Journal of Advanced Nursing

Aim.  This paper reports a study of the perceptions of patients and nurses of palliative care and, in particular, the concept of the expert palliative nurse.

Background.  Palliative care is a growing speciality and is practised globally. There is, however, limited information on patients’ views about palliative care. While the idea of expertise in nursing is not new, few studies have explored the concept of the expert nurse in palliative care. Some evidence exists on palliative nurses’ perceptions of their care, that it is supportive and involves maintaining therapeutic relationships with patients. Facing a terminal illness has been identified as a stressful and fearful experience that affects all aspects of life. It has also been revealed that dying patients may have unmet care needs, mainly in the areas of pain and symptom control, emotional support, and spending time alone.

Methods.  A phenomenological study was carried out, using in‐depth interviews and thematic content analysis. A convenience sample of 22 Registered Nurses and 22 dying patients was interviewed in 1996–1997.

Findings.  Dying patients had a desire to maintain independence and remain in control. Palliative care nurses experienced both effective and ineffective interpersonal communication, the building of therapeutic relationships with dying patients and attempting to control patients’ pain and distressing symptoms. Patients and nurses agreed that the two most important characteristics of an expert palliative nurse were interpersonal skills and qualities such as kindness, warmth, compassion and genuineness.

Conclusion.  Although the study was conducted in the United Kingdom, the findings have relevance for palliative care practice globally in terms of dependence, issues of patient choice, nurses being interpersonally skilled and building therapeutic relationships with patients.

Background. Much attention has been paid to the problem of postpartum depression in women. However, there is some indication that men also experience depression after the birth of a child, and that paternal depression is linked to maternal depression.

Aims. The purpose of this integrative review was to examine current knowledge about postpartum depression in fathers. Specific aims were (1) to examine the incidence of paternal depression in the first year after the birth of a child, (2) to identify the characteristics and predictors of paternal postpartum depression, (3) to describe the relationship between maternal and paternal postpartum depression, and (4) to discuss the influence of paternal depression on the family and infant.

Methods. A literature search from 1980 to 2002 was carried out using the CINAHL, PsychInfo, and Medline electronic databases. Twenty research studies were identified that included incidence rates of paternal depression during the first year postpartum. These were further examined and synthesized regarding onset, severity, duration, and predictors of paternal depressive symptoms, and for information about the relationship between maternal and paternal depression.

Findings. During the first postpartum year, the incidence of paternal depression ranged from 1·2% to 25·5% in community samples, and from 24% to 50% among men whose partners were experiencing postpartum depression. Maternal depression was identified as the strongest predictor of paternal depression during the postpartum period. The implications of parental depression for family health were discussed.

Conclusions. Postpartum depression in men is a significant problem. The strong correlation of paternal postpartum depression with maternal postpartum depression has important implications for family health and well‐being. Consideration of postpartum depression in fathers as well as mothers, and consideration of co‐occurrence of depression in couples, is an important next step in research and practice involving childbearing families.

The management of post‐operative nausea and vomiting

Despite the advent of new technology and pharmacological agents, post‐operative nausea and vomiting (PONV) continues to have an incidence of 20–30% today. Development of PONV can lead to serious complications such as aspiration, dehydration, electrolyte disturbances and disruption of the surgical site. PONV leads to increased cost of treatment, and may be associated with increased anxiety, dissatisfaction with the surgical experience and anticipatory nausea in the future. The mechanisms of PONV are examined with associated risk factors. A review of the literature of PONV management is included covering pharmacological, dietary and behavioural interventions; culminating in the development of assessment and management guidelines and identification of areas for further study.

