcotic drugs and their
physiological effects were interspersed with questions
about actual nursing practice in defined situations.
Results showed that substantial numbers of nurses in all
of the grades were not aware of the effects of narcotics.
The sisters were the most knowledgeable group, SENs knew
less than either .of the student nurse groups. Staff nurses,
who have a major responsibility in administering analgesics,
gave answers that were particularly surprising.
The responses to questions relating to nursing practices
indicated that physiological signs of pain were not
recognised by substantial numbers; nurses were most likely
to consider giving prescribed analgesia when the patient
complains of pain.
The questionnaire revealed that more than half of the
respondents were unaware of the rationale of pain
prevention and would disregard a prescribed request to give
regular analgesia. Results also showed that more than
half the nurses questioned would not recognise signs
indicating that it might be dangerous to give a narcotic
analgesic.
This paper presents an analysis of the study. Possible
reasons for the response of various groups questioned will
be explored.
K.J. Hosking, SRN ONC,
Analgesia Sister, Departments of Anaesthetics and Surgery,
University of Sheffield
(30-minute presentation)
61)
BACK PAIN IN THE NURSING PROFESSION - THE NEED FOR A
SYSTEMS APPROACH
An ongoing study into the problem of back pain within the
N.H.S. nursing profession was initiated in 1980. This
paper describes the progress of the work from a
methodological standpoint. It first examines existing
epidemiological data and contrasts it with those
generatediby the present study.
The questions arising as a result of these analyses, indicate
the need for a multi-disciplinary systems approach. Such an
approach combines not only the disciplines of physiology
and biomechanics, but also those of ergonomics and
epidemiology.
Progress along these lines is described with the aid of
examples. The need to examine the many facets of the
nurses interaction with both patients and equipment is
considered. Sample models of these categories are
presented for a number of commonly observed tasks. These
include the lifting of patients and the operation of
equipment.
The role of psychological and sociological1 factors within
are acknowledged, especially with respect to
such a system
j,
the implementation of recommendations, although the
inherent 'dangers of ’’casting the net” too wide are discussed.
The application of such an approach to other areas of
nursing research will also be presented.
(vj, nuasoii,
>. a . o cuuuS, P.W. Buckle, P. Rivers & D. Baty,
M.
Hudson, lD.A.Stubbs
Department of Human Biology and Health, University of
Surrey, Guildford
(30-minute presentation)
THE DEVELOPMENT OF A CASSETTE RECORDED ASSESSMENT FOR
USE BY NURSES IN SCREENING THE HEARING OF ELDERLY
PATIENTS/CLIENTS
62)
The process will be described by which a cassette recorded
hearing assessment was developed by the Regional Nursing
Research Liaison Officer in collaboration with a Director
of a Centre for Deafened People and a Nursing Officer in
a local geriatric hospital.
The setting up of a pilot study in a geriatric hospital
will be outlined through which the feasibility of using
the cassette recorded assessment by nurses will be tested.
The methods developed to test the assessment will be
discussed. The methods involve the development and use
by nurses of a ’’Patient Communication Scoring Assessment”
and a self assessment by patients of their own hearing
capacities. The results of both these assessments are
then compared with those obtained by the cassette recorded
method to identify differences and similiarities.
Verification of the results of all the assessments will
be obtained through referral of all patients identified
as having hearing/communication difficulties for specialist
examinations.
The results of the pilot study will be presented and the
next stages of the study outlined. The need for nurses
to develop and use less crude assessment processes than
are in use currently will be discussed.
Maura Hunt,
M. Phil., HV, HV Tutor’s Cert., Nursing Research Liaison
Officer, South East Thames Regional Health Authority
and Reader in Department of Nursing & Community Health
Studies, Polytechnic of South Bank___________________
(30-minute presentation)
PATIENTS WITH PAIN
63)
This study is an investigation of the nursing assessment
of patients with pain. The assessment process is
investigated, with particular reference to the information
used by nurses in their assessment. Pain was seen as a
uniquely personal experience, the presence of which can
be inferred in an individual, but not measured directly.
Valid indicators and manifestations of pain were identified
from a search of the relevant literature. These indicators
were categorised and then represented in eleven short
patient descriptions or vignettes.
A questionnaire which incorporated these vignettes was
devised and distributed to a sample of qualified nurses.
Each nurse was asked to study the patient description, and
rank any "clues” which they felt would be useful to them if
assessing the patient depicted for pain, with the most
useful ranked in first position.
The data thus produced was examined with respect both
to the number of times each type of pain indicator was
ranked in any position, and the amount of agreement between
nurses in their rankings of usefulness.
It was found that the pain indicators could be grouped
into four "levels” of usefulness as perceived by the
nurses of the study, but that the usefulness of any
particular cue varied from one situation to the next, and
between nurses. It is suggested that individual nurses
have idiosyncratic approaches to the assessment process,
and that this may be due to the highly complex nature of
the task. The results of this study were seen to have
implications for both practise and training in nursing.
Gary James, Hull
(30-minute presentation)
NURSING IN A CONTINUING CARE UNIT
64)
Stimulated by the literature on and by the hospice
movement, a study on ’’The role of the nurse in the care
of the dying” was carried out at a purpose built
continuing care unit in the north-east of Scotland.
Drawing on that research, this paper is about the nurses
and their work pn the unit. It is concerned with how
the care of the dying is organised in practice rather than
looking at how it ’’should" theoretically, be organised.
The study involved working as a nurse on the unit, and
aimed to understand the means by which the nurses were
able to continue looking after the dying patients, how
such work affects the nurses, and how the nurse makes
sense of her experience, I shall be looking at the ways
in which the nurses on the unit perceived themselves, and
were seen by others, as being in some way different.
A ’’team" and a ’’family” were self-descriptions by the
nurses, and it is suggested that it was through this
sense of identity that a feeling of solidarity was
nurtured and bonds between workmates forged. The unit
took in ill-people, generally accounted to be medical
failures, invariably associated with impending loss, and
attempted to redefine them in terms of success. Being
part of the unit meant taking part in this redefinition
and learning the ways of the unit in order to defend them
or pass them on in appropriate circumstances.
The participant observation study used a variety of means
of data collection, including field notes, a research
diary and tape recorded interviews. It was sponsored by
the Social Science Research Council.
Nicky James, Alcoholics Recovering Project,
Corporation Street, Birmingham
(30-minute presentation)
DEVELOPMENT OF A NEW INDWELLING URETHRAL CATHETER
65)
This paper will describe the nursing research involved in
the development of a new indwelling urethral catheter.
The research was funded by the British Foundation for
Age Research and is being supervised by Professor
J.C. Brocklehurst in the Department of Geriatric Medicine
at Manchester University.
The first stage of the project involved a biologist and
a biophysicist who made anatomical, physiological, dynamic
and hydrostatic studies of the ageing female urethra.
The new catheter design was based on the findings from this
work.
The nursing research took place over three years. Initially,
a survey was undertaken to study current practices and
problems of catheter management in the elderly in hospital
and the community. The results and a review of the
literature showed many problems associated with nursing
the elderly catheterised including:
how to decide who would benefit from catheterisation;
what catheter and drainage equipment to use ;
how to manage the very common problems of catheter
bypassing and blocking.
Nurses were found to have very few guidelines for catheter
management and this resulted in a wide range of management
practices. An analysis of the results showed that use of
wide diametered catheters was associated with increased
catheter bypassing and blocking.
A longitudinal study was then made to look at the
development of catheter related problems over a longer
period of time.
A number of trials were run to study the currently available
catheter and drainage equipment. The results showed that
the catheters tried were inadequate for long-term use in the
elderly and that the drainage equipment was unsatisfactory.
Studies of catheter management were made:
(1)
an investigation of the effectiveness of
bladder washouts
(2)
an investigation into the problems of
catheter bypassing.
The final part of the research involved trials of the new
c a t li e t e r .
66)
It is hoped that this nursing research will have helped
in the development and use of a new catheter and will
result in improved catheter care for the elderly.
Anne Kennedy, Research Associate,
Department of Geriatric Medicine, University of Manchester
(40-minute presentation)
67)
DYNAMICS OF QUALITY IN NURSING : A MODEL FOR EVALUATION
This paper reports findings of the first phase of an ongoing
multiphased project on the Quality of Nursing Care in acute
care facilities in Canada. Phase I focuses on the review
and critique of the quality of care literature and the
elaboration of a model outling relationships between
relevant variables. Findings reveal great variance in
the nature and scope of quality assurance programmes, a
paucity of instruments, inadequate reliability and validity
testing, and limited evaluation of the impact of selected
nursing practices on outcomes. There is further limited
evidence of collaboration between nursing and other health
care professions in monitoring those aspects of care that
are interdependent. Finally, problems unique to published
standards of nursing practice were identified. First, the
validity of the standards of nursing practice are widely
accepted, but evidence to support this validity is
universally lacking. Second, where standards of practice
and quality instruments are both in place in a particular
1 inkage
setting, there is limited if any evidence of a linkage
between the two.
Phase II, a survey incorporating both structured and
unstructured interviews, will identify quality assurance
philosophies, practices, outcomes and costs. Survey
results will be compared with the findings derived from
the review and critique of the literature in Phase I.
Phase III focuses on realiability and validity testing of
instruments used to measure the quality of care. Integral
to this phase is the comparative study of several
dimensions of quality implying process and outcome criteria.
Phase IV assesses efficacy of the components of the model
identified in Phase I.
Impetus for this study arose from recognition that the
responsibility for the provision of quality nursing care
is a professional one as well as from alarming increases
in health care expenditures including those for quality
monitoring. Finally, there are few practices in nursing
today that do not purport to have direct relevance to the
improvement of quality of care. Inability to demonstrate
direct relationships between such practices and care
outcomes has been attributed primarily to the absence of
valid, reliable, and sensitive measures of quality.
Dr. Janet Kerr, Faculty of Nursing,
University of Alberta, Edmonton, Alberta, Canada
(30-minute presentation)
GIVING ADVICE TO PATIENTS WITH CARDIAC INFRACT IN THE
FACE OF REHABILITATION
68)
83 patients admitted acutely with a cardiac infract were
followed during a 9 month period after their discharge
from the hospital.
During the period of hospitalization the patient went
through a structured teaching programme concerning the
cardia infract. What is a cardial infract? Which
precautions are recommended for the rehabilitation: Diet,
motion, smoking etc. The teaching programme consisted of
leaflets, educational films and follow ups by discussions
with physicians and nurses.. After discharge from hospital
the patients received 5 visits by a nurse in their home.
During each visit the nurse interviewed the patients
concerning his/her understanding of the received teaching
in the hospital and the situation after having returned to
his/her home. The interviews were analysed and a scoring
system was established to measure the degree of rehabilitation
throughout the 9 month period.
