Journal of Advanced Nursing


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Nutritional status and its health-related factors among older adults in rural and urban areas

June 3, 2014 - 10:12pm
Abstract Aim

To compare health-related characteristics, nutrition-related factors and nutritional status of older adults living in rural and urban counties of Taiwan.

Background

The older adult population of Taiwan is increasing. Furthermore, older people living in rural areas have shorter life expectancy and more chronic diseases than their urban counterparts. However, little is known about the health-related characteristics, nutrition-related factors and nutritional status of older adults living in rural and urban areas of Taiwan, limiting nurses' ability to identify and care for older adults at risk of poor nutritional health.

Design

Cross-sectional, comparative.

Methods

Older adults were randomly selected from names of residents of an adjacent rural and urban area of northern Taiwan and having completing the 2009 health evaluation. From March–July 2010, older adult participants (N = 366) provided data on demographic and health-related information, nutritional self-efficacy, health locus of control and nutritional status. Data were analysed by descriptive statistics and compared using chi-square and t-test.

Results

Older rural participants had significantly lower educational level, less adequate income, higher medication use, lower scores on self-rated health status and researcher-rated health status and lower self-rated healthy eating status than their urban counterparts. Moreover, rural participants had significantly lower nutritional self-efficacy, higher chance health locus of control and poorer nutritional status than their urban counterparts.

Conclusions

Our results suggest that nurses should assess older adults living in rural areas for nutritional health and nutrition knowledge. Based on this assessment, nurses should develop easy, practical and accessible nutritional programmes for this population.

Categories: Nursing

Application of Heideggerian phenomenology to mentorship of nursing students

June 3, 2014 - 10:11pm
Abstract Aim

To discuss interpretations of the lived experience of mentoring based on Heidegger's concept of dasein. The focus is on one main theme identified in an in-depth study of the lived experience of nurses mentoring students in their workplace: a world of hope for the nursing profession.

Background

This article focuses on dasein's ‘existence’, which is temporally aligned with having a future. Data relating to this theme are presented and interpreted with respect to the temporal aspect of dasein pertaining to ‘having a future’ and the Heideggerian existentials of existence and verstehen (understanding).

Design

The research design was based on hermeneutic phenomenology, exploring the mentors' ‘being’.

Methods

Data were gathered during 2008 through hermeneutic interviews, event diaries and participant drawings. Analysis occurred through sustained hermeneutic engagement with the data and application of an interpretive lens provided by Heidegger's care structure.

Results

Three sub-themes are identified: ‘being a gatekeeper’, ‘sustaining a professional will’, and ‘passing on the special things’.

Conclusions

Mentors can and need to engage on a deep personal level with their students if they are to intervene appropriately as gatekeepers to the profession.

Categories: Nursing

Theoretical sampling

June 3, 2014 - 5:17am
Categories: Nursing

Conceptualizations of dignity at the end of life: exploring theoretical and cultural congruence with dignity therapy

May 27, 2014 - 11:36pm
Abstract Aim

To explore the conceptualization of patients' dignity in the context of end-of-life care in Taiwan.

Background

Dignity therapy – a novel nurse-delivered psychotherapeutic intervention – has been demonstrated to have potential to alleviate terminal patients' psycho-existential distress in western countries. In Taiwan, over half of end-of-life patients experience psychological-spiritual suffering and dignity therapy might be helpful in improving this situation. Hence, a preliminary study to clarify Taiwanese conceptualizations of ‘dignity’ was conducted prior to planning a feasibility study to gauge the potential cultural fit of an intervention of this type.

Design

Qualitative exploration.

Methods

Nine people with terminal cancer and ten health professionals were recruited from palliative care services in 2008. In-depth interviews were audiotaped and transcribed verbatim. A hermeneutic approach was employed to analyse and interpret data.

