International Journal of Nursing Studies

Editorial Board

2010-04-01

Nurses and politics—laurels for the hardy

Hugh McKenna — 2010-04-01

Just because you do not take an interest in politics doesn’t mean politics won’t take an interest in you! (Pericles 430 B.C.) Nursing is the largest healthcare profession with the greatest amount of contact with the public. However, it is a truism that we are not the most powerful, the most respected, the best paid, or the most politically active. While Florence Nightingale is often perceived as the founder of modern nursing, she was, according to her sister Parthe, a terrible nurse (). However, she was politically astute and the support she had from senior politicians such as Sidney Herbert enabled her raise the profile of nursing. It was not unknown for her to have regular afternoon tea with Queen Victoria and drop in on 10 Downing Street to advise the prime minister on issues of relevance to military or health reform. In her latter years Nightingale took to her bed and it was from there that she held court with the leading policy makers of the day. It is remarkable that from her sick room she was able to influence the future of nursing worldwide. She did so, not by practising the art and science of nursing, but by exercising her political influence.

Pressure ulcer prevention: Development and psychometric validation of a knowledge assessment instrument

D. Beeckman, K. Vanderwee, L. Demarré, L. Paquay, A. Van Hecke, T. Defloor — 2010-04-01

Abstract: Background: Profound knowledge of pressure ulcers is important to enable good prevention. Validity and reliability of instruments assessing pressure ulcer knowledge are limited evaluated in previous research.Aims and objectives: To develop a valid and reliable instrument to assess knowledge of pressure ulcer prevention.Design: Prospective psychometric instrument validation study.Methods: An extensive literature review was performed to develop an instrument to assess knowledge of pressure ulcer prevention. Face and content validity were evaluated in a double Delphi procedure by an expert panel of nine trustees of the European Pressure Ulcer Advisory Panel (EPUAP) who each have extensive experience in pressure ulcer care and research (PhD level). A convenience sample of 608 nurses and nursing students from Belgium and The Netherlands participated to evaluate validity of the multiple-choice test items (item difficulty, discriminating index, quality of the response alternatives), construct validity, internal consistency, and stability of the instrument. The data were collected between February and May 2008.Results: A 26-item instrument was developed, reflecting 6 themes expressing the most relevant aspects of pressure ulcer prevention. The content validity was excellent (CVI=0.78–1.00). Group scores of nurses with a (theoretically expected) high level of expertise were found to be statistically significantly higher than those of participants with (theoretically expected) less expertise (P<0.001). The item difficulty index of the questions ranged from 0.27 to 0.87, while values for item discrimination ranged from 0.29 to 0.65. The quality of the response alternatives was found to be good. The overall internal consistency reliability (Cronbach's α) was 0.77. The 1-week test–retest intraclass correlation coefficient (stability) was 0.88.Conclusion: The instrument demonstrated acceptable psychometric properties and can be applied in both research and practice for evaluating knowledge about pressure ulcer prevention.

Correlates of self-care behaviors for managing hypertension among Korean Americans: A questionnaire survey

2010-04-01

Abstract: Background: While self-care behaviors have been documented as one of the main determinant of hypertension control, studies investigating correlates of self-care behaviors have been rare regarding hypertension among minority population.Objectives: The purpose of this study was to examine factors associated with self-care behaviors for hypertension using a community sample of Korean Americans.Design: A descriptive cross-sectional design.Settings: Community setting in the Baltimore–Washington metropolitan area.Participants: The sample included 445 middle-aged (40–64 years of age) Korean Americans with hypertension (systolic BP≥140 and/or diastolic BP≥90mmHg; or taking antihypertensive medication).Methods: Guided by Social Cognitive Theory, a variety of personal (age, gender, marital status, employment status, years in U.S., duration of hypertension, hypertension knowledge, hypertension belief, and hypertension control self-efficacy) and environmental (social support) factors were examined in relation to hypertension self-care behaviors, including medication-taking, exercise, diet, and weight control.Results: The model explained 18.0% of the total variance in self-care scores. Hierarchical multiple regression revealed that personal factors contributed significantly to the explanatory model, whereas social support did not add much. Examination of individual regression coefficients showed that Korean Americans who were older, who had longer duration of hypertension, and who had higher hypertension control self-efficacy were more likely to have higher self-care scores.Conclusions: Hypertension control self-efficacy emerged as the most significant contributing factor to hypertension self-care. Future intervention programs should focus on improving hypertension control self-efficacy as a modifiable personal factor.