A major part of the patients were found not to benefit from
the information programme they went through during their
stay in hospital (in average 12 days). During the home
visits there was a need to repeat and follow up on the
given information. A critical period emerged during the
two first visits after the discharge. It was found that a
great part of the patients had consulted their G.P. during
that period. Their use of psychopharmica had increased and
the major part of the readmissions into hospitals took place
in that interval. Findings indicated that a high level of
stress and fear was experienced during the critical period.
The findings showed that the patients suffered from stress
and fear for several months after the discharge. Gradually
the stress and fear decreased and it was found that a visit
by a professional person who could listen and talk about the
problems which the patient experienced was beneficial. In
addition to stress and fear several patients also felt an
overwhelming tiredness during the months after the discharge.
A major part of the patients who had been advised to change
their life style in relation to risk factors such as diet,
smoking and exercise habits did follow recommended changes.
Level of rehabilitation included health status, functional
status, and returning to work were measured. A significant
correlation was found between the low score in rehabilitation
and hypertrophia cordis whereas no significant correlation
was found between rehabilitation score and the degree of
hard physical work, social group, and the patient's
expectations concerning the future.
Hedvig Moller Larsen R.N.,
Esbjerg Hospital, 6700 Esbjerg
(20-minute presentation)
69)
THE USE OF ACTION RESEARCH TO DEVELOP AND EVALUATE A
TRAINING PROGRAMME FOR WARD SISTERS
The ward-based training scheme for ward sisters, established
in 1979 by the King Edward's Hospital Fund for.London for
an experimental period, has been studied in depth by
researchers in the Nursing Education Research Unit,
Chelsea College. The purpose of this study has been two
fold. First, a particular model of training for the role
of ward sister has been tested and modified during the
four years of the experiment. Second, an evaluation of the
effects of the scheme has been undertaken in a series of
smaller evaluations, culminating in a final overall
evaluation. Such a strategy, known as action research,
which combines the elements of developmental consultancy
and evaluative research is valuable in ensuring that
research findings are taken into account and used both
in a relatively immediate way, and in making recommendations
for the future.
The paper will highlight some of the ways in which the
results of the evaluation in the various stages of the
programme were translated into action. It will also
describe how certain fundamental issues were tackled: for
example, the tension that can arise between a consultancy
and an evaluative role; the relationships between the
researchers and clients which can be difficult and change
over time.
It is hoped that the paper will encourage and help others
who are already involved in, or are considering using,
the action research approach. It will also summarise the
main points of the final research report which should be
available in the summer of 1984.
Judith Lathlean, B.Sc (Econ), M.A.,
Project Director/Research Fellow, Nursing Education Research
Unit, Chelsea College, London
(30-minute presentation)
70)
THE ACCOUNTABILITY AND ACTION OF NURSES IN PATIENTS' CARE
IN HOSPITAL
The aim of the research
The aim of this research is to explain the independent
action of nurses in patients' holistic care by studying
what kind of decisions the nurses make to implement
patients' care. In addition, the nurses' participation
in the decision making with other occupational groups is
explained.
Theoretical framework
The theoretical framework of the research is the
preconditions leading to professional accountability
and decision-making process. The professional
accountability requires responsibility, authority and
independence. The independence means freedom to make
decisions which are based on the specific knowledge, skills
and values of nursing and freedom to act according to these
decisions. The decision-making process includes several
stages: 1) analysis of information and choice from
different alternatives 2) decision 3) implementation
4) evaluation.
Research problems
(1)
what is the nurses' role in the different stages
of decision-making process?
(2)
what is the content of the nurses’ decision-making?
(3)
what is the nurses' role in the teaching and
guidance of patients' care?
(4)
what are the decision-making models in the
different areas of patients' care?
Research methods
A nurse identifies and evaluates her decision-making process
in one patient's care by the questionnaire compiled for the
purpose during one day. The evaluation is directed to the
content and those concerned (e.g. nurse physician, auxiliary
nurse) in the decision-making and the different stages of
the decision-making process. The subjects are 100 nurses
and specialised nurses from two central hospitals in Finland.
Results
The research will be implemented in December 1983 and the
results are available in April 1984.
Sirkka Lauri PhD, RN, HV, Associate Professor of Nursing,
University of Kuopio, Finland
(30-minute presentation)
71)
DETERMINATION OF THE TIME SPENT OFF THE WARD BY NURSING
STAFF IN THE KETTERING HEALTH AUTHORITY
Nursing Staff seem to spend a great deal of time off the
1
go ? Does the
ward on various tasks ! Where do they
-.e is spent on errands
errand need a nurse ? How much time
off the ward ?
Proving this statement and answering these questions is
the essence of the project undertaken by 3 Sisters at
Kettering General Hospital. In order to answer these
questions posed above, five areas of investigation have
been carried out:(1)
a search of existing research documents for a
similar study
(2)
information was gathered from other hospitals,
both in and outside the Region, to determine the
severity of the problem elsewhere, to establish
their level of support services and use of
ancillary staff
(3)
a month’s Data Collection was organised in the
Acute Kettering General Hospital and Maternity
Hospital to capture the exact amount of time
spent off the ward (excluding meal breaks) by
Nursing Staff.
(4)
collation of existing data in the Kettering
Health Authority to:-
(5)
a)
look for any changed employment patterns
within Portering and Ancillary Staff;
b)
examination of number of staff on duty
during the data collection;
c)
analysis of Hospital Activity Data for
the same period.
Help was sought from the Oxford Region Computer
Unit and Statistics personnel.
A computer
programme was written to enable the Project
Sisters to both key in their data and analyse
it, on a micro computer, based in the Nursing
Administration Department at Kettering.
In January 1984 the full Report of this research will be
available. This Project should be welcomed as a tool by
Nurse Managers who are currently being pressed by the
Government, et al, to scrutinise their work,loads, shift
patterns and performance indicators.
The Sisters involved in this Project are:- 1
72)
Sister L.M. Goddard
Sister J.E. Strangward
Sister P.M. Knight
NOTE Experts involved in this project are Martin Hall,
Micro Programme, Oxford Regional Computer Unit, and
Mrs. Sheila Rogers, Oxford Regional Statistical Department.
S. Leavesley, Senior Nurse, Planning/Research ,
Kettering Health Authority, General Hospital, Rothwell Road,
Kettering•
(20-minute presentation)
73)
NURSING EDUCATION AND STUDENT REACTIONS: AN EMPIRICAL
STUDY OF ATTITUDES IN BASIC NURSING EDUCATION
_
This investigation was undertaken to study the development
of. student nurses' attitudes regarding their educational
experiences, with the purpose of finding empirical evidence
of change.
Based on a study carried out in 1974/5 in four basic
schools of nursing, the present study had three main
purposes:
(1)
to retest an attitude scale developed for and
used in a former study (1974/75)
(2)
to extend the former study to include the
third and last year of education, and
(3)
to compare results from a cross-sectional
study of attitudes (1974/75) with a
longitudinal approach.
Methods
To test several, hypotheses an attitude scale was constructed,
pre-tested and administered to students in four schools of
nursing in 1974 (N=449). In the present study the same
instrument was used with minor revisions. A random sample
of four was drawn out of a total number of 30 schools,
including all students starting in January 1977 (N=117).
Data were collected after the first six months, next after
another twelve months and for the third time after another
twelve months. Total number of respondents: N=313. F-tests
were used to test hypotheses. Level of significance
chosen was 0.11.
Results
The internal consistency of the scale was tested by
Cronbach's Alpha, showing r=91 (for the main scale),
compared to r=89 in 1974/75.
The tests of hypotheses confirmed the results from the
previous study, demonstrating a significant decline in
favourable attitudes as the students moved from their first,
through their second and to their third year of training.
The trend of the present study was mainly identical with
the former one, indicating that a cross-sectional and a
longitudinal approach produced similar results.
Conclusion
These studies give empirical evidence to demonstrate that
basic nursing students have more favourable attitudes to
74)
their educational experiences in the early phases of
their education than in later phases.
It has been confirmed that there are significant differences
between schools. Students with less positive attitudes
have more frequent absences from classroom Studies as well
as from clinical practice. . Students feel satisfaction with
their direct patient contacts. And there is a significant
relation between attitudes to education and motivation to
practice as nurses after graduation.
Kjellaug Lerheim, RN, Cand.paed.
Dean, Norwegian School of Advanced Education In Nursing,
Oslo, 2, Norway
(30-minute presentation)
75)
STUDIES ON COMMUNICATION AND COLLABORATION BETWEEN HEALTH
PROFESSIONALS; PHYSICIANS AND NURSES; TEAMWORK
The objectives of the study were defined as describing
patterns of professional interaction, mainly of nurses,
physicians and social workers in their organizational
context with a view to:-
(a)
identifying the factors that promote or impede
the effectiveness of teams and groups in health
care delivery
(b)
developing a methodology for evaluating the
effectiveness of teams and groups in health
care delivery
(c)
planning educational programmes designed to
promote team or group effectiveness and
(d)
identifying areas requiring research.
Eight primary health care centers which practised the
team work concept in 5 different European countries were
selected for at study visit of a 2 day-duration each.
A topic guide with subtopic was developed as a framework
for discussions during the visits to the primary health
care teams.
The following areas concerning each teamwork group were
investigated:
A.
B.
C.
D.
E.
F.
Background information
Resource provision and accountability
The environment of the team
The internal organization of the team
Education for teamwork
Geneial appraisal of the team experience.
Because of the exploratory nature of the study and the
differences of basic structure in which the teams function,
it was difficult to draw general conclusions that would
apply in all cases, but three factors of particular
significance became apparent.
These are the problems of:-
(2)
the individual team member's professional
status and
(3)
the relationship of the team to the management
structure of the larger health care system.
- refers to role conflicts due to the way
Dual 1loyalty
z
people are employed and the requirements of their
76)
occupational position; it may be of particular significance
in changing traditional roles and responsibilities.
The professional’s position in society - is subject to
influences which include legal status, educational
background and, more loosely, a view of the nature and
Scope of a particular profession. These will have an
effect on the capacity of individuals to contribute to team
development.
The relationship to the management structure of the health
care system - involves consideration of the constitutional
position of the team within the structure and its
accountability to the system and to the community. Issues
here are the teams’ ability to determine its priorities
and to negotiate for resources, its need for support of
various kinds and its capacity to feed information back
into the system and thus influence policy.
It was concluded that with the changing of health care
provision in order to meet the consumer’s health need, the
professions’ social role is changing, and while teamwork
may be an expression of this change, it is also likely that
the team itself contribute to change. These changes have
implications to the individuals’ legal and administrative
status as well as to their education to a more flexible
adaptive approach to professional practice.
If the team model is to become the organization of
services in the community, it is necessary further to
examine it in terms of wider policy of what the team is
expected to be or to become. Essentially the teamwork
concept must be tested as a means of providing health
care in the context of modern patterns of demography and
morbidity, e.g. in the care of the elderly and the
management of chronic illness.
