Concept analysis of recovery in mental illness in young adulthood.

Recovery, as a concept, emerged as a core philosophy of the service user movement that began in the late 1960s and 1970s. Previous reviews on recovery in mental health have presented definitions or a conceptual framework; however, over time it has been open to disparate interpretations. The aim of this paper was to conduct the first concept analysis of mental health recovery in young adulthood within various multidisciplinary contexts. Rodgers's (2000) six-stepped evolutionary method enabled the analysis of recovery's conceptual characteristics, the identification of an exemplar and the proposition of a hypothesis with implications for practice. This analysis has revealed the derivation of the term recovery does not convey its identified conceptual characteristics. Identified attributes include the reawakening of hope, reclaiming a positive self and meaning through personal growth. Antecedents include the disruption of illness, stigmatization, internal inventory and contemplative recovery. Identified consequences include the return to normality, reconstruction of self and active social connection. The new conceptual definition is the reawakening of hope and rediscovery of a positive sense of self through finding meaning and purpose within personal growth and connection using creative self-care coping strategies. This paper reveals an apparent disparity between professional and personal interpretations of recovery. Therefore, the implication for mental health nursing is the congruence of recovery-orientated practice with the process of recovery experienced by young adult service users.

An exploration of the experience of cancer cachexia: what patients and their families want from healthcare professionals.

The aim of this paper is to investigate the perceptions of patients and family members with regard to care received for cancer cachexia. A qualitative study recruited 27 participants, of which 15 were patients with advanced cancer who had primary cachexia and 12 were family members. Participants were recruited from a regional cancer centre in the UK. All participants took part in a domiciliary interview, which was transcribed verbatim for analysis. A major finding from analysis was 'lack of response from health care professionals' in relation to cancer cachexia management. This finding illuminated that patients and their family members wanted three things from healthcare professionals. They wanted their profound weight loss acknowledged, they wanted information about it and why it was happening and they wanted interventions to deal with it. This paper provides powerful messages for healthcare professionals and highlights the needs of patients and their family regarding cancer cachexia management. Patients and their families want this problem addressed by healthcare professionals. This client group requires supportive healthcare interventions, so that they can understand the nature and impact of this syndrome.

Exploring caring using narrative methodology: an analysis of the approach.

The investigation of caring in nursing practice and the need to explicate what it is nurses do when they care present a challenge for nurse researchers. This is due largely to the complex and nebulous nature of caring as a concept and the contextual elements that influence its perceived meaning. Consequently, the use of qualitative methods in the exploration of caring is the method of choice, with researchers employing a variety of such approaches. In particular, the use of stories as a primary way of making sense of an experience has gained attention in the literature and the narrative method is being seen increasingly as a valid means of tapping into the patient experience. However, the use of narratives is complex with a diversity of approaches often being presented. This paper discusses the use of narratives in the exploration of caring, focusing specifically on an approach developed by Donald Polkinghorne. Issues associated with the collection and analysis of narrative data using this approach are examined.

A critical review of the Delphi technique as a research methodology for nursing.

The Delphi technique is an approach used to gain consensus among a panel of experts. This is normally achieved through a series of rounds where information is fed back to panel members using questionnaires. It has been used extensively within social science research and is being increasingly employed by nurse researchers. This popularity has meant that the technique has been adapted in various ways and there is the possibility that the rigour associated with the original format has been threatened. This signals the need for a critical review of the Delphi as a robust and systematic approach to data collection. While there is a great volume of literature surrounding the "Delphi", there is a dearth of papers critically analysing the technique. This paper aims to examine critically the Delphi technique from a range of perspectives. Discussion will focus on problems of definition and the advantages and disadvantages and the techniques' application in nursing. The critique will be structured through an analysis of the key aspects of the Delphi process. These key aspects include analysis of sampling, anonymity, use of experts, rounds and application. The critical analysis highlights the increasing popularity of the Delphi and the modifications to the process which may cause methodological problems. Ultimately, the Delphi has much to offer in terms of gaining consensus from a wide range of individuals on specific topics.

Caring: theoretical perspectives of relevance to nursing.

Caring as a central concept within nursing has led to the development of several caring theories, the most well known being Madeleine Leininger's Theory of Culture Care and Jean Watson's Theory of Human Caring, both of which were formulated in the 1970s. This paper explores a total of four caring theories: the two established theories presented by Leininger and Watson, Simone Roach's theory developed in the 1980s, and a recent caring theory developed by Boykin & Schoenhofer. A comparison of these theories is presented drawing on a number of criteria, namely: origin of theory, scope of theory, definition of caring, description of nursing, key concepts of the theory, and goal/outcome. Additionally, simplicity as a central component of internal structure is examined in relation to each. Based on this analysis, similarities and differences are highlighted, concluding with a discussion of the utility of the caring theories within nursing practice.