Trăng lưỡi liềm và Hồi giáo: chữa lành, điều dưỡng và khía cạnh tâm linh. Một số cân nhắc hướng tới sự hiểu biết về quan điểm của Hồi giáo đối với sự chăm sóc

Việc chăm sóc từ quan điểm của Hồi giáo không được trình bày nhiều trong văn liệu điều dưỡng mang tính châu Âu. Có sự hiểu lầm phổ biến về khái niệm và thực hành Hồi giáo trong bối cảnh chăm sóc sức khỏe và thực hành điều dưỡng. Các khu vực tranh luận, trong bối cảnh các hệ thống chăm sóc sức khỏe, là liệu các mô hình chăm sóc và quản lý điều dưỡng phương Tây có áp dụng được cho các tín đồ Hồi giáo và không phải Hồi giáo trong cả hai quốc gia Hồi giáo và không phải Hồi giáo. Điều thiếu sót trong một số mô hình và khung lý thuyết chăm sóc không chỉ là thành phần tinh thần cơ bản của sự chăm sóc mà còn là tầm quan trọng của sự phát triển tinh thần của cá nhân hướng tới việc chữa lành. Tập trung chính của bài báo này là tạo ra một nhận thức về các thực hành y tế Hồi giáo, các hành vi sức khỏe, quy tắc đạo đức và khung quan điểm của Hồi giáo về việc chăm sóc và tâm linh. Một cái nhìn tổng quát về thế giới Hồi giáo, sự phát triển lịch sử trong việc chăm sóc và y tế và những trụ cột của đức tin Hồi giáo cung cấp bối cảnh cho bài báo. Đề xuất một mô hình chăm sóc dựa trên quan điểm của Hồi giáo được đưa ra.

Title.  Nurse education: factors associated with attrition.

Aim.  This paper is a report of a study to identify the factors having an impact on student completion rates in a preregistration programme.

Background.  Nursing student attrition is an international issue causing concern in many parts of the developed world including Australia, the United States and Europe. In the United Kingdom, nursing student attrition has become a major issue, despite having one of the lowest general university dropout rates in the developed world.

Method.  A retrospective cohort study was conducted in 2007 using routinely‐collected demographic and completion data on four cohorts of nursing students (1259 in total) studying at a large English university.

Findings.  Students who were older on entry were more likely to complete the programme than younger students, and those who had only the minimum educational qualifications on entry were less likely to complete than those with higher‐level qualifications. There was some evidence of increased risk of resigning from the course in students taking the child branch, and increased risk of discontinuation (involuntary removal) from the course in both male and black/minority ethnic students. There was also some evidence that the healthcare organization responsible for a student’s placement could influence completion rates.

Conclusion.  To improve attrition rates on preregistration nursing programmes, higher education institutions should actively target recruitment at mature candidates; increase the level of qualification required to gain entry; examine course structures for flexibility and provide multi‐level student support.

Title. Diversity, attrition and transition into nursing.

Aim. This paper is a report of a study to explore the relationship between selected diversity variables (sex, country of birth, ethnicity, age, educational qualifications, and additionally visa status, application route, absence rates), and nursing students’ progression and attrition.

Background. Debates on levels, forms and causation of nursing student attrition have been professional, academic and political concerns for some time on an international level. However, a more systematic approach to studying the topic is needed. We lack commonly operationalized national and international data on the relationship between attrition and diversity variables, and their implications for cost, social justice and demographic representativeness in nursing.

Methods. A longitudinal cohort design was used. Data were collected from 2003 to 2005 from routinely collected data in student records.

Results. Males had lower odds of completing the programme than females, as did younger students. Compared with United Kingdom‐born students, those born in Ireland, Zimbabwe, or other English‐speaking countries were more likely to complete the programme. Students born overseas in non‐English‐speaking countries did not differ statistically significantly from United Kingdom‐born students. Those at all qualification levels had similar odds of completion, except students already qualified at degree level, who were less likely to complete.

Conclusion. Further national and international research is needed to understand better the causal variables underpinning differential attrition rates, with particular regard to understanding how different groups may experience the relationship between education and their broader circumstances and between the theoretical and the clinical elements of nurse education itself.

For a person with a chronic illness, life is altered in some way. Whether simple or complex, changes are nevertheless permanent. A patient with a chronic disease assesses recommended treatments on how well they can be integrated into his life. Evidence suggests that an individual's perception of his situation will determine whether or not he will comply with a medical regimen. Health professionals neglect the patient's point of view if they believe that patients regard the health professional as an absolute authority, thereby contributing to non‐ compliance. The contingency contract provides a model of patient‐provider transaction, which requires input from both parties. The health professional can work with the person to make the medical regimen compatible with the individual's lifestyle.