Biomedical subjects

Abbey Hyde

Publications and source records attributed to Abbey Hyde.

18 recordsLinked to original sources

PubMed2007

Children talking: emerging perspectives and experiences of cigarette smoking.

Despite efforts to prevent the onset of smoking, the rate among older children remains high. In this article, the authors report on a longitudinal, qualitative study of 11 to 16-year-old children describing children's construction of what it means to be a smoker, the reasons given for children smoking, and their views of smoking behavior. Findings indicate that children adopt broad interpretations of what constitutes smoking behavior; although they strongly disapprove of children who smoke, they are less disapproving of older children or adult smokers and are increasingly tolerant of smoking behavior as they get older. Children's disapproval of smoking acts as a protective mechanism against smoking for younger participants. Participants' broad interpretation of what it means to be a cigarette smoker, their association of smoking with adulthood, and their increasing tolerance of and exposure to smoking behavior as they move into adolescence appears to increase susceptibility to becoming cigarette smokers.

Adolescent↗

PubMed2006

The politics of heterosexuality--a missing discourse in cancer nursing literature on sexuality: a discussion paper.

In this article, a critique of cancer nursing literature on the issue of sexuality is presented, with particular reference to literature on cancers common to women. The paper begins with an account of two competing perspectives on sexuality. The first is a version of sexuality rooted in sexology, underpinned by biomedical science that makes a claim to having identified 'normal' sexuality. The second is a version of sexuality developed within feminist scholarship that tends to reject biological determinism as a basis for understanding sexuality, instead favouring constructionist perspectives, with the socio-political context of sexual relations problematised. The focus of the article then shifts to cancer nursing literature on sexuality that deals primarily with cancers common to women, to appraise the extent to which either of the above perspectives on sexuality is invoked. Within this body of nursing knowledge, I argue that there has largely been an uncritical endorsement of biomedical constructions of sexuality, rooted in orthodox sexology, with a dominant focus on sexual functioning and on sexual rehabilitation for women with cancer. Moreover, in this knowledge base, phallocentric heterosexuality over and above other forms of sexual expression is privileged, and the socio-political context of unequal gender power relations is largely excluded. References to the social sphere as a dimension of nursing care are focused almost exclusively on maintaining normality, and reflect the emphasis on functional restoration. The largely individualistic, uncritical and biocentric emphasis in this literature may serve inadvertently to reinforce and maintain existing gender inequalities in heterosexual relationships. Finally, I consider the difficulties for oncology nurses in dealing with contradictory truth claims or conventional wisdoms about sexuality from the disparate disciplines of which holism is comprised.

Female↗

PubMed2006

Sexuality as an aspect of nursing care for women receiving chemotherapy for breast cancer in an Irish context.

In this article, findings are presented from a study that aimed to explore the perceptions and experiences of a sample of nurses in addressing sexuality as an aspect of care for women receiving chemotherapy for breast cancer. A sample of 10 oncology nurses was selected from oncology units at three hospitals in Ireland, and each participant was interviewed in depth. A qualitative strategy was employed to analyse data. Findings indicated that participants tended to construct sexuality in broad terms, and were well aware of the effects of chemotherapy on a person's sexuality. In addition, they considered sexuality education to be a legitimate and important aspect of their role. However, they also revealed that they avoided addressing sexuality with patients, or encountered structural obstacles in doing so. Some participants expressed anger and frustration when discussing barriers to incorporating sexuality into their practice. A strong theme in data was participants' perceptions that they were not adequately prepared in either pre- or post-registration programmes to incorporate sexuality as a dimension of patient care, although post-registration programmes were more likely to furnish them with knowledge about sexuality. Finally, participants' views on sexuality care are considered in the context of Irish culture which until recently was dominated by Catholic Church teachings.

Adult↗

PubMed2006

Discursive practices in the documentation of patient assessments.

AIM: This paper reports a study analysing the various functions of nurses' documentation of patient assessments. BACKGROUND: Modes of documentation have received much attention in the nursing press since the integration of the nursing process and nursing models. Previous research has shown that current documentation practices do not consistently promote effective communication and evaluation of patient care. A recent systematic review found no evidence that any particular system of documentation improved this situation. However, nurses' documentation serves not only to communicate information to others, but also has a political function as a presentation of what is important and ethically 'right' to report. METHOD: A Foucauldian approach to discourse analysis was used to analyse 45 patient records. FINDINGS: The findings indicate that nurses employ three discernible discursive practices in the documentation of patient assessments: medical, nursing and informal. Each practice has an effect on the presentation of nursing in the documentation. Because of the complex interplay between these practices, nurses present themselves as aligned with the medical profession, as distinct and professional, and as informal in their descriptions of non-biological information. The use of these practices appears to be motivated by the type of information being reporting. CONCLUSION: Existing literature highlights the functional aspects of nursing documentation. In contrast, this paper explores the way in which nurses, through their documentation, constitute themselves and the nursing profession. In this way, nursing documentation is viewed as a social practice and a conduit through which particular power effects are produced and reproduced, rather than simply a matter of, for example, knowledge, individual choice or good practice.