Establishing the credibility of qualitative research findings: the plot thickens.

Qualitative research is increasingly recognized and valued and its unique place in nursing research is highlighted by many. Despite this, some nurse researchers continue to raise epistemological issues about the problems of objectivity and the validity of qualitative research findings. This paper explores the issues relating to the representativeness or credibility of qualitative research findings. It therefore critiques the existing distinct philosophical and methodological positions concerning the trustworthiness of qualitative research findings, which are described as follows: quantitative studies should be judged using the same criteria and terminology as quantitative studies; it is impossible, in a meaningful way, for any criteria to be used to judge qualitative studies; qualitative studies should be judged using criteria that are developed for and fit the qualitative paradigm; and the credibility of qualitative research findings could be established by testing out the emerging theory by means of conducting a deductive quantitative study. The authors conclude by providing some guidelines for establishing the credibility of qualitative research findings.

Loss: an analysis of a concept of particular interest to nursing.

The term 'loss' is used frequently in the nursing literature and by nurses in the clinical setting. However, loss as a concept has not been defined comprehensively. In this paper, an attempt will be made to analyse the concept. The paper will begin with an overview of approaches to concept analysis. Subsequent sections include a literature review examining current and classic usage of the concept. General and specific definitions of loss provide a template for discussion. The paper will conclude with the identification of critical attributes for the concept which will form the basis for an exploration of explicit empirical referents.

Caring: dealing with a difficult concept.

The concept of caring is the focus of this paper, in which an attempt is made to clarify the meaning of caring in nursing using one method of concept analysis. The decision to complete an analysis on caring was made following a substantial review of the literature, from which a concise definition of the concept remained elusive. Concept analysis as described by Walker and Avant (1995) is utilised and this paper demonstrates the various steps involved in this approach.

Victimization of people with enduring mental illness in the community.

The deinstitutionalization of care for the mentally ill has been in vogue for about fifty years. Broadly speaking, this transition can be seen to exhibit the following main trends: a dramatic decline in the inpatient population of psychiatric hospitals, coupled with a corresponding increase in community facilities such as psychiatric units in general hospitals, day hospitals, and day centres. It has been claimed that deinstitutionalization ends previously enforced seclusion, enhances human dignity and allows individual privacy. The deinstitutionalization movement has inevitably led both to large numbers of former long-stay patients being cared for in the community and to significant numbers of individuals developing enduring mental illness in the community without ever having had a long inpatient tenure. The findings of recent studies (Gould 1992, Brockington et al. 1993) suggest that there is a positive public attitude towards the mentally ill. However, Kelly (1997), while carrying out Quality of Life research, found that over half of the community-based long-term mentally ill he surveyed reported that they had experienced harassment/victimization. This paper is not a report on the Quality of Life research but a discussion on the theme of victimization that has emerged from the study. The extent of the problem is discussed as are the implications for mental health professionals.

Theory and research: a linkage to benefit practice.

This paper begins with a critical overview of what the extant literature sees as the relationship between research, theory and practice. Most scholars maintain that there are two main viewpoints: research exists to build theory from practice and/or research exists to test existing theory in practice. It will be argued that is too simplistic a view and four specific linkages will be proffered: Theory Testing Research, Theory Generating Research, Theory Evaluating Research and Theory Framed Research. All four will be discussed and their contribution to the knowledge base of nursing practice explored. In concluding, an argument will be put forward proposing the view that undertaking research without considering theory is an empty and non-productive exercise.

Dissemination and application of mental health nursing research.

Various government reports recognize that research is not informing practice. This article discusses the reasons for this and what organizations and individuals can do about it.

A multiprofessional approach to audit.

This article presents the case for a co-operative approach to audit that includes input from a range of healthcare professionals. Evaluating the obstacles which have prevented such an approach already being in place, the author outlines the basis of and benefits to be gained from multiprofessional audit.

Nursing skill mix substitutions and quality of care: an exploration of assumptions from the research literature.

A comprehensive search of the research literature was undertaken to explore the relationship between skill substitution and quality of care. It was possible to identify three central assumptions based upon the studies reviewed. The first suggests that a rich skill mix of mostly qualified nurses is often an ineffective and inefficient way of providing health care. The second assumption is based on research which appears to indicate that a skill mix of mostly unqualified staff is an ineffective approach to health care provision. Finally, there is a plethora of research findings which suggest that the most effective and efficient way to provide health care lies in the employment of high numbers of qualified staff. This paper examines the evidence for each of these positions and highlights the inherent limitations of the underlying studies.

