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PubMed2002

Spirituality and health: towards a framework for exploring the relationship between spirituality and health.

BACKGROUND: A growing body of evidence has found that spirituality enhances health. However, spirituality is an elusive concept that defies clear definition. This inevitably presents difficulties when comparing the findings of studies. Therefore conceptual clarification is essential if practitioners are to better understand the relationship between spirituality and health. AIMS: The aim of this paper is to develop a conceptual framework, which can be used to explore the relationship between spirituality and health. METHODS: The concept-indicator model was used to analyse spirituality in the literature. The literature was searched for empirical indicators or what are taken as essential attributes of spirituality. Similarities and differences between approaches were identified and these formed the basis of a framework. FINDINGS: The analysis identified three approaches (a trichotomy) to spirituality in the literature. These were termed the transcendent, the value guidance and the structuralist-behaviourist approaches. The paper shows how by clarifying the different conceptualizations of spirituality and the interrelationship between them researchers can also clarify their respective contributions to health. Thus a contribution is made towards making more explicit the ways in which key aspects of spirituality such as transcendence, meaning and purpose, connectedness, hope, and faith, work to produce health benefits in terms of prevention, recovery from illness, or coping with illness. CONCLUSIONS: The framework (or trichotomy) will enable practitioners to understand better the connection between spirituality and health. In particular, it will show that to appreciate the benefits that patients might experience from their value or belief systems, practitioners must actively explore the content of those systems in a respectful way.

Health↗

PubMed2002

Comfort: exploration of the concept in nursing.

BACKGROUND: Comfort is a substantive need throughout life. However, the rise of technological influence coupled with a desire to embrace the medical concept of cure has frequently relegated the importance of nursing comfort interventions to simple tasks that can be provided by non-professional caregivers rather than an integral part of health promotion at all levels. DEFINITION: Comfort is a concept that has been explored by a number of authors. Various definitions have included comfort as an outcome of nursing, a function of nursing, a basic human need, and a process. No consensus on a definition of comfort was found in the literature. THEORY: This investigation attempts to link the ideas of comfort presented in the literature with the theories of Watson (Human Care) and Leininger (Culture Care), and discovers the existence of an integral locus for comfort in both. IMPLICATIONS: Theory-based strategies for nursing education are offered. Further research is clearly required, research methodologies based on Watson and Leininger would be appropriate for additional exploration of this concept. Practice implications include reflecting on the meaning of comfort to the patient in the context of his/her cultural values, and using this one as one of the factors in planning and implementing nursing care. CONCLUSION: Given the current emphasis on health promotion and the importance of comfort to the process of healing, comfort is an indispensable element of holistic, culturally congruent human care.

Cultural Characteristics↗

PubMed2002

Pressure area care: an exploration of Greek nurses' knowledge and practice.

BACKGROUND: Despite a plethora of information on the prevention of pressure sores, they remain a significant problem in both hospital and community settings. The need to reduce the incidence of pressure sores has been well documented; unfortunately there is little evidence to suggest improvement. The reasons for this lack of improvement have been explored, but the picture remains unclear. While some studies have suggested that nurses have the appropriate knowledge to prevent pressure sores developing (but do not use their knowledge), others suggest that nurses' knowledge of preventive strategies is deficient. In Greece, similarly to the United Kingdom (UK), the incidence of pressure sores is high. There is currently no evidence on Greek nurses' knowledge and practice and therefore no baseline on which to build, in terms of improving practice. AIM: The purpose of this study was to explore Greek nurses' knowledge of 'risk factors', 'areas at risk' and 'recommended preventive strategies' in relation to pressure area care. In addition, information was sought on nurses' 'current preventive practice' and any barriers to 'good practice'. RESEARCH METHODS: The study was exploratory and descriptive, adopting a cross-sectional survey approach. The sample was drawn from the population of nurses working in a military hospital near Athens. The data were collected over a 4-week period in June 2000, using a self-completed questionnaire. RESULTS: Although the knowledge-base of many of the nurses was good in relation to 'risk factors' and 'areas at risk', a significant proportion were unaware that methods such as 'massage' and 'donuts' are no longer recommended. This lack of knowledge influenced practice with these methods commonly being used. In relation to barriers to good practice, a significant proportion of nurses reported that they could not access, read or understand research findings. This has obvious implications for the implementation of evidence-based practice. CONCLUSION: The results of this study suggest that the knowledge and practice of participants could be improved. It is of particular concern that methods known to be detrimental were in common use. Finally, there is a need to improve the research skills of Greek nurses in order to provide them with the appropriate knowledge to use research findings.

