Theoretical perspectives of nursing: a review of the literature

Measurement of Health-Related Quality of Life in Chronic Heart Failure, from a Nursing Perspective—a Review of the Literature

BACKGROUND

Living with chronic heart failure (CHF) is distressful and affects daily life. Because of the lack of a cure for CHF, there has been a progressive interest in using health-related quality of life (Hr-QoL) as an outcome measurement of the treatment in patients with CHF.

OBJECTIVE

The aim of this review was to describe the instruments/questionnaires used in different studies in the measurement of Hr-QoL in patients with CHF, and how they were put into operation as seen from a nursing perspective.

METHOD

MEDLINE and CINAHL databases were searched from January 1995 to June 2002, by using the keywords CHF, heart failure, QoL and Hr-QoL. A total of 33 articles were analysed.

RESULTS

Thirty-two different Hr-QoL questionnaires were found. Generic, disease-specific and battery approaches were different ways used to measure Hr-QoL. To assess/describe Hr-QoL, evaluate the impact of interventions and examine relations/predictors were three main objectives. However, different aspects of the concept Hr-QoL, influencing factors, how to implement the questionnaires and a lack of unified CHF criteria existed.

CONCLUSIONS

To create a guideline for the measurement of Hr-QoL in CHF patients is of great importance for nurses and might generate homogeneity in the measurement methods and promote the scientific approach in the nursing care process.

Understanding how older adults living in deprived neighbourhoods address ageing issues

Older adults living in deprived areas are at risk of developing frailty and becoming care dependent. The aim of this qualitative study is to explore how community-dwelling, older adults living in deprived neighbourhoods address ageing issues. In-depth interviews were conducted with 20 participants who were community-dwelling (independently living), aged 65 years and older, not dependent on care, and living in a socioeconomically deprived urban neighbourhood in the northern part of the Netherlands. Data were analysed using the constant comparative method. Our findings emphasise the resourcefulness of these older adults when coping with apparent adversities. Simultaneously, the findings convey deficits concerning knowledge about ageing and health. Despite this, it appeared that these older adults possess an optimistic view of life, accept their situation, and are content with the capacities they still possess. Perspectives on how older adults address ageing issues are important for developing leads for nursing practice. Nurses will be challenged to recognise the coping strategies of older adults, particularly considering their deficits in health knowledge. The results of this study may serve as a basis for community nurses to manage care for older adults in deprived neighbourhoods.

The essence of nursing care: Polish nurses? perspectives

AIM

This paper is a report of a study to identify Polish nurses' definition of the concept of nursing care.

BACKGROUND

Polish nursing currently is in a period of scientific research focusing on development of precise definitions of concepts. Definitions of nursing are influenced by culture, social expectations and healthcare systems. Accepted scientific definitions of concepts should be based on empirical verification that takes theoretical and practical perspectives into account.

METHODS

A survey questionnaire was constructed from analysis of a random sample of 27 essays about nursing care that had been completed by 300 Polish nurses. The survey questionnaire, which was designed to measure the essence of nursing care, was completed by 324 Polish nurses during 2004 and 2005.

FINDINGS

Analysis of survey questionnaire responses revealed that the essence of nursing care encompasses providing care, communicating, supporting, helping, assisting, accompanying and managing. Participants indicated that nursing care recipients include healthy persons, ill persons and persons at risk for disease.

CONCLUSION

The concept of nursing care encompasses several traits or characteristics that can be applied to both well and ill people.

Nonphysician clinicians in the neonatal intensive care unit: meeting the needs of our smallest patients

Regional variations in the distribution of neonatal physicians and dependence on housestaff with restricted work hours have created workforce shortages in many NICUs. Although neonatal nurse practitioners assist in the delivery of high-quality care, availability of these providers may be inadequate in certain regions. Physician assistants represent a historically underutilized resource to resolve neonatology's workforce issues. We have developed a postgraduate training program for physician assistants in neonatology that we hope will improve local and regional workforce shortages. In this article we discuss the history of neonatal nurse practitioners and physician assistants in newborn care and outline the program that we developed. We further discuss some of the barriers we had to overcome in developing this program. Our program can serve as a model for other neonatology programs to adequately prepare physician assistants for a career in the NICU.

Treatment advice in primary care: a comparative study of nurse practitioners and general practitioners

AIM

This paper reports a study comparing the content of talk about treatments by nurse practitioners and general practitioners in order to understand how this might be related to satisfaction.

BACKGROUND

Studies show that satisfaction with nurse practitioner care is high when compared with that given by general practitioners. Clinical outcomes are similar. Nurse practitioners spend statistically significantly longer on consultations, and spend more time discussing treatments as well as social and emotional aspects of patients' lives.

METHODS

Based on transcripts of audiotaped consultations, clinicians' talk about treatment was compared across 18 matched pairs of nurse practitioner and general practitioner consultations where 'same day' appointments were sought. Case studies of six paired consultations were analysed in depth. The data were collected in 1998 in the United Kingdom.