The evaluation of a nursing model for long-stay psychiatric patient care. Part 1--Literature review and methodology.

A modified action research approach was used to implement a selected nursing model on a long-stay psychiatric ward. Within a broader quasi-experimental design, specific quality of care indicators were appraised before and after the implementation of the model. These dependent variables were also monitored on a control ward and data were collected on both wards at one pre-test and two post-test points. This paper presents a comprehensive overview of the literature and the methodology for the study. Planned change theory was used as a guiding framework for the implementation of the model and this process is described in detail.

The evaluation of a nursing model for long-stay psychiatric patient care. Part 2--Presentation and discussion of findings.

A nursing model selected by a population of ward managers was implemented on a long-stay psychiatric ward in Northern Ireland using an adapted action research approach within a quasi-experimental design. A range of dependent variables were appraised at one pre-test and two post-test evaluation points on an experimental (Ward X) and a control ward (Ward Y). A thorough review of the literature and methods used can be found in Part 1 (McKenna et al., 1995, Int. J. Nurs. Stud., 32, 79-94). The findings and their interpretations are presented here. Results indicate that on the experimental ward there were statistically significant improvements in "Psychiatric Monitor", patients' and staff's perception of ward atmosphere, patient satisfaction, staff's views about nursing models, and patient dependency levels. No significant changes were noted in nurse satisfaction levels nor nurses' perception of patients' behaviour. Particular emphasis is placed on the possible threats to the internal and external reliability of these findings and on the attempts made to control these threats.

Mental disorder among a homeless population in Belfast: an exploratory survey.

This study aimed to identify the prevalence of mental disorder in hostels for the homeless in Belfast, Northern Ireland. In addition, it attempted to assess the facilities and support offered from both the hostels and the Health Service to homeless people who have a mental disorder. Lastly it sought to determine whether or not psychiatric hospital bed closure had any influence on the prevalence of homelessness among these persons in Belfast. An exploratory approach was adopted, using semi-structured interviews as the method of data collection. The sample consisted of 12 hostels for the homeless with a total occupancy of 250 residents. Officers in charge were surveyed. The results obtained indicated that approximately 25% of the homeless in Belfast hostels have a diagnosed mental disorder and that hospital closure has had a direct effect on the size of this percentage. In addition, it was found that the hostels generally are not able to offer the levels of therapy and support given in hospital or in designated hostels for people with mental health problems. Responses also suggest that support from Health Service personnel is less than satisfactory. While the findings in this study do not look at the entire homeless population in Northern Ireland, interesting and useful information emerged that has implications for policy and further areas of study elsewhere.

The Delphi technique: a worthwhile research approach for nursing?

Since its introduction as a research approach in the late 1940s the Delphi technique has had over 1000 published research utilizations. Most of these have been in the field of social policy. However, a review of contemporary nursing literature suggests that it is becoming a popular choice among nurse researchers. With its focus on maximizing participant's judgements and decision-making abilities the Delphi technique is a useful tool in the research armoury of a young profession. However, questions remain about its scientific respectability. This paper gives an overview of what the Delphi technique is, the criteria for selecting it as a research approach, the studies where it has been used and its advantages and disadvantages.

The essential elements of a practitioners' nursing model: a survey of psychiatric nurse managers.

Most of the existing models of nursing have been formulated by academic theorists rather than practising nurses. According to the literature, the template used by these theorists is their perception of what the essential elements 'nursing', 'health', 'person' and 'environment' are: the so-called 'metaparadigm' of professional nursing. However it is also generally accepted in the literature that all nurse practitioners have their own 'personal model' of nursing, invariably based upon the individual nurse's values and beliefs concerning the same elements! Within this study it was possible to enable 95 ward managers to make their views on the four elements explicit, thereby forming a basis for a practitioners' model of nursing.

The attitudes of traditional and undergraduate nursing students towards nursing models: a comparative survey.

The underpinning of nursing curricula with nursing models and their inclusion as part of the curriculum has increased dramatically in the last 10 years within the United Kingdom. However there is a dearth of research not only into how nursing students in general view these frameworks, but also into how students from different courses compare in their perception of them. In this study a questionnaire on attitudes to models was distributed to 20 second-year undergraduate (BSc Nursing) students and 20 third-year 'traditional' (RGN) students. Findings indicate that although both groups have a positive attitude overall towards nursing models, the traditional nursing students had a more positive perception than their undergraduate counterparts. In the discussion section possible explanations are put forward as to why these differences in attitudes exist.