Biomedical subjects

D Arthur

Publications and source records attributed to D Arthur.

At least 19 recordsLinked to original sources

PubMed2001

The effect of technology on the caring attributes of an international sample of nurses.

This paper commences by refining the psychometric characteristics of a quantitative instrument, which was developed to examine the caring attributes of an international sample of 1957 nurses working in 11 countries. Using factor analysis to support the construct validity, and removing weak items, the original 60 caring items were reduced to a 31 item global caring scale which revealed the sub-scales: 'caring communication'; 'caring involvement'; 'caring advocacy'; and 'learning to care'. The sub-scales were internally consistent and revealed generally high correlation coefficients. The subjects also responded to a scale, which was designed to measure degree of technological influence and provide a score for each respondent to reflect how highly they were influenced by technology in the work units of their hospital. The sample was then divided into three equal groups to reflect high, medium and low technological influence. The caring attribute scores then became the dependent variable by which the degree of technology was compared. The group with the lowest technological influence recorded the lowest mean score for caring while the group with the highest technological influence recorded the highest mean score for caring. A significant difference between the group with lowest and highest technological influence (F=6.84, p<0.001) was noted. This also applied to the 'caring communication' and 'caring involvement' sub-scales. For 'caring advocacy' the lowest technology group recorded the highest caring mean which was found to be significantly different to both mean scores for medium and highest technology groups (F=7.15, p<0.001). These results are discussed in the light of the international sample and suggestions for future research are raised.

Attitude of Health Personnel↗

PubMed2001

Nursing competencies: personal characteristics contributing to effective nursing performance.

AIMS OF THE STUDY: Core competencies are important in enabling an individual to adapt to new environments and perform superior professional practice. This study was to identify the underlying competencies which contributed to effective nursing performance. BACKGROUND: Most of the previous competencies are either derived from researchers' conceptual analysis or based on practitioners' direct report. Competencies derived from these methods either are subject to bias or are unable to identify the essential elements for effective nursing care. METHOD: Following the McBer method, 50 experienced nurses in China were asked to report 82 valid critical incidents in their jobs. Two individuals coded the scripts and decided the presence of each competency according to a pre-established coding system. RESULTS: Ten competencies including interpersonal understanding, commitment, information gathering, etc. were identified. Each competency was illustrated by behavioural indicators. CONCLUSIONS: Skills, traits, motives and attitudes all contribute to effective nursing performance. The findings assist in the delineation and development of nursing competencies and thus provide realistic working behaviours for nursing education and management.

Adult↗

PubMed2001

Symptom frequency and severity in patients with metastatic or locally recurrent lung cancer: a prospective study using the Lung Cancer Symptom Scale in a community hospital.

PURPOSE: To define symptoms and therapeutic requirements for patients with metastatic or locally recurrent lung cancer. METHODS AND MATERIALS: Data were collected from 69 consecutive patients with locally advanced lung cancer seen in consultation at a radiation oncology facility serving a community hospital in Virginia. The Lung Cancer Symptom Scale, a validated quality of life instrument, measured the incidence of symptoms in this group. RESULTS: Average survival for the entire group was 7 months. Fifty-seven patients received 81 courses of radiation therapy, 33 directed at thoracic disease and 48 delivered to sites of metastasis. Thirty-three percent of those who received radiation therapy required treatment to more than one anatomic site. Every patient was symptomatic at the time of consultation, with the number (p = 0.001) and severity (p = 0.001) of symptoms they suffered worse in the patient group seen 0 to 3 months prior to death rather than 4 to 6 months prior to death. With the exception of cough, symptoms were marked in their severity. CONCLUSIONS: Patients with advanced lung cancer suffer frequent and severe symptoms that worsen in the final months of life. The appropriate timing and combination of radiotherapy and chemotherapy are yet to be resolved. Future studies will require use of validated quality of life instruments to better catalogue palliation and treatment toxicity.

Aged↗

PubMed2001

Long-term local control and survival after concomitant boost accelerated radiotherapy for locally advanced cervix cancer.