Attitude of Health Personnel↗

PubMed2006

Towards a nursing minimum data set for Ireland: making Irish nursing visible.

AIM: The aim of this study was to identify patient problems, nursing interventions and nursing outcomes to be included in a nursing minimum data set for Ireland. BACKGROUND: In 2002, a research programme funded by the Irish Health Research Board, was established to develop and test a nursing minimum data set to capture the nursing contribution to patient care in Ireland. A nursing minimum data set is comprised of the smallest number of information items required to capture the range of patient problems, nursing interventions and nursing outcomes recorded by nurses on a regular basis. Nursing minimum data sets have been developed in several countries for a range of applications such as workforce planning, financing nursing care, examining patient profiles and forecasting trends in nursing diagnoses. METHOD: Eleven focus groups were conducted with 59 registered general nurses to explore their conceptualizations of patient problems, nursing interventions and nursing outcomes. In addition, data relating to nurses' recordings of patient problems, nursing interventions and nursing outcomes were collected from a sample of 45 sets nursing records. The research took place between January 2003 and April 2004. FINDINGS: A range of patient problems, nursing interventions and outcomes were identified that were similar to those found in existing nursing minimum data sets. However, several new items and categories of items were also identified, justifying the empirical approach taken to generate the initial list of items. Data from nursing records supported several points raised in focus groups and also highlighted some inconsistencies between nurses' perceptions and recordings of what they do. CONCLUSION: Our research identified several new types of indirect interventions and managing/organizing activities in addition to items found in existing nursing minimum data sets. The importance of these aspects of the nursing contribution to patient care will be tested further in the development of the Irish nursing minimum data set.

Adult↗

PubMed2006

Nurse-related factors in the delivery of preoperative patient education.

AIMS AND OBJECTIVES: This article aimed to explore the factors relating to nurses themselves that influence the delivery of preoperative patient education in everyday surgical clinical contexts at one large general adult teaching hospital in Ireland. BACKGROUND: As landmark studies of preoperative education undertaken in the UK in the 1970s identified the superiority of structured programmes of patient education over and above 'regular' preoperative care, there have been many intervention/outcome experimental studies carried out in this area. However, there has been little interpretative work conducted that explores the regular, or 'usual' preoperative education given to patients in everyday surgical units. Methods. A sample of 12 experienced surgical nurses was selected and each participant was interviewed in depth. Data were analysed using a qualitative strategy resembling grounded theory. RESULTS: Findings indicate that preoperative education was variously interpreted by participants, and participants' accounts suggested that different understandings and practices by nurses resulted in patients receiving different levels of care. In addition, diverse levels of knowledge and experience of individual nurses resulted in unevenness in the type of preoperative education that patients received. A number of participants advocated a more formal method of preparation for nurses in the area of preoperative education. Finally, in some surgical areas, specialist nurses worked side-by-side with regular ward nurses and their input in preoperative education was largely seen by participants in a positive way, particularly in view of the structural constraints that ward nurses faced. CONCLUSIONS: We conclude that nurse-related factors in preoperative education do not arise in a vaccum, but rather are related to the wider organizational practices and culture. The difficulties with preoperative education identified in data may be addressed through organizational investment in preoperative education. RELEVANCE TO CLINICAL PRACTICE: This paper produces evidence for nurses and clinical nurse managers about how nurse-related factors impede preoperative education, and may provide a starting point for how to begin to address obstacles to better preoperative care.

Humans↗

PubMed2006

Nursing minimum data sets: a conceptual analysis and review.

It is commonly acknowledged that nursing care is underrepresented in the healthcare record. The nursing minimum data set (NMDS) has been proposed as a method of routinely collecting information on core aspects of the nursing contribution to care, organised primarily in terms of phenomena, interventions and outcomes. Potential applications in clinical nursing, healthcare management, education and research have been identified. NMDS systems have been developed in a number of countries, with applications mostly related to resource allocation. To date, NMDS systems have tended to examine physical nursing care provided in institutional settings, with implications for construct and content validity. While NMDS research helps to clarify the nursing contribution to care, attention is now required to better understand the domains of nursing care across a broader range of care settings.

