Implications For Nursing Practice Research Articles

Globalisation as we enter the 21st century: Reflections and directions for nursing education, science, research and clinical practice

The events of September 11th, 2001 in the United States and the Bali bombings of October 2002 are chastening examples of the entangled web of the religious, political, health, cultural and economic forces we experience living in a global community. To view these forces as independent, singular, linearly deterministic entities of globalisation is irrational and illogical. Understanding the concept of globalisation has significant implications not only for world health and international politics, but also the health of individuals. Depending on an individual’s political stance and world-view, globalisation may be perceived as an emancipatory force, having the potential to bridge the chasm between rich and poor or, in stark contrast, the very essence of the divide. It is important that nurses appreciate that globalisation does not pertain solely to the realms of economic theory and world politics, but also that it impacts on our daily nursing practice and the welfare of our patients. Globalisation and the closer interactions of human activity that result, have implications for international governance, policy and theory development as well as nursing education, research and clinical practice. Nurses, individually and collectively, have the political power and social consciousness to influence the forces of globalisation to improve health for all. This paper defines and discusses globalisation in today’s world and its implications for contemporary nursing education, science, research and clinical practice.

Nurses embrace Agenda for Change

Following nurses' overwhelming vote in favour of the new pay and conditions structure, Karen Didovich considers the implications for practice nurses

Women's experiences with recurrent ovarian cancer.

Most women with a diagnosis of ovarian cancer, because of the advanced nature of the disease at the time of diagnosis, will face the very real possibility of an early death. Thus the disease can have a significant impact on women who play a central role in the day-to-day management of family life, the nurture of children, and the care of extended family. This article reports the perspectives of women living with ovarian cancer regarding their experiences confronting recurrent disease. For this qualitative study 18 women were interviewed. Four primary themes emerged from the analysis of the verbatim interview transcripts: waiting for recurrence, facing the diagnosis of recurrence, managing treatment-related concerns, and attempting to regain control. The practice implications for oncology nurses involve understanding the significant meaning associated with monitoring tumor markers and recurrent disease, assisting women in accessing information and support, and engaging in sensitive communication.

Resident and family perspectives. The first year in a long-term care facility.

The purpose of this longitudinal study was to explore perspectives, needs, and expectations of residents (N = 6) and family members (N = 3) of the resident's first year in a long-term care facility. The narrative method and a semi-structured interview guide were used to obtain participants' views at 2 and 6 weeks, and 3, 6, 9, and 12 months after admission. During data analysis, six themes emerged, which suggest implications for gerontological nursing education and practice. The authors conclude that by listening to residents and family members, nurses can use this information to improve life for residents and dignify them as individuals.

Biofeedback Applications for Psychiatric Nursing

Americans increasingly are becoming disillusioned with traditional medical treatment and are seeking relief in complementary or alternative medicine (CAM) treatments for chronic physical or mental health problems. Biofeedback is a CAM approach that has important implications for holistic psychiatric nursing practice. This article covers the basics of clinical biofeedback and its potential applications for clients with psychiatric mental health issues. Information is provided about the availability of training, supervision, and certification in this expanding field.

Healthy children 2010: Implications for pediatric nursing practice

Healthy children 2010: Implications for pediatric nursing practice

Father-to-father support: fathers of children with cancer share their experience.

Fathers are important to the stability of the family and to the coping of mothers and their children when there is a child in treatment with cancer. The vulnerability they experience is stupefying and causes self-doubt, general worry, and frustration with the medical care they receive. Fathers' experiences are relatively unreported in the literature, and even less so, the experiences of fathers with children who have cancer. This research is based on two focus groups of five men each who spoke unabashedly for more than 2 hours about their grief, their struggle to come to terms with the diagnosis and the role strain, and role confusion they experienced as fathers and husbands. The findings could be described as reflecting the following themes: (1) impact on the provider role, (2) the emotional impact: I cry privately, (3) it's the fight of our lives, (4) tag-team parenting, (5) hypervigilance, (6) that place is scary!, and (7) what happens next--coping and moving on. The group format was powerful in terms of what these men were willing to share of themselves and their experience. These groups could be characterized as the coming together of strangers, bound by the common experience of "cancer," who actively supported each other and each other's process. Implications for holistic nursing practice are provided.

Hard of hearing with NHS aid

NHS hearing aids have received a negative review from Defeating Deafness. Rhonda Siddall considers the implications for practice nurses.

Quality of life of stroke survivors: a research synthesis.

