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Biomedical subjects

I J Norman

Publications and source records attributed to I J Norman.

At least 19 recordsLinked to original sources
PubMed2006

Computer-aided vs. tutor-delivered teaching of exposure therapy for phobia/panic: randomized controlled trial with pre-registration nursing students.

BACKGROUND: Exposure therapy is effective for phobic anxiety disorders (specific phobias, agoraphobia, social phobia) and panic disorder. Despite their high prevalence in the community, sufferers often get no treatment or if they do, it is usually after a long delay. This is largely due to the scarcity of healthcare professionals trained in exposure therapy, which is due, in part, to the high cost of training. Traditional teaching methods employed are labour intensive, being based mainly on role-play in small groups with feedback and coaching from experienced trainers. In an attempt to increase knowledge and skills in exposure therapy, there is now some interest in providing relevant teaching as part of pre-registration nurse education. Computers have been developed to teach terminology and simulate clinical scenarios for health professionals, and offer a potentially cost effective alternative to traditional teaching methods. OBJECTIVE: To test whether student nurses would learn about exposure therapy for phobia/panic as well by computer-aided self-instruction as by face-to-face teaching, and to compare the individual and combined effects of two educational methods, traditional face-to-face teaching comprising a presentation with discussion and questions/answers by a specialist cognitive behaviour nurse therapist, and a computer-aided self-instructional programme based on a self-help programme for patients with phobia/panic called FearFighter, on students' knowledge, skills and satisfaction. DESIGN: Randomised controlled trial, with a crossover, completed in 2 consecutive days over a period of 4h per day. PARTICIPANTS: Ninety-two mental health pre-registration nursing students, of mixed gender, age and ethnic origin, with no previous training in cognitive behaviour therapy studying at one UK university. RESULTS: The two teaching methods led to similar improvements in knowledge and skills, and to similar satisfaction, when used alone. Using them in tandem conferred no added benefit. Computer-aided self-instruction was more efficient as it saved teacher preparation and delivery time, and needed no specialist tutor. CONCLUSION: Computer-aided self-instruction saved almost all preparation time and delivery effort for the expert teacher. When added to past results in medical students, the present results in nurses justify the use of computer-aided self-instruction for learning about exposure therapy and phobia/panic and of research into its value for other areas of health education.

Analysis of Variance↗
PubMed2005

An investigation of job satisfaction, organizational commitment and role conflict and ambiguity in a sample of Chinese undergraduate nursing students.

This study aimed to explore the relationships between job satisfaction and organizational commitment, role conflict and ambiguity, and demographic variables associated with retention of nurses within the Chinese healthcare workforce. A hypothetical model derived from a review of research studies investigating relationships between these variables was tested in a cross-sectional questionnaire survey of all the final year nursing students in a medical university in China. Seventy-one out of the total sample of 75 final year nursing students completed the questionnaire, producing a response rate of 95%. Descriptive and inferential statistical analysis of the data revealed a positive relationship between job satisfaction and organizational commitment, and a negative relationship between job satisfaction and role conflict and ambiguity. These results largely support the hypothesised associations between variables found in research studies derived mainly from samples of Western qualified nurses. However, contrary to previous studies, the findings suggest that aspirations to work in a clinical post are associated with high job satisfaction, and degree level student nurses have relatively high job satisfaction. The main implications for nursing education and practice are that educators and clinical mentors should work collaboratively to reduce the gap between theory and practice, specifically to improve the quality of student nurses' clinical experience in China and elsewhere. Positive clinical placement experience is related to high job satisfaction, and so, potentially, to improved retention. Future studies are needed which investigate changes in job satisfaction and other related variables over time, which have student nurse samples that are sufficient to enable the predictive value of these variables on retention in the healthcare workforce to be investigated.

Adult↗
PubMed2001

Putting portfolios in their place.

This paper discusses the use of portfolios in nursing education and sets this in an international context. It argues that the assessment of clinical competence in the practice setting is inherently problematic, as recognized in certain recent policy documents, and evaluates the role that portfolios can play. A number of theoretical approaches to the definition and use of portfolios are discussed, and particular attention is paid to their reliability and validity as assessment tools. The paper concludes by arguing that there is a need for further research into the credibility, reliability and validity of this approach to the assessment of nurses' competence.

Clinical Competence↗
PubMed1998

Clinical leadership in nursing development units.