Adult↗

PubMed1998

Exploring the concept of user involvement in mental health through a participation continuum.

Although recent years have seen an increased emphasis on involving service users in decisions about their care, there has been limited exploration of the theories and ideologies underpinning the concept. This paper identifies two approaches to user involvement, each with implications for the extent to which users can be involved in decisions about their care. The approaches are linked through a 'participation continuum' which is a framework through which the concept of user involvement can be explored, and against which practice can be assessed. The framework must be seen within the context of constraints to user involvement. A more realistic assessment of the extent to which users can be involved in decisions can then be made and the risks of raising unrealistic expectations avoided.

Continuity of Patient Care↗

PubMed1997

Audit: an exploration of two models from outside the health care environment.

Whilst there has been exponential growth in auditing health care services and a proliferation of the instruments involved, there seems to have been less cross-fertilization of audit systems and instruments between health care environments and other environments. This paper identifies and explores two audit systems and instruments outside the health care environment. The objective is to seek to improve the level of common understanding, communication and collaboration amongst those who are interested or involved in audit in any sector of the economy. This exercise offers an opportunity and incentive for cross-fertilization of ideas with respect to audit concepts, systems, instruments, results and experiences. Yet there is a more fundamental question to be considered: why bother with audit? This paper identifies core reasons for performing audit which, although they have been mentioned elsewhere, are worth recalling once again. The two non-health care audit systems and instruments are then identified and explored. On the one hand it is seen that the two audit systems and instruments outside health care have common features with audits in health care. On the other hand, it is also suggested that there are some significant differences in the two audit systems and instruments when compared to health care audits. This paper identifies and discusses similarities and differences. Finally, if we fail to learn from the mixture of experiences and insights of various audit exercises, not only will be doing our professions and our customers a disservice but we will lower the chances of continuous improvement in knowledge and understanding.

Communication↗

PubMed2001

A qualitative study exploring how qualified mental health nurses deal with incidents that conflict with their accountability.

In reviewing the literature on accountability within nursing practice, it became clear that accountability is a complex issue. By using a qualitative new paradigm approach, this study explored how 22 mental health nurses deal with the complex issue of conflict in their accountability within their daily practice, by taking a 'snapshot' of their practice. This was achieved by using written critical incidents as proposed by Flanagan (1954), as this allows the researcher to explore the real clinical situations, as identified by the nurse. Cormack's (1983, 1996) technique for analyses of critical incidents was used. The results identified that these nurses are working in an environment in which they have to deal with aggression, suicide and a lack of support from their line managers, as well as from medical colleagues. The nurses in this study identified the importance of team support; clinical supervision and debriefing as methods which help them deal with issues that affect their accountability, within their practice.

Aggression↗

PubMed2002

A qualitative exploration of treatment decision-making role preference in adult asthma patients.

OBJECTIVES: To explore preferred treatment decision-making roles, and rationales for role preference, and to identify perceived facilitators to and barriers from attaining preferred role. DESIGN: Qualitative design. SETTING AND PARTICIPANTS: One secondary care and four primary care sites in North-west England. Purposive sample of 32 adult asthma patients with varied socio-economic backgrounds and disease severity. METHODS: Tape-recorded focused-conversation style interviews. Interview topic guide derived from the literature. Sort cards employed to provide the focus for exploration of role preferences. RESULTS: Active (n = 7), collaborative (n = 11) and passive (n = 14) decisional role preferences were identified. Respondents cited level of knowledge; trust; duration of condition; severity of condition at the decisional juncture; lifelong nature of asthma; a perception that 'it is my body'; characteristics of the individual and their response to health professionals as influencing role preference. Perceived facilitators and barriers to participation included condition-related knowledge, practical issues (e.g. lack of time during consultation) and clinicians' interpersonal skills. CONCLUSIONS: Most respondents wished to contribute to or feel involved in treatment decision-making, but not necessarily to control it. Some hindrances to participation would be amenable to intervention. The quality of the provider-patient relationship is central to facilitating participation.

Adult↗

PubMed1998

Exploring the precursors of outcome evaluation in Australia: linking structure, process and outcome by peer review.

