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PubMedDate not supplied

Toward compassionate action: pragmatism and the inseparability of theory/practice.

Believing that the purpose of knowledge development and practice is compassionate action, in this article, we discuss how pragmatism can help us move toward that goal. Specifically, we show how pragmatic inquiry draws attention to the inseparability of practice/theory and the integral role practice experiences play in the ongoing development of theory. We demonstrate the utility of pragmatism to nursing by describing how we have explicitly approached theory development as a practical (and practice) activity of inquiry to attend to experiences of culture and diversity in family nursing.

Cultural Diversity↗

PubMed1999

Experiences of critical care nurses caring for unresponsive patients.

Grounded theory methodology was utilized to explore the experiences of critical care nurses caring for patients who were unable to respond due to a traumatic brain injury or receiving neuromuscular blocking agents. The registered nurses participating in the study worked in a neuroscience intensive care unit. Saturation of the categories was achieved with 16 interviews. The core category that emerged from the study is Giving the Patient a Chance. The subcategories of Learning about My Patient, Maintaining and Monitoring, Talking to My Patient, Working with Families, Struggling with Dilemmas and Personalizing the Experience all centered upon the focus of doing everything to help the patient attain the best possible outcome. Factors influencing each of the subcategories were identified such as the acuity of the patient, experience level of the nurse and the presence or absence of family members or significant others. These factors accounted for the variations in the nurses' experience. Several reasons accounting for the variations were determined. The study identified areas that need to be addressed in both general nursing education and nursing practice, such as instruction on talking to comatose patients, working with families and orientation information for nurses new to caring for these populations. Recommendations for improvement in these areas, as well as for future studies are discussed.

Adult↗

PubMed2006

Uniaxial and biaxial nematic liquid crystals.

The unusual exhibition of a biaxial nematic phase in nonlinear thermotropic mesogens derived from the 2,5-oxadiazole biphenol (ODBP) core is placed in a general context; the uniaxial nematic phase of the prototypical rod-like mesogen para-quinquephenyl does not follow the classical mean-field behaviour of nematics, thus questioning the utility of such theories for quantitative predictions about biaxial nematics. The nuclear magnetic resonance spectra of labelled probe molecules dissolved in ODBP biaxial nematic phases suggest that a second critical rotation frequency, related to the differences in the transverse diamagnetic susceptibilities of the biaxial nematic, must be exceeded in order to create an aligned two-dimensional powder sample. Efforts to find higher viscosity and lower temperature biaxial nematics (with lower critical rotation rates) to confirm the above conjecture are described. Several chemical modifications of the ODBP mesogenic core are presented.

Journal Article↗

PubMed2001

Neural-network analysis of the vibrational spectra of N-acetyl L-alanyl N'-methyl amide conformational states.

Density-functional theory (DFT) calculations utilizing the Becke 3LYP hybrid functional have been carried out for N-acetyl L-alanine N'-methylamide and examined with respect to the effect of water on the structure, the vibrational frequencies, vibrational absorption (VA), vibrational circular dichroism (VCD), Raman spectra, and Raman optical activity (ROA) intensities. The large changes due to hydration in the structures, and the relative stability of the conformer, reflected in the VA, VCD, Raman spectra, and ROA spectra observed experimentally, are reproduced by the DFT calculations. A neural network has been constructed for reproducing the inverse scattering data (we infer the structural coordinates from spectroscopic data) that the DFT method could produce. The purpose of the network has also been to generate the large set of conformational states associated with each set of spectroscopic data for a given conformer of the molecule by interpolation. Finally the neural network performances are used to monitor a sensitivity analysis of the importance of secondary structures and the influence of the solvent. The neural network is shown to be good in distinguishing the different conformers of the small alanine peptide, especially in the gas phase.

Alanine↗

PubMed2006

Compton scattering study of water versus ice Ih: intra- and intermolecular structure.

The hydrogen-bond geometries in water and polycrystalline ice Ih are studied using synchrotron radiation-based Compton scattering data of unprecedented statistical accuracy and consistency. By combining the experimental data with model calculations utilizing density functional theory, we show that the technique provides unique and complementary information on hydrogen bonding in water. The comparison of water and ice indicates the necessity of including a local intra-intermolecular geometric correlation for water, relating the intramolecular O-H bond length to the corresponding hydrogen-bond geometry. By using the hydrogen-bond geometries obeying this correlation, we demonstrate a further constraint on the angular distortions of the hydrogen bonds in water.