There is an expectation for Nursing Development Units (NDUs) to explore and develop the clinical leadership role. This paper describes how 28 Department of Health funded NDUs in England sought to meet this objective. We describe the personal and professional characteristics of NDU clinical leaders (CLs) and their perceived responsibilities. We identify 10 elements which appear to be central to the CL role and together form a core role set of the leader which is applicable, to some extent, across clinical specialties and settings. The position of the CL in the organizational hierarchy emerges as crucial to his/her ability to act on these responsibilities and fulfil a leadership role.

Adult↗
PubMed1998

Priorities for mental health and learning disability nurse education in the UK: a case study.

The closure of psychiatric and mental handicap hospitals, the emphasis on community rather than hospital care and the distinction between health and social care for people in the community, with its funding implications, have demanded that mental health and learning disability nurses face the challenges of developing new skills and new ways of working. In this paper the findings of a study funded by the English National Board for Nursing, Midwifery and Health Visiting (ENB) are reported. This study explored the impact of these reforms on nurses and their practice, and identified the educational needs of mental health and learning disability nurses that have changed as a result. The study took a multiple-case study approach and involved interviews with 22 'key informants' and 88 mental health and 59 learning disability stakeholders in six sites, three in each nursing specialty. Inductive analysis of the interview data revealed 20 categories which summarize the major issues facing the two nursing specialties. These categories are discussed under seven themes and issues for nurse education are raised.

Attitude of Health Personnel↗
PubMed1998

The changing emphasis of mental health and learning disability nurse education in the UK and ideal models of its future development.

This paper reports the findings of a research study funded by the English National Board for Nursing, Midwifery and Health Visiting (ENB), which explored the impact of community care reforms on mental health and learning disability nurses and their practice. In this study we were struck by the divergent views of our respondents about the nature of mental health and learning disability nursing as practice disciplines and the implications of these views for the future shape of preregistration educational preparation. We noted, in particular, the debate between those who advocate what is referred to as specialist educational preparation and others who favour generic preparation. The specialist-generic debate is relevant to nursing as a whole but was magnified in the context of our study because genericism was perceived by many of our respondents as a threat to the minority branches and especially to those (arguably mental health and learning disability) that are not rooted in the biomedical tradition of general nursing. This paper seeks to contribute to this debate as it impinges on the two nursing specialties by developing models of future nurse education grounded in the empirical data from our research and interrogating them to draw out their central features. Two models are clearly independent: the 'specialist' and the 'generic' models. Another three models are partial in that they draw upon the first two: the 'pragmatic' model, the 'unity-of-nursing' model, and the 'social care' model. A common feature of the pragmatic and unity-of-nursing models is that they support the existing DipHE programme, which is now the dominant form of preregistration nurse preparation in the UK. The social care model is applicable principally to learning disability nursing.

Community Mental Health Services↗
PubMed1998

Managed mental health care: problems and possibilities.

Case management has become an established organizational approach to mental health care. However, a recent development of case management, known as 'managed care' has received only limited attention in the UK and this has been confined to acute medical or surgical hospital care. The potential of managed care as applied to mental health care is uncertain. This paper clarifies the nature of managed care and discusses its relevance to mental health care, in particular to the care of people suffering from schizophrenia. The high incidence and heavy resource demands of this user group makes these people an ideal focus for managed care. However, there are conceptual and practical problems hindering its development and implementation, including: the variability and unpredictability of the disease process of schizophrenia; challenges of outcome measurement; and problems relating to the current organization of mental health care.

Case Management↗
PubMed1997

Testing a model of absence and intent to stay in employment: a study of registered nurses in Malta.

This study used a cross-sectional, correlational design to test a model of absence and turnover of registered nurses developed from a review of the research literature (Gauci Borda and Norman, 1997). Testing the model involved comparing the relationship between job satisfaction, kinship responsibility, pay, employment opportunity, intent to stay in employment and absence for male and female registered nurses. All registered nurses (n = 254) working in clinical areas on a full-time shift basis, in one large general hospital in Malta were surveyed by questionnaire and their absence data were obtained from the hospital personnel records. A response rate of 67% (n = 171) was achieved. The results showed that nurses were satisfied with their job and intended to stay in their present employment for the next 12 months. Relationships between variables differed between male and female nurses, with job satisfaction being associated with intent to stay for male nurses but not for females and kinship responsibility and intent to stay being associated with absence in female but not male nurses. In contrast to many previous studies of nurses, an association was found between job satisfaction and absence. Several variables, including fear of change, which may influence intent to stay of Maltese nurses, were identified. The proposed model of absence and turnover stood up reasonably well to testing, but the results for the whole sample, and the sub-samples of male and female nurses supported different parts of the model. The main implication for future research is that male and female nurses should be studied separately due to differences found between the two groups.

