Christine E. Hallett

Caring for dying people in hospital

Background.  Fifty-four per cent of people who die in England and Wales do so in hospital. Evidence suggests that care delivered to dying people in hospital does not match up to the ideal of a good death. These studies have provided organizational and structural explanations of nurses’ behaviour that support argument for change at the macro level, in order to improve the quality of care delivered to dying people. There has been little study of the perceptions of nurses working in acute medical settings in relation to their experience of caring for dying people. Therefore, there is little evidence on which to base supportive strategies at the level of individual nurses. Aim.  In this study we set out to develop an understanding of care for dying people in hospital, from the perspective of newly qualified staff nurses in the UK. The purpose was to build a theory of how nurses might be helped to deliver quality care to dying people in hospital. Methods.  This paper is based on an exploratory study underpinned by phenomenological philosophy. In-depth interviews were conducted with 28 newly qualified nurses, focusing on their experiences of caring for dying people on medical wards in two acute hospitals in England in 1999. The interview transcripts were interpreted using a phenomenological approach. Findings.  The findings presented in this paper relate to commonalities found to underlie study participants’ perceptions of their experiences. All the nurses’ stories were found to be built around six essences – the personal ideal, the actual, the unknown, the alone, tension and anti-tension. These essences, and the relationships between them, were used to build a model of the experience of caring for dying people in hospital. Limitations.  This descriptive study of the experience of individual nurses does not examine the wider social context. It attempts to complement existing sociological theory of death and dying. Conclusion.  The study revealed how a group of newly qualified nurses experienced caring for dying people. We theorize that the model developed has utility as a tool for gaining understanding of the experience of caring for dying people. It is assumed that nurses, through using this model to find explanations for their emotions and behaviours, may gain emotional support that might have a positive impact on the quality of care delivered to dying people in hospital.

Physical restraint: experiences, attitudes and opinions of adult intensive care unit nurses

BACKGROUND Patients within the adult intensive care unit have the potential to develop delirium and agitation. This can result in the patient displaying unwanted behaviours such as attempting to remove the medical devices to which they are attached. Some adult intensive care units within the UK are starting to adopt physical restraint as a method of managing unwanted behaviours. AIM To determine the experiences, attitudes and opinions of adult intensive care nurses in relation to the application of physical restraint. DESIGN Questionnaire survey. METHODS A postal questionnaire was distributed to all nurses (n = 192) within two purposefully selected large adult intensive care units in the UK. RESULTS Data were collected between November 2012 and February 2013. The questionnaire was completed by 38·9% (n = 75) of the nurses contacted. All believed that physical restraint had a place, with the majority of the view that the reason for its application was to maintain patient safety. Some expressed discomfort about the use of physical restraint. Nurses were happy to discuss the use of restraint with families. There was a perceived need for training and support for nursing staff as well as the need for medical staff to support the decision-making process. CONCLUSION Nurses require more support and evidence to base their decision-making upon. They require guidance from professional bodies as well as support from medical colleagues. The findings have limited generalizability as they can only be applied to the units accessed and the response rate was poor. RELEVANCE TO CLINICAL PRACTICE Alternative approaches such as pain management, sleep promotion and the involvement of relatives need to be explored before physical restraint policy can be written. Further research is required into the safety of physical restraint, alternative methods of managing the risk of agitation and identifying predisposing factors to accidental device removal.

The Attempt to Understand Puerperal Fever in the Eighteenth and Early Nineteenth Centuries: The Influence of Inflammation Theory

Puerperal fever was a devastating disease. It affected women within the first three days after childbirth and progressed rapidly, causing acute symptoms of severe abdominal pain, fever and debility. Although it had been recognized from as early as the time of the Hippocratic corpus that women in childbed were prone to fevers, the distinct name, “puerperal fever” appears in the historical record only in the early eighteenth century.

The helping relationship in the community setting: the relevance of Rogerian theory to the supervision of Project 2000 students

A series of twenty-six interviews, fourteen with district nursing sisters and twelve with students they supervised, was conducted in 1992 in one Project 2000 demonstration district in England. The data were collected as part of an English National Board funded research study; data were reinterpreted in 1994 and formed one element in the authors PhD thesis. Participants described the ways in which a supervisor might enable a student to learn during a community placement. One of the most important means by which supervisors could provide assistance was by creating an environment in which the students felt supported. Students described how supervisors demonstrated concern, acceptance and understanding, attributes which bore striking resemblance to the qualities of congruence, unconditional positive regard and empathic understanding identified by Carl Rogers as