Flexible working and the contribution of nurses in mid-life to the workforce: A qualitative study

Ruth Harris, Janette Bennett, Barbara Davey, Fiona Ross — 2010-04-01

Abstract: Background: With the changing demographic profile of the nursing workforce, retaining the skill and experience of nurses in mid-life is very important. Work–life balance is a concept that is gaining increasing prominence in today's society. However, little is known about older nurses’ experience of family friendly policies and flexible working.Objectives: This study explored the organisational, professional and personal factors that influence perceptions of commitment and participation in the workforce for nurses working in mid-life (aged 45 and over).Design: A qualitative study using a range of methods including biographical methods, semi-structured face-to-face interviews, focus groups and telephone interviews. Data were analysed using constant comparative method.Settings: A large inner city acute teaching hospital and an inner city mental health and social care trust providing both community and inpatient health and social care.Participants: 34 nurses and 3 health care assistants participated in individual interviews, 10 nurses participated in two focus groups and 17 managers participated in individual telephone interviews.Results: Four themes emerged: the nature of nursing poses a challenge to the implementation of flexible working, differences in perceptions of the availability of flexible working, ward managers have a crucial role in the implementation of flexible working policies and the implementation of flexible working may be creating an inflexible workforce.Conclusions: The findings suggest that there are limits to the implementation of flexible working for nurses. In some areas there is evidence that the implementation of flexible working may be producing an inflexible workforce as older nurses are required to compensate for the flexible working patterns of their colleagues. Ward managers have a key role in the implementation of family friendly policies and require support to fulfil this role. There is a need for creative solutions to address implementation of flexible working for all nurses to ensure that workforce policy addresses the need to retain nurses in the workforce in a fair and equitable way.

The mediating role of psychological empowerment on job satisfaction and organizational commitment for school health nurses: A cross-sectional questionnaire survey

Li-Chun Chang, Chia-Hui Shih, Shu-Man Lin — 2010-04-01

Abstract: Background: The importance of the professional role of school health nurses in promoting children's health in their school environment is widely recognized. However, studies of their working experience have revealed feelings of disempowerment that appear to be related to insufficient support from school managers. In these unsupportive working environments, it seems possible that psychological empowerment may play a mediating role to strengthen employees’ satisfaction and commitment to their employing organization.Objectives: The aim of this study is to test an exploratory model of empowerment in a Taiwanese sample of school health nurses by examining the mediating role of psychological empowerment in the relationship between external factors and work-related attitudes, specifically job satisfaction and organizational commitment.Design: A cross-sectional survey with self-reported questionnaires.Participants and methods: Probability proportional sampling was used to generate a randomly selected sample of 500 school health nurses in elementary and junior high schools in Taiwan. A total of 330 valid questionnaires were returned, yielding a response rate of 66%.Results: The exploratory model including all hypothesized variables provided an adequate fit (χ2=29.24; df=17; p=.052; adjusted goodness-of-fit index [AGFI]=.96; goodness-of-fit index [GFI]=.98; root-mean-square error of approximation [RMSEA]=.05) for the data and indicated that psychological empowerment did not fully mediate the relationship between organizational empowerment and job satisfaction because of the strong direct effects of organizational empowerment on job satisfaction. The influence of empowerment on organizational commitment was mediated through job satisfaction.Conclusions: Psychological empowerment did not mediate the relationship between external factors and work attitudes, and job satisfaction emerged as an important factor. If school leaders can improve the job satisfaction of school health nurses, this will help them achieve greater commitment and loyalty of school health nurses to their employing schools.

The impact of social support upon intention to leave among female nurses in Europe: Secondary analysis of data from the NEXT survey

2010-04-01

Abstract: Objectives: This study examined the importance of one's social work environment in the light of prevention of premature leave from the nursing profession. A research model with social support (from direct supervisor and close colleagues) as predictor and intention to leave as the dependent variable has been tested, while controlling for job satisfaction and age. Moreover, we have studied the impact of nurses’ age upon the prevalence of social support from both parties.Participants: Data were obtained from 17,524 registered female nurses working in hospitals throughout Europe (Belgium, Germany, Finland, France, Italy, The Netherlands, Poland, and Slovakia).Results: Our findings indicated that a lack of job satisfaction is an important risk factor in the light of nurses’ turnover as for most countries the intention to leave cannot be buffered by social support from one's close colleagues. However, in general, social support from one's direct superior appeared to contribute negatively to the intention to leave the profession, over and above job satisfaction and age. As regards age effects, in line with our expectation, we have found a significant negative relationship between age and social support from close colleagues, while the hypothesis regarding the relationship between age and supervisory support could not be confirmed.Conclusions: Given its importance in the light of preventing premature leave, we advocate not to neglect the possible positive effects of social support from important key figures like nurses’ direct supervisor and close colleagues. It is necessary for health care institutions to carefully pay attention to finding opportunities to obtain more social support for all staff members. In Section , limitations and practical implications of this study are dealt with.