Absenteeism↗
PubMed1997

Factors influencing turnover and absence of nurses: a research review.

This review of the nursing literature aims to identify the factors with the greatest influence on turnover and absence of qualified nurses, possible common factors influencing both, and the relationship between absence and turnover. A hypothetical model grounded in the literature which depicts the expected relationships between these variables is presented for testing in an empirical study. The review identifies intent to stay in current employment as the variable with the greatest influence on turnover. Intent to stay is in turn most strongly associated with job satisfaction. Other variables are identified by single studies as having an influence on intent to stay, but are not supported by the results of other studies; exceptions are pay, opportunity for alternative employment and kinship responsibility, which are supported by the results of two studies. The relationship between job satisfaction and absence is unclear and requires further investigation. However, job satisfaction is identified as possibly influencing both absence and intent to stay and kinship responsibility is identified as a common antecedent of absence and intent to stay. Similarly, absence is identified as an antecedent to turnover. Thus, it is expected that absence would be positively related to turnover and negatively related to intent to stay. Understanding such relationships should allow identification of management strategies to reduce both turnover and absence.

Absenteeism↗
PubMed1996

The validity of two quality assessment instruments: Monitor and Senior Monitor.

This paper is concerned with validity of Monitor and Senior Monitor. The study carried out, which was funded by the Department of Health, attempted to establish the validity of the instruments through a multiple triangulation research design. Monitor and Senior Monitor were compared to another instrument, Qualpacs, and also to other methods that focused on quality of nursing care--observation of patients' activities and interactions with nurses, and interviews with patients and nurses on their perceptions of quality. The results did not reveal a clear picture. Convergent validity was relatively strong for Senior Monitor and the Monitor DG3 schedule, but not the DG1, DG2 and DG4 schedules, when compared to Qualpacs. The comparison with observation of nurse-patient activities and interactions supported Monitor rather more than Senior Monitor, particularly with respect to frequency of omitted activities. Both instruments showed considerable construct validity in that congruence emerged between their items and the views of patients and nurses on what constitutes quality.

Aged↗
PubMed1996

Clinical audit, related cycles and types of health care quality: a preliminary model.

This paper is drawn from a study carried out in England, funded by the Department of Health. The aims of the study were to explore clinical audit in the four health professions of clinical psychology, occupational therapy, physiotherapy and speech and language therapy and to develop a model of clinical audit and guidelines for use by practitioners and managers. The focus in this paper is the model development. Included are examples of audits relevant to different types of health care quality that illustrate the process of clinical audit using the model. The modelling process involved interrogating the clinical audit cycle and related cycles against the data and identifying their inter-connecting links. The model was refined and reformulated to include guidelines for the professions on what is needed to make clinical audit work. The position of the professional service manager is crucial. A mandate that includes creating machinery at provider unit level, mobilizing the principal working groups and promoting internalization of audit by practitioners, is essential for audit to be effective.

England↗
PubMed1996

A model of clinical supervision for nurses undertaking short placements in mental health care settings.

This paper presents a model of supervision developed from the experience of supervising undergraduate general nursing students undertaking clinical experience in psychiatric wards. Supervision structures and methods are presented and the theoretical under-pinnings of the supervision model are discussed. Our experience of using the model over the past 5 years suggests that it has the potential to allow students to gain a good understanding of individual patients within a short time span and to engage with them as active collaborators in care. The supervision model can also assist students to develop the knowledge and insights needed to gain the respect of senior colleagues, and the confidence to challenge the professional conservatism that often characterizes psychiatric wards.

Clinical Competence↗
PubMed1995

Quality assessment instruments in nursing: towards validation.

The aim of this study was to explore the validity of the nursing quality assessment instruments, Monitor, Senior Monitor and Qualpacs. This follows recommendations in the literature for the need for more comprehensive validation of instruments than has been the case hitherto. A multiple triangulation research design was used which included observation of and interviews with nurses and patients as well as administration of the instruments with the same patients and a questionnaire completed by the nurses in charge on ward organisation and their approach to nursing care. Results reported here focus on our experiences of using the instruments, their inter-rater reliability and comparisons of instrument scores within medical, surgical and elderly care wards. Difficulties were encountered in using the instruments but most of these can be overcome given sufficient time for preliminary discussions. Inter-rater reliability of all three instruments taken as a whole reached acceptable levels, although some of the section score correlation coefficients were low, especially for Qualpacs. Convergent validity was achieved for the Senior Monitor-Qualpacs comparisons in four elderly care wards. The results were less clear for the Monitor-Qualpacs comparisons in seven medical and surgical wards. Explanations for the equivocal results are suggested and subsequent hypotheses were tested which supported these explanations.

