Ethical problems in practice as experienced by Malawian student nurses

Student nurses are confronted by many ethical challenges in clinical practice. The aim of the study was to explore Malawian students' experiences of ethical problems during their clinical placement. A phenomenological hermeneutic design comprising interviews and qualitative content analysis was used. Ten students were interviewed. Three main themes emerged: 1) Conflict between patient rights and the guardians' presence in the hospital; 2) Conflict between violation of professional values and patient rights caused by unethical behaviour; and 3) Conflict between moral awareness and the ideal course of action. The students had difficulties ensuring patient rights and acting in accordance with western norms and values which are not always appropriate in the Malawian context. The students require role models who demonstrate professional attitudes towards patients' rights and values. There is a need to create pedagogical strategies in which a caring attitude and ethical reflection can be learned and cultivated in clinical practice.     

Maternity care professionals' perceptions of supporting employed women in Norway

The World Health Organization calls on health professionals to support women in combining maternity and work. The aim of this study was to explore midwives' and public health nurses' perceptions of supporting employed women to balance work and family life during pregnancy and early motherhood. An exploratory design, including multistage focus group interviews, was used. The focus group consisted of five midwives and one public health nurse who was working in maternity care. The data were analyzed by using qualitative content analysis. The comprehensive theme, "empowering the women when they are in 'another' state of normality", was based on two themes, "being in dialogue with the women" and "supporting the women to manage daily activities". The first theme was based on the subthemes, "perceiving the women to be in 'another' state of normality" and "providing an open atmosphere for dialogue", while the second subtheme was based on "confirming self-esteem" and "suggesting adjustments at work". The midwives and public health nurse empowered the women by enhancing their ability to carry out the self-care that was necessary in order to manage both their work and family life. Collaboration between maternity healthcare providers and employers should be developed in order to support employed women.     

Reconstructing mental health nursing in home care

BACKGROUND: Psychiatric care for people in Sweden with long-term mental health problems has shifted from institutional to community and home settings. AIM: The aim of this study was to explore and describe mental health nurses' experiences of how structural changes in mental health nursing influence interaction when providing home care to patients with long-term mental health problems. METHOD: We conducted interviews with 11 mental health nurses who provided home care to people with long-term mental health problems. The constant comparative method of grounded theory was used for data collection and analysis. FINDINGS: The process of attempting to reconstruct mental health nursing by entering into the everyday reality of people with long-term mental health problems was identified as the core category. Central to this process was a change in perspective from nurse-controlled to client-centred care. This led to changes in moral values, assessment of client needs, and ways of meeting clients and establishing relationships. However, attempts to reconstruct mental health nursing according to a client-centred perspective became problematic when clients were at risk of harming themselves. In these situations, respondents felt the need to make decisions for clients, and this was experienced as burdensome and lonely. CONCLUSIONS: Our study indicates that the process of reconstructing mental health nursing in line with a client-centred perspective is incomplete. Opportunities to interact with people with mental health problems in the home environment may lead to a broader perspective on the daily lives of these people, but also to a realization that home care cannot be modelled on institutional care.     

Experiences of Guilt as a Mother in the Context of Eating Difficulties

The aim of this study was to explore motherhood in the context of eating difficulties. The research question was: What are mothers' daily life experiences when suffering from ED? An explorative design was used. In-depth interviews (n = 8) focused on experiences of motherhood and eating difficulties. Data were interpreted by hermeneutic analysis. The main theme, “experiencing guilt as a mother in the context of eating difficulties,” comprised two themes: (1) having a guilty conscience in relation to being a good enough mother and (2) being preoccupied about not involving the children in the eating difficulties. The study illuminates the importance of identifying mothers with eating difficulties and offering them treatment and support.     