Margarethe Lorensen, C.F. Richsvej 71,
2000 Copenhagen F, Denmark
(20-minute presentation)
THE RESPONSE OF NURSES’ TOWARDS THE MANAGEMENT AND
77)
TEACHING OF PATIENTS ON CONTINUOUS AMBULATORY PERITONEAL
The aim of this paper is to describe the response of nurses'
towards the management and teaching of patients on
Continuous Ambulatory Peritoneal Dialysis (C.A.P.D.).
The date on which this paper is based were collected by
means of participant observation over a period of nine
months, on one male and one female medical ward.
Supplementary data were collected at the out-patient clinic
and by means of informal conversational-style interviews in
patients' own homes. In keeping with the inductive method
advocated by Glaser and Strauss (1967), this approach
allows for analytic categories to emerge from the data.
These are subsequently followed up in order to guide further
data collection. In this sense some themes which emerged
from the analysis of the participant observation data have
been tested out in the informal interviews.
Garfinkel (1956) talks of taken for granted or common
sense expectations and in this context we were interested in
finding out what the taken for granted expectations were,
with regard to C.A.P.D. patients.
When analysing the data it soon became apparent that
nurses tended to label patients quite early on in their
C.A.P.D. career as either 'good' or 'bad'. It is contended
that the attitudes which nurses hold about a particular
form of treatment may positively or otherwise affect the
patient's response. Similarly it is argued that nurses'
perceptions of patients as either 'good' or 'bad' may also
influence the outcome of treatment.
In conclusion it was observed that nurses had difficulties
in assimilating C.A.P.D. patients into the 'normal ward
routine’ and consequently the case is made for a specialist
nurse to undertake the teaching and management of these
patients.
Karen A. Luker, PhD., R. Nurs., Lecturer in Nursing,
Department of Nursing, University of Manchester, Manchester
Denise Box BA(Hons), S.R.N., DIP.T.D., Research Assistant,
Department of Nursing, University of Manchester, Manchester
(30-minute presentation)
78)
EVALUATION OF THREE CORD-CARE PROCEDURES ON NORMAL NEWBORNS
The purpose of this randomized controlled study is to compare
the quality of three standardized umbilical cord-care
procedures.
The research will be performed on 240 babies classified in
four groups:
the first group receives a single application
of hibitane
the second receives an application of
isopropanol and eosin
the third receives an application of
isopropanol and sicombyl
the last one is a control group with no
treatment.
Some babies are excluded for the following reasons:
(1)
(2)
(3)
the mother received antimicrobial agents during
the last trimester of pregnancy
all caesarean sections
infants developing complications during labour
and/or delivery or during the period of
hospitalization (including treatment with
antimicrobial agents).
The procedures are assessed by process and outcome criteria
class as follows:
the clinical aspect of the umbilical cord scar
is the first outcome criterium:
the aspect of the surrounding ubilical skin
the aspect of the umbilical cord
the aspect of the navel during five days
the date of separation of the umbilical cord
umbilical wound infection is the second outcome
criterium
the process criteria concern the cord-care:
standardized care steps
care frequency
care duration
receptivity of the educational message
facility of care by the mothers
material cost
conservation of the antiseptics used.
the data are collected in four ways:
(1)
by a daily observation of the babies by the nurses
and the pediatrician during the hospitalization,
and one follow-up observation by the pediatrician
at the outpatient department
79)
(2)
(3)
(4)
a questionnaire on the cord-care procedure used is
filled in by the mother on the fifth hospitalization
day
bacterial cultures of the nose and umbilical areas
are obtained from the infants studied on days 0, 1
and 5 of life, using damp cotton-tipped swabs
examination of the patient’s record.
This prospective study is realised at Erasme Hospital,
Brussels, from October to December 1983.
From the results of this study we hope to discover the most
effective cord-care procedure.
Anne Maas, Infirmiere graduie hospitaliere accoucheuse,
Dejpj*_rtme
s_>_ JlU1_s_,n_P_ J
(30-minute presentation)
HISTORY OF NURSING: HOW RELEVANT?
80)
The relationship between the historical method and the
development of a critical approach to nursing in its
widest sense has long been acknowledged by those used
to a degree system of nurse training. For some of these,
an awareness of past research was equated with the
’history’ of nursing; for others, it was the discussion
about ethics which made up this area of knowledge. For
a relative few, more important historiographical questions
needed to be asked.
The need for historical studies in general to address
contemporary issues has also received attention in Britain
following the radical reorganisation of one of the
principal funding agencies, the Social Sciences Research
Council. That exercise was, in turn, stimulated by
developments within the doctoral programmes in history
in the United States of America.
The current state of knowledge of nursing’s past, despite
a growing body of literature, remains low. Few
researchers address theoretically-significant issues and
much of the reported results appears stuck in outmoded
styles of political history.
There is an urgent need to define the areas of inquiry
which those historians interested in nursing ought to
address, including concepts of health and ill-health, and
ideological constructs such as femininity and caring.
There is also a need, just as urgent, to show practitioners
and nurse-educators the results of research in history and
the value to them of the historical method as an
operational tool.
Dr. Christopher Maggs, PhD, SRN., RMH., RCNT,
University of Bath, Ji n g1 a n d _
(30-minute presentation)
81)
THE CLINICAL TEACHER - A SECOND CLASS CITIZEN IN NURSING?
This paper considers the role and status of the clinical
teacher in England within the context of policy for the
education of nurses. The relationship between nursing
education and nursing service, i.e. the school of nursing
and clinical nursing in acute medical and surgical wards,
and the position of the clinical teacher within this
relationship was examined within the sociological
framework of professional and bureaucratic modes of
occupational organisation. The status of nursing as a
semi-profession is briefly examined.
The research adopted a social interaction theoretical
stance, appropriate for the examination of the process of
nurse education and the exploration of colleague
relationships. A comparative case study design in two
Hospital groups/Nurse Training Schools was used and the
data were collected through the use of 'focused' interviews.
Clinical Teachers, Tutors, Ward Sisters and Student Nurses
described their own occupational roles, their perceptions
of each others' roles, and their experiences of nurse
education in the Training School/Hospitals . The analysis
of qualitative data will be commented on.
The results of the study indicate that many clinical
teachers hold strong feelings that their role is not fully
appreciated by tutors and ward sisters whilst they seem
to have little impact upon student nurses. The
implications of the results for nurse education policy will
be considered and the wider issue of career paths in
nursing will be raised.
Lyn Martin, S.R.N., S.C.M., B.A., M.Sc., Cert.Ed.,
Senior Lecturer in Nursing Studies, University of
Sou thamp ton
(30-minute presentation)
THE ADMINISTRATION OF INFUSIONS AND GASTRIC TUBES TO
DYING SENILE DEMENTED PATIENTS. INTERVIEWS REGARDING
PRACTICE AT LONG-STAY WARDS
82)
Introduction
Many senile demented patients in the terminal stage of
life became impossible to nutriate by assisted spoon-feeding.
Then there has to be taken a decision of whether the
patient should be given fluids by a tube or by infusions
or whether he should be allocated to die without any other
fluids than what can be given by mouth-moistening, The
aim of this study was to describe the practice of
administering fluids and gastric tube to dying senile
demented patients.
Material and methods
Interviews were performed with the ward sister and an
experienced practical nurse (or mental nurse) at 30 wards
in the South Health Care Region of Sweden. The wards were
selected through a stratified random sampling technique.
The ward sister and the practical nurse (mental nurse) were
interviewed together. The interviews were tape recorded
and later typewritten.
Results
The interviewees from 25 wards said that they occasionally
gave intraveneous infusions to dying senile demented
patients. In 12 of these wards intraveneous infusions were
preferred to subcutaneous ones.
The interviewees from 20 wards said that they occasionally
gave subcutaneous infusions. In 9 of these wards,
subcutaneous infusions were preferred to intraveneous
infusions. In 4 wards intraveneous infusions were used
as often as subcutaneous ones.
At 17 out of the 25 wards where infusions were given some
patients were allowed to die without any infusions, often
on the request of relatives. No infusions at all were
given to dying patients with senile dementia in five out
of 30 wards. In one of these wards a gastric tube was
given occasionally but seldom.
The reasons for giving intravenous infusions were :
the prognosis was dubious
the patient might feel thirsty
the urinary catheter could be blocked, if not
rinsed by a urine volume of sufficient size
relatives wished infusions to be given
subcutaneous infusions could not be given, e.g.
due to patient being too cachectic
83)
intraveneous infusions were thought to be less
painful to the patient than subcutaneous
infusions
the reasons for giving subcutaneous infusions were:
the prognosis was known
the patient might feel thirsty
relatives wished infusions to be given
intraveneous infusions could not be given, e.g.
due to brittle veins, or lack of registered nurses
danger of pulmonary oedema when intraveous infusions
were given
the need of parenteral fluid was limited, since the
patient could take some fluid by mouth.
the reasons for not giving any infusions were:
infusions prolonged the meaningless suffering
of the patient
relatives wished infusions not to be given
the patient had previously expressed a wish to
be allowed to die without infusions
infusions produced respiratory distress in the
dying patient.
Conclus ions
There are varied practices of administration of fluids and
gastric tubes to dying senile demented patients. The
different practices are not based on scientific knowledge.
The need of research is great.
E. MichaKlsson, RNT, Varnhem’s Hospital, S-212 16 Malmo
A. Norberg, RN, PhD, Department of Advanced Nursing,
Umea University, S-901 87 Umea,
B. Norberg, MD, PhD, Department of Internal Medicine,
University Hospital, S-901 85 Umea, Sweden
(20-minute presentation)
84)
THE ELDERLY, FOOD BEHAVIOUR
This study examined food behaviour of people of age
65-74. Actual food behaviour of the study group was
compared'with an ideal model constructed for this study.
The ideal model contained following categories of food
behaviour *'bad”, ’’satisfactory", "good", and "excellent".
Also differences between women and men and various areas
were examined. The data were collected from three
communes of the Kuopio county and from three communes of
the North Karelia county, both counties are located in
Eastern Finland. From each six communes 40 women and
40 men of 65-74 age were sampled. The original sample
size was 480, the absence being 25 percent. Thus the
data comprised 385 men and women.
The data were collected by health investigations made by
a public health nurse and by a mail questionnaire.
Food behaviour of the study group was better than
expected in many areas. Quality of fat used for preparing
food, use of vegetables, berries and fruits were
satisfactory. Most men and women in both counties
belonged to the category good of the ideal model on the
basis of the use of milk and sour milk, amount of fat on
sandwiches and visible fat of meat. Over half of the
men in the Kuopio county did never or seldom eat visible
fat of meat, whereas 26 percent of men in the North Karelia
county ate always visible fat of meat. Two-thirds of
women in the North Karelia county but two-thirds of both
men and women in the Kuopio county belonged to the
category excellent in the ideal model on the basis of the
use of fat in daily meals (30 g/day), whereas one-third
of men in North Karelia belonged to the ideal model
category bad (over 60 g/day). Men in the North Karelia
county got considerably more fat in different food stuffs
then men in the Kuopio county. Use of salt and sugar
was minor in the sample. The whole study population used
vegetables, berries and fruits very little. Food
behaviour of the examined group is fairly good if compared
with the ideal model evaluated at population level. The
study indicates a need for health instruction among the
population studied. Also the need for further research
is needed to solve different problems of food behaviour
among the single elderly people.