Aged↗
PubMed1995

The nurse-doctor relationship: a selective literature review.

The disciplines of nursing and medicine are expected to work in unusually close proximity to one another, not just practising side by side but interacting with one another to achieve a common good: the health and well-being of patients. This selective review of literature addresses some of the issues arising from the frequently controversial subject of the nurse-doctor relationship and seeks to draw out the principal themes emerging from the application of sociological theory to the nurse-doctor relationship and research into its operation in clinical settings. Particular attention is paid to the 'doctor-nurse game', a stereotypical pattern of interaction, first described in the 1960s, in which (female) nurses learn to show initiative and offer advice, while appearing to defer passively to the doctor's authority. This pattern of interaction seems less common in clinical practice today but the problem remains of each profession having ideal expectations of one another which inevitably fall short as a result of differing views of qualities of doctors and nurses to be valued.

Communication↗
PubMed1995

The validity of Qualpacs.

The validity of the quality assessment instrument Qualpacs is discussed. The literature reviewed addresses the sensitivity, scoring and scope of the instrument, operational decisions and cost and policy implications. Specific attention is given to the reliability and validity of Qualpacs and methodological challenges of convergent validity testing. The study, which was funded by the Department of Health, England, employed a multiple triangulation research design to assess the validity of the instrument. Qualpacs was compared to two other instruments (Monitor and Senior Monitor) and to other quality of nursing care data derived from: observation of patients' activities and nurse-patient interaction, and interviews with patients and nurses on their perceptions of quality of care. The results support Qualpacs as a relatively valid instrument in that it displayed greater convergent validity than Monitor or Senior Monitor. Convergent validity was stronger when compared to Senior Monitor and the Monitor DG3 schedule than the other Monitor schedules. Comparison with the observation of nurse and patient activities and interactions supported Qualpacs for medical and surgical wards but not for elderly care wards. Congruence between Qualpacs' items and the views of patients and nurses provides evidence in support of construct validity of the instrument.

Data Collection↗
PubMed1995

Patients' perceptions of the quality of psychiatric nursing care: findings from a small-scale descriptive study.

This study tested a development of the Critical Incident Technique (CIT) (Flanagan, 1954) in a field-study to gather incidents of high- and low-quality nursing care as perceived by 24 patients with mental-health problems in two admission wards of a psychiatric hospital. The development of the CIT used took the form of an interactive, guided interview, developed previously for the same purpose with other groups of patients and their nurses and is discussed in detail elsewhere. This paper describes the results of the study which throws light on patients' perceptions of high- and low-quality nursing care in an acute-care setting. Qualitative analysis of the interviews revealed 239 indicators of high- and low-quality psychiatric nursing care which were grouped into six main categories. Patients' responses indicated the importance attached to the therapeutic functions of the psychiatric nurse, in particular the value placed by patients on nurses being active listeners. Aspects of practice most often identified as of poor quality included nurses' failure to explain their actions, the negative impact of nurses' group behaviour on ward atmosphere, their inadequate knowledge base and the negative consequences of inadequate staffing. The CIT fulfilled its potential as an interactive method of eliciting the views of this patient group of the quality of nursing care.

Adult↗
PubMed1994

Kitson's Therapeutic Nursing Function Indicator as a predictor of the quality of nursing care in hospital wards.

This study examines the value of Kitson's (1991) Therapeutic Nursing Function Indicator (TNFI) as a predictor of the quality of nursing care in hospital wards. The TNFI was updated and modified for use in medical and surgical as well as elderly care wards, and was administered to the sister and deputy of 11 wards. Kitson's Therapeutic Nursing Function Matrix (TNFM), which assesses the quality of self-care activities (more precisely, the level of therapeutic nursing), was administered to patients in the first nine wards and was tested for inter-rater reliability. Acceptable reliability was achieved for identification of activities. However, correlations between activity scores were low, although statistically significant. Scores from the modified TNFI were compared with mean TNFM ward scores to test Kitson's finding that the TNFI is a predictor of the quality of nursing; our results did not support this hypothesis. Differences in the design of our study with Kitson's might be responsible for this result. Our analysis, however, suggests that the TNFI has become out of date because of changes in the organisation of nursing work, and that it is no longer a sensitive predictor of the quality of nursing care.

Activities of Daily Living↗