Students'' expectations of postregistration degree programmes

The needs of postregistration students pursuing degree-linked clinical courses have received little attention and there are few insights concerning their aspirations when they enrol on such courses. Thus the aim of this study was to explore postregistration students' perceptions of the specific needs of their patient/client group and to examine how they envisaged the course on which they had just enrolled might help them to meet these needs in addition to their own requirements for professional and personal development. Data were collected by group interview from 62 students enrolling on eight different postregistration courses, all employed in an acute hospital trust. The results were analysed inductively. They indicated that students had internalized the state of the healthcare market and were keenly aware of the need to fulfil the expectations of employers and the public, while fulfilling their own needs for education and pursuing their own professional and career trajectories. They appeared ambitious and yet appeared to demonstrate empathy for patients and their families and felt a tremendous desire to provide care of a high quality through the optimal development of technical expertise. Students' emphasis on the importance of keeping abreast of technological developments should not be lightly dismissed considering its prominent position within the acute areas where they were employed, especially as it did not replace their desire to promote the caring aspects of their work.     

From educational philosophy to educational practice: fidelity and the curriculum in context

As part of a higher degree on research methods, exploratory work was undertaken concerning educational philosophy and educational practice using an ethnographic approach. This author discusses, using this exploratory work, the difficulties of attempting fidelity to an educational philosophy, through curriculum practice. Schools of nursing are increasingly adopting a rational approach to education, without considering the wider social context within which education occurs. The attempt to establish and pursue a single philosophy, ignores the plurality of ideological commitments held by nurse teachers. Further research is proposed using naturalistic methods in order to understand the processes of interpretation and implementation of educational philosophy.     

The culture of midwifery in the National Health Service in England

The culture of midwifery in the National Health Service was examined in order to foster understanding of the context of midwifery practice. In-depth interviews were conducted with midwives in five, very different, sites across England. The culture which emerged was one of service and sacrifice where midwives lacked the rights as women which they were required to offer to their clients. There was a lack of mutual support and of positive role models of support with considerable pressure to conform. Guilt and self-blame were common as was learned helplessness and muting. The dilemmas of this culture are considered and the resistance which it offered to change in relationships. Change was either resisted, brought about by stealth or strategically planned to equip midwives to change their culture.     

Computer training in nurse education: a bird''s eye view across the UK

This paper is borne of the increasing interest and relevance of computers in nursing. It describes the method, and results obtained from a postal questionnaire survey distributed across the United Kingdom to gain information about the developments in computing in nursing education. The results indicate that considerable developments have been made, but that they are more piecemeal than co-ordinated. A selection of the results are presented and discussed, and one or two points concerning future proceedings are raised.     

Pressure support and elevation following the removal of a radial artery for coronary artery bypass grafting

The saphenous vein was once the standard coronary artery bypass graft. Alternate grafts, primarily the radial artery and the internal mammary artery are now being utilised for revascularisation of the heart. However, the radial artery graft site can be at risk of oedema and the development of haematoma during the post-operative period. Also tension on the suture line may compromise circulation and create functional problems for the patient. The aim of this study was to assess the effect of pressure support (elastic support bandage) and elevation in reducing swelling and arm discomfort in the harvest arm.

The patients in the study undergoing coronary artery bypass grafts were randomly assigned to one of three groups: elastic support bandage, collar and cuff sling and elevation on two pillows. There were 30 patients in each group. The circumference at three locations on the forearm was measured pre-operatively and on post-operative days 3 and 5. Pain was measured on a visual pain scale, which went from 1-10, with 10 being the most painful. The patients were also asked whether their arm movement felt restricted. The study found that there was no statistically significant difference (at the 0.05 level) between the three groups in the amount of swelling witnessed at the different forearm locations. There was, however, a significant decrease in swelling for all groups between days 3-5, but no difference in pain scores between the groups. Moreover, the collar and cuff sling group reported movement restriction, which was not apparent in the other two groups.

In view of the findings, the researchers advocate the elastic support bandage. Patient compliance has practical implications when applying treatment and this is enhanced by the non cumbersome elastic support bandage. This can be compared to the collar and cuff

sling and pillow elevation groups where the patient's daily activities affects compliance with these two treatments. It is recommended that future research be conducted comparing the effects of the elastic support bandage with a control group.     

Spiritual coping strategies: a review of the nursing research literature

AIMS OF THE PAPER: This paper reviews some of the limited nursing research-based literature, orientated towards the use of spiritual coping strategies in illness. This review aims at identifying those spiritual coping strategies used by the believers and nonbelievers followed by implications for holistic nursing care. LITERATURE SEARCH: The CINAHL and MEDLINE CD Rom databases were searched, identifying literature published from 1975 onwards which amounted to 187 articles. The majority of the literature traced were found anecdotal with only few studies investigating directly spiritual coping strategies. Following scrutiny of the available articles, only five research studies explored directly the spiritual coping strategies used in various illness, four of which were conducted in USA and one in UK. Because of the small scale research studies, generalization of the findings of this review is limited to the samples used. THEORETICAL BACKGROUND: Research suggests that spiritual coping strategies, involving relationship with self, others, Ultimate other/God or nature were found to help individuals to cope with their ailments. This may be because of finding meaning, purpose and hope, which may nurture individuals in their suffering. Spirituality is oftenly referred by literature as being synonymous with religiosity. Thus the use of spiritual coping strategies is restricted to individuals who hold religious beliefs. However, the definition of spirituality indicates that this concept is broader than religiosity. The theories on stress-coping (Folkman & Lazarus 1984) and the numinous experience (Otto 1950) outline the rationale for the use of these strategies which are applicable to both the believers and nonbelievers. IMPLICATIONS: This review suggests that the onset of illness may render the individual, being a believer or nonbeliever to realize the lack of control over his/her life. However the use of spiritual coping strategies may enhance self-empowerment, leading to finding meaning and purpose in illness. This implies that holistic care incorporates facilitation of various spiritual coping strategies to safeguard the wholeness and integrity of the patients.     

Nurses'' opinions of the introduction of computer-assisted learning for use in patient education

Computers have only recently begun to find a place in the everyday work of health care staff. The use of computer-assisted learning (CAL) in patient education is in its infancy. However, the medium appears to offer several advantages to patients. The successful integration of the medium into clinical practice requires the acceptance and support of staff members. Little research exists to date which examines staff responses to the introduction of CAL into their workplace. This small study (n = 14) aims to explore the reactions of staff to the introduction of an experimental CAL package for use in the education of renal patients on continuous ambulatory peritoneal dialysis (CAPD). The opinions of staff members to CAL are probed and their views ascertained regarding the usefulness of CAL to both staff and patients. Results suggest that, despite their initial reservations about CAL, staff were generally positive about the medium.     

Quality assurance: is it professional insurance?

Quality assurance (QA) is being hailed as a 'new frontier' of nursing. Its diffusion into nursing theory and practice in the United Kingdom is outlined. QA is not an alien import; favourable preconditions already existed. The systems-reasoning of the nursing process, which sprawned a plethora of models, each geared to the 'orderly' progression of stages, objectives and process, is resonant with the values and measurement techniques of QA. A major limitation of QA is that it downplays the organizational complexity of hospitals. Although QA is projected as being in the service of clients, its major impetus is concerned with professional self-defence, as regards other professions, the state and litigious clients. Further, QA enlisted by nursing strongly reproduces the ethos and logic of the dominant medical model; patients are 'objectified' as the technical products of production. The 'medical gaze' is now being joined with the 'nursing gaze'.