Australia↗

PubMed2006

Developing a data dictionary for the irish nursing minimum dataset.

One of the challenges in health care in Ireland is the relatively slow acceptance of standardised clinical information systems. Yet the national Irish health reform programme indicates that an Electronic Health Care Record (EHCR) will be implemented on a phased basis. [3-5]. While nursing has a key role in ensuring the quality and comparability of health information, the so- called 'invisibility' of some nursing activities makes this a challenging aim to achieve [3-5]. Any integrated health care system requires the adoption of uniform standards for electronic data exchange [1-2]. One of the pre-requisites for uniform standards is the composition of a data dictionary. Inadequate definition of data elements in a particular dataset hinders the development of an integrated data depository or electronic health care record (EHCR). This paper outlines how work on the data dictionary for the Irish Nursing Minimum Dataset (INMDS) has addressed this issue. Data set elements were devised on the basis of a large scale empirical research programme. ISO 18104, the reference terminology for nursing [6], was used to cross-map the data set elements with semantic domains, categories and links and data set items were dissected.

Databases as Topic↗

PubMed2005

Social regulation, medicalisation and the nurse's role: insights from an analysis of nursing documentation.

BACKGROUND: Medicine is recognised as a dominant source of governmentality and social regulation, and although nursing has been implicated in the same process, analytical work in this area has been sparse. OBJECTIVES: The article aims to present an analysis of nursing records in order to understand the structural and social processes that mediate the texts. METHODS: 45 sets of nursing records drawn from four clinical sites in Ireland were subjected to a discourse analysis. RESULTS: This article focuses on two main themes that were derived from data: (i) the manner in which nurses controlled, regulated and invigilated patients' activities of daily living and (ii) the way in which activities of daily living were mediated by a biomedical worldview in the clinical settings. Through the organising framework of Activities of Daily Living (ADLs), normative social practices relating to hygiene, eating and drinking, sleeping and so forth were surveyed and monitored within clinical settings. We construct qualitative categories around a range of ways that nurses assessed and judged patients' capacities at ADLs. Furthermore, it is argued that the framework of ADLs epitomises the medicalisation of normative social practices, whereupon the most mundane of normal functions become redefined as an actual or potential clinical pathology, legitimating nursing interventions. According to the nursing documentation, biochemical interventions in the form of various medications were the most dominant means through which nurses attempted to restore or improve the functional capacity of an ADL. CONCLUSION: We conclude by proposing that nurses' invigilation of patients' ADLs is not necessarily a repressive feature of nursing practice, but rather has the potential to be used to advocate on patients' behalf in certain circumstances.

Activities of Daily Living↗

PubMed2005

Masculinities and young men's sex education needs in Ireland: problematizing client-centred health promotion approaches.

In recent decades, dominant discourses in health promotion have emphasized empowerment, client participation and the notion of people identifying and being facilitated to meet their own health needs. However, there has been little analysis of the concept of 'need' and the possibility, at least, that the fulfillment of some such self-defined needs are not in the interest of social justice and equality. In this article, we present an account of the sex education needs of secondary school pupils from their own perspectives, and problematize the concept of self-identified needs in health education. Twenty-nine focus group interviews were conducted with 226 secondary school pupils in Ireland, and data were subjected to a qualitative analysis. Findings suggested that young men tended to prioritize practical guidance that would provide them with the skills and confidence to take the lead in sexual encounters, and display competence in the act of penetrative sex. We argue that these self-defined sex education needs emanate from a culture of traditional masculinity where, for a male, one's place in the pecking order is derived from one's capacity to conquer, lead and display mastery with regard to sex. In the discussion, we attempt to unpack the notion of clients identifying their own needs and the concept of empowerment as it relates to our data, in the context of gender-based structural inequalities.

Adolescent↗

PubMed2005

The focus group method: insights from focus group interviews on sexual health with adolescents.

This article concerns the manner in which group interaction during focus groups impacted upon the data generated in a study of adolescent sexual health. Twenty-nine group interviews were conducted with secondary school pupils in Ireland, and data were subjected to a qualitative analysis. In exploring the relationship between method and theory generation, we begin by focusing on the ethnographic potential within group interviews. We propose that at times during the interviews, episodes of acting-out, or presenting a particular image in the presence of others, can be highly revealing in attempting to understand the normative rules embedded in the culture from which participants are drawn. However, we highlight a specific problem with distinguishing which parts of the group interview are a valid representation of group processes and which parts accurately reflect individuals' retrospective experiences of reality. We also note that at various points in the interview, focus groups have the potential to reveal participants' vulnerabilities. In addition, group members themselves can challenge one another on how aspects of their sub-culture are represented within the focus group, in a way that is normally beyond reach within individual interviews. The formation and composition of focus groups, particularly through the clustering of like-minded individuals, can affect the dominant views being expressed within specific groups. While focus groups have been noted to have an educational and transformative potential, we caution that they may also be a source of inaccurate information, placing participants at risk. Finally, the opportunities that focus groups offer in enabling researchers to cross-check the trustworthiness of data using a post-interview questionnaire are considered. We conclude by arguing that although far from flawless, focus groups are a valuable method for gathering data about health issues.

