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doi: 10.1111/j.1365-2702.1993.tb00165.xpmid: N/A
Summary • Catheter‐associated urinary tract infection is still one of the most challenging aspects pf clinical practice, not only for professionals who work in the area of infection control, but for all who care for patients. • Urethral catheters may be used to promote post‐operative repair, relieve anatomical or physiological obstruction and provide an accurate measure of urinary output. • Catheters also have a part to play in the management of intractable urinary incontinence, but admittedly less so than 10 years ago, as we now have alternative techniques and appliances, such as intermittent self catheterization (ISC), penile sheaths and an extensive range of incontinence pads. • This paper reviews recent developments in catheterization and catheter care intended to prevent or alleviate urinary tract infections and associated problems.
doi: 10.1111/j.1365-2702.1993.tb00166.xpmid: N/A
Summary This paper aims to examine the promotion of advanced clinical practice. It addresses questions such as: • what is advanced clinical practice? • what is the relevance of knowledge to clinical practice? • what is the relevance of research to clinical practice? • what is the relevance of the culture to clinical practice? • what is the role of the clinical nurse? It does not present ready answers. Rather, it attempts to highlight difficulties and ambiguities originating from the contradictory goals and requirements of nursing education, research and practice.
doi: 10.1111/j.1365-2702.1993.tb00167.xpmid: N/A
Summary • Spirituality is often equated or used synonymously with the word religion but it appears this concept can be defined in broader terms. • Nurses do not appear to consider spirituality adequately in clinical practice but if holistic care is to be given to patients it is essential that the spiritual component of individuals is addressed. • This paper explores the concepts of spirituality and clinical practice. Clarification of the term spirituality is given followed by a critical review of the literature in order to establish its relevance to nursing practice and to what extent patients' spiritual needs are met. Aspects of spiritual assessment and spiritual care are also outlined. • It is suggested that nurse education may help nurses incorporate spirituality into clinical practice by increasing their knowledge and understanding of such a concept.
TITCHEN, ANGIE; BINNIE, ALISON
doi: 10.1111/j.1365-2702.1993.tb00168.xpmid: N/A
Summary • This case‐study provides a description and interpretation of the traditional power relationship between a sister and staff nurses, in an acute general medical ward. • The ways in which the nurses changed that power relationship, with the introduction of team nursing are explored. • The paper describes, from the sister's and nurses' perspectives, the difficulties associated with the devolution of authority, from sister to team leaders, and the resulting confusion about the new relationship between them. • Three themes emerged in the changing power relationships and these are presented and examined.
doi: 10.1111/j.1365-2702.1993.tb00169.xpmid: N/A
Summary • The aim of this paper is to explore how the theoretical definitions of accountability might be put into practice within a structure of primary nursing. • Bergman's preconditions leading to accountability (1981) are discussed with respect to traditional ward organization and contrasted with primary nursing. The size of the case‐load is identified as a significant factor in the way and the depth with which the concept is operationalized. • Adaptations to nursing roles are necessary in order to facilitate accountability in action. The primary nurse is given authority as both case manager and line manager. The ward manager role changes to focus on resource management and developmental need. • Changes of this nature lead to accountability being viewed in a positive light and an abstract concept becoming grounded in reality.
doi: 10.1111/j.1365-2702.1993.tb00170.xpmid: N/A
Summary • A 1991 phenomenological case‐study investigated the effect of long‐term gastrostomy tube feeding on an incompetent patient and her surrogate decision maker. In this case, a daughter chose tube feeding for her severely debilitated mother after she had become aphasic. The report includes the daughter's perceptions of (a) her relationship and experience with a tube‐fed mother, and (b) her mother's experience with tube feeding. • The experience of tube feeding differed from what the daughter had expected. The daughter perceived that tube feeding reduced her mother's quality of life. Taste sensations and pleasures of eating were lost. Tube feeding also negatively influenced the daughter's activities and subsequent relationship with her mother. Tube feeding, however, did extend life and did allow ongoing visits by the daughter and her children. • The mother could still continue to fulfil the role of a mother and grandmother to a certain extent. Most significantly, however, tube feeding was perceived to prolong death. Concern over whether her mother would have chosen tube feeding for herself prevailed.
doi: 10.1111/j.1365-2702.1993.tb00171.xpmid: N/A
Summary • This paper reports on an investigation of women's experience of motherhood as a possible factor in the development of postpartum depression. • Several aspects of the experience of motherhood were found to be associated with depression in a sample of 60 first‐time mothers. These included: — the social impact of motherhood, — the extent to which expectations of motherhood were met, — the adequacy of support received from partners or from the mothers' wider social networks. • It is argued that these findings, while tentative, are consistent with a social model of depression. • Implications for health professionals and other care providers are discussed.
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