Mikkanen, Pirkko and Partanen, Tuula,
M.N., Researcher, University of Kuopio, P.O.B. 6, 70211,
i°
Finland______________________ __ ______
(30-minute presentation)
NURSING MANAGEMENT OF PASSIVE ABDOMINAL WOUND DRAINS
8 5)
Whilst surgeons continue to debate which type of wound
drain, if any, should be used following various operations,
the management of such drains continues to be primarily
a nursing concern. Problems associated with the
management of passive wound drains (eg corrugated, Yeates
tissue drains, Penrose drains) have long been recognised.
The use of plastic drainage bags, which adhere to the
patient’s skin around passive abdominal wound drains, arose
as an attempt to solve the problem of bulky, wet absorbent
dressings which needed frequent changing and were a
potential infection hazard to the patient.
This paper discusses the results of a preliminary
investigation into the use of plastic drainable bags over
passive abdominal wound drains in post-operative patients.
In many cases these proved to be far from ideal, not only
because of their specification, but also due to inappropriate
usage.
The range of products available for use in the management
of passive wound drains is accompanied by an equally
impressive price range. Portex Ltd., sold approximately
60,000 corrugated wound drains and 40,000 Yeates tissue
drains in 1982. Bearing these facts in mind it is apparent
that nursing research has a potentially valuable contribution
to make in helping to highlight and solve the problems
which arise during the nursing care of such drains.
Mrs. R.A. Molyneux BSc (Hons) SRN,
Lecturer, Liverpool University Nursing JStu dies Jhi it_
(20-minute presentation)
86)
FORCE-FEEDING OF PATIENTS AT NURSING HOMES
Introduction
In nursing homes in the County of Vasterbotten, Sweden,
the most common diagnoses among the patients who are
spoon-fed are senile dementia, cerebrovascular disease
and Parkinsomism. These patients may exhibit refuse
like eating behaviour like keeping their mouth shut,
spitting, not swallowing. When this refuse-like
behaviour is persistent the nurses are facing a conflict.
Should the patient be left to starve, should he be
fed by tube-feeding or should some kind of force-feeding
be tried? The aim of this study was to elucidate how
nurses feel about some specific feeding technique that
could be used for force-feeding.
Method
One hundred and ninety-one nurses' aids and practical
nurses at 23 nursing homes in the County of Vasterbotten,
Sweden, (99$ of a stratified and randomized sample) were
interviewed through structured interviews. The
interviews were tape recorded and later transcribed. The
interviewees were 19-63 years old (me=36, Q^-Q,=25-48) and
they had worked in care from 1 to 37 years 1(me=7, Q1-(K=4-14
years).
A preliminary analysis of the data was discussed with
personnel (414) at 22 nursing homes in order to attain a
deeper understanding of the data.
ResuIts
Fifty per cent of the interviewees defined force-feeding
as ’’all feeding against the patient's will". Thus even
persuadation was defined as force. Fourty-seven per cent
thought that force-feeding was only "violent feeding".
Thus if you open the patient's mouth with a spoon in a
friendly and careful manner it is not force-feeding.
If
you do it unfriendly, ruthless and brutal, then it becomes
force-feeding.
The interviewees were asked: How far could you imagine
yourself going with force? and special kinds of feeding
techniques were mentioned:
hold the patient (32%)
coax or force the patient’s mouth open with a spoon
(67’0)
open up the patient’s mouth by squeezing his cheeks
(181)
open up the patient's mouth by compressing his
nostrils (18%)
elicit the patient's swallowing reflex by
introducing the spoon deep down into the throat
(26%).
87)
It was evident from the comments that it is very hard for
caregivers to know when a specific feeding technique
should be defined as force-feeding and when it should be
seen as help to the patient. This difficulty was
especially evident in relation to senile demented patients
who may exhibit very ambiguous eating behaviours. Several
of the behaviours described by the interviewees might be
due to symptons of agnosia and apraxia and easily released
oral reflexes. However the interviewees seemed to have
no knowledge of these symptons and their relevance for
the patients' eating behaviours.
Conclusion
Caregivers at nursing homes sometimes feel they have to
use feeding techniques they feel could be defined as force.
They feel this is wrong but there is no alternative. Part
of this conflict experienced seem to be due to their lack
of knowledge of how to interpret the patients' eating
behaviours.
A. Norberg RN, PhD; A. Backstrom, radiograph,
Department of Advanced Nursing, Umea University,
S-901 87 Umea, Sweden
,
(20-minute presentation)
TEACHING AND LEARNING IN NURSING PRACTICE - A STUDY
OF STRUCTURE, CONTENT AND ROLES IN CLINICAL TEACHING
88)
In later years there has been expressed concern about
problems related to clinical learning experiences of
nursing students. This study surveyed existing ways of
structuring clinical teaching, and contractual systems
between schools of nursing and their associated clinical
fields.
The sample consisted of 28 schools of nursing and 220
units in the clinical area covering acute care, long-time
care and community care. Data were gathered through a
questionnaire.
Findings
Most schools (26) had established formal arrangements with
nurses as coresponsible in the clinical teaching.
Preceptorship, each student having a specific nurse-contact
on the unit, was the arrangement most often in use (4 7%) .
Twenty-two percent of the units reported that one nurse was
responsible for all student-instruction on the unit.
Nurses, teachers and students do all participate in the
planning, implementation and evaluation of clinical
learning experiences. The teachers, however, were those
with the major responsibility, specifically of the
planning. The selection of the learning situations were
most often based on "the students learning needs", and
"the types of patients on the unit". The latter
representing a factor not easily controlled.
Both the schools and the practice settings strived for
solutions to ascertain continuity, assigning students to
patients rather than to tasks and procedures. Proficiency
in technical procedures was focused by the nurses, more
frequent in the acute care setting than in other areas
however.
The collaboration between schools and practice settings was
said to be "fair", only two schools judged it to be "very
good" and none saw it as "poor". All schools had formal
meetings focusing on collaboration where teachers, students
and nurses participated.
The nurses were positive to having students on their units.
The responsibility of participating in student-instruction
was, however, said to take too much time. The nurses also
felt that their contact with the teachers on the unit was
too infrequent. There was a tendency of dissatisfaction
89)
with the present way of structuring clinical teaching.
The majority of the nurses, however, felt that the
students were inspiring and enhanced the professional
milieu on the unit.
None of the schools had established permanent courses
in continuing education for the nurses coresponsible for
student instruction and supervision. There were, 1.^
however,
formal meetings where the programme, objectives etc., were
discussed. The majority of the schools had arranged
conferences and seminars on nursing and learning theory.
The nurses expressed their need for more knowledge about
clinical instruction, student evaluation and theories
of learning. These topics were covered at some time by
the school at the above mentioned conferences and
seminars.
The schools were asked what they judged to be the most
important factor to facilitate student learning.
Professional and ethical values held in common, as
reflected by aims and objectives of the school and the
clinical area were the factors most listed, Other
important factors mentioned were the continous supervision
and evaluation of the students, qualified nurses interested
in teaching, and extensive collaboration between the school
and the practice setting.
Conclusion
The schools' and the practice areas'
areas’ assessment of
important aspects of clinical teaching were in agreement.
This -was especially true with regard to some practical
TU4„
arrangements like the students shifts, the shared
---teaching responsibility and the schools' offering of
continuing education to the nurses. The nurses wished a
more frequent contact with the teachers in the clinical
field. They also felt the need for more knowledge about
the students' preparedness and their learning objectives.
The school and the practice setting have both vested
interest in furthering clinical teaching and learning.
Their agreement on core issues addressed in this study is
a solid foundation for future collaboration and problem
solving .
Randi Nord, RN, MA., Lecturer at the Norwegian School of
Advanced Education in Nursing, Oslo, Norway
May Solveig Fagermoen, RN, MA., Lecturer in Advanced
Nursing Education, University of Troms0, Troms0, Norway
(20-minute presentation)
90)
THE PLACE OF THE TRADITIONAL MIDWIFE OR TRADITIONAL BIRTH
ATTENDANT IN CONTEMPORARY MIDWIFERY PRACTICE IN EASTERN
NIGERIA
This paper sets to review the role of the TBA in Midwifery
practice from a Primary Health Care perspective.
Traditional practices are still very widely employed in
Nigeria as in most developing countries where health
facilities are still beyond the reach of the majority of
the population.
Traditional birth attendants form the core of primary
health care workers in maternal and child care in rural
communities. In some very romote rural areas they are
responsible for over 801 of normal births.
This paper is based on studies carried out on three rural
communities in two Eastern States, one community is in the
Cross Rivers State where there is an ongoing training
programme for TBAs and the other two communities are in
Imo State, where there is no training programme.
Of particular interest is the position of the TBA in the
health team, the degree of her acceptance or non-acceptance
by the orthodox midwife, on partnership basis.
From a comparative study of the findings the hypothesis
is that with training the TBA can be effectively
integrated into the rural health team with positive results,
and the benefits resulting from the programme would be
realised by both the pregnant mother and the community and
would be evidenced by:
(a)
(b)
improved maternal and neonatal care
less maternal and neonatal deaths
Mrs. Nnenna Grace ..
••
-Deputy
-—
- - -•Nursing Officer,
Nzeribe,
Chief
(Education and Research), Ministry of Health,
Nursing Services Division, •Njjg^ria,
i* ' *
(20-minute presentation)
91)
HEALTH VISITING AND CHILDREN'S HEALTH NEEDS - THE
PARENTS’ VIEW
This paper presents the results of an exploratory study
which set out to examine parents' perceptions of child
health services, in particular health visiting, in the
context of children's health needs. The parents of
sixteen children aged between 12 and 15 months were
interviewed. Analysis of transcripts followed the
methods of Glaser and Strauss (1967) used in the
generation of grounded theory. The overall themes which
have emerged are described; 1) Concepts of health and
illness, related anxieties and parents' need for
reassurance. 2) The role of health visitors as
perceived by parents, in particular the dichotomy between
the adviser and the policing agent. 3) The factors which
influence the parents' choice of health adviser.
The implications of the study are discussed. They are
first for practice: in improving levels of communication
and reassurance, in informing parents about the possible
roles of the health visitor, in training health visitors
to be aware of the importance of their approach and in
enabling professionals and parents to share experience
and expertise : Second, for further research to enable
the in depth exploration of some themes which may also be
relevant to the development of health visiting practice,
and in other areas of the child health services: Third,
a commitment to provide feedback to all participants,
as considerable interest has been shown by parents in
the results of the study.
(Methods used are described).
Reference
Glaser B and Strauss A.L. (1967) 'The Discovery of Grounded
Theory: Strategies for Qualitative Research', Aldine,
Chicago.
Pauline Pearson, B.A. SRN, H.V. Cert.