Between 1989 and 1994, a prospective clinical trial tested the safety and efficacy of concomitant boost accelerated superfractionated (CBASF) radiotherapy for patients with locally advanced cervix cancer. CBASF radiotherapy included 45 Gy/25 fractions to the pelvis and a 14.4 Gy/9 fraction concomitant boost to the primary tumor, followed by brachytherapy for a total point A dose of 85 Gy to 90 Gy. The 22 patients of International Federation of Gynecology and Obstetrics stages IIIA-IVA who received CBASF radiotherapy now have a median follow-up time of more than 8 years. The 7-year actuarial rates of local control and overall survival are 81% and 36%, respectively. Serious late toxicity included bowel injury requiring colostomy in eight patients within 2.5 years after treatment, but no other severe toxicity was observed after longer follow-up intervals. The local control and survival rates achieved with CBASF radiotherapy were higher than those observed within a matched contemporaneous cohort of patients treated with standard radiotherapy alone at the same institution (p = 0.1 for local control, 0.09 for survival). The encouraging trend toward improved tumor control, tempered by the complication rate, suggests an opportunity to apply more sophisticated radiotherapy techniques that might sustain the favorable effects of dose intensification while mitigating the normal tissue toxicity.

Adult↗

PubMed2001

The effects of the problem-based Alcohol Early-Intervention Education Package on the knowledge and attitudes of students of nursing.

The profession of nursing is seeking to establish its unique professional identity by developing discipline-focused research and clinical practice supported by university education. However, according to refereed literature, educating undergraduate nurses in alcohol-related problems is lacking. The literature reveals that nurses in general lack the necessary knowledge, attitudes, and skills to work with problem drinkers. Alcohol early intervention is advocated as a strategy compatible with contemporary nursing practice. This paper reports a study that commenced with the development of a problem-based, five-week Alcohol Early Intervention Education Package (AEIEP). This package became an intervention around which the knowledge and attitudes of a sample of 212 students of nursing were evaluated. A comprehensive instrument was developed to measure the respondent's knowledge and attitude regarding alcohol-related problems in general and specifically in early intervention. The effects of the education intervention on the different strata of students, were examined in a quasi-experimental, pre-post test design. The findings demonstrated it had a significant effect on the knowledge and attitudes of students enrolled in an integrated bachelor of nursing curriculum.

Adult↗

PubMed2000

The alcohol use disorders identification test (AUDIT): validation of an instrument for enhancing nursing practice in Hong Kong.

This paper describes the psychometric analysis of the alcohol use disorders identification test (AUDIT) after it was modified for use in Hong Kong and administered to examine the patterns of hazardous and harmful drinking. The modified version of AUDIT was an 18-item instrument in which 10 items were completely adopted from the original version and 8 items were added to improve its cultural sensitivity. It was translated into Chinese and back translation was undertaken to confirm the equivalence of the Chinese and English versions. Following a pilot study the instrument was administered to 450 subjects who were recruited from two acute general hospitals, a University Health Clinic and three community health centres. The content validity was judged as adequate by a panel of five international and local experts and the instrument achieved a high reliability coefficient of 0.99 during a test-retest procedure conducted with 20 subjects. Factor analysis was performed on the responses obtained from 450 subjects which supported the construct validity of the 18-item instrument. The modified instrument had a consistently high internal consistency reliability (Cronbach's alpha=0.96-0.97) when tested in the different settings. It was found that a higher percentage of respondents from the hospitals (14.5%) drank at a hazardous or harmful levels compared to those from the community (6.2%) or the University (5.3%). The AUDIT proved a reliable and valid measure with potential applications in Chinese cultures. Early intervention and identification of 'at risk' drinking by the AUDIT is supported as a strategy to be implemented by nurses in primary and secondary health care settings in Hong Kong, where there are indications of increasing alcohol overuse.

Adolescent↗

PubMed2000

The effects of the 'learning by proposing to do' approach on Hong Kong nursing students' research orientation, attitude toward research, knowledge, and research skill.

The knowledge, attitudes, research orientation and skills of a group of Hong Kong Registered Nurses studying a BSc(Hons) Nursing course were evaluated using a quantitative instrument developed specifically for this purpose. The objectives of the study were to develop and examine the reliability and validity of the instrument and to evaluate the effects of a Research Methodology subject which focused on learning by 'proposing to do'. The instrument was administered to 72 participants at the beginning of the research subject, and 14 weeks later at the end of the subject. There was a statistically significant increase in the means for the knowledge, research orientation and skills sections of the instrument between pre- and post-testing. The instrument proved reliable as a measure of the research constructs and offers opportunities for future comparative research studies.

Adult↗

PubMed1999

Caring attributes, professional self concept and technological influences in a sample of Registered Nurses in eleven countries.