Reviews of the structure of the health system and the processes that contributed to them were the main forms of evaluation within nursing in Australia during the 1970s and 1980s. The documentation of the end result of care, or outcome evaluation, was rarely undertaken until more recent times. The development and implementation of formal assessment tools such as Qualpacs, the Phaneuf Nursing Audit, the Rush Medicus Nursing Process Methodology, Monitor, and Senior Monitor indicated the focus on structure and process evaluation. This paper examines how nursing care delivered to patients during the l970s and 1980s was evaluated, and explores why structure and process review were necessary precursors to outcome evaluation in the nineties. The necessity of linking structure and process analysis is discussed, in order to perform effective outcome evaluation to close the feedback loop between quality assessment and quality improvement. Peer review is one mechanism that can be used to achieve this. How this may also be a form of evidence-based practice which results in health gains for patients is also explored.

Australia↗

PubMed2001

Explorations of a trust approach for nursing ethics.

Trust has long been acknowledged as central to nurse-patient relationships. It, however, has not been fully explored normatively. That is, trust must be examined from a perspective that encompasses not only reliability and competence, but also good will within nursing relationships. In this paper, we explore how a trust approach, based on Annette Baier's work on trust in feminist ethics, could help inform future developments in nursing ethics. We discuss the limitations of other approaches such as those based on contracts, paternalism, and care. By drawing out central features of Baier's theory, we demonstrate how it can help overcome the problems of these previous models. In doing so, we emphasise the importance of combining the ethics of care and justice, acknowledging vulnerability and the potential for evil in nursing relationships, and politically situating the ethical concerns of nursing.

Authoritarianism↗

PubMed2003

NMDA lesions of Ammon's horn and the dentate gyrus disrupt the direct and temporally paced homing displayed by rats exploring a novel environment: evidence for a role of the hippocampus in dead reckoning.

Dead reckoning, a form of navigation used to locate a present position and to return to a starting position, is used by rats to return to their home base. The present experiment examined whether dead reckoning is displayed by rats during their first exploratory excursions in a novel environment and also examined whether the behaviour requires the integrity of the cells of the hippocampus. Experimental rats, those with NMDA (N-methyl d-aspartate) lesions of Ammon's horn and the dentate gyrus, and control rats could leave a cage to explore a large circular table under light and dark conditions. Home base behaviour, use of olfactory cues, and thigmotaxic- based navigation were evaluated. Temporal, topographical and kinematic analyses were conducted on the first three exploratory excursions that extended at least halfway across the table. Groups did not differ in numbers of exits from the home base, lingering near the home base, distance travelled, or the use of surface cues as might be exemplified by thigmotaxic and olfactory behaviour. Temporal, topographical and kinematic reconstructions of homing behaviour, however, indicated that control rats, but not hippocampal rats, made direct high velocity return trips to the home base in both the light and the dark. Peak velocity of the trips occurred at the trip midpoint, independent of trip distance, suggesting the movements were preplanned. These results are discussed in relation to the ideas that dead reckoning is used in the homing of exploring rats and that this form of navigation involves the hippocampus.

Animals↗

PubMed2003

"Vanished twin": an exploration of women's experiences.

BACKGROUND: Evidence suggests that in identified twin pregnancies 30 percent become a "vanished twin," that is, when two gestation sacs are identified at early ultrasound but subsequently only one fetus is seen. This study explored the thoughts, feelings, and hospital experiences of women who have a vanished twin. METHOD: The study was conducted in a large teaching hospital in northwest England from April to June 2001. The experiences of 9 women were explored through 4 focus groups and an individual interview. Nulliparous and multiparous groups were separated for homogeneity. The study's philosophical approach was based on constructivism, and the thematic analysis used a feminist interpretation to search for patterns of meanings from the women's words. RESULTS: The women wanted to be cared for in a humanistic manner, and they felt that acknowledgement of the vanished twin by the professional was important. The findings highlighted the need for better information giving to improve communication between caregivers and women. Multiparas were more prepared than nulliparas to ask for the attention that they wanted. CONCLUSIONS: Despite the small number of study participants, results suggest that maternity caregivers should be sensitive to the feelings and individual nature of a woman who has experienced a vanished twin. Humanistic approaches to communication and improved methods of information based on the development of an information sheet are advised.

Adult↗

PubMed2003

Exploration of a putative susceptibility locus for idiopathic generalized epilepsy on chromosome 8p12.