Journal Article↗

PubMed1992

Why doesn't performance pay work?

The NHS is about to embark on the widescale introduction of performance-related pay. A number of recent studies have seriously questioned the efficacy of merit pay. Utilizing the expectancy theory of motivation, explains why performance pay is unlike to motivate NHS staff.

Employee Performance Appraisal↗

PubMed1991

'Not for resuscitation': the student nurses' viewpoint.

A variable proportion of hospital in-patients were deemed 'not for resuscitation'. Using a qualitative methodology, this phenomenon was investigated, placing particular emphasis upon the effect on nursing care. A total of 71 student nurses from two district general hospitals were interviewed and from transcriptions of tape recordings of the interviews, utilizing a grounded theory approach, the following conceptual categories were identified: the patients; decision making; changes in nursing care? are patients and/or their relatives consulted? the unsuccessful resuscitation; the right to die; and dying and death. Up to 40% of patients on medial wards, and up to 100% of patients on geriatric and psychiatric wards, were deemed 'not for resuscitation'. The most junior members of the medical team had the power to make this decision without consultation with the nursing staff, patients or relatives. Nurses spent more time attending to patients 'not for resuscitation', but physiotherapists and medical staff withdrew. Informants felt that subjecting patients to cardiopulmonary resuscitation was incompatible with a dignified death. Senior members of the nursing staff were felt to be unfeeling in dealing with the distress of their juniors when laying out deceased patients. More discussion and joint decision making between health care professionals would alleviate some of the student nurses' distress concerning patients who are 'not for resuscitation'.

Adult↗

PubMed1992

Some determinants that effect patient participation in decision-making about nursing care.

Until recently patients were expected to be the passive recipients of nursing care. This passive role has been changing, and nurses are now being actively encouraged to promote the inclusion of patients in decision-making. However, this stance is being taken with very little empirical evidence to support it, and the evidence that does exist appears to indicate that patients do not always welcome this more active role. A modified grounded theory approach was utilized in order to discover how patients feel about participating in decision-making about nursing care. Eight informants were interviewed informally, 7-10 days following discharge from hospital after undergoing surgical intervention. A state of category saturation was not achieved and the analysis of the data can only tentatively suggest the existence of three 'second order' categories that describe situations that effect patient choice and participation in decision-making about their nursing care. The first category, 'If I am well enough...', describes the states of 'Being too ill' to be involved in decision-making to 'Being well' which allows greater involvement. The second category, 'If I know enough...', describes situations that, first, require technical knowledge, 'Nurse knows best', where patients prefer to take a passive role in decision-making; secondly, less technical matters about which patients require information but still prefer to be passive; and finally an 'I know best' situation where patients prefer to be actively involved in activities of living. The third category, 'If I can...', describes the organizational constraints or freedom that can either restrict or encourage choice and participation in decision-making. Limitations and recommendations that arise from the study are discussed.

Activities of Daily Living↗

PubMed2005

Coping with uncertainty within the preceptorship experience: the perceptions of nursing students.

A substantial amount of time and resources are channelled into supporting clinical practicum in nursing education programmes. Attention is targeted at the most effective models to achieve this aim. The provision of sound support models regardless of specific clinical setting is recognized as integral to student development and transition periods throughout nurses' careers. Within the mental health setting, this situation is compounded by the negative attitudes nursing students tend to hold towards people experiencing a mental illness. Preceptorship has been widely used both nationally and internationally for clinical practicum. Although this model seems to have been endorsed by virtue of its increasing use, additional examination is necessary to assess efficacy and effectiveness across clinical practicum, including those in mental health settings. In utilizing a grounded theory approach, this study addresses the question: what is the experience of preceptorship for undergraduate nursing students in the mental health setting? The major themes identified include: 'fear of the unknown', 'reconciling difference between general acute health and mental health settings' and 'supporting practice'.

Adaptation, Psychological↗

PubMed2005

Attempting to accomplish connectedness within the preceptorship experience: the perceptions of mental health nurses.

The provision of sound support models for clinical practicum is recognized as integral to the development of nursing students and their transition to registered nurses. In mental health settings, there is the additional issue of positively influencing recruitment rates. Preceptorship has been widely adopted nationally and internationally, however, there is a paucity of research, particularly in mental health settings, to assess its effectiveness. The current study utilized a grounded theory approach to explore the experience of preceptorship for mental health nurses. The findings suggest that mental health nurses seek to accomplish connectedness in the preceptorship relationship. A number of factors inhibit the degree of success in achieving this connectedness, including fear of mental health settings, misconceptions about mental illness and organizational constraints.

