The development and evaluation of computer assisted learning for patients on continuous ambulatory peritoneal dialysis

This article briefly describes the development and evaluation of six computer assisted learning (CAL) packages for use with renal patients on Continuous Ambulatory Peritoneal Dialysis (CAPD). The factors influencing the choice of CAL as the teaching medium are detailed, and some of the difficulties facing nurses involved in patient education highlighted. An outline of the development of program content is given and the methods to be used in the evaluation are briefly explored. Since data collection has only recently commenced, no conclusions can be drawn. However, the authors' anticipation that the study may help to make inroads into exploring the acceptability of CAL to patients and patient educators is expressed.

Reluctant collaborators: do patients want to be involved in decisions concerning care?

Against the background of the popularity of the concept of 'patient collaboration' in care, this paper describes, from the frame of reference of the patients, how they perceive being involved in decisions concerning their own treatment and nursing care. A convenience sample of 12 patients were selected. The data collection and analysis were informed to some extent by the approach known as grounded theory. Although only 12 in-depth interviews were conducted, one major theme emerged from the data and that was named 'toeing the line'. The data suggests that some patients are more concerned about doing what is right, that is, pleasing the nurse, than participating in decisions concerning care. It is contended that if nurses adopt practices which encourage involvement they may unwittingly coerse patients to comply. It is argued that patients will accept this situation even if they do not wish a collaborative role. Despite the small sample size, interesting questions are raised concerning the underlying rationale of patient involvement. The conclusion is drawn that promoting individualized care is not necessarily synonymous with active patient involvement as advocated in much of the literature.

Staff interaction with vocally disruptive demented patients compared with demented controls

This study addressed the effect of social isolation on vocally disruptive demented patients (V); the results center on the amount of time patients spent in interactions, and the differences in type and time of staff-patient interaction (IA), compared to controls (C). Semi-structured observations were collected (1100 hours) for 37 vocally disruptive patients and 37 controls, all residents of psychogeriatric wards. Quantitative analysis revealed a low frequency of interactions, elicited mainly for procedural matters and short duration of most interaction episodes. Multiple regression analysis showed a significant difference in the type of interaction: there was more correction of undesired behaviour for vocally disruptive patients than for controls. The results show that social isolation is part of the institutionalized demented patients' life. The dominance of short interaction episodes could contribute to overstimulation. The only significant difference found was the frequency of corrective interactions in the group of vocally disruptive patients. We conclude that this is not the cause of their behaviour, but it may reinforce it. Other factors that might cause and maintain this behaviour require investigation.

Gaining access to clients: the case of health visiting

The aim of this paper is to explore the concept of gaining access to clients as it emerged from an in-depth qualitative study of health visiting practice. The study was conducted using a grounded theory approach to data collection and analysis. Forty-five experienced health visitors were interviewed using a semi-structured interview guide. The interviews were tape recorded and later transcribed. A detailed analysis of the processes involved in 'entering' into client situations to begin health visiting work is presented. Entry into the client/family situation is a process which involves both obtaining access to the client in the environment where health visitor and client meet and 'entering' into the client situation more fully to continue the health visiting work. The data from this study would suggest that the work involved in entering client situations involves many strategies to ensure entry and re-entry. This process is influenced by many factors within the client, the health visitor, and the health visitor-client encounter. This paper makes a contribution to our understanding of the processes involved in everyday health visiting practice.

The referral process in health visiting

The aim of this paper is to explore the concept of referral as it emerged from an in-depth qualitative study of health visiting practice. The study was conducted using a grounded theory approach to data collection and analysis (Glaser and Strauss, 1967). Forty-five experienced health visitors were interviewed using a semi-structured interview guide. The interviews were tape recorded and later transcribed. A detailed analysis is presented of the processes involved in referring. This includes working up the client for referral, working up the agency, third party referrals, and issues of control in the referral process. The outcome of referral in terms of the effect on the client is also discussed. This paper makes a contribution to our understanding of the microprocesses in everyday health visiting practice.

The elderly at home: service needs and provision

This paper arises from research to develop a profile of the elderly living in the community. Data are presented from interviews with a stratified random sample of 1406 elderly people living in the Trafford area of Greater Manchester. The findings suggest that in reality community care for the elderly means care by lay carers. Assistance with all tasks ranging from intensely personal care, for example bathing and dressing, to the practical household tasks, such as cooking and cleaning, was more often provided to the elderly by spouses and daughters/daughters-in-law than by the statutory services.It is suggested that some form of eligibility criteria may be used either consciously or unconsciously by general practitioners and other health care workers when referring elderly people to the nursing and social services which may mean that the statutory services do not complement the care given by lay carers. Furthermore, the presence of a lay carer may prevent the situation coming to the attention of the primary health care team.

The response of nurses towards the management and teaching of patients on continuous ambulatory peritoneal dialysis (CAPD)

The aim of this paper is to shed some light on the way trained nurses responded to the challenge of teaching patients to manage life on Continuous Ambulatory Peritoneal Dialysis (CAPD). This topic is of interest since nursing skills and knowledge are central to the successful management of patients on CAPD. More importantly, the treatment has the potential to keep patients alive who would not previously have been treated. Hence the assumption underpinning this work is that the opinions which nurses hold regarding this form of treatment may in due course influence its future. The data on which this paper is based were collected by means of participant observation over a period of nine months on one male and one female medical ward. Supplementary data were collected during this time at the out-patient clinic and at multidisciplinary CAPD meetings. The findings reported here are impressionistic and hypothesis-generating, but nevertheless they do provide sound insights into the way nurses reacted to patients on this new form of treatment. The type of patient selected for treatment and the ward workload were found to be the most influential factors in the way nurses regarded CAPD patients. It seemed that patients were viewed as 'members' of a collectivity rather than as individuals. Hence the job of the nurse was to rationalize competing demands on her time. Our data suggest that nurses viewed CAPD patients as generating 'extra work' and these patients were more likely to be viewed unfavourably.(ABSTRACT TRUNCATED AT 250 WORDS)

Reading nursing: the burden of being different

The data on which this paper is based were collected by means of informal interviews with final year nursing undergraduates at one university. From students' accounts it is apparent that the lives of undergraduate nurses are dominated by an all embracing feeling of 'difference'. This paper centres on the theme of 'difference' and draws upon the literature from the field of disablement in an attempt to explain the position of undergraduate nurses.

Measuring life satisfaction in an elderly female population

The study described in this paper was undertaken as part of the pilot work for a main study, which attempts to evaluate the effectiveness of health visitor intervention on an elderly female population in Scotland. The Life Satisfaction Index A (Neugarten et al. 1961) was modified by the researcher and tested on a female Scottish population and is subsequently being used as one of three outcome measures of health visitor intervention.