PURPOSE: A recent genome-wide scan revealed a major susceptibility locus for idiopathic generalized epilepsies (IGEs) in the chromosomal region 8p12 in 32 IGE families without members with juvenile myoclonic epilepsy (JME). This study explored the presence of an IGE locus in the chromosomal region 8p12. METHODS: Our study included 176 multiplex families of probands with common IGE syndromes. Parametric and nonparametric multipoint linkage analyses were carried out between the IGE trait and six microsatellite polymorphisms encompassing the putative susceptibility locus. To explore the associated phenotype-genotype relation, two distinct subgroups of families were selected by the presence (n = 64) or absence (n = 112) of a family member with JME. To adjust the phenotypic spectrum toward adolescent-onset IGEs, a third subgroup of 28 families without JME was chosen through an IGE proband with seizure onset at age 10-20 years. RESULTS: Parametric and nonparametric multipoint linkage analyses provided no evidence for linkage between IGE and markers encompassing the putative IGE locus in the chromosomal region 8p12. Furthermore, we found no hint of linkage along the candidate region in any of the three family subgroups. CONCLUSIONS: We failed to provide evidence for a major IGE locus in the chromosomal region 8p12. On the contrary, these parametric linkage results provide strong evidence against linkage across the candidate region under a broad range of genetic models. If there is a susceptibility locus for IGE in the chromosomal region 8p12, then the size of the effect or the proportion of linked families is too small to detect linkage in the investigated family sample.

Adult↗

PubMed2004

Exploration of multilocus effects in a highly polymorphic gene, the apolipoprotein (APOB) gene, in relation to plasma apoB levels.

A detailed exploration of all the polymorphisms in candidate genes is required to better characterize the relationship between gene variability and complex traits. We propose a novel strategy for investigating the association between a highly polymorphic gene and a phenotype, by combining a multilocus genotype analysis and an haplotype analysis. For the multilocus genotype analysis, a data mining tool--termed DICE (Detection of Informative Combined Effects)--was developed to identify the best subset of polymorphisms that are associated--individually or in combination--with the phenotype. For the haplotype analysis, we used our recently developed method of haplotype-phenotype association to determine the most informative and parsimonious haplotype model fitting the data. We illustrate this strategy by investigating the association between twelve polymorphisms of the APOB gene and plasma apoB levels in 1442 European subjects. After exploring all main effects and interactions between polymorphisms, DICE identified the N4311S polymorphism as the most informative polymorphism in relation to apoB levels. Haplotype analysis led to the same conclusion. Additionally, DICE identified the E4154K (EcoRI) and the T2488T (XbaI) polymorphisms as potentially interesting. This selection was not modified by inclusion of the common APOE polymorphism in the analysis.

Adult↗

PubMed2004

Adaptive combinatorial design to explore large experimental spaces: approach and validation.

Systems biology requires mathematical tools not only to analyse large genomic datasets, but also to explore large experimental spaces in a systematic yet economical way. We demonstrate that two-factor combinatorial design (CD), shown to be useful in software testing, can be used to design a small set of experiments that would allow biologists to explore larger experimental spaces. Further, the results of an initial set of experiments can be used to seed further 'Adaptive' CD experimental designs. As a proof of principle, we demonstrate the usefulness of this Adaptive CD approach by analysing data from the effects of six binary inputs on the regulation of genes in the N-assimilation pathway of Arabidopsis. This CD approach identified the more important regulatory signals previously discovered by traditional experiments using far fewer experiments, and also identified examples of input interactions previously unknown. Tests using simulated data show that Adaptive CD suffers from fewer false positives than traditional experimental designs in determining decisive inputs, and succeeds far more often than traditional or random experimental designs in determining when genes are regulated by input interactions. We conclude that Adaptive CD offers an economical framework for discovering dominant inputs and interactions that affect different aspects of genomic outputs and organismal responses.

Adaptation, Physiological↗

PubMed2002

Assessing functional status: exploring the relationship between the multiple sclerosis functional composite and driving.