NewcastleL-upon-T^ne
(20-minute presentation)
92)
EVALUATING THE LEARNING SKILLS OF INNUMERATE LEARNERS
This paper will discuss a recent project entitled
"Deficiencies in basic mathematical skills among nurses
- development and evaluation of methods of detection and
treatment". The basis for the research lay in the
widely held view that many nurses have severe difficulties
in some mathematical areas essential to their work. There
has been very little work done in this field and the aim
was, therefore, to define these problem areas and then go
on to investigate ways of remedying the nurses’
mathematical deficiences. The project had 3 stages.
The first was to produce a taxonomy of nursing mathematics
together with the necessary mastery levels. The second
involved testing nurses and learners for deficiencies in
mathematical skills and thus identifying the common
problem areas. Nurses’ and learners’ awareness of their
own numeracy was also considered as this might affect
reactions to any learning needed. The final stage was to
investigate possible means of proffering help. Anxieties
and attitudes to mathematics among nurse tutors as well as
learners were likely to affect the efficiency of any
remediation suggested and so research methods were governed
by the overriding consideration that any recommentation
made would have to be easily assimilated into the
existing nurse-training structure. Little would be gained
by promulgating results which could not or would not be
applied to the benefit of learners insufficiently numerate
to become safe, effective nurses.
Dr. S.E.B. Pirie, Oxford
(20-minute presentation)
THE NURSING CARE ASSESSMENT MODEL
93)
In an attempt to explore the theme NURSING RESEARCH - DOES
IT MAKE A DIFFERENCE, this paper demonstrates how a
patient profile assessment model has been developed from
the author's research. How this has been applied and
now constitutes part of the planned process of nursing
the elderly.
In Britain a growing percentage of the population are
elderly and the proportion of the very old are rising
(OPCS 81). There is sufficient evidence to suggest that
as age increases, so does the requirement for health care.
Care of the elderly thus constitutes an important aspect
of health and social services and encompasses a wide range
of correlated activities. The main purpose of care is to
enhance the quality of life and wherever possible restore
the maximum level of independence.
The measurement of qualitative assessment of the effects
of nursing care is still in its infancy. The assessment
model is based on the author’s research study (Poulton 81)
using Donabedian’s (1966) Structure Process Outcome Model,
Henderson’s Nature of Nursing (1966) and McFarlane’s
Carter of Care (1976).
The purpose of the research on which this model rests was
to ascertain how primary nursing care is perceived by both
the elderly infirm living in the community and their
district nurses. How the perceptions of needs for care
were translated into action and the sort of expectations
they had and results they achieved. The research also
examined whether or not differences in nursing care
patterns occurred between those nurses working within a
primary health care team and those aligned to a number of
single-handed general practices. The main research
These
instrument was in the form of interview schedules,
contained structured and open ended questions as well as
Likert assessment scales, and were administered by the
researcher to patients, nurses and general practitioners
at various stages of care.
Over a period of 18 months a total of two hundred patients
and their district nurses and general practitioners from
one health district participated. The results were
analysed with the help of a computerised statistical
package for social science.
The findings indicate that district nurses’ perception of
patient needs is illness focused and, as such, prescribe
and give nursing care on the basis of the medical model.
94)
The patients' perceive their state of health mainly
in terms of discomfort and disability and their effects.
As their problems manifest themselves to a great extent
in multiple health as well as social issues as a legacy
of past life events, a shift from the medical towards
the social model of care seems, therefore, of prime
importance.
This paper discusses the assessment model which was
developed in an attempt to bring the patients' needs
into focus, and to allow the nurses to assess these
needs realistically.
It will also discuss the difficulties experienced with
relating process of nursing to the health status outcome
of the patients, and also how the experience has
contributed to the development and implementation of
the care model operational in the district.
REFERENCES:
A. Donabedian (1966) - Evaluating the Quality of Care,
Milbank Memorial Fund Quarterly, p.167-206, USA.
V. Henderson (1966) - The Nature of Nursing, MacMillan,
London.
J. McFarlane (1976) - A Charter of Caring, Advanced Nursing
Journa1, 1.3.
Office of Population Census Statistics (1981) - HMSO, London.
K.R. Poulton (1981) - Perceptions of Wants and Needs by
Nurses and their Patients.
(Unpublished Ph.D. Thesis,
University of Surrey).
Karin Poulton, Nurse Adviser, Research and Planning,
St. George's Hospital^ London
(30-minute presentation)
95)
THE EFFECTS OF TOUCH ON PATIENTS’ PHYSICAL AND PSYCHOLOGICAL
WELLBEING : A FEASIBILITY STUDY TO DEVELOP METHODS
Backgrqund to the study
It is assumed that touch between nurses and patients is a
necessary part of skilled nursing care and an essential
element of comforting behaviour, but it is given little
explicit attention in nurse training and has received
scant systematic evaluation in this country. It is
thought that nurses use little "expressive" or affectionate
touch with patients compared with "instrumental" touch,
that is, touch which is a necessary part of a nursing
procedure.
The available literature confirms the human being's basic
need for touch, and although individuals do vary, deprivation
of expressive touch seems to be relatively common
particularly for the old, the dependent and the impaired.
• ’ is
' necessary
--- ; therefore.
--- r
, in order to describe the
A study
nature and frequency of nurse-patient touch and to evaluate
the effects of touch on patient recovery and wellbeing.
In preparation for a study of this kind it was important
to develop and test the feasibility of some of the methods.
This was the purpose of the feasibility study which had the
following specific aims:
CD
(2)
to develop and assess the feasibility of:
a)
a suitable observation schedule for recording
nurses’ touch behaviour, and
b)
a record sheet to document independent
variables relevant to the touch interaction,
such as age, sex, marital status, ethnic
group and patient's condition
to assess the appropriateness and replicability
of certain rating scales as outcome measures
with elderly patients in hospital.
Mothods
Design of the obseryationi schedule
Draft observation schedules were developed which included
components relevant to nurse-patient touch, such as body
area touched, duration of touch episode and total
interaction, position of patient and nurse, type of touch,
and other types of communication. The draft schedules
were developed and tested using video tapes and the final
schedule.was also tested during observations of nurses and
patients on one geriatric ward.
Outcome measures
96)
These were selected to assess patient dependency, moods
and wellbeing, and they included the CAPE Behaviour Rating
Scale (Pattie & Gilleard, 1979), the Mood Adjective
Checklist (Lischmann, 1972), the Bradburn Affect Balance
Scale (Bradburn, 1969), and an author designed wellbeing
scale.
Samples
(i)
all the patients (13) in one acute geriatric
ward who could understand and consented to
take part
(ii)
all the staff nurses and student nurses on the
ward (11) who agreed to take part.
Results
The analysis focussed on assessing the observation
schedule for inter-observer agreement and reliability, and
on the appropriateness of the outcome measures for use
with elderly patients. The findings will be discussed in
some detail, and the plan for a future major study will be
outlined.
AsAn.?.* 1®.48-e.?ie nt
This feasibility study was made possible by the generosity
of the Nuffield Foundation who funded the project and
enabled us to employ a research assistant.
Sally Redfern, Lynn Porter, Andree Le May,
Department of Nursing Studies, Chelsea College,
552 Kings Road, London SW1O OIJA
(30-minute presentation)
97)
NURSING RESEARCH
NEED IT BE ANY USE?
In the past, the work of many scientists has been
criticised because it appeared to have no practical
application whatsoever. The present paper attempts to
demonstrate how techniques and concepts developed by
individual scientists (working on apparently "useless”
projects) have combined to produce advances of immense
importance.
Examples from the field of biochemistry are used to show
that research which was apparently far removed from
human physiology has produced our present understanding
of molecular genetics - a subject of fundamental importance
in modern medicine.
Parallels are drawn between the state of scientific research
70 years ago and the condition of nursing research today.
It is concluded that nursing research can catalyse change
and development if the conditions for its dissemination are
improved and if research and research appreciation are seen
as an integral part of nursing practice.
In conclusion, examples are given of the effects of smallscale research projects carried out by post registration
students at Sheffield City Polytechnic, on health care
practice within their speciality. It is suggested that the
combination of theoretical research with applied projects
like these will result in progress such as that which took
place within the natural sciences.
Dr. V. Reed, Research Co-ordinator
Dr. P. Lyne - Lecturer Health Studies
She ffie1d City Poly technic, She f f ieId
(20-minute presentation)
98)
DO GENERAL PRACTITIONERS AND DISTRICT NORSES KNOW WHAT
DRUGS THEIR PATIENTS ARE TAKING?
This paper analyses how far there is agreement between
general practitioners, district nurses and the patients
themselves over prescribed medication for an elderly
group of patients receiving domiciliary nursing care.
The results reported in this paper form part of a study
in which an individual medication guide was distributed
to elderly dependent patients at home.
The paper sets out to identify and examine in detail
the areas of disagreement between the doctors and
nurses and between the professionals and the patient.
In particular there will be discussion of the number of
drugs reported by the doctor or nurse only, drugs
reported by doctor and nurse that were unknown to the
patient and drugs reported by the patient that were
unknown to the doctor and nurse. The implications of
the findings will be discussed in the context of first,
the district nurse’s role in the supervision of drugs,
second, the development of a patient's personal drug
guide, third, communication in the primary care team and
finally the delivery of informed and co-ordinated primary
health care.
Fiona M. Ross, BSc, SRN, NDN Cert.,
Lecturer in Community Nursing, Department of Nursing
Studies, Chelsea College, London
(20-minute presentation)
99)
WHY DOES GRANNY KNOW BEST?
This paper sets out to describe the methods employed in
a study concerned with parentcraft class uptake and
women's perceptions of information sources available
to them during pregnancy. The study involved three
phases of data collection.
In the first phase, a sample of 150 post-natal women,
in the maternity wards of two district general hospitals,
were surveyed by means of a recording schedule. This
measured parentcraft class attendance and uptake of
ante-natal care in relation to age, parity and socio
economic factors.
In the second phase, a pilot study identified five
types of information required by women during pregnancy
and 15 sources of information used by them at this time.
A sample of 40 women, drawn from the original sample,
was interviewed twice at home. At the first interview,
the respondents rated the quality, quantity' and
effectiveness of timing of the information received
during pregnancy. They also completed Kelly's
Situational Resources Grid, as described by Fransella
and Bannister, (1977), by ranking sources of information
according to types of information sought* Subsequent
discussion of the grid enabled the elicitation of
constructs. At the second interview, these constructs
were rated in relation to the information sources.
As the data gathered in the first two phases were
dependent on retrospection, it was decided to follow a
small sample of primagravidae through pregnancy, in the
third phase of the study. Descriptions of their
information needs and the means by which they chose their
information sources were recorded in 'taped' semi-structured
interviews at 15 weeks, 25 weeks and 35 weeks gestation.
This combination of methods generates both quantitative
and qualitative data. It avoids 'the error of misplaced
precision', Campbell and Stanley, (1963), and enables
different levels of description and explanation as to why
Granny may appear to know best!