Findings

Being a valuable person is the core meaning of patients' dignity and this comprised intrinsic characteristics and extrinsic factors. Intrinsic characteristics of dignity encompassed living a moral life, having peace of mind and a sense of existence involving the perception of resignation to God's will. Extrinsic factors that influenced patients' dignity included illness-related distress, care delivery and the perception of being loved. A dynamic relationship between these elements determined the state of patients' dignity.

Conclusion

The concept of dignity is culturally bound and understood differently in the Chinese and Western context; such differences should be considered when planning and delivering care. Modifications should be made to dignity therapy to ensure it is culturally congruent with Taiwanese patients' beliefs.

Categories: Nursing

Systematic review of instruments for measuring nurses' knowledge, skills and attitudes for evidence-based practice

May 27, 2014 - 11:35pm
Abstract Aim

To identify, appraise and describe the characteristics of instruments for measuring evidence-based knowledge, skills and/or attitudes in nursing practice.

Background

Evidence-based practice has been proposed for optimal patient care for more than three decades, yet competence in evidence-based practice knowledge and skills among nurse clinicians remains difficult to measure. There is a need to identify well-validated and reliable instruments for assessing competence for evidence-based practice in nursing.

Design

Psychometric systematic review.

Data Sources

The MEDLINE, EMBASE, CINAHL, ERIC, CDSR, All EBM reviews and PsycInfo databases were searched from 1960–April 2013; with no language restrictions applied.

Review Methods

Using pre-determined inclusion criteria, three reviewers independently identified studies for full-text review, extracting data and grading instrument validity using a Psychometric Grading Framework.

Results

Of 91 studies identified for full-text review, 59 met the inclusion criteria representing 24 different instruments. The Psychometric Grading Framework determined that only two instruments had adequate validity – the Evidence Based Practice Questionnaire measuring knowledge, skills and attitudes and another un-named instrument measuring only EBP knowledge and attitudes. Instruments used in another nine studies were graded as having ‘weak’ validity and instruments in the remaining 24 studies were graded as ‘very weak’.

Conclusion

The Evidence Based Practice Questionnaire was assessed as having the highest validity and was the most practical instrument to use. However, the Evidence Based Practice Questionnaire relies totally on self-report rather than direct measurement of competence suggesting a need for a performance-based instrument for measuring evidence-based knowledge, skills and attitudes in nursing.

Categories: Nursing

Predicting emotional exhaustion among haemodialysis nurses: a structural equation model using Kanter's structural empowerment theory

May 27, 2014 - 11:30pm
Abstract Aim

To test an explanatory model of the relationships between the nursing work environment, job satisfaction, job stress and emotional exhaustion for haemodialysis nurses, drawing on Kanter's theory of organizational empowerment.

Background

Understanding the organizational predictors of burnout (emotional exhaustion) in haemodialysis nurses is critical for staff retention and improving nurse and patient outcomes. Previous research has demonstrated high levels of emotional exhaustion among haemodialysis nurses, yet the relationships between nurses' work environment, job satisfaction, stress and emotional exhaustion in this population are poorly understood.

Design

A cross-sectional online survey.

Methods

417 nurses working in haemodialysis units completed an online survey between October 2011–April 2012 using validated measures of the work environment, job satisfaction, job stress and emotional exhaustion.

Results

Overall, the structural equation model demonstrated adequate fit and we found partial support for the hypothesized relationships. Nurses' work environment had a direct positive effect on job satisfaction, explaining 88% of the variance. Greater job satisfaction, in turn, predicted lower job stress, explaining 82% of the variance. Job satisfaction also had an indirect effect on emotional exhaustion by mitigating job stress. However, job satisfaction did not have a direct effect on emotional exhaustion.

Conclusion

The work environment of haemodialysis nurses is pivotal to the development of job satisfaction. Nurses' job satisfaction also predicts their level of job stress and emotional exhaustion. Our findings suggest staff retention can be improved by creating empowering work environments that promote job satisfaction among haemodialysis nurses.

Categories: Nursing