Acting Out↗

PubMed2005

Nurses' experiences of distance education programmes.

AIM: This paper reports on a study exploring the experiences of nurses undertaking distance education (DE) programmes. BACKGROUND: While DE has many advantages in terms of the flexibility, autonomy and freedom that it affords to learners, the literature reports that students undertaking these programmes can also experience feelings of being disconnected and isolated. METHODS: A convenience sample of 15 participants was selected, and data were collected using in-depth interviews. Data were analysed using a qualitative design that drew most heavily on the methodological procedures of grounded theory. FINDINGS: Habermas' theory of communicative action was found to be relevant to the interpretation of data and four categories were constructed to explain participants' experiences in relation to DE, namely: lifeworld lamented; lifeworld experienced; lifeworld ceded and learning within a bounded system. These categories reflect the manner in which participants experienced the lifeworld component (the interactive and subjective dimensions) and the system component (objective and outcome oriented dimensions) of the educational realm. While data indicated diversity in how the boundedness of the programmes was experienced, overall such standardized, instrumental courses were viewed favourably by participants within the limitations of their own personal circumstances. CONCLUSION: Distance education as a means of disseminating nursing knowledge should be strengthened. The challenge for nurse educators is to develop DE programmes that minimize their limitations and maximize their potential.

Adult↗

PubMed2005

Modes of rationality in nursing documentation: biology, biography and the 'voice of nursing'.

This article is based on a discourse analysis of the complete nursing records of 45 patients, and concerns the modes of rationality that mediated text-based accounts relating to patient care that nurses recorded. The analysis draws on the work of the critical theorist, Jurgen Habermas, who conceptualised rationality in the context of modernity according to two types: purposive rationality based on an instrumental logic, and value rationality based on ethical considerations and moral reasoning. Our analysis revealed that purposive rationality dominated the content of nursing documentation, as evidenced by a particularly bio-centric and modernist construction of the workings of the body within the texts. There was little reference in the documentation to central themes of contemporary nursing discourses, such as notions of partnership, autonomy, and self-determination, which are associated with value rationality. Drawing on Habermas, we argue that this nursing documentation depicted the colonisation of the sociocultural lifeworld by the bio-technocratic system. Where nurses recorded disagreements that patients had with medical regimes, the central struggle inherent in the project of modernity became transparent--the tension between the rational and instrumental control of people through scientific regulation and the autonomy of the subject. The article concludes by problematising communicative action within the context of nursing practice.

Aged↗

PubMed2005

What characterizes the 'usual' preoperative education in clinical contexts?

The literature on preoperative education is dominated by studies that employ experimental designs to measure the effects of structured programs on patient outcomes. These studies predominantly compare structured preoperative educational interventions with the usual care that patients receive. However, the notion of what the "usual" care comprises is largely elusive and unexplored. This study aimed to understand how the usual preoperative education is practiced in a number of surgical clinical units at one particular hospital in Ireland. Twelve experienced surgical nurses were interviewed in depth. A qualitative strategy resembling grounded theory was employed to analyze the data. The findings indicated that the content and quality of the preoperative education that patients received depended largely upon the individual nurse caring for the patient. Although there was a generic content of preoperative education that all participants identified as important, this related to physical and technical issues, and to the transmission of administrative or procedural information. Perspectives on the process of delivering preoperative education were diverse. The vast majority did not relate to the formal language of the discourses of teaching and learning; nonetheless, their descriptions of engaging in their work indicated the application of some elements of educational theory. The data suggested that the use of teaching tools was inconsistent, depending on their availability and the practices of individual nurses. On the whole, the usual care as described by participants in our study may be characterized as uneven, variable, and mutable. We conclude by raising some methodological issues relating to the use of the usual care in control groups in experimental studies on preoperative education.

Clinical Competence↗

PubMed2004

Midwifery practice and the crisis of modernity: implications for the role of the midwife.

