Privacy or help? The use of curtain positioning strategies within the maternity ward environment as a means of achieving and maintaining privacy,or as a form of signalling to peers and professionals in an attempt to seek information or support

Midwives in the local maternity unit had noted that the interactions between women within the ward environment had started to decline. Women were spending long periods of time behind curtains drawn around their bed space. The staff hypothesized that this was because women desired the privacy of a single room. The literature review revealed a lack of understanding of the concept of privacy within a ward environment from a nursing or midwifery perspective. The review therefore, concentrated on the information offered by the fields of psychology and sociology. This study aimed to observe the methods women use to maintain or preserve their privacy within the ward environment. An ethnographic approach was used incorporating use of documentary evidence, participant observation and discussion, field maps and field notes. The findings of this study centred around the use of curtain positioning, subsequently referred to as 'signalling'. The strategies employed by women included complete closure for total withdrawal, semi-closure for seeking information or support, and partial closure of curtains around the individual's bed space for periods of solitude or rest. The findings have implications for both general and maternity hospital wards but in particular, wards within maternity units that incorporate women with mixed methods of infant feeding, or women in labour mixed with either postnatal or antenatal women.     

The presentation of competence in health care

This paper briefly addresses the views of social reality which underpin our interpretation of data, and argues that a social actor's statement is one account in a potentially infinite series, in which the actor presents him or herself as morally competent. This argument is illustrated by data from a study of subfertile couples, and other data from studies of parenting handicapped children. There is, however, a disjunction between these calm measured self-presentations, and the professional literature which describes a host of negative emotions. This raises questions about how needs, particularly emotional needs, are defined in health care.     

The theory-practice gap in nursing: from research-based practice to practitioner-based research

The aim of nursing research is generally agreed to be the generation of knowledge, and whilst this is a relevant aim in theory-based disciplines such as sociology, the primary concern of nursing is with practice. Using examples drawn mainly from the field of mental health, it will be argued in this paper that the application of generalizable, research-based knowledge to individual, unique, person-centred practice, the so-called 'research-based practice' advocated by the Department of Health, is one of the main causes of the theory-practice gap. It will be further suggested that nursing requires a paradigm of clinical research which focuses on the individual therapeutic encounter in order to complement the existing sociological paradigm of theoretical research which is best suited to the generation of generalizable knowledge and theory. The paper will conclude by suggesting that such a clinically based research paradigm must not only focus on the individual nurse-patient relationship, but that it must be carried out by the nurse herself. Clinical research, if it is to make a difference to practice, must therefore be practitioner-based research.     

Assessment of anxiety in hospital patients

There has been research in North America to validate the nursing diagnosis of anxiety As part of this work, Young used the defining characteristics and developed a tool to measure anxiety The present research sought to extend that study in the United Kingdom, assess the anxiety-defining characteristics tool and identify key indicators of anxiety that might be useful in clinical practice Four anxiety measurement tools, drawn from the literature, were used These were the state trait anxiety inventory, the graphic anxiety scale, the hospital anxiety and depression scale, and the anxiety-defining characteristics tool A random sample of 79 hospitalized patients were interviewed and their anxiety rated using all four measures Calculation of Spearman's correlation co-efficients revealed convergent validity between the anxiety-defining characteristics tool and the state trait anxiety inventory and the anxiety score on the hospital anxiety and depression scale Anxiety levels were found not to be affected by the age or sex of the respondent, or the length of stay or number of previous admissions Discriminant analysis suggested that six characteristics adequately discriminated anxious subjects sweating, faintness, tendency to blame others, continual review of things in then- mind, focus on self and a lack of self-confidence The study concluded that there is a scope for further research into these characteristics and then- use in clinical practice     

Towards a new model of nursing research

Nursing research is generally located within the paradigm of the social sciences, and therefore reflects the concerns and agenda of social research. In particular, nursing has become embroiled in the ongoing dispute between the advocates of qualitative and quantitative methodologies. However, it is argued in this paper that whereas the aim of social research is to develop knowledge, the aim of nursing research is primarily to advance practice. This paper offers an alternative model of nursing research which categorizes approaches to research not according to the methodology employed but on the extent to which the research process is likely to bring about change. These approaches are termed level 1, level 2 and level 3 research, where level 1 researchers are concerned with generating information for others to conceptualize and implement, while level 3 researchers see their aim as directly bringing about clinical change. Two approaches to level 3 research are suggested, and examples of projects at all three levels are examined. Finally, it is contended that only by adopting an appropriate model of research for a practice-based discipline can nursing address the real issues of relevance to nurses and patients in clinical settings.     

Effect of systematic relaxation techniques on anxiety and pain in older patients undergoing abdominal surgery

Inadequate pain control in older patients who have undergone abdominal surgery can lead to many complications. This study investigates the effect of systematic relaxation techniques on pain and anxiety in older patients undergoing abdominal surgery. One hundred twenty‐four patients were randomly assigned into the experimental and control groups. The systematic relaxation techniques consisted of older patients in the experimental group slowly reading relaxing sentences during recovery in ambulation after the surgery. Patients' satisfaction with pain and anxiety relief was recorded, as was their use of opioid analgesia. Statistically significant differences in pain and anxiety, and in analgesic use, were reported between the patients in experimental and control groups after the intervention. These relaxation techniques can be incorporated into the care plan to reduce pain and anxiety after surgery as well as offering a measure for increasing the patients' independence in pain management control.     

Caring, patient autonomy and the stigma of paternalism

Caring, patient autonomy and the stigma of paternalism ¶This paper utilizes data generated during a qualitative study in palliative and maternity care settings to guide discussion of the current discourse, which emphasizes patient autonomy and derides paternalism. Data are presented which illustrate that this ideology is established in nursing practice. Respect for patient autonomy is identified as an essential element of individualized, patient-centred and ethical care but conversely, it is suggested that over-emphasis may confuse and suppress beneficent intervention. The value of ethical theory to provide an objective means to explore ethical dilemmas in practice is not debated, but exploration of the issues raised by the data suggest, that principle-based ethical theory suffers the following constraints: the predetermined balance of ethical principles in favour of respect for autonomy prevents an unbiased perspective and optimum guidance; in contrast to caring relationship, application of ethical theory does not reveal the particulars necessary to guide ethical decisions aimed at promoting good for the individual; current discourse appears to disregard the inherent inequality in the relationship between the helped and helper and practitioners' need to preserve their own moral integrity. Consequently, this paper argues that beneficence derived through caring should not be superseded uncritically and suggests that mutual nurse-patient relationship, which balances respect for patient autonomy and beneficent guidance based on practitioner's clinical expertise, protects the moral integrity of both patient and practitioner. For conciseness, the term patient will be used to indicate recipients of both nursing and midwifery care and while both nurses and midwives are not always specified, any term referring to nurses, denotes both.