Caring, the theoretical foundation of nursing, is identified as one of the core values by Hospital Authorities world-wide to be actualised in clinical practice. Exactly how caring attributes relate to nurses' professional self image and quality nursing service in the context of a contemporary technological environment have yet to be operationalised. In total, 1957 Registered Nurses from 11 different countries were involved in the study which aimed to: develop an understanding of and compare the responses to items relating to caring, professional self concept and technological influences. To collect data an instrument containing 104 Likert items was administered to RNs working in general hospitals. The instrument contained sections which examined professional self concept, technological influences and caring attributes. Descriptive and inferential statistics revealed that many of the Asian nurses in the sample were younger, had less experience yet were more qualified than their 'western' colleagues. The mean scores for the caring attributes for nurses from the Philippines, Sweden and South Africa were significantly higher than those from China (Beijing), Korea, China (Hong Kong) and Scotland. The Korean sample demonstrated the lowest mean score for professional self concept while the New Zealand sample the highest. The Australian, Canadian, NZ, Scotland and Swedish samples were strongly of the opinion that the increase in technology has not brought about the any more spare time in nursing and generally had a more negative opinion about the influence of technology when compared to those from China (Beijing), Philippines, China (Hong Kong) and Singapore. The results are discussed in the light of the cultural differences in the sample and recommendations for future research are considered.

Adult↗

PubMed1999

Assessing nursing students' basic communication and interviewing skills: the development and testing of a rating scale.

This study explores the communication skills of a group of nursing students who were required to interview a simulated client as part of their studies. In order to assess the students and to improve the process of learning discrete skills, an instrument was developed and tested as part of this process. The subjects were 212 nurses enrolled in a bachelor of nursing programme, in New South Wales, Australia, who were studying a problem-based learning package the focus of which was 'alcohol early intervention'. The sub-groups within the sample included registered nurses, a significant percentage of whom had completed their basic nursing education in overseas countries. The Simulated Client Interview Rating Scale (SCIRS) was developed to assess basic humanistic communication skills as well as beginning motivational interviewing skills. The students were required to interview a simulated client and demonstrate competence in interviewing. This was assessed by the SCIRS which was completed by the students and the simulated clients. The instrument proved to be a reliable and valid means of assessing student interview technique as well as a flexible educational tool, while valuable insights into students' interviewing techniques were gained.

Alcoholism↗

PubMed1999

Therapeutic communication strategies used by Hong Kong mental health nurses with their Chinese clients.

Therapeutic communication is central to mental health nursing and through this process nurse-client relationships can be enhanced. In Hong Kong, mental health nurses are educated in 'western' theories and strategies in using therapeutic communication and the field of communication is predominantly Eurocentric. However, the majority of people in Hong Kong are Chinese and little research has been conducted into how Hong Kong nurses communicate with their Chinese clients. This qualitative study focused on identifying the therapeutic communication strategies used by mental health nurses with Chinese clients in Hong Kong. Three case study vignettes with some of the characteristics of Chinese culture were developed to elicit information about the strategies that respondents used in therapeutic communication. The purposive sample of 20 comprised 10 admission ward nurses and 10 community nurses from two psychiatric hospitals. All participants had at least five years post-registration experience. Content analysis revealed categories of communication and theme clusters for the nurses' response to the vignettes. The result showed a unique cultural influence emerged in communication patterns. In view of the scant nature of existing literature and studies in this area, this research provided some valuable data for further studies. Implications for mental health nursing education and practice in Hong Kong are raised, as are implications for nurses working in multicultural countries such as Australia, the UK and the USA, where there are significant numbers of Chinese clients who would benefit from nurses practising with a deeper understanding of communication strategies which are culturally bound.

Adult↗

PubMed1999

A report of the development of a Chinese and British education initiative.

A significant event in the development of psychiatric and mental health nursing in China was conducted at An Ding Hospital, Beijing from May 5th to 9th 1999. The Peking Union Medical College, School of Nursing and An Ding Psychiatric Hospital hosted a series of workshops, conducted by Professor Philip Burnard (University of Wales), Dr David Arthur (Hong Kong Polytechnic University) and Madam Wang Zhiying (Director of the Nursing Department An Ding Hospital) for approximately 100 nurses from various regions of China.

China↗

PubMed1999

Secondary leukemia or myelodysplastic syndrome after treatment with epipodophyllotoxins.