成都市新都区餐饮具消毒效果监测

为了解餐饮具消毒现状,采用纸片检验法对新都区饮食单位餐饮具消毒效果进行了监测。结果,抽检餐饮单位297户,餐饮具样本1914份,总合格率为73.51％;抽检全部合格的单位占43.43％,全部不合格的单位占8.08％。结果显示,新都区餐饮业消毒效果和卫生状况整体水平较低,其中以中餐业和中等规模餐饮店卫生状况最差。因此,必须加强管理,加大监督监测力度,全面落实消毒和卫生管理制度,改进餐饮业卫生质量。     

Desire to survive emotional pain related to self-harm: A Norwegian hermeneutic study

The aim of this study was to explore and interpret women's desire to survive emotional pain related to self-harm. Women who suffer from borderline personality disorder describe emotional pain as intense. Previous research indicates that self-harm is a way of obtaining emotional relief and offers an escape from unwanted emotions, thoughts, and/or distressing situations. An explorative, interpretative design was employed. The data were collected by means of in-depth interviews with a sample of women resident in Norway suffering from borderline personality disorder and were analyzed using a hermeneutic approach. The findings revealed one main theme, self-sacrifice, and two other themes, self-harm (a struggle to be relieved of responsibility) and a fear of intimacy versus intrusion. This study indicates that self-sacrifice appears to imply a longing for reconnection with the self and others. To preserve their self-image, the women require courage to survive the painful state of unworthiness.     

Effects of Cardiomyoplasty on Cardiac Growth in Rats

A bstract Background and aim of the study : Cardiomyoplasty (CMP) has been proposed as a treatment for pediatric patients, but restriction of cardiac growth by the muscle wrap is a potential source of concern. This possibility was investigated in an immature animal model. Methods : Six-week-old rats (body weight 203.8 ± 5.4 g, mean ± SEM) underwent either left thoracotomy with CMP (group I, n = 7), or thoracotomy without CMP (group II, n = 8). A third group (group III, n = 7) served as untreated controls. Final measurements were made 20 weeks later after body weights had reached a plateau. Results : Preoperative body weights were not significantly different between the groups. At elective sacrifice, the body weights of animals that underwent surgery did not differ significantly (group I, 558.0 ± 21.5 g and group II, 617.3 ± 20.3 g), but were significantly less than those of control animals (727.6 ± 13.3 g, p < 0.001 and p < 0.01, respectively). Cardiac ventricular weights in the CMP group were significantly less than those of control animals (group I, 1.21 ± 0.06 g; group III 1.45 ± 0.04 g; p < 0.01), but were not statistically different from those of the sham thoracotomy group (group II, 1.36 ± 0.05 g). Mean left ventricular end-diastolic volumes were similar in all groups (group I, 0.67 ± 0.07 mL; group II, 0.66 ± 0.07 mL; and group III, 0.69 ± 0.10 mL; p = ns). Conclusions : A major surgical procedure impairs growth in juvenile rats. No evidence emerged from this study for additional restriction of cardiac development due to cardiac wrapping. However, studies that include stimulated muscle wraps are needed before CMP should be considered for the pediatric age group.     

Nurse supervisors' views of their supervisory styles in clinical supervision: a hermeneutical approach

The purpose of this paper is to describe and analyse the nurse supervisors' styles with special focus on their actions in the supervision session, their expectations with regard to the 'ideal' supervisor and their 'visions' regarding effects of clinical supervision, as well as their views of ethics, rules and values that they are guided by in clinical supervision. This study used a hermeneutic approach in order to characterize nurse supervisor style. Data were collected by open-ended interviews with skilled and experienced nurse supervisors ( n= 18). The interpretation is that the supervisors' actions in clinical supervision may affect their ability to understand their actions. Whether a supervisor acts as the 'real' supervisor or attains to the level of the 'ideal' supervisor depends on her/his state of preparedness reached through reflection. The nurse supervisors' perceptions of styles are: striving to perfect the art of communication in the supervision session by using selected techniques; to assist in increasing the supervisees' self-esteem and autonomy by reflecting on essential themes in the supervision dialogue; and striving to attain the level of the 'ideal' supervisor, expressing a positive attitude to and motivation for theoretical and practical knowledge, and developing the supervisees' human attitudes.