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This article develops a theoretical discussion related to the value of a phenomenological framework in contributing to contemporary nursing knowledge. Nursing is based on the understanding of patients' personal experiences and their responses to their illness. Phenomenological methodology utilizes the patient's own language to reflect meanings embedded in their health experience.
Nurse managers face many issues that concern withholding and withdrawing life-sustaining therapy in acute care. The author offers a framework for clinical decision making, an overview of the legal and ethical principles involved, and strategies to enrich communication between patients, families, and the health care team.
Literature on clinical judgment is discussed as a background for proposing an integrated model of diagnostic-therapeutic and ethical reasoning. Information processing and nursing process components related to problem identification and problem solving serve as a framework for the integration of the two domains of clinical reasoning. Discussion focuses on the integration of process components, identification of areas of research, and the use of the model in education and practice.
AIMS: To discuss the results of the evaluation, assessment and effectiveness of the trust-wide clinical practice development of a preceptorship programme for newly qualified nurses at Salford Royal Hospitals NHS Trust. To apply the European Foundation for Quality Management (EFQM) model as a tool for monitoring and assessing the performance of the programme. BACKGROUND: Newly qualified nurses need support and preparation for their working role in their first recruitment. A preceptorship programme, developed around a quality-monitoring framework, was introduced to address this need at Salford Royal, an acute NHS Trust. METHOD: The generic EFQM model was adapted to the specific case of the preceptorship programme. A questionnaire survey was undertaken to obtain evidence to assess how the EFQM tool was applied in the context of the preceptorship programme. Pre- and post-programme questionnaires were sent to preceptees and post-programme questionnaires to respective ward managers. FINDINGS: Following introduction of the preceptorship programme, recruitment and retention of newly qualified nurses have increased, with preceptees self-reporting increased levels of confidence. Use of the EFQM tool has provided the information that managers and departments require. Anecdotal evidence to date suggests that barriers are being broken down. Utilization of the framework has also identified areas of practice that need to change. CONCLUSIONS: This paper demonstrates how use of a generic tool such as EFQM can provide systematic and evaluative information for nursing.
The article considers the issues raised by Chaplain Yes and Chaplain No earlier in this volume. They are considered in the framework of the distinctive dimensions of a profession. I contend that chaplaincy could be served by internal discussions of specialized skills and goals it wants to claim in the professional sphere, and that scientific tools could be used to evaluate, refine, and communicate those skills and goals. Possibilities include benchmarks, outcomes research, and inclusion of "consumers" in research designs. I argue that distinctive core skills and competencies of chaplaincy lie in affective, intuitive, and symbolic domains more than scientific domains, but that chaplaincy can benefit from strategic utilization of tools moore native to other disciplines. I caution against reductionism from either domain, while arguing for vigorous dialogue.
Taylor's reflective framework has been in place for several years and as far as can be ascertained there has been no review of its utility. The aim of this paper is to explore Taylor's framework in an endeavour to encourage its critical use by nurses in both clinical and academic roles. In the spirit of critical theory, upon which Taylor's framework is based, the use of it as an instrument for reflecting practice will be scrutinised thoroughly.
The world-wide nursing shortage is resulting in institutions all over the world recruiting nurses from other countries with varying nursing skill levels and cultural backgrounds. The purpose of this article is to provide a framework for international institutions to adopt, to ensure continued quality care for oncology patients. At King Faisal Specialist Hospital & Research Centre (KFSH&RC) in Riyadh, Saudi Arabia, nurses have been recruited from over 25 different countries. Many of these nurses have never cared for oncology patients or given chemotherapy. A framework combining the strategies of planning and problem-solving was utilized to operationalize this unit in a multicultural setting. Cultural variants related to caring for Saudi patients by a multinational work force with differing cultural backgrounds as well as differing educational programs for nurses was reviewed in terms of their impact on staffing an oncology unit. An oncology/chemotherapy certification course was developed to document the competency of these multinational nurses to administer chemotherapy and to provide safe quality care to oncology patients.
This article presents a fictitious case study to demonstrate a model of problem solving. In the case study, a student threatens legal action when she is dismissed from the radiography program due to her failing grade in a clinical education course. The theoretical framework of the classical model of decision making is reviewed and applied to the problem. Legal precedents are examined, a solution is proposed, and recommendations are provided to reduce the likelihood of future legal actions.