Cognitions associated with nurse performance: A comparison of concurrent and retrospective verbal reports of nurse performance in a simulated task environment

James Whyte, Eileen Cormier, Roxanne Pickett-Hauber — 2010-04-01

Abstract: Background: Cognitions represent the computations associated with human thought processes. Verbal protocols offer a method by which to record these processes. While concurrent and retrospective verbal reporting of cognitions have been used extensively within nursing and other domains, the use of this methodology in nursing has been characterized by inconsistencies in its application.Objectives: The primary objective of this study was to describe and compare the content of concurrent and retrospective verbal reports provided by nurses during and after administering care in a simulated task environment.Design: The study utilized a laboratory based quasi-experimental research design.Setting: The study was based in a simulation laboratory designed specifically for use in studies designed to measure nursing performance. The laboratory integrated extensive instrumentation that facilitated the comprehensive audio and video recording of participant actions.Participants: The participants (N=15) were recruited from a College of Nursing at a large university in the Southeastern United States.Methods: Research participants were asked to admit a patient experiencing an acute exacerbation of congestive heart failure in a simulated task environment, during which they were required to prioritize and provide care. Participants were trained in the method for providing verbal reports of thoughts, and concurrent and retrospective report data were collected during and after the simulation exercise. The data were then coded for the purposes of descriptive analysis.Results: The results indicated that the concurrent verbal reports provide a more complete representation of the cognitions of research participants providing care in a simulated task environment. However, the results reflect that additional unique data is present in the retrospective reports, exclusive of the concurrent reports.Conclusions: The findings support the utility of concurrent and retrospective verbal reports as a method of gathering data in studies that address nursing performance in a clinical context.

Middle-aged women's awareness of cholesterol as a risk factor: Results from a national survey of Korean Middle-aged Women's Health Awareness (KomWHA) study

2010-04-01

Abstract: Background: Dyslipidemia, a risk factor for cardiovascular disease (CVD), is more prevalent in middle-aged women than in men of the same age in Korea. This study, the first national survey that focused on cholesterol in Korean women, aimed to: (1) assess their awareness and knowledge of cholesterol, (2) evaluate their risk reduction behavior, and (3) examine differences in these variables among geographical regions in Korea.Methods: A questionnaire survey study was conducted in a randomly selected national sample of 1304 Korean women, aged 40–64 years in 3 geographic regions.Results: High cholesterol was identified as a cause of CVD by 54.4% of respondents, however, 95.4% did not know their own values. Only 4.1% of respondents were aware of desirable level of total cholesterol. Eight percent of respondents perceived correctly the meaning of high-density lipoprotein cholesterol (HDL-C) as good cholesterol. And 32.9% had cholesterol check at least once a year. No significant regional differences were found in women's awareness and knowledge on cholesterol. No smoking (93.6%), low salt diet (52.5%) and weight management (50.6%) were the most prevalent risk reduction behaviors. Women in the rural area performed less risk reduction behaviors than those in urban area.Conclusions: Given the low level of awareness and knowledge about cholesterol in these women, nurses need to increase their education about cholesterol and risk reduction behaviors of CVD for middle-aged Korean women, particularly those in rural area. To resolve identified disparities in women's risk reduction behaviors between the rural and urban area, a national-level health policy can result in a successful effort to promote women's awareness of cholesterol and risk reduction behaviors for the cardiovascular health of the public.

