Portraits of pain and promise: a photographic study of Bosnian youth.

In the early 1990s, war erupted in Bosnia and Herzegovina, forcing large numbers of people to flee their homes and country, abandoning their culture and all that was familiar to them. For the children, often described as war's "innocent victims," the conflict and subsequent uprooting represented a dramatic end to their peaceful lives. Although many were fortunate enough to escape with their families and resettle amid more peaceful circumstances, there is considerable evidence that refugee youth are forever changed by their exposure to war and that the pain of war does not end when the fighting is over. This paper presents the results of a study with 7 Bosnian children, aged 11-14, who came to Canada as refugees during the 1990s. The everyday challenges and struggles faced by this group were explored using an innovative research method called photo novella. A secondary purpose of the research was to evaluate the merits and limitations of photo novella as a method for capturing children's perspectives and feelings. Participants were given disposable cameras and asked to take pictures of important people, places, and events. The meaning of the photographs was then explored through a dialogic process the researchers call phototalk. The findings revealed that while these children had many strengths, they continued to struggle to understand the events that so profoundly changed their lives. The results and the implications for nurses are discussed.

Dispelling myths and creating opportunity: a comparison of the strengths of single-parent and two-parent families.

Although single-parent family life has become mainstream in many ways, knowledge about these families has been focused predominantly on the chronic problems they experience. This study describes the strengths of single-parent families, compares these strengths to those of two-parent families, and describes families' explanations of the effect of self-identified strengths on health. Although single-parent and two-parent families are different structurally, the nature and pattern of strengths are found to be more similar than different between these two groups. These findings challenge stereotypical views of single-parent families that emphasize problems and vulnerability and exclude a consideration of their strengths.

Evaluation of an advanced health assessment course for acute care nurse practitioners.

The Acute Care Nurse Practitioner (ACNP) role is being implemented in many centres in Canada. Administrators need to be aware there are very few universities in Canada that prepare ACNPs for advanced health assessment. Therefore, a need may exist for continuing education in the work environment. The ACNPs in London, Ontario recognized such a need, and developed and implemented an Advanced Health Assessment Course using available resources, and administrators supported participation in the course. A pre-post course evaluation based on Bandura's Self-Efficacy theory (1997) was performed. From pre-test to post-test there were significant increases in: (a) the use of health assessement skills; (b) confidence in performing these skills; and (c) confidence in recognizing abnormalities on health assessment. The reasons most often cited for infrequent skill use were "inappropriate to clinical setting" and "used only if problem suspected". The majority of participants agreed that the course met their needs. Implications for practice include administrative support for continuing education at other centres to enhance health assessment skills of ACNPs.

Combining stories and numbers: a methodologic approach for a critical nursing science.

The critical paradigm is increasingly being recognized as an appropriate perspective for the development of nursing knowledge. While different research approaches including feminist, neo-Marxist, and participatory research have been described, all share the goals of empowerment, emancipation, and change. As a relatively new world-view for nursing, the concept of a critical nursing science faces much the same resistance as the interpretive paradigm did a decade ago. This article reviews the aims and assumptions of the critical paradigm; discusses the merits of combining stories and numbers for the agenda of change; and, using examples from our research, describes three strategies for combining stories and numbers in the critical paradigm.

Family strengths, motivation, and resources as predictors of health promotion behavior in single-parent and two-parent families.

The extent to which selected aspects of family health potential (strengths, motivation, and resources) predicted health work (health-related problem-solving and goal attainment behaviors) was examined in a Canadian sample of 138 female-headed single-parent families and two-parent families. The mother and one child (age 10-14) each completed mailed self-report instruments to assess the independent variables of family cohesion, family pride, mother's non-traditional sex role orientation, general self-efficacy, internal health locus of control, network support, community support, and family income, as well as the dependent variable, health work. With the effects of mothers' education held constant, the independent variables predicted 22 to 27% of the variance in health work in the total sample and each family type. Family cohesion was the most consistent predictor of health work, accounting for 8 to 13% of the variance. The findings challenge existing problem-oriented views of single-parent families by focusing on their potential to engage in health promotion behavior.

The effect of a clinical practicum on undergraduate nursing students' self-efficacy for community-based family nursing practice.

Providing family nursing care using a collaborative practice model presents a challenge to undergraduate students and to faculty who structure their learning experiences. A pre-test-post-test design was used to assess the impact of a 13-week family nursing clinical practicum on the perceived self-efficacy of two groups of nursing students in three areas: knowledge related to family nursing, home visiting, and collaborative practice. Students completed the Family Nursing Self-Efficacy Questionnaire (FNSE) at the beginning of the academic year and 4 and 8 months later to coincide with the timing of the practicum for each group (fall or winter term). A two-factor repeated measures analysis of variance (ANOVA) revealed a significant group X time effect (lambda = .80, p < .001). Students' self-efficacy differed significantly by group at time 2 only (t = 4.3, p < .001), supporting the positive effects of the clinical practicum on students' self-efficacy. Consistent with Bandura's (1977, 1986) theory, students rated actual performance of family nursing skills in a clinical setting as the most important source of efficacy information. Implications for designing meaningful clinical experiences in family nursing are discussed.

Stories and numbers: coexistence without compromise.

Research methods are not paradigm specific but should be selected on the basis of whether they fit with the purposes of an investigation. In the postpositivist, interpretive, and critical paradigms, both qualitative and quantitative data or a combination of these may be used without violating paradigm assumptions. Attention to the four basic issues of quality of the data, investigator bias, quality of the research process, and usefulness of the finding is necessary to produce valid research. Although researchers in each paradigm deal with these differently, combining strategies across paradigms may enhance the scientific value of a study and result in new methodologies to address the health needs of all people.

A comparison of two nursing models: Allen's developmental health model and Newman's theory of health as expanding consciousness.

Allen's developmental health model and Newman's theory of health as expanding consciousness are compared here with respect to their goals, theoretical influences, general orientations, and conceptualizations of the metaparadigm concepts of person, health, environment and nursing. While development of each of these models began around the same time (early 1970s) and each emphasizes health as the central concept, clear differences and relatively few similarities are evident. Each proposes that health is a process which evolves over time, yet conceptualization of these processes lies at the heart of the distinctiveness of the models. For Allen, health is a phenomenon of the family which can be developed through the learning of healthy behavior (coping and development skills). In Newman's view, health is not developed through behavior change but reflects increasing awareness of one's unitary pattern of interaction with the universe. Both models contribute to nursing science in a unique way by offering alternative perspectives of health and nursing and, for Allen, considering the family as the unit of concern.

The teamwork project: a collaborative approach to learning to nurse families.

The purpose of this exploratory study was to gain insight into students' perceptions of learning to nurse families using a team approach. A sample of 112 third-year baccalaureate nursing students provided data from clinical journals and responses to a teacher-developed questionnaire regarding number of home visits made with a partner, the extent to which partners shared responsibility for the nursing care of two families, perceived benefits and disadvantages of teamwork, roles assumed by team members, perceived outcomes of the team approach, and suggestions for revision of the approach. The degree to which students shared responsibility was moderate and positive perceptions of teamwork were significantly correlated with the degree of sharing of nursing activities. Using Spradley's qualitative method of domain analysis, interpretation of data from students' clinical journals revealed subjective aspects of the experience that appeared to influence teamwork practices and attitudes. Results suggest that the shared assignment approach offers students a unique opportunity to learn about the realities of collaborative nursing practice.