RESULTS

A statistically significantly greater proportion of nurse practitioners' talk concerned treatments, with talk about how to use treatments and discussion of side effects contributing most to the difference. Nurse practitioners also recommended a greater number of treatments. Qualitative comparison of case study pairs suggested that nurse practitioners demonstrated greater concern with the acceptability and cost of treatments to patients.

CONCLUSIONS

Nurses offered more holistic care to these patients and it is likely that this, and the greater provision of information, led to the higher levels of satisfaction found by other investigators. General practitioners are more focused on gathering information directly relevant to diagnosing and treating the immediate presenting complaint. Both types of practitioner may benefit from seeing the detailed illustrations of different approaches provided.

The origins of current nurse education policy and its implications for nurse educators

The publication of Fitness for Practice [UKCC Commission for Nursing and Midwifery Education, 1999. Fitness for Practice (Chair Sir Leonard Peach). UKCC, London] in the United Kingdom (UK) came at a time when anxiety was being expressed by UK government and the National Health Service (NHS) over the suitability of newly trained nurses to be 'fit for purpose'. There had been growing disquiet that the education reforms of the 1990s, which had seen nurse education move into higher education, had failed to deliver skilled nurses for the modern healthcare system. Fitness for Practice (loc. cit.) became the driving force behind government's attempts to bring about change nurse education policy. In the process of these reforms, nurse educators were marginalised and portrayed a negative light. The implementation time of the report was one to two years. This makes the policy ripe for discussion and analysis to explore the complexity of its recommendations, and its implications for UK nurse educators within a higher education context.

Skills or skilled? Children's nursing in the context of the current debate around nursing skills

This article seeks to demonstrate how the current debate around nursing skills is derived from an economic model of care and competency that has been based on the needs of the adult population. The professional perspective of children's nursing has been unheard in policy and decision-making circles concerning the skills agenda debate within educational and clinical practice. As a consequence, the need of children's nurses has been assumed to be the same as those of general/adult nursing. This article argues that children's nursing has followed a different historical and professional pathway on its progression to maturity. These differences call for alternative educational and clinical solutions for children's nurses in the issue of skills acquisition. In the children's nursing context, this is the difference between having a skill and being skilled. Recognition of this could ensure that children's nursing has a valuable contribution to make to the debate from its unique perspective.

The importance of nursing values in interprofessional collaboration

Nursing values are fundamental to the practice of nursing. They guide standards for action, provide a framework for evaluating behaviour and influence practice decisions. Despite the importance that can be attributed to nursing values, acknowledgement of them is difficult to find in the current debate about how interprofessional working is changing the healthcare system in which nurses currently work. This article argues that the profession needs to demonstrate that values are not only a theoretical concept but also that they can, and do, have a profound impact on the practical working life of nurses delivering care in collaboration with other professions.

The nature of advanced practice nursing

In attempting to define "advanced practice," we argue that nursing as such is teleological or goal-directed with those goals being defined by the patient or client in interaction with the nurse. In helping the patient meet identified goals, the nurse requires 2 kinds of knowledge-general and particular. General includes theory (know what/why), pattern recognition (know what), and practical knowledge (know how). Particular (know who) is personal knowledge about the patient. The advanced practice nurse, by virtue of graduate education, is able to move beyond the familiar and experientially learned. He or she makes a deliberate attempt to situate self in a dialectic between general and particular knowledge in such a way that the interplay opens possibilities. Knowing when a particular action would be most helpful is defined as practical wisdom. We argue that a highly developed sense of practical wisdom is the hallmark of advanced practice.

Who cares? Offering emotion work as a 'gift' in the nursing labour process

Who cares? Offering emotion work as a 'gift' in the nursing labour process The emotional elements of the nursing labour process are being recognized increasingly. Many commentators stress that nurses' 'emotional labour' is hard and productive work and should be valued in the same way as physical or technical labour. However, the term 'emotional labour' fails to conceptualize the many occasions when nurses not only work hard on their emotions in order to present the detached face of a professional carer, but also to offer authentic caring behaviour to patients in their care. Using qualitative data collected from a group of gynaecology nurses in an English National Health Service (NHS) Trust hospital, this paper argues that nursing work is emotionally complex and may be better understood by utilizing a combination of Hochschild's concepts: emotion work as a 'gift' in addition to 'emotional labour'. The gynaecology nurses in this study describe their work as 'emotionful' and therefore it could be said that this particular group of nurses represent a distinct example. Nevertheless, though it is impossible to generalize from limited data, the research presented in this paper does highlight the emotional complexity of the nursing labour process, expands the current conceptual analysis, and offers a path for future research. The examination further emphasizes the need to understand and value the motivations behind nurses' emotion work and their wish to maintain caring as a central value in professional nursing.