Maternal return to work and breastfeeding: A population-based cohort study

2010-04-01

Abstract: Background: In recent decades there has been a marked rise in the participation of women with infants in the labour market, while there has been a decline in the prevalence rate of breastfeeding.Objective: To explore the relationship between maternal return to work and breastfeeding.Design: An on-going prospective longitudinal study.Setting and participants: Multistage stratified systematic sampling was designed to recruit 24,200 pairs, postpartum women and newborns, from the Taiwan national birth register in 2005. Participating women underwent two home interviews at 6 and 18 months after giving birth, following structured questionnaires. A total of 21,248 and 20,172 women were interviewed, and the completed interview rate was thus 87.8% and 83.4% at 6 and 18 months, respectively. All study participants provided informed consent as approved by the Ethics Review Board of the National Taiwan College of Public Health.Results: The overall prevalence of initial breastfeeding was 83.7%. Postpartum women returning to work less than or equal to 1 month had the lowest initiation of breastfeeding rate (77.5%), but had a higher prevalence of breastfeeding duration less than or equal to 1 month (34.9%) than the overall population (26.8%). Overall 67.9%, 39.4%, 25.4%, and 12.7% mothers who started breastfeeding still breastfed their infants at the age of 1, 3, 6 and 12 months, respectively. Women with maternal leave of less than or equal to 6 months ceased breastfeeding earlier than those with maternal leave beyond 6 months and those who did not return to work up to 18 months after birth. After adjustment for potential confounders, odds ratios of initial breastfeeding seemed no different, except those for postpartum women who returned to work less than or equal to 1 month and those who did not return to work. Mothers returning to work within 1 year after giving birth were significantly earlier in weaning than those without return to work.Conclusion: In our study, an early maternal return to work, especial within 6 months after giving birth, was a barrier to the initiation and continuation of breastfeeding. Thus, a comprehensive strategy is required to encourage the practice of breastfeeding in working women from pregnancy to the return to work, and nurses should work to promote breastfeeding in the different occasion.

Perceived HIV stigma and life satisfaction among persons living with HIV infection in five African countries: A longitudinal study

2010-04-01

Abstract: Background: Descriptive literature exists on the effects of HIV-related stigma on the lives of people living with HIV infection but few empirical studies have measured perceived HIV stigma nor explored its potential relationship to quality of life (QoL) over time in people living with HIV infection.Aim: A cohort study of a purposive convenient sample of 1457 HIV-positive persons was followed for one year in a longitudinal design that examined the effects of stigma and the life satisfaction dimension of the HIV/AIDS Targeted Quality of Life Instrument (HAT-QOL) over time, as well as the influence of other demographic and assessed social variables. Data were collected three times about six months apart from December 2005 to March 2007.Results: The average age in this sample was 36.8 years (SD=8.78, n=1454) and 72.7% (n=1056) were female. The initial sample of participants was balanced among the five countries: Lesotho, Malawi, South Africa, Swaziland, and Tanzania. An attrition analysis demonstrated few demographic differences between those who remained in the study 12 months later compared with those at baseline. However, those who completed the study and who answered the QoL questions had significantly higher life satisfaction scores at baseline than those who left the study. There was a general increase in the report of life satisfaction QoL in all countries over the one-year period. However, as stigma scores increased over time there was a significant decrease in life satisfaction with differing rates of change by country. Certain factors had a positive influence on life satisfaction QoL: positive HIV media reports, taking antiretrovirals, reduced symptom intensity, and disclosure to a friend.Conclusion: This cohort study is the first to document empirically in a longitudinal sample, that perceived HIV stigma has a significantly negative and constant impact upon life satisfaction QoL for people with HIV infection. In the absence of any intervention to address and reduce stigmatization, individuals will continue to report poorer life satisfaction evidenced by reduced living enjoyment, loss of control in life, decreased social interactivity, and decreased perceived health status.

The user experience of critical care discharge: A meta-synthesis of qualitative research

Suzanne Bench, Tina Day — 2010-04-01

Abstract: Objectives: This review identifies the most significant factors, which impact upon the user experience of progress and recovery from critical illness during the first month after discharge from critical care, and discusses these in relation to the development of effective critical care discharge support strategies.Design: Meta-synthesis of qualitative primary research.Data sources: Qualitative research published in English between 1990 and 2009 was identified using online databases: CINAHL, MEDLINE, EMBASE, British Nursing Index, CDSR, ACP Journal Club, Cochrane library, Social Policy and Practice and PsycInfo. Studies of adult patients, relatives/carers/significant others, which focused on experiences after discharge from an intensive care or high dependency unit to a general ward were retrieved.Review methods: Following screening against inclusion/exclusion criteria, methodological appraisal of studies was conducted using a published framework. Ten studies met the criteria for inclusion.Results: Five key themes emerged from the meta-synthesis: physical and psychological symptoms; making progress; the need to know; and safety and security.Conclusions: Findings from this meta-synthesis and other related literature supports the existence of physical and psychological problems in the immediate period following discharge from critical care to the ward, and suggests that patients and their families have a desire for more control over their recovery. However, this desire is countered by a need to feel safe and protected, culminating in an expression of dependence on healthcare staff. Any effective support strategy needs to take account of these findings.