After ten years of debate and discussion, the political situation within Poland finally allows the possibility to implement basic reforms in the health care system. Parallel development of the political and technical aspects of the reform has now lead to a final proposal for fundamental reforms in health system responsibility, financing and management. This article describes the current conceptual developments and the political and social context for these final reform proposals at the time of their submission to the government. The primary changes suggested are aimed at increasing the awareness of local, regional and national administrations, health care professionals and the general public that health care has a cost, and that resources must be used carefully if they are to cover health needs. In addition, 'health care' as a term must be extended to include factors and activities besides direct medical services. Such factors as air and water quality, diet, smoking and alcohol consumptions are examples of matters which will also be included in the focus of health system planners. A key element of the organisational reforms is decentralisation of responsibility for health care planning and administration within the framework of nationally set standards and priorities. Based on local decisions, the current basic organisation unit of health care delivery, the ZOZ or integrated health care units, will be redefined and either decomposed into their component services or receive newly defined responsibilities more adapted to the local realities of available manpower and medical facilities. In addition, the development of a private health care sector complementing and even competing with the public services sector will be actively encouraged.
Patients with significant medical problems who refuse some aspects of their medical care present medicolegal and management problems for their physicians. The selective refusal of transfusion of blood products by Jehovah's Witnesses typifies such situations. To explore physicians' reactions to these constraints, we sent a questionnaire to medical students, residents, and faculty wherein we asked them to respond to case simulations involving Jehovah's Witnesses and refusal of transfusion. Fifty percent of all respondents, including 84% of the faculty, reported experience in dealing with Jehovah's Witnesses. Overall, respondents were more likely to give transfusion to an infant or an incompetent adult than to competent adults. Only educational level made a significant difference in response: faculty members most frequently mentioned obtaining a court order when giving transfusion against a patient's will. Case law, upon which legal grounds such decisions stand, is often conflicting and is evolving toward allowing patients a freer hand in their choices of therapy. We sketch the history and present status of these precedents and offer a framework for dealing with patients' refusal of care.
For the first time in its history, this journal assumes the unusual form of a monograph: the issue is dedicated to the problems of research methodology, as it applies to the nursing context and activities. The purpose and the contents which are developed along the eight "chapters" can be summarised as follows: 1. It is widely recognised that health care systems are undergoing a profound and rapid transformation phase, which is obviously affecting the nursing profession and roles. To minimize the very real risk of being passive observers of the changes, a propositive strategy based on diffuse and intense research activities (aiming at describing, anticipating, assessing, experimenting changes and hypotheses) appears to be a priority choice (besides the more classical and needed institutional battles and arrangements). 2. Since its very beginning (back 15 years ago), this journal had adopted among its main objectives and distinctive features, the promotion of a research oriented mentality in a profession which (mainly, but not exclusively in Italy) has been characterised more in terms of executive and basically dependent tasks. The key thesis all over the years has been that, to be relevant for the whole profession, research should not be conceived as a separate or élite area of interest but it should be as close as possible (in its scope and methods), to the routine activities of the majority of the nurses. 3. The years long experience has produced (both through the materials which have been published, and the training initiatives which the Rdl has promoted) an important body of concepts and suggestions, which appear to be possibly useful to integrate the existing standard literature dedicated to research methods and designs. 4. The structure chosen for the overall organisation of the issue tries to comply to this "experimental" background: after a first part focused on the close articulation between the conceptual and historical specificities of nursing research (chapter 1 and 2), the more traditional themes of research textbooks are developed as components and expression of a process which suggests, the exigences and possibilities of an "empowerment" of the profession, with respect to its technical tasks and its institutional responsibilities (see chapters 3 to 6). The last chapters concentrate on the two apparently opposite trends and challenges, of both institutional changes and methodological exigencies and evolutions; on the one side, the re-discovery of the "old" qualitative - narrative competences and resources; on the other side the requirements of a health structure which is increasingly centered on administrative-managerial criteria and rules. 5. Coherently with the roots in the concrete experiences which has led to this issue, each chapter tries not to be a repetition of general principles and definitions, but to develop around real-life situations and cases, in order to provide "explicit" framework of application for the definitions and the methodological instruments. 6. A last (possibly interesting) characteristic of the issue, is the fact that it has been conceived, and it is formally presented and proposed (see chapter 1) as a "work in progress". The text is formally offered to the readers-users as a draft on which to work actively: observations, comments, integrations are requested and stimulated. Over a six month period, a collective writing project is launched so that the preparation of a "final" methodological text could become in itself a participatory (and expectedly didactic and rewarding) research activity.