PURPOSE: The incidence of secondary leukemia after epipodophyllotoxin treatment and the relationship between epipodophyllotoxin cumulative dose and risk are not well characterized. The Cancer Therapy Evaluation Program (CTEP) of the National Cancer Institute (NCI) has developed a monitoring plan to obtain reliable estimates of the risk of secondary leukemia after epipodophyllotoxin treatment. METHODS: Twelve NCI-supported cooperative group clinical trials were identified that use epipodophyllotoxins at low (<1.5 g/m2 etoposide), moderate (1.5 to 2.99 g/m2 etoposide), or higher (> or =3.0 g/m2 etoposide) cumulative doses. Cases of secondary leukemia (including treatment-related myelodysplastic syndrome) occurring on these trials have been reported to CTEP, as has duration of follow-up for all patients, thereby allowing calculation of cumulative 6-year incidence rates of secondary leukemia for each etoposide dose group. RESULTS: The calculated cumulative 6-year risks for development of secondary leukemia for the low, moderate, and higher cumulative dose groups were 3.3%, (95% upper confidence bound of 5.9%), 0.7% (95% upper confidence bound of 1.6%), and 2.2%, (95% upper confidence bound of 4.6%), respectively. CONCLUSION: Within the context of the epipodophyllotoxin cumulative dose range and schedules of administration encompassed by the monitoring plan regimens, and within the context of multiagent chemotherapy regimens that include alkylating agents, doxorubicin, and other agents, factors other than epipodophyllotoxin cumulative dose seem to be of primary importance in determining the risk of secondary leukemia. Data obtained by the CTEP secondary leukemia monitoring plan support the relative safety of using epipodophyllotoxins according to the therapeutic plans outlined in the monitored protocols.

Adolescent↗

PubMed1998

Professional self-concept of nurses: a comparative study of four strata of nursing students in a Canadian university.

This study represents an effort to refine our understanding of measurement of professional self-concept by testing a tool across various strata of nursing students. The Professional Self Concept of Nurses Instrument, developed in studies of Australian nursing students, was applied to samples of basic undergraduate, post-basic and graduate students in a Canadian university nursing programme. The findings suggest that the tool is sensitive to the predictable development of professional self-concept as students advance through professional education, especially in the dimensions of professional practice and satisfaction. The authors propose that the instrument may have specific applications in evaluating the effects of traditional and innovative educational strategies upon the evolution of professional self-concept in nurses.

Analysis of Variance↗

PubMed1998

The professional self concept of Korean hospital nurses.

From a background of strong North American influence in a country with deeply embedded customs, a collaborative study was initiated to examine and communicate to the international nursing community some of the characteristics and features of Korean nurses. Seven hundred Korean hospital nurses were administered an instrument aimed at examining their professional self concept, their self esteem and related demographic variables. Older, married graduates and those with more than 12 years nursing experience reported a higher professional self concept than their younger, unmarried, diploma and less experienced colleagues. Of concern was the small number (6%) of graduates who were over 35 years of age and who had worked for over 12 years. Useful information for clinicians, educators and nurse administrators is provided and useful data for future research to compare nursing samples, is offered. The instruments used in the study proved reliable and useful as a measure for examining the self-esteem and professional self concept of nurses.

Adult↗

PubMed1998

Alcohol-related problems: a critical review of the literature and directions in nurse education.

It is generally accepted the around 2-5% of the adult population show major signs of alcohol dependence, that alcohol-related harm is experienced by up to 20% of the population, and that approximately 60% drink at risk-free levels. Further prevalence studies show that there are high numbers of problem drinkers who attend general hospital services for reasons other than their alcohol consumption. Nurses are in constant contact with patients who may have an early problem with alcohol but who are admitted for other reasons, and they are in a prime position to comprehensively assess patients (including alcohol screening), develop rapport and provide 'counselling'. Also, university nursing education is propelling nurses toward adoption of independent discipline focused models of care which are increasingly becoming independent of the medical model. Recent trends in the management of problem drinkers suggest that controlled drinking approaches may well offer treatment options to nurses that the traditional abstinence approaches did not. This paper presents a brief overview of the notion of controlled drinking, then critically reviews the nursing research studies and the descriptive literature providing direction for nursing education. Some recent clinical initiatives are discussed which highlight the flaws existing in nursing education, including lack of sufficient curriculum hours and the need for better designed education models and strategies.

Adult↗

PubMed1998

Process consent: a model for enhancing informed consent in mental health nursing.