Stroke is the third leading cause of death and a major cause of disability in the United States. Individuals experiencing a completed stroke are faced with a multitude of challenges to restore their highest quality of life within the limitations of residual impairment. This research synthesis provides a summary of previous research on quality of life for stroke survivors. Research studies for inclusion in the review were identified by conducting a search of computerized databases through August 2000 and by using the ancestry method of reviewing reference lists from relevant publications. Thirty-nine studies were identified that focused on stroke survivors' quality of life during the recovery process. Stroke survivors' overall quality of life varied based on the country where the study was implemented. Variables positively associated with stroke survivors' quality of life were independence with activities of daily living, increased functional ability, social support, and healthcare resources. Variables negatively associated with stroke survivors' quality of life were psychological impairment, severity of impairment, severity of aphasia, inappropriate reactions to illness and pessimism, and inability to return to work. Specifically, 22% to 73% of the variance in stroke survivors' quality of life was primarily explained by presence of depression; functional ability, especially the upper extremities; and socialization, in particular, leisure activities. Implications for professional nursing practice to enhance stroke survivors' quality of life include encouraging independence, managing depression, and fostering interpersonal relationships. Areas for future research include longitudinal studies, rigorous psychometric assessment of quality of life instruments, and intervention studies.

Creating a Pain Management Educational Module for Hospice Nurses: Integrating the New JCAHO Standards and the AHCPR Pain Management Guidelines

PURPOSE. To describe a self-instruction module that integrates published pain management information, AHCPR cancer pain management guidelines, and new JCAHO pain management standards into a manual for orienting new hospice nurses. DATA SOURCES. Published materials and authors' experiences. DATA SYNTHESIS. Pain continues to be a predominant theme in palliative care. Despite the plethora of information about pain management, some nurses lack knowledge about pain management fundamentals. Multiple role expectations place constraints on time available to learn needed information. Further, JCAHO recently has expanded its expectations for pain management. CONCLUSIONS. Targeted orientation can enhance nurses' knowledge about pain management and promote patient satisfaction with care. IMPLICATIONS FOR NURSING PRACTICE. An easily accessible, self-paced learning module can facilitate better patient outcomes regarding pain management in palliative care.

Barriers to Hospice Care for African Americans: Problems and Solutions

PURPOSE. To identify barriers to hospice care perceived by African Americans. SAMPLE. African-American members (N = 30, 4 males, 19 females) of a metropolitan community in the Midwest. METHODS. Four focus groups were conducted, three with community members and one of hospice-experienced members. Responses were content analyzed and coded into barriers. FINDINGS. Four barriers were identified: lack of knowledge, hospice perceived as giving up hope, dying at home, second-class care. CONCLUSIONS Make hospice presentations to the African-American community, recruit African-American staff/volunteers, support patient decision to choose hospice, identify community resources. IMPLICATIONS FOR NURSING PRACTICE. Nurses may be the first to recommend hospice, address barriers frankly with patient/family, and identify resources to support home care.

A Brief History of Advanced Practice Nursing and Its Implications for WOC Advanced Nursing Practice

In Brief Although the evolution of clinical nurse specialists and nurse practitioners during the previous several decades has led to a sense of novelty regarding advanced practice, it is important to remember that nurses have engaged in such roles for nearly 100 years. This article will review the history of advanced nursing practice, summarize current definitions of specialty and advanced practice, discuss the evolution of advanced practice and its impact on contemporary nursing, and provide a background for advanced practice considerations for the WOC nurse, which are discussed in detail in subsequent articles by Janice Beitz (pp 55–64) and Dorothy Doughty (pp 65–8) in this issue. This article reviews the history of advanced practice nursing and provides a foundation for considering the evolution of WOC specialty practice within this growing area.

Hispanic mothers' knowledge and care of their children with respiratory illnesses: a pilot study.

This pilot study was designed to identify Hispanic mothers' knowledge and health practices regarding caring for their children with respiratory illnesses. Using an interview guide, the researchers identified the mothers' perceptions of their children's health, the etiology and symptoms of asthma and other respiratory illnesses, health practices, folk illnesses, services sought and language barriers when using health services. The findings suggest that Hispanic mothers have limited knowledge of respiratory illnesses and use culturally related practices when caring for their sick children. Implications for pediatric nursing practice are discussed, and strategies to improve care for Hispanic families are presented.

Health promotion in cervical cancer prevention among the Yakama Indian women of the Wa'Shat Longhouse.

The purpose of this 3-year study was to gain a greater understanding of the importance of the Wa'Shat Longhouse religion to the design of a culturally appropriate health promotion (cervical cancer prevention) program with the Yakama Indian people of eastern Washington. This descriptive study involved interviews with 10 Wa'Shat members, observations, and participant observations of 30 community ceremonial activities. The framework of health promotion planning guided the investigation. We found that (a) program goals needed to be holistic and wellness oriented, (b) teaching methods needed to include circular symbols, and (c) intervention strategies needed to be linked to the natural patterns of communication of the Wa'Shat Longhouse and to involve elders. Storytelling, talking circles, and use of role models were all found to be important teaching methods. We confirm previous perspectives on the importance of religion, provide greater depth in this understanding and outline implications for transcultural nursing practice.

Women's symptoms at the menopause and their expectations of hormone replacement therapy

How do women feel about the menopause, and what factors do they consider when deciding whether to take hormone replacement therapy (HRT)? A random sample of 1,200 women aged between 38 and 58 was generated from Family Health Services Authority (FHSA) records. A postal questionnaire, based partly on Ajzen's Theory of Planned Behaviour (Ajzen, 1988) about symptoms, attitudes to and knowledge of the menopause and HRT, and their sources of information, was sent to the women. Respondents were asked about perceived physical and psychological problems in the previous six months and about whether they had consulted a doctor. Results indicate little difference in psychogenic symptoms between those who are taking HRT and those of a similar age who are not. The case for physical symptoms is more complicated, with HRT alleviating hot flushes and night sweats in particular. The most useful source of information was reported as being the media, although satisfaction with information varied between groups. Implications for practice nurses are discussed.