Despite the emphasis of homework assignments in psychotherapy research and practice, methods to assess homework compliance have been relatively neglected. This article presents a brief review of 32 studies that described the assessment of homework compliance, and evaluated homework compliance in relation to treatment outcome. More than half of the studies relied on a single source of compliance data (n = 23), eight studies involved retrospective accounts, and only four studies used the same measure of homework compliance. The vast majority of studies focused on the assessment of "homework compliance" without consideration of the "quality of homework completion" or other key factors. A more comprehensive framework for homework compliance is discussed, and a new Homework Rating Scale (HRS) is proposed as the first step towards assisting the field in a more reliable and valid assessment of homework compliance.
Within the last decade nurse educators have been required to introduce research into the curriculum of every pre- and post-registration programme. This has lead to a debate concerning what practitioners need to know about research and about the best way to teach the research component of any educational programme. Two main approaches may be identified: facilitating research awareness and learning research by 'doing'. Both approaches raise a number of logistical and ethical problems. Certain of these problems are compounded by the large numbers of nurses who may be required to undertake a research project as a course component. Moreover, the absence of research evidence about the most effective means of educating nurses to become discerning consumers of research leaves the teacher without a sound framework to guide educational practice. In the light of recent educational reforms, this paper considers the unprecedented opportunities for nurse and midwife teachers to explore the role of research in the curriculum and in teaching.
This course for expanded perioperative role assumption as an RNFA intends to prepare nurses who eventually can become individually responsible for comprehensive care of the patient undergoing surgical intervention, and help them establish collegial relationships with other nursing colleagues, surgeons, and health care providers. The RNFA is concerned about the intraoperative safety of the patient and is involved in patient assessment and patient and family education. The RNFA collaborates with the physician to provide patient care in a complementary, collegial partnership. Within a framework of communication, trust, and mutual respect, the perioperative nurse prepared to first assist emerges as a renewed patient advocate, confident of her or his contribution to patient care, and committed to responsibility and accountability for the quality of that care.
This paper describes the development and validation of bicultural clinical indicators that measure achievement of mental health nursing practice standards in New Zealand (ANZMCHN, 1995, Standards of practice for mental health nursing in New Zealand. ANZCMHN, Greenacres). A four-stage research design was utilised including focus groups, Delphi surveys, a pilot, and a national field study, with mental health nurses and consumers as participants. During the national field study, consumer files (n=327) from 11 District Health Boards, and registered nurses (n=422) completed an attitude questionnaire regarding the regularity of specific nursing and service activities. Results revealed a variation in the mean occurrence of the clinical indicators in consumer case notes of 18.5-89.9%. Five factors with good internal consistency, encompassing domains of mental health nursing required for best practice, were derived from analysis of the questionnaire. This study presents a research framework for developing culturally and clinically valid, reliable measures of clinical practice.
Nursing models have had a long and often troubled history of development. Many that have been developed are not applicable in the pediatric setting. Models of pediatric care, though in use in many developing countries, are often not applicable within the cultures of those countries. This article outlines the history of the development of nursing models, the debate that has accompanied their progress, and the way in which they have been applied. An argument about the influence of culture on the way children are cared for in hospitals is postulated, and explanations are given as to why current models are not appropriate for use in pediatrics. A new philosophical model for pediatric nursing, the Parent-Staff Interaction Model of Pediatric Care, is presented and analyzed using Jacqueline Fawcett's framework for evaluation of nursing models. Its applicability to and use in any culture is explained, and feedback for further development is requested.
Interest in manual therapy appears to continue to grow among physical therapy clinicians and educators throughout the world even though the underlying concepts and techniques have not been justified by a knowledge base. The purposes of this article are to critically assess the role of manual therapy within the physical therapy profession and to provide an introduction to the other articles in this special issue. Eisner's model of explicit, implicit, and null curricula is used as a framework for our analysis and our discussion of manual therapy. The explicit area of manual therapy includes discussions of the definition and the role of manual therapy, the scientific rationale for manual therapy, and manual therapy in education and a comparison of manual therapy evaluative frameworks. The implicit area deals with the role of clinical decision making and critical thinking in manual therapy in education and rehabilitation. In the null (unaddressed) area of manual therapy, we suggest directions for future development and research.
The Manitoba Centre for Health Policy and Evaluation (MCHPE) developed POPULIS, a population-based health information system, as a vehicle for changing the way we think about the role of health care as a determinant of health. Serving as a bridge between analysts who produce research and politicians and policymakers who use it, MCHPE has developed a research infrastructure that can transform routinely collected administrative data into policy-relevant information. This paper provides a description of Manitoba and its health care system, as well as how MCHPE was started and how it functions. It describes how we at the Centre work with various databases, from the acquisition process through developing concepts and capabilities to the final validity and sensitivity testing of results. We detail the role of a population-based conceptual framework in challenging those who suggest more spending on medical care is self-evidently desirable.