OBJECTIVE: To explore the relationship between the Multiple Sclerosis Functional Composite (MSFC), which is comprised of 3 clinical dimensions (arm and hand function, leg function and ambulation, cognition), and an everyday functional skill, driving performance. DESIGN: Cohort study. SETTING: Medical rehabilitation research organization. PARTICIPANTS: Twenty-nine individuals with documented multiple sclerosis (MS) and limited motor decrements. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Driving-related skills were measured by using the overall category rating from the Useful Field of View (UFOV) Test, its 3 subtests, the error and latency scores from the Neurocognitive Driving Test (NDT), subjective (self-report) and objective (Department of Motor Vehicles [DMV] reports) reported driving experience, and number of motor vehicle crashes. Within the group, differences were explored between participants rated as low risk versus moderate-high risk on the UFOV overall score and between participants who reported a change in driving habits after MS versus those who reported no change. RESULTS: The overall MSFC score correlated significantly with the UFOV overall score, the visual-information processing and selective attention subtests of the UFOV, the NDT latency score, as well as with the number of days a week the individual drove and the number of crashes reported by the DMV. An examination of the MSFC components revealed that the cognition component was significantly related to the UFOV overall score, all 3 subtests of the UFOV, and the NDT latency score. The arm and hand function component correlated significantly with NDT latency and the selective attention subtest of the UFOV. Individuals classified as low risk on the UFOV overall had more education, better MSFC scores, and lower NDT latency scores. Only the overall MSFC score distinguished those who reported a change in driving habits after onset of MS. CONCLUSIONS: Problems with everyday functional skills such as driving are accurately identified through the use of the overall MSFC and its components.

Adult↗

PubMed2000

Selective laparoscopic probing for a contralateral patent processus vaginalis reduces the need for contralateral exploration in inconclusive cases.

BACKGROUND/PURPOSE: Repair of an indirect inguinal hernia is the most common procedure performed by pediatric surgeons, yet the need for contralateral exploration remains controversial. This prospective study evaluated the use of laparoscopy combined with the selective use of probing to determine the presence or absence of a contralateral patent processus vaginalis (CPPV). METHODS: A consecutive series of 75 of the author's patients presenting with a unilateral inguinal hernia were studied. Laparoscopy was performed through the known hernia sac with CO2 insufflation utilizing a 4-mm 70 degrees telescope to inspect the contralateral inguinal region. A patent processus was diagnosed when an obvious opening through the internal ring was identified. In some patients this evaluation was found to be inconclusive because of the inability to determine accurately the length of the patent processus or to rule out a patent processus obscured by a veil of peritoneum. This group of patients was then evaluated selectively with a silver probe placed under direct vision through a 14-gauge intravenous catheter placed through the abdominal wall on the side in question to manipulate the peritoneum and directly measure the length of the potentially patent processus. A patent processus greater then 1.5 cm was considered positive. RESULTS: A total of 54 patients (72%) had a conclusive laparoscopic evaluation of the contralateral inguinal region with a CPPV clearly absent in 38 and an obvious CPPV present in 16. A total of 21 patients (28%) had inconclusive laparoscopy finding and were evaluated further with probing. The probing technique changed the determination of a CPPV in 15 patients (12 positive to negative and 3 negative to positive; P = .029, Fisher's Exact test). Probing resulted in a decrease in the overall rate of identification of a CPPV from 45% to 32%. CONCLUSION: In inconclusive cases, the addition of selective probing to the laparoscopic evaluation for a CPPV reduces the number of patent processus vaginalis found and the need for contralateral inguinal exploration.

Female↗

PubMed2002

Mature teratoma arising in intraabdominal undescended testis in an infant with previous inguinal exploration: case report and review of intraabdominal testicular tumors in children.

The authors report the youngest case of postoperative intraabdominal mature testicular teratoma in a 5-year-old boy after previous exploration for impalpable testis. A total of 26 cases of intraabdominal testicular tumor in children including our case were reviewed and discussed from both the English- and the Japanese-language literature. The average age was 2.5 years, and, in the 13 children younger than 1 year there were no malignant teratomas, although there was one immature teratoma. Four of these had undergone previous inguinal exploration in which 3 patients except our patient were more than 10 years old. This case report confirms the importance of finding an intraabdominal testis at operation for impalpable testis. Early detection of the testicular location near the internal inguinal ring in these patients supports the hypothesis that the intraabdominal testicular teratoma itself may have been the primary cause of the undescended testis. Furthermore, it is suspected that many of the intraabdominal testicular malignant teratomas in adults may have arisen from these mature testicular teratomas in infants.

Child, Preschool↗

PubMed1996

Elective Laparoscopic Splenectomy: Person Experience and Literature Review.

Laparoscopic splenectomy has become an attractive treatment for patients with selected hematologic disorders. Almost 200 observations have been reported. The rate of conversion to laparotomy is 10% to 15%, and the complication rate is between 0% and 30%. Adequate selection of patients, preoperative administration of intravenous immunoglobulin in patients with idiopathic thrombocytopenic purpura, meticulous surgical techniques, and careful preoperative and intraoperative search for accessory spleen are critical factors for success in these patients. The procedure should be confined to expert laparoscopic surgeons with considerable experience in the management of hematologic diseases.

Journal Article↗