Intensive care unit psychosis, the therapeutic nurse-patient relationship and the influence of the intensive care setting: analyses of interrelating factors.

It has been estimated that between 12.5% and 38% of conscious patients admitted to critical care settings experience Intensive Care Unit psychosis, a condition which seems to resolve upon transfer to the ward. This phenomenon was traditionally recognized when the patient outwardly exhibited abnormal behaviours and signs in the form of confusion, delirium, anxiety, depression, delusions and audiovisual hallucinations, yet it has been argued that due to the illness of the patient and their suppressed ability to communicate, such overt displays of unusual behaviour are the tip of the iceberg. In recognizing this phenomenon, it is felt that a relationship exists between Intensive Care Unit Psychosis, the therapeutic nurse-patient relationship, and the environment in which nurses' interactions with their clients occur. This paper will explore the interaction between these three elements while considering the implications for contemporary nursing practice.

Health beliefs, health locus of control, and women's mammography behavior

Research has shown that routine mammography screening can significantly reduce mortality from breast cancer. The use of mammography screening, however, remains well below national goals. In an effort to understand the factors that influence women's mammography behaviors, this study explored the relation between health beliefs, locus of control, and women's mammography practice. Survey instruments used were Champion's health belief scales and the Multidimensional Health Locus of Control (MHLC) scales. The study used a convenience sample of 25 African Americans and 72 white women ages 35 to 84. Findings showed that women who participated in mammography screening were significantly more likely to perceive greater benefits, greater health motivation, and fewer barriers to screening than those who did not participate. These same three variables were similarly associated with greater frequency of receiving mammograms. It also was found that perceived benefits and health motivation were significantly correlated with shorter duration of time since the last mammogram. No support was found for perceived susceptibility, perceived seriousness, and health locus of control as predictors of women's mammography behavior. Implications for nursing research in further examining the MHLC and the Health Belief Model construct of susceptibility as they relate to mammography behavior are identified. Practice implications for nurses are suggested.

A path analysis of self-care of elderly women in a rural area of southern Taiwan.

For rural elderly women in Taiwan, in addition to poor economic situations and limited health resources, changing traditional roles and responsibilities and changing family structures further aggravate their conditions of health. Self-care was considered as a strategy or a form of coping to enhance the health and quality of life of these women during their aging process. To design an effective health-promotion program for elderly women, therefore, understanding their self-care model is important for health care professionals. The purpose was to use a path analysis to test a model of self-care in predicting the direct and indirect effects of selected key variables on self-care among rural elderly women. A non-experimental, cross-sectional study was designed to test the proposed hypotheses and the paths in a causal model of self-care. Of the 200 elderly women invited to participate, 192 completed all interview questions. The proposed causal model was tested with a path analysis, using the LISREL 8 program. The resultant model showed that the chi square was 3.65 with four degrees of freedom. The p-value for the resultant model was 0.46, revealing that the model fit the data and it was, therefore, retained. In addition to the chi 2 test, other fit indices also indicate the model fit the data well. In the resultant model, 56.0% of the total variance in self-care was accounted for by age, socioeconomic status, perceived health status, and social support (p < 0.001); 16.4% of the total variance in social support was accounted for by age, socioeconomic status, and marital status (p < .001); and 7.3% of the total variance in perceived health status was accounted for by social support (p < .001). The implications of nursing practice and research were discussed based on the findings.

Review of magnet hospital research: findings and implications for professional nursing practice.

The label "magnet hospitals" originally was given to a group of U.S. hospitals that were able to successfully recruit and retain professional nurses during a national nursing shortage in the early 1980s. Studies of magnet hospitals illuminated the leadership characteristics and professional practice attributes of nurses within these organizations. Recent investigations within magnet hospitals document significant relationships between nursing and patient outcomes, including mortality and patient satisfaction. The purpose of this review is to: 1) synthesize the magnet hospital research that describes and evaluates the professional practice of nurses within these institutions and (2) identify areas for future research to advance professional nursing models within current hospital organizations.

Foundations of genetics: genetic structure, function, and therapeutics.

Molecular genetics provides the basis for understanding patterns of health and disease in people and is part of the scientific foundation on which acute and critical care nurses should build their practice. The human genome, defined as all the genetic information in the cells of humans, provides the blueprint for protein production and cellular function in the body. Alterations in protein production may result in illness or organ malfunction that has a genetic derivation. One therapeutic strategy that holds promise to manage genetic diseases is gene therapy. Gene therapy, or human gene transfer, occurs when scientists or physicians modify the genetic material in cells for therapeutic purposes. Genetic structure, function, and therapeutic reflect the science of the present and future and have profound practice implications for acute and critical care nurses.