Almost since its inception, the concept of modernity was found to display tensions between its emancipatory potential to liberate the human subject from the manacles of tradition, and the application of reason to co-ordinate and control the natural world through scientific knowledge. This paper presents a qualitative analysis of in-depth interviews with 12 midwives about their role in the Irish maternity services and argues that, in a period of late modernity, these tensions continue to manifest themselves in the context of the midwife's role. Although the contemporary period is marked by a loss of faith in scientific truths, widely contested obstetric knowledge and practices continue to exercise mastery over nature while undermining a central feature of the midwife's role-the liberation of the autonomous subject. Drawing on the theory of communicative action developed by the critical theorist Jürgen Habermas, it is argued that the midwife's role in facilitating the autonomous choices of women through communicative action is impeded by the colonization of the lifeworld of labour and childbirth by the technocratic system of obstetrics. Although participants reported that their role involved empowering women and facilitating choices through dialogue congruent with communicative action, data also suggested that participants used strategic communication with clients aimed at achieving particular ends. The use of strategic communication was linked to the way in which the midwife's role is determined to a large extent by the practices and protocols of obstetrics, and also to the notion of client passivity. The instrumental rationality of obstetrics is linked to an outcome orientation to power and money, and a political economy perspective of medicine. It appears that communicative action between midwives and obstetricians is important in bringing about structural changes to facilitate the conditions for communicative action between midwives and their clients.

Clinical Competence↗

PubMed2002

Staff nurses' perceptions of supernumerary status compared with rostered service for Diploma in Nursing students.

BACKGROUND/RATIONALE: In the Republic of Ireland, the amount of clinical teaching expected of staff nurses has increased substantially in the wake of the transfer of nursing education to universities, and the advent of supernumerary status for students. A modicum of previous research noted that staff nurses are unclear about their role in relation to facilitating the clinical learning of supernumerary students. AIMS OF THE PAPER: To explore staff nurses' perceptions of their role in the facilitation of learning for university-educated diploma students in the clinical area and their attitudes towards these students. DESIGN/METHODS: Sixteen staff nurses were interviewed in depth using semi-structured interviews. Data were analysed qualitatively, using content analysis, with the help of the software package NUD*IST. FINDINGS: Among the central themes to emerge, upon which this article is focused, was participants' perceptions of supernumerary status compared with rostered service for diploma students. Data suggested that the rostered status of students was generally favoured by staff nurses over and above supernumerary status because, unlike supernumerary students, rostered students did not disrupt the existing social structure within the clinical setting. Both structuration theory and role theory are drawn upon to explain the reproduction of the prevailing social structure, where the concentration is on getting through nursing work with little emphasis on the supervised learning of supernumerary students. STUDY LIMITATIONS: This study is constrained by eliciting only the views of staff nurses. Further studies are required of student nurses' experiences of rostered service and supernumerary status. CONCLUSIONS: Because staff nurses are part of the system within which they work, they need to modify their role to include active student teaching as a legitimate component of that role.

Attitude of Health Personnel↗

PubMedDate not supplied

Developments in nursing in Ireland: the emergence of a disciplinary discourse.

This article presents a conceptualization of nursing as it is presently being constructed in Ireland. Official discourses on nursing are explored and the ways in which these discourses have been further shaped through consultation is highlighted. This is further supported by reference to research examining practicing nurses' discourses. There is some evidence to suggest that Irish nurses may be beginning to internalize many of the nursing concepts articulated at an international and national level over the past 20 years. However, barriers to actualization in practice are identified. Emerging discourses in Ireland suggest the conceptualization of nursing as promoting and maintaining health with nurses as coordinators of care who also engage in the development of therapeutic relationships with patients. The interpersonal aspect of nursing is considered central to the nursing role.

Education, Nursing↗

PubMedDate not supplied

Certificate-trained staff nurses' perceptions of the changes in nursing education in Ireland from certificate to diploma level.

Over the past decade, nursing education in Ireland has experienced revolutionary changes, during which the hospital-based apprenticeship certificate model of nurse training was replaced with a college (diploma level) education model. This article reports on a qualitative study that explored traditionally trained staff nurses' perceptions of their role in the facilitation of learning for diploma students in clinical contexts and their attitudes toward such students. A central issue that emerged was participants' perceptions of the diploma program vis-à-vis the traditional apprenticeship training to which they themselves had been exposed. Guided by the strategy of grounded theory, in-depth interviews were conducted with 16 participants, and interview transcripts were analyzed. Three subthemes emerged: feeling the old way was best, confusion and uncertainty, and acceptance of change. These subthemes reflect the finding that although certificate-trained staff nurses thought the traditional apprenticeship model of educating nurses was superior and expressed confusion and uncertainty about the concept of supernumerary status, a sense of acceptance of change also mediated their accounts.

Certification↗