Sheila Shannon, SlIHD Nursing Research Training Fellow,
Nursing Research Unit, University of Edinburgh
(20-minute presentation)
100)
EPISIOTOMY IN NORMAL DELIVERY - A RANDOMISED CONTROLLED
TRIAL COMPARING TWO POLICIES FOR MANAGING THE PERINEUM
A thousand women, for whom a normal vaginal delivery was
confidently anticipated, were randomly allocated to one
of two different policies for managing the perineum. Of
these 498 were assigned to the ’’restricted episiotomy"
group, the intention being that the procedure should,
as far as possible, be restricted to fetal indications
only. The other 502 were allocated to the "liberal
episiotomy" group with the intention that an episiotomy
should be used more liberally to prevent tears. The
resultant episiotomy rates were lot in the restricted
group and 51% in the liberal group.
There were more intact perinea as well as more anterior
and posterior tears among those allocated to the
restrictive policy. This group contained two cases of
severe perineal injury, but overall it sustained less
trauma and this policy resulted in substantial savings
in staff time and suture materials.
There were no differences in fetal outcome nor in the
amount of pain experienced by the mothers both at ten
days and three months after delivery. However, women
in the restrictive policy group resumed sexual intercourse
earlier.
191 of all women reported some degree of urinary
incontinence three months after delivery but there was no
evidence that the liberal1 use of episiotomy prevented
this problem.
A long-term follow-up of women in this trial is planned.
so that the effects of the two policies on urinary
incontinence and vaginal prolapse can be evaluated.
Jennifer Sleep, Royal Berkshire Hospital, Reading
(30-minute presentation)
101)
POST-OPERATIVE PAIN MANAGEMENT: EDUCATION OF STAFF
AND PATIENT OUTCOMES
There is abundant evidence that patients frequently suffer
unnecessary pain post-operatively . One reason for this
may be lack of awareness by nursing staff of the importance
of complete pain relief as a major goal. In part, this
situation may have been brought about by deficiences
within traditional education programmes for nurses.
In an attempt to see if the situation could be improved,
a clinically based educational programme on factors
relating to pain and its management was implemented on
four surgical wards.
The programme included discussions of the psychological
and cultural aspects of pain, use of pain assessment and
pain therapies. Its effect is reported in terms of some
patient outcomes on each ward. These outcomes included
patient pain ratings and subjective impressions of the
pain care given.
The subjects were 98 female patients who underwent major
surgery for non-malignant conditions. Data were collected
from two groups of patients on each ward. The first
group in each ward comprised those patients studied
before the education of the staff. Their outcomes are
compared with the second group of patients who were
studied following completion of the staff programme.
Beatrice Sofaer, S.R.N., S.C.M., R.C.T.,
Postgraduate Student, Nursing Research Unit,
Department of Nursing; Studies , Universityof ..Edinburgh
(30-minute presentation)
102)
EMPLOYER - EMPLOYEE ASPECTS OF THE NURSE TUTOR - STUDENT
RELATIONSHIP
The paper is focused on one section of a study of the
nurse tutor-student nurse relationship. The sample
consisted of 22 students nurses and 23 nurse teachers
in two schools of nursing in England.
Qualitative methodology was used involving a modified
grounded theory approach as delineated by Glaser and
Strauss (1967). A sociological perspective was
adopted, using role theory as the organising theoretical
framework.
Questions focused on whether the respondents perceived
the tutor as the students employer, and if they did
was this believed to have any effect on the relationship.
Secondly to query whether they perceived the implications
to the Employment Protection (Consolidation) Act (1978)
as having any effect on the relationship.
The results indicated that students did not perceive
tutors as their employers and were unaware of the Act
having any effect on their relationship.
Tutors did not believe they were the students employers
and the senior teachers disagreed. The tutors identified
seven areas in which the Act effected tutors and students.
There were suggestions that increased bureaucratisation
had resulted following the Act, and that students
progress was monitored more closely. Most tutors
believed that there had been an increase in the number
of students whose training had been discontinued since
the Act had been passed.
Minimal reference was made to role conflict occurring
owing to tutors being the students employer and their
counsellor.
Tutors were aware of structural elements, such as
legislation and the activities of trade union stewards,
having an effect on their relationship.
Patricia M; Stephenson, MSc., Dip.Curriculum Dev., SRN.,
OND., DN.(Lond.), Cert.Ed., RNT,
Lecturer in Nursing, Department of Nursing, University
of Manchester, Manchester
JL?.O-minute _p re sent a t i on)
103)
MEASUREMENT OF PATIENT DEPENDENCY AND QUALITY OF CARE
- THEIR CONTRIBUTION AS PERFORMANCE INDICATORS
HEALTH CARE MANAGEMENT
S E.h e r e _o f S t ud^
The project is concerned with the use of performance
indicators as a mangement tool to assist in the
deployment of nursing staff for the provision of care
services.
s P.c.9.i £
?_y.e
To explore, through a pilot study the feasibility of
developing indicators, which extend beyond activity
data and incorporate aspects of nursing workload and
quality of care. In essence the project considers the
comparison of nurse staffing levels with activity,
nursing dependency and quality of care data.
Introduction
Considerable emphasis is placed (not least by the report
of the "Griffiths” Inquiry) on the effective use of
performance indicators. In principle there is general
agreement that a systematic analysis of the relative
use of resources will aid health care management.
There is no lack of research on the subject and
"Performance Indicators” are widely used. The problem
which exists is in that previous work has concentrated
on one of three broad categories. The "top-down” approach,
which examines the relationship between measures of
manpower and measures of activity or cost. The "bottom-up”
approach, which relates nursing manpower to tasks actually
performed at ward level. Or the consultative approach
in which managers and staff justify "needs" through
d i scuss ion.
The method outlined in this paper recognises the value
inherent in each of these approaches and seeks to use
the better aspects of each. Unlike past research, not
isolating the method from broader consideration of
practice planning and care. But taming the subjective
nature of Professional Judgement and using it to provide
a constructive assessment of input which when added to
existing data bases, provides a comprehensive perspective
for realistic management decision making, based on our
prime concern - patient care.
R c s e a r c h _A [> E.r o_a_c h
(1)
Workload Evaluation - which constitutes the main
Focus as a pilot project contained on six wards
of one Health District, these were selected as
representatives of the general population.
Two wards from each:- Surgery
Medicine
Geriatrics
104)
Documentation was designed in consultation with
the staff to provide information on care and
dependency levels of patients, this was then
related to hospital activity analysis, sickness
absence data and duty rosta’s. A computer
system was developed to analyse the information,
which is then reproduced in graph form to provide
a very functional tool for both managers and
clinical practitioners. Briefly it compares
the levels of care received by patients- to their
level of dependency (output : input) and monitors
this against available staff and extraneous
factors. One of the important features is in the
application of "Professional Judgement" to an
objective data base.
(2)
Questionnaire
This was developed to meet the following objectives:-
a)
b)
c)
to assess realiability of "Professional Judgement"
to provide an indication of previous experience
with such studies
to provide an insight into staffs perceptions of
their value
The outcome reveals a high degree of congruence in
the ’’Professional Judgement" of care and dependency
levels.
(3)
Nursing Audit
A well known and tested form of nursing audit was
adopted to provide a "benchmark" for comparison
and to test the validity of the Work Evaluation
Study. Two internal and one external auditor
performed the assessments, the conclusions of which
indicated that care was being fairly assessed by
our methods. As the project continues it is
intended to develop this still further as a "dipstick"
to ensure reliability.
What has been proven in this work is that Quality of Care
and Dependency can be measured using professional judgement
and when related to the traditional quantifiable aspects
of service provision can provide far more realistic and
comprehensive indicators of performance than have previously
been available.
The distinction which the method holds is that it
originates from reality, does not take measurements in
105)
isolation and has appeal as a functional tool, to
managers and clinical practitioners alike. It addresses
the relevant aspects of performance, always maintaining
the central focus on the patient and his care.
In the context of this conference we feel that the
contribution to be made is in presentation of a research
approach, the product of which can and has made a
difference.
J. Goucher, RMN SRN, District Nursing Officer
J. Stevens MSc, SRN, RUNT, Support Nurse, Research
Planning Information, Sandwell Health Authority,
West Bromwich, West Midlands
(30-miniite presentation)
106)
THE ANALYSIS OF QUALITATIVE EVALUATION DATA - ISSUES
ARISING FROM EVALUATINGACyRRICUIAJMDEVELO PM E NT P RO J F. CT
This paper will describe one aspect of the evaluation of
a Curriculum In Nurse Education development project
(CINE), funded by the Health Education Council.
The aim of the project is to plan, implement and
evaluate a programme of communication skills teaching
in selected schools of nursing. The research is designed
using a quasi-experimental model involving four
experimental and two control schools in England.
The comprehensive evaluation of the impact of the teaching
programme included the collection of demographic data,
assessment of changes in students' responses to attitude
measurement scales and responses to patient case histories
using both written and audio-visual triggers.
An additional aspect of evaluation involves the collecti on
of data from feedback sheets which students complete
following each teaching session. These sheets provide
rich qualitative data related to students' reactions to
and perceptions of, the teaching programme.
These data have been categorised and underlying themes
identified. This paper focuses on an explanation of the
way the coding framework was devised and the results
arising from the analysis will be discussed in detail.
The difficulties encountered when attempting to quantify
diverse qualitative data will also be discussed.
Anne Tomlinson, MSc, SRN, RNT,
Jill Macleod Clark PhD, BSc, SRN,
^R^Et™®?lt_o?._Nursing_Studies 1_Chelsea Conege
(20-minute presentation)
London
107)
INTERACTION, LABOUR, MIDWIFE, MOTHER
The purpose of this study was to survey and describe
the interaction between mother and midwife during the
first, second and third stage of labour. The study
was concerned with the contents and amount of
interaction between mother and midwife and also with
their experience about labour and interaction.
The material for the study was collected in the delivery
room of the Kuopio University Central Hospital by
observing ten labours by interviewing mothers whose
labour was observed and by surveying to 23 midwives
working in the delivery-room.
According to observation 43$ of the interaction was
instructions that midwife gave to mother during the three
stages of labour. Nonverbal interaction including
operations and assisting the doctor without talking to
mother took also an important part of the whole
interaction. Only a small part of the interaction was
about experience of labour, expressing feelings and
asking opinions. During the first stage of labour
the interact ion■was one sided; midwife started the
discussion in 87$ of cases. Interaction concentrated on
physical care of the mother. Psychological care took
only a little part of the time.
According to observation mothers didn’t take an active
role in their own labour.
Every third mother had felt loneliness during the opening
phase. The mothers would have liked the midwife to be
present during that time. All midwives that answered to
the questionnaire agreed with mothers that they have too
little time to be with mothers during the opening phase.
The reason for this was lack of time and taking care of
other mothers.
The results of this study indicate the importance of
further research of the interaction in nursing.