Promoting healthy behaviors: How do we get the message across?

Rachel E. Myers — 2010-04-01

Abstract: The world is experiencing a rapid rise in chronic health problems, which places an enormous burden on health care services. Modifiable health behaviors are largely responsible for this high prevalence and incidence of chronic diseases. This realization has made initiatives that promote healthy behaviors an international and interdisciplinary priority. How can nurses and other health care providers get the message across to their patients in order to maximize likelihood of leading to desired outcomes? Message tailoring is a well-established health communication approach shown to increase the persuasiveness of message effects in the promotion of healthy behaviors. Message framing is an effective message tailoring strategy that has been well-studied in the psychology literature over the past 20-plus years across a breadth of health behaviors while being severely understudied in the nursing literature. Numerous variables, especially those related to individual differences, have been shown to moderate message framing effects, a finding of great utility for nursing. This article presents a detailed review of the current state of the message framing literature, offers specific suggestions for advancing this literature, and highlights implications for research, education, and practice, with particular attention to nurses.

Health assets: A concept analysis

2010-04-01

Abstract: Purpose: Traditionally, nursing care has focused primarily on patients’ problems and to solve these problems on behalf of the patient. However, with the growing focus in health care on patient-centered care, self-management of illness, and patient empowerment, the problem-oriented approach to nursing care is no longer sufficient. Assessing and strengthening patients’ health assets has evolved into a complementary approach to problem-focused care, helping patients achieve and maintain their health and wellness. This requires a clear definition of the concept of health assets and a better understanding of their role in overall health and wellness. The purpose of this paper was to examine the concept of health assets, including its attributes, associated concepts, and application in a health care context.Methods: We systematically reviewed 60 journal articles and Web documents dated from 1966 through March 2007. Data were then analyzed using Rodger's evolutionary method of concept analysis.Results: The health assets concept has not been widely used in health care. However, use has increased during recent years within multiple disciplines, including psychology, psychiatry, nursing, medicine, social sciences, and public health. This concept analysis identified core attributes of health assets to be potentials in the individuals’ possession. The core attributes embraces relational, motivational, protective, and volitional strengths, which are internal; and support, expectations of others, and physical and environmental elements, which are external. The antecedents of health assets are genes, values, beliefs, and life experiences. Health assets mobilize an individual to engage in deliberation, decision making, and change. Consequences of health assets are positive health behaviors that can lead to mastery, self-actualization, and improved health outcomes. We propose both a definition of health assets and a descriptive model of its components and relationships.Conclusion: Focusing nursing care on a person's health assets, as a complement to the traditional approach of addressing a person's health problems, may contribute to improved health behavior and outcomes. Health assets should, therefore, receive greater attention in nursing practice, education, and research.

Emotional intelligence and nursing: Comment on Bulmer-Smith, Profetto-McGrath, and Cummings (2009)

K.V. Petrides, Nick Sevdalis — 2010-04-01

The aim of this commentary is to address a number of issues and omissions arising from the integrative review of on emotional intelligence (EI) and nursing. An important objective is to bring to the attention of readers the growing research on trait EI (or trait emotional self-efficacy), which did not feature in Bulmer-Smith et al.’s review.

Postmodernism and evidence-based practice: A reply to Holmes et al. (2009)

Sam Porter, Peter O’Halloran — 2010-04-01

critical commentary on our ‘Postmodernist war on evidence-based practice’ article in IJNS () shows clearly the weaknesses in our paper. It does so not by persuasive argument but by style of presentation. We wrote our paper in the hope that a disinterested and dispassionate stance would contribute to a diffusion of the antagonism which has dogged the debate around evidence-based practice (EBP). The less than convivial response of Holmes et al. demonstrates that we were naïve in our aspirations. We failed to take account of the apparent inability of these authors to tolerate any criticism of their position with equanimity. Having been placed firmly, albeit unwillingly on our part, in the camp of the enemy, we feel we have no choice but to take up the combative challenge. We do so because we cannot allow the unfair and inaccurate comments that are included in Holmes et al.’s commentary to pass unopposed. We will address these in the order they are presented by our critics.