Adult↗

PubMed1984

Resource theory and power in families: life cycle considerations.

We begin our discussion by outlining the usefulness of "resource theory" as a theoretical framework for the study of family power. This framework is then used to analyze changes in the balance of power between elderly parents and their middle-age children. With respect to intergenerational power relationships, we argue that the autonomy of elderly parents has increased, but their power and influence over adult children has decreased. This trend is likely to continue in coming decades. Resource theory is then utilized to analyze changes in marital power relationships as couples age. Most studies of power relationships between elderly spouses have an important limitation--they tend to reflect yesterday's definitions of male and female roles. Recent changes in these roles may significantly alter the social meanings of aging for both men and women in coming years.

Adolescent↗

PubMed1982

Peribronchial stress analysis utilizing concentric cylindrical shells of parenchyma.

The mechanical dependence of bronchial volume on parenchymal properties and on intrabronchial and pleural pressures was investigated utilizing finite elasticity theory. Treating the lung parenchyma as a compressible continuum, and using a simple strain-energy-density function fitted to pressure-volume curves of saline-filled lungs, we analyzed nonhomogeneous large deformations of the fluid-filled excised dog lobe by numerical procedures. For the purpose of obtaining peribronchial stress distributions, the lung was represented by a hollow very thick-walled cylinder corresponding to an axial bronchus with surrounding parenchyma. Finite elements consisted of concentric cylindrical shells. In general, we found that the theoretical results corresponded well to published stress and strain data for bronchial collapse. Peribronchial radial and circumferential stresses were found to be concentrated at the bronchial wall, but dissipated rapidly with 1-2 bronchial radii away from the wall. We conclude that the magnitude of regional lung recoil around bronchi during collapse can be reasonably well estimated by a theoretical analysis based on total lung pressure-volume relationships.

Airway Resistance↗

PubMed2003

Optical-CT gel-dosimetry I: basic investigations.

Comprehensive verification of the intricate dose distributions associated with advanced radiation treatments is now an immediate and substantial problem. The task is challenging using traditional dosimeters because of restrictions to point measurements (ion chambers, diodes, TLD, etc.) or planar measurements (film). In essence, rapid advances in the technology to deliver radiation treatments have not been paralleled by corresponding advances in the ability to verify these treatments. A potential solution has emerged in the form of water equivalent three dimensional (3D) gel-dosimetry. In this paper we present basic characterization and performance studies of a prototype optical-CT scanning system developed in our laboratory. An analysis of the potential role or scope of gel dosimetry, in relation to other dosimeters, and to verification across the spectrum of therapeutic techniques is also given. The characterization studies enabled the determination of nominal operating conditions for optical-CT scanning. "Finger" phantoms are introduced as a powerful and flexible tool for the investigation of optical-CT performance. The modulation-transfer function (MTF) of the system is determined to be better than 10% out to 1 mm(-1), confirming sub-mm imaging ability. System performance is demonstrated by the acquisition of a 1 x 1 x 1 mm3 dataset through the dose distribution delivered by an x-ray lens that focuses x rays in the energy range 40-80 KeV. This 3D measurement would be extremely difficult to achieve with other dosimetry techniques and highlights some of the strengths of gel dosimetry. Finally, an optical Monte Carlo model is introduced and shown to have potential to model light transport through gel-dosimetry systems, and to provide a tool for the study and optimization of optical-CT gel dosimetry. The model utilizes Mie scattering theory and requires knowledge of the variation of the particle size distribution with dose. The latter was determined here using the technique of dynamic-light-scattering.

Algorithms↗

PubMed2002

Attachment and cancer: a conceptual integration.

Cancer traditionally has been explained by the biomedical model; however, it is limited in comprehensively accounting for all factors in this disease. Recently, it has been suggested that a broader theoretical framework that includes psychosocial components in cancer is needed to complement the traditional approach. The purpose of this article, therefore, is to explore the utility of attachment theory as a biopsychosocial model of both development and health. Attachment, a developmental theory, explains how repeated interactions between caregiver and child in the early years establish lifelong psychosocial, physiological, affective, and cognitive patterns as well as enduring patterns of stress response to threat or illness. Despite attachment theory's biopsychosocial foundation, the application of attachment security as a factor in physical health and psychosomatic medicine is relatively recent. The current work reviews attachment theory and psychosocial literature with regard to cancer and follows with a novel attempt to conceptually integrate both bodies of literature. A concluding integrative model of attachment theory and the type C behavior pattern is provided to illustrate potential links and integrative processes that may lead to disease resilience or vulnerability.