Vehvilainen, Katri M.M.N., University of Kuopio,
Kuopio 21, Finland
(20-minute presentation)
108)
PREVALENCE, DISTRIBUTION AND ONSET OF PRESSURE SORES
IN AN ORTHOPAEDIC POPULATION
Orthopaedics has one of the highest pressure sore rates
in the acute sector, but detailed epidemiological
evidence on pressure sore occurrence within the
speciality is scarce. This paper presents data on
pressure sore prevalence, distribution and onset, in
two of the commonest types of orthopaedic admission to
acute general hospitals. Namely patients admitted for
fractures of femur/hip site and elective surgery.
The study reported here surveyed all femur and hip
admissions, i.e. a population of 283 patients, who were
admitted to the orthopaedic service of one acute general
hospital during a calendar year. In the hospital
concerned, a prophylactic nursing system aimed at
preventing pressure sores was already established, This
included a central nursing register of "at risk" cases
and patients with established lesions. This nursing
system and register is briefly discussed in the paper.
The paper documents some of the following findings from
the study, illustrated with slides.
(1)
"at risk cases" half of the total admissions
popufation were identified as "at risk" of
pressure sores according to the Norton Scale.
(2)
prevalence period prevalence rate of pressure
sore sufferers for the year was one third of
the admissions. Half of these patients had
two or more lesions.
(3)
pressure sore distribution is considered in
reFation to patient ancTother variables,
including age, sex, type of admission (i.e.
trauma or elective), type of operation,
mortality, and duration of hospitalisation.
Pressure sore sufferers are compared to the
admissions population from which they are
drawn, and the results are considered in the
paper.
(4)
pressure sore onset was concentrated at the
Beginning of the Tiospital stay, and showed a
definite relationship to the day of surgical
operation, as the distribution tables will
show.
(5)
anatomical sites and distribution of lesions
per patients are aFso TrFeFFy reviewed
including the presence of an unusual lesion
site which may be specific to patients treated
by internal fixation of pin and plate.
The study shows a definite pattern of pressure sore
distribution in relation to age, sex, and type of
admission. It also reveals that onset of visible
lesions falls into a definite time span related to
patients’ progress through the hospital.
Margaret Versluysen, Research Fellow in Nursing,
Central Nursing Offices, St. Bartholomew’s Hospital,
London
(30-minute presentation)
109)
110)
THE METHODOLOGICAL PROBLEMS OF MEASURING THE CUSTOMARY
PHYSICAL ACTIVITY OF HOSPITAL PATIENTS
Customary physical activity is that activity which
characterizes an individual's normal everyday life.
A stay in hospital must, by necessity, disrupt such
activity and, as research has shown, a reduction in
physical activity speedily results in a decline in
physical status (e.g. Taylor, Henschel, Brozek and Keys,
1949; Saltin, Blomquist, Mitchell, Johnson, Wildenthal
Chapman, 1968); a similar decline has been observed in
patients undergoing survery (e.g. Adolfsson, 1969;
Bassey and Fentem, 1974).
This research hypothesizes that the quantity of
physical activity carried out in the immediate post
operative period may influence recovery. In order to
examine this hypothesis, a reliable and valid method
is needed for the measurement of this kind of activity
in a hospital setting.
Methods used to measure customary activity fall into two
major categories: those methods which involve the
measurement of physiological variables and those which
depend upon sociological methods.
Instruments tested during this study belonging to the
former category include Mechanical Pedometers, the
Oxford Instruments Tape Recorder and the ’’Footswi tch";
those belonging to the latter category include Activity
Sampling and Interview Schedules.
Fieldwork, testing the instruments will be discussed.
Their use in the hospital trial to measure the activity
of patients undergoing major gynaecological surgery will
be discussed.
REFERENCES
G. Adolfsson (1969) - Circulatory and respiratory function
in relation to physical activity in female patients before
and after cholecystectomy. Scandinavian Journal of
Rehabilitation Medicine, Vol. 14, 14-15.
E.J. Bassey and P.H. Fentem (1974) - Effect of deterioration
on physical condition during post-operative bed-rest and
its reversal by rehabilitation. B.M.J., Vol. 4, 194.
B. Saltin, G. Blomquist, J.H. Mitchell, R.L. Johnson,
K. Wildenthal and C.B. Chapman (1968). Response to
exercise after bed rest and after training. A longitudinal
study of adaptive changes in oxygen transport and body
composition. Circulation, Vol. 38, No. 5, Suppl.7.
Ill)
H.L. Taylor, A. Henschel, J. Brozek and A. Keys (1949)
- Effects of bed rest on cardiovascular function and
work performance. Journal of Applied Physiology, Vol.2,
223-239.
Julia M. Walker BA (Hons), SRN SCM/
Pamela J. Hawthorn PhD, SRN, SCM,
Nursing Studies Unit, Queen’s .Medical Centre
(30-minute presentation)
Nottingham
112)
TEACHING RESEARCH: A PRACTICAL APPROACH
There is a widely held view that nursing research will
not make a difference until the students and ordinary
nurses have acquired skills in research mindedness.
The point will be made that nursing research cannot be
expected to make a difference in practice unless nurses
have been encouraged to develop a certain level of
research sophistication. This, it will be argued,
should stress methods rather than results and that it
is inappropriate to stress the need to use research
findings in nursing practice (Bond, 1982) independent
of understanding how information is collected. The
need then is to emphasise teaching research, especially
the behavioural sciences, as a process rather than as
a content based subject (see Wattley and Muller, 1983a,b,).
Some practical suggestions on how this might be achieved
will be discussed (see Wattley and Muller, 1984).
Lesley A. Wattley, BA, SRN, Lecturer in Nursing Studies,
Welsh National School of Medicine, Cardiff, Wales
Dave J. Muller, B’Ed. PhD, ABPsS, Senior Lecturer in
Psychology, Preston Polytechnic, Lancashire, England
(20-minute presentation)
113)
A STUDY OF TRAINED NURSES’ ATTITUDES AND OPINIONS REGARDING
THEIR WORK ON GYNAECOLOGY WARDS
Attitudes and behaviour of doctors in relation to women
patients have been a focus of psychological and sociological
research since the development of modern feminism. At the
same time much has been written about how women perceive
their treatment and encounters with the health care system.
In contrast, little or no attention has been given to
nurses’ attitudes towards working with women patients.
This exploratory study may be seen as a first step in
making good this deficiency. Its aims were to collect
data focussing on whether and why nurses choose to work
on gynaecology wards, what they consider to be the
differences (if any) between this work and that on other
surgical wards, and what training and preparation they have
had for their work.
Data were collected by means of informal tape-recorded
interviews of a focussed conversation type, carried out in
respondents' homes. Respondents were 30 trained nurses
working on gynaecology wards in two hospitals in the
north of England. Twenty interviewees worked in a
specialisted obstetrics and gynaecology hospital forming
part of a teaching hospital, and the remaining 10 nurses
were employed at a non-teaching hospital in the same
geographical area. The topic of the research was
introduced to interviewees as "a study of how you see
your work on a gynaecology ward" and they were promised
a copy of the research report at the end of the study.
The limitations of a self-report method of studying
attitudes are recognised, but a concurrent study by the
same researcher of gynaecology patients at one of the
hospitals concerned provides some data which can be used
to validate nurses’ reports.
Interviewees saw gynaecology patients as clearly different
both from other female surgical patients and from male
patients in terms of their emotional problems and needs.
Negative stereotyping and denigrating comments were
frequent, as were reports of condescending and unsympathetic
attitudes and behaviour on the part of doctors similar
to those found widely in the literature. Nurses were
very aware of patients* needs for information and advice,
and felt that the relatively informal and relaxed
atmosphere on gynaecology wards helped them to meet these
needs. Their descriptions of the kind of information they
gave to patients were of practical guidelines formulated
in very general terms, and topics such as women’s feelings
after gynaecological surgery and warnings of possible
signs and symptoms during recovery were not mentioned.
Those nurses who were thinking of changing to a different
type of work mentioned more technologically-oriented
114)
specialities as attractive, but some wished for
opportunities for further study to help them to be more
effective in their present work, for example a ’’care of
the dying” course, and social and communications skills
training.
The limitations of the study in terms of reliance on a
single method of data collection and small sample size
are acknowledged. Nevertheless important directions
for further research are identifiable, and a number of
areas emerge for consideration by nursing managers and
educators.
Christine Webb, BA, MSc, SRN, RSCN, RNT,
Lecturer .in Nursing, University of Manchester
(30-minute presentation)
115)
UNFITNESS FOR NURSING. EXPLORATORY INTERVIEWS WITH
PHYSICIANS AND REGISTEREO NURSES
In Sweden there are very few or no rules of when and on
which criteria nursing students should be separated from
their training. This fact is experienced with a growing
dissatisfaction among nurse teachers as well as among
care personnel. The aim of this study was to elucidate
how registered nurses and physicians perceive an unfitting
student of nursing or an unfitting registered nurse.
Methods
Seven physicians, nine nurse teachers, nine registered
nurses in the County of Vasterbotten, Sweden, were
interviewed regarding unfitting nurse students and nurses
through a semistructured interview which was tape recorded.
The interviewees told about 45 cases of registered nurses
and students in nursing of whom the fitness of the person
for nursing had been questioned, The descriptions of the
cases were analysed by content analysis.
Results
As the requisites absolutely necessary for a nurse to hold
were mentioned:
knowledge (30)
reliability (27)
interest in people (21)
ability of cooperation (15)
the most common reasons for unfitness mentioned were:
unreliability (42)
lack of knowledge (37)
lack of ability to put their theoretical knowledge
into practice (21)
lack of ability to perceive the wholeness of the
patients' needs (17)
lack of insight into their own limits (17)
nonchalance (9)
concrete bad mistakes (9)
carelessness (8)
a few typical cases will be described and discussed.
Conclusion
The discussion of the cases of unfitness to nursing
of nursing in education.
illustrates the need of a theory
1
B. Westermark, RNT, A. Norberg, RN PhD,
Depar_tinent_of_AdvancedJNursingLjL_ymea University_,.._Sweden
(20-minute presentation)
116)
UTILISATION OF HEALTH SERVICE FACILITIES BY CHILDREN
DURING THEIR FIRST TWO YEARS OF LIFE
The aims of the research project will be outlined, The
survey method employed to collect the data will be
discussed. Some of the findings of the research will be
presented. A comparison will be made regarding the health
experience of three samples (an inner-city district
sample (n=756), a suburban district sample (n=127) and an
affluent suburban district sample (n=97) ). Particular
attention- will be given to the findings with regard to
the relationship between various influences (demographic
factors, health visitor input), and the uptake of the
DHSS recommended prophylactic measures (6 week infant
examination, primary immunization, infant hearing test,
and 15-24 month developmental assessment). The
utilisation of casualty departments, out-patient and
in-patient hospital facilities will be described. The
incidence of potentially detrimental social circumstance
in family life (simple parentage, homelessness, reliance
upon State benfits, social services' casework) will be
discussed in relation to poor health experience in early
childhood. Finally, the implications of the findings
will be discussed briefly.