Informed consent, essentially a legal doctrine, is designed to protect the rights of patients. However, in an area of practice such as psychiatry, informed consent imposes many problems if one considers it to be a static process. In this paper we propose that process consent, the type of consent considered essential in qualitative research projects, is not only appropriate but necessary for mental health nursing practice. This type of consent is an ongoing consensual process that involves the nurse and patient in mutual decision making and ensures that the patient is kept informed at all stages of the treatment process. We have used neuroleptic medications as an example throughout the paper and have suggested that seeking informed consent should be added to the role of the nurse in the mental health setting.

Disclosure↗

PubMed1998

Caring in context: caring practices in a sample of Hong Kong nurses.

In an effort to place the international literature and research in nursing in a Chinese cultural context a study was commenced to examine the caring practices of nurses in Hong Kong. In view of a recent study (Wilkes & Wallis, 1993) which utilised Roach's 5Cs of caring (Roach, 1987, 1992), a pilot study was commenced on a sample of 77 Hong Kong Registered Nurses studying a Diploma of Nursing. An open ended questionnaire was designed which asked nurses to respond to questions about caring in general and the 5Cs: compassion, competence, confidence, conscience and commitment. The questions asked what each of the concepts meant to them as a nurse. Data was analysed into themes based on key words for each of the six areas revealing that the sample of Hong Kong nurses viewed caring in a similar light to those in overseas studies. The sample highlighted compassion and competence as their major features and it is suggested that methodological problems may have inhibited a deeper analysis of their caring attributes and behaviours. When asked to expand on the 5 Cs in terms of their own practice they were able to supply themes which were closely related to Roach's definitions but which may have been more 'textbook' in their origin and certainly lacked a richness of response. The paucity of responses in terms of clarity and richness of data, followed by discussions with the participants led to conclusions about the methodological issues of cross-cultural research and recommendations for future research are made. Highlighted are the problems with attempting to use concepts such as the 5 Cs across cultures and the problems encountered with translation of concepts related to caring from Chinese into English, and vice-versa. The study has provided some insights into the concepts of caring in Hong Kong Chinese nurses. In the light of advances in China and unification of previously separate countries these findings provide and offer insights into nursing in China and are encouraging for future research.

Clinical Competence↗

PubMed1997

A pilot study of concomitant boost accelerated superfractionated radiotherapy for stage III cancer of the uterine cervix.

PURPOSE: Retrospective studies suggest that prolonged treatment time adversely affects control rates of squamous carcinomas managed by radiotherapy. From 1989 to 1994 a prospective clinical trial was conducted to assess the feasibility and efficacy of concomitant boost accelerated superfractionated (CBASF) radiotherapy for advanced uterine cervical carcinoma. METHODS AND MATERIALS: Twenty newly diagnosed patients with FIGO stage III squamous cell carcinoma of the cervix were irradiated using a CBASF regimen. Patients received 45 Gy administered to the whole pelvis in 25 fractions in 5 weeks. On Monday, Wednesday, and Friday of the last 3 weeks, an additional 1.6 Gy boost was given 6 hours after the whole pelvis treatment. The 9 boost treatments, totaling 14.4 Gy, were given via lateral fields encompassing the parametria and primary tumor for a cumulative tumor dose of 59.4 Gy. A single low-dose rate brachytherapy procedure was performed within 1 week after the external beam radiotherapy to raise the point A dose to 85-90 Gy in 42 days. Primary endpoints of analysis were local control, complications, and patterns of failure. Results are compared with the outcomes of 21 patients treated with conventionally fractionated (CF) radiotherapy during the same years. RESULTS: Median total treatment time was 46 days in the CBASF group (range 37-62). Median follow-up interval among surviving CBASF patients is 3.8 years. The four-year actuarial local control rates are 78% and 70% in the CBASF and CF groups, respectively (p = ns). Only 2 CBASF patients required a treatment break because of acute toxicity, but severe late complications occurred in 8/20 CBASF patients for a crude rate of 40%. Distant failure was more common than local failure in the CBASF group, and para-aortic node failure occurred in six of the eight CBASF patients with distant failure. CONCLUSIONS: In the management of stage III cervix cancer, the CBASF regimen produced a trend toward improved local control when compared with the CF regimen, shifting the patterns of failure toward a higher rate of isolated distant failures. The high frequency of para-aortic node failure warrants consideration of elective treatment to this region in stage III patients treated with curative intent. Although the high local control rate of the CBASF regimen supports further investigation of accelerated treatment regimens for locally advanced cervix cancer, the unacceptable risk of late complications necessitates refinement in technique and scheduling to improve the therapeutic ratio.

Adult↗