Adaptation, Psychological↗

PubMed2006

Exercise use as complementary therapy among breast and prostate cancer survivors receiving active treatment: examination of exercise intention.

BACKGROUND: Exercise is associated with an improved quality of life among cancer survivors. Previous research has highlighted the utility of the theory of planned behavior in understanding cancer survivors' intention to exercise. The purpose of this study was to extend the research on the theory of planned behavior in relation to exercise intention in breast cancer survivors and to provide preliminary evidence supporting its application with prostate cancer survivors during treatment. METHODS: Participants consisted of 126 breast and 82 prostate cancer survivors receiving active treatment. Participants completed self-administered, mail-in questionnaires that assessed demographic and medical variables, past exercise, and the theory of planned behavior. RESULTS: For breast cancer survivors, the results revealed that attitudes, subjective norm, and perceived behavioral control explained 66% of the variance in exercise intention with the instrumental component of attitude, subjective norm, and perceived behavioral control making significant unique contributions to intention. For prostate cancer survivors, attitudes, subjective norm, and perceived behavioral control explained 57% of the variance in exercise intention, with subjective norm and perceived behavioral control making significant unique contributions to intention. CONCLUSIONS: The results provide further support that the theory of planned behavior is a useful framework for understanding determinants of exercise intention in breast cancer survivors undergoing active treatment and preliminary support for prostate cancer survivors undergoing active treatment. When designing exercise interventions, differences in breast and prostate cancer survivors' exercise intention merit consideration.

Aged↗

PubMed2004

Exercise motivation and adherence in cancer survivors after participation in a randomized controlled trial: an attribution theory perspective.

The purpose of this study was to examine postprogram exercise motivation and adherence in cancer survivors who participated in the Group Psychotherapy and Home-Based Physical Exercise (GROUP-HOPE; Courneya, Friedenreich, Sela, Quinney, & Rhodes, 2002) trial. At the completion of the GROUP-HOPE trial, 46 of 51 (90%) participants in the exercise group completed measures of attribution theory constructs. A 5-week follow-up self-report of exercise was then completed by 30 (65%) participants. Correlational analyses indicated that program exercise, perceived success, expected success, and affective reactions were strong predictors of postprogram exercise. In multivariate stepwise regression analyses, program exercise and perceived success were the strongest predictors of postprogram exercise. Additionally, perceived success was more important than objective success in understanding the attribution process, and it interacted with personal control to influence expected success and negative affect. Finally, postprogram quality of life and changes in physical fitness were correlates of perceived success. We concluded that attribution theory may have utility for understanding postprogram exercise motivation and adherence in cancer survivors.

Adult↗

PubMed1991

An attachment classification of desperate love.

The assessment utility of attachment theory constructs for research and diagnostic purposes is being increasingly explored and demonstrated. This study focuses on the association between desperate love and a modification of Ainsworth, Blehar, Waters, and Wall's (1978) taxonomy of attachment styles, hypothesizing that the experience of desperate love will be positively associated with the dependent and resistant/ambivalent attachment styles with no gender differences. The findings based on multivariate regression analyses generally corroborate the attachment style hypotheses, although with significant gender differences. Discussion focuses on the possible contrasts in the intrapsychic experience of desperate love for men and women as well as indications of causal trends for future research.

Journal Article↗

PubMedDate not supplied

Interpreting problematic behaviour in people with learning disabilities: 2.

The main theme of the first part (Vol 5(8): 546-50) of this two-part article was a focus on understanding the causative factors of problematic behaviour in people with a learning disability. A logical sequence to the identification of causes of problematic behaviours is that interactions to lessen such behaviours are identified. In this article, a discussion on interventions to guide nursing practice is offered. A short list of some interventions which emanate from the identified causes is presented in Table 1 for guidance; these interventions are analogous with many nursing and related theories (Peplau, 1952; Johnson, 1980; Wolfensberger, 1983; Roper et al, 1985; Jenner, 1992; Burford, 1993; Quinn and Mathieson, 1993). It is suggested that there is need for a paradigm shift to take place in the interpretation and understanding of problematic behaviours, and it is further suggested that nursing theories should be utilized within such a paradigm.

Humans↗