Alison E. While, BSc, MSc, SRN, MVCert.,
Departmen.t of Nursing Studies, Chelsea College, Lui
London
(40-minute presentation)
117)
RESEARCH INTO THE HISTORY OF NURSING
The recent upsurge of interest in the history of nursing
has produced a small spate of research based studies.
The approach taken by most researchers has been a
reappraisal of the traditional histories and past events.
New data has become available and nurses are becoming
more adept at finding sources, so far not tapped. New
insights and new interpretations have emerged.
Interpretations of history rely on current values and
concerns as well as on the raw data. Nurses today are
freeing themselves of the conventional hand-maiden
constraints. They have evolved a newer occupational
consciousness and have been busy developing an under
standing of the theoretical foundations of nursing.
Nurses today tend to be better educated. With these new
perceptions of nursing and nurses, the interpretation of
history has taken on a new meaning.
The newer self-consciousness of nurses and the re
interpretation of the history of nursing have developed
into a dialogue between the past and the present and
the results of this dialogue have produced a better
insight into our roots, the present and the future.
will explore this process and will describe
The paper
i .
i--- * that ;it
4. 4^
the impact
is having on the development of
nursing.
Rosemary White, SRN, SCM, OHNC, MSc., PhD.,
Winchester, Hants.
(40-minute presentation)
118)
A RANDOMIZED CONTROLLED TRIAL OF A NEW APPROACH TO
PREOPERATIVE TEACHING AND PATIENT COMPLIANCE
Active patient involvement is an essential requirement
for successful prevention of postoperative complications.
Several studies found that various teaching methods
substantially increased the knowledge patients had about
their conditions, but that none improve their compliance.
This study proposed a new approach to preoperative teaching
that combined educational and behavioural strategies to
improve patient adherence to those activities that are
designed to prevent postoperative complications. It
consisted of an individualized learning activity package
to be used in conjunction with identified reminder and
reinforcement behavioural strategies. In this study,
compliance was measured by the accuracy, regularity and
willingness that patients demonstrated in execution of
the prescribed activities after surgery. This study was
a randomized controlled experiment. Eligible patients
were assigned randomly to the experimental (N=51) and
control group (N=47). Five hypotheses were formulated.
Relative to the control patients, experimental subjects
will (1) demonstrate a significantly higher score in the
regularity and willingness with which they perform the
prescribed postoperative activities, (2) demonstrate a
significantly higher score in the accuracy with which
they perform the prescribed activities; (3) demonstrate
a more adequate postoperative chest expansion; (4)
have no or fewer postoperative complications, and (5)
be more satisfied with the preoperative teaching approach.
Three data collection tools were used:
(1) a Compliant
Behaviour Index that measured the regularity, willingness
and accuracy which patients demonstrated in performing
the prescribed activities, (2) a patient satisfaction
scale which determined patients' receptiveness towards
this approach to preoperative teaching, and (3) a
Postoperative Complication Index that recorded the number
of postoperative complications.
Hypotheses were tested by using one-way analysis of
variance F test with a 0.05 level of significance. Results
indicated: (1) a highly significant difference between
the two groups in the regularity, willingness and
accuracy with which they performed the prescribed
postoperative activities (PcO.Ol).
(2) The experimental
patients were significantly more satisfied with this
approach to preoperative teaching than the control
patients (P<0.01). (3) There was no significant difference
in postoperative chest expansion between the two groups
(P>0.05). (4) Two control patients and one experimental
patient encountered postoperative complications. Although
the difference in the number of postoperative complications
between these two groups was statistically insignificant,
it was clinically significant.
119)
An analysis of covariance was performed to determine the
factors that significantly influenced patients' total
compliance score. Findings revealed a significant
difference between the groups (P<0.01), and patient
compliance decreased significantly with age (P<0.01).
When the satisfaction score was correlated with the
groups and previous operations by using a two-way
analysis of variance, results showed a significant
difference between the groups (PcO.Ol), but no significant
effect due to previous surgery (P>0.05).
This study concludes that an approach to preoperative
teaching which combined the educational and behavioural
strategies does indeed produce significant effects on
patients' adherence to the prescribed postoperative
activities. Nurses play a vital role in increasing patient
compliance.
Project funding was obtained from the National Health
Research and Development Programme, Health and Welfare,
Canada. File number: 6603-1148-55.
Julia Wong, R.N. MSc.N.,
Associate Professor
Shirley Wong, R.N. MsC.N.,
Associate Professor,
Dolhousie University, NovaScotia, Canada
(40-minute presentation)
120)
CRISIS AS AN AGENT OF CHANGE: NURSES PERCEPTION OF
THEIR ROLE DURING A PHYSICIANS’ STRIKE
During the first half of 1983 a physician strike took
place in Israel. Although physicians’ strikes occurred
before, the last one was different in its length and
character.
The total absence of primary physicians from the country’s
primary care facilities, during 118 days, imposed on the
community based nurses an unfamiliar situation. In
previous physicians’ strikes (the latest took place in
1973) medical services similar to those provided during
weekends and holidays were given by physicians in the
existing community clinics.
In Israel, not elsewhere, nurses are employed by highly
structured bureaucratic health systems. As a consequence,
they are accountable to a variety of authority figures:
physicians, managers, nursing administrators, etc. Their
position in the hierarchy limit their ability to initiate
and/or introduce change in their traditional roles.
Moreoever, those of them who wish to initiate change in
their professional role are confronted by difficulties
stemming from within the health organizations as well as
by restrictions imposed by laws, Nevertheless, change
takes place in health systems as it does in other human
systems.
Some grow gradually while others follow crisis situations.
The physicians' strike was a crisis situation because a
dominant professional group ceased to function in its
normal milieu. As a consequence, it left a void that had
to be filled, least in part, by a different professional
group.
The present research was aimed at finding out how primary
health care nurses adjusted to an unfamiliar situation,
how they performed as the only primary health care
providers group left in the field, and how they perceived
their changed role. Also, it was aimed at finding out
if nurses believed that the crisis situation they
encountered could serve as an opening for change in their
future nursing role.
As soon as the physicians' strike ended, 2500 semi
structured questionnaires were sent to the total nurse
population employed, as primary health providers, in
Kupat-Holim’s primary urban and rural clinics spread
throughout the country. The response rate reached over 800&.
Statistical analysis included correlations, T tests and
cross tabulations. The major findings showed that the
perceptions nurses hold about their nursing role during
physicians’ strike vary with age, level of general
121)
education, and basic and post-basic nursing preparation.
The same was evident in the nurses' view of their
future nursing role. In general, nurses remarked that
patients responded willingly and favourably to their
enlarged role. They reported, also, that they saw the
physicians' strike period as a situation that enabled
them to carry a more direct responsibility for their
patients, that it enabled them to better acquaint
themselves with their patients and their needs and that
it gave them an opportunity to practice what they have
been trained for. Also, nurses saw different future
developments in their professional role: a small majority
forsaw a reverse to previous limiting roles as inevitable,
while others felt that their expanded role was there to
stay. In addition, the findings indicated areas that the
nurses felt needed additional knowledge in, studies for
and skills to be performed.
Dr. Lea Swanger, Head, Allied Health Division,
KUPAT - HOLIN, Health Insurance Institution of the General
Federation of Labour in Israel
(30-minute presentation)
122)
GENERAL INFORMATION
LECTURE THEATRES
Great Hall, level 2, Sherfield Building.
Read Lecture Theatre,, level 5, Sherfield Building.
Pippard Lecture Theatre, level 5, Sherfield Building.
Quiet Room 002, Basement level, Sherfield Building.
Room 213, Dept, of Mathematics, Huxley Building.
Room 340, Dept, of Mathematics, Huxley Building.
REGISTRATION
From 16.30 - 19.15 on Tuesday, April 10,
and from 8.45 on Wednesday, April 11.
EXHIBITION
The exhibition will be
Sherfield Building.
Opening hours:- April
April
April
in the Junior Common Room, level 2,
10
11 & 12
13
16.30
10.00
10.00
20.30
18.00
14 .00
CATERING
In the main refectory of the Sherfield■Building.
FIRST ATD
First aid officers will be on duty and there is a first aid
room in the Sherfield Building.
BANKING
A branch of National Westminster Bank (and a service till)
is on the premises. No charges are made to members of other
banks.
KtHSinr-toN
GARDtM
H'rot
o
TO KENSINGTON
HIGH STREET.
HAMMERSMITH.
BARNES-
r*HK
PARKING
I
NCP•HYDE PARK
ENTRANCE PARK LANE
123)
OR MARBLE ARCH
jeNsiScTSN »o.‘o
--------------PARKING
NCP BEHIND BARKER! OR
NCP - EARLB COURT ROAD
JUNCTION WITH HtGM STRFET
KENSINGTON
SS05*
TO KNIGHTSBRIDGE,
L HVDE PARK
TO
HAMMERSMITH
MA THE WEST.
9
MORTLAKE, Barnes, Hammersmith, Kensington, Knightsbridge, Hyde Park Corner, Piccadilly, Trafalgar Square,
Aldwych, St Paul’s, Bank, LIVERPOOL STREET STATION.
14
HORNSEY RISE, Holloway, Caledonian Road, King’s Cross, Euston, Piccadilly Circus, Hyde Park Comer,
Knightsbridge, South Kensington, Fulham Broadway, PUTNEY.
30
HACKNEY WICK, Hackney, Dalston, Highbury, Islington, King’s Cross, Euston, Baker Street, Marble Arch,
Hyde Park Corner, Knightsbridge, South Kensington, Earls Court, Fulham, Putney, Putney Heath,
ROEHAMPTON.
45
SOUTH KENSINGTON, Battersea, Clapham Junction, Clapham, Stockwell, Brixton, Camberwell, Elephant,
Blackfriars, Holbom Circus, Gray’s Inn Road, KING S CROSS.
49
STREATHAM GARAGE, Tooting Bee, Clapham Junction, Battersea, Kensington, SHEPHERD'S BUSH.
52
VICTORIA STATION, Knightsbridge, Kensington, Notting Hill Gate, Ladbroke Grove, Kensal Rise, Willesden.
Neasden, Kingsbury, Burnt Oak, Mill Hill, BROADWAY STATION.
73
STOKE NEWINGTON, Newington Green, Islington, King's Cross, Euston, Oxford Circus, Marble Arch, Hyde
Park Comer, Knightsbridge, Kensington, HAMMERSMITH.
74
CAMDEN TOWN, The Zoo, Baker Street, Marble Arch, Hyde Park Comer, Knightsbridge, South Kensington,
Earl’s Court, Fulham, Putney, Dover Street, ROEHAMPTON.
124)
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Imperial College of
Science &
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MAIN VEHICULAR ACCESS
ENTRANCE TO SOUTH KENSINGTON
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SUBWAY
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ENTRANCE TO SUMMER ACCOMMODATION CENTRE RECEPTION (SAC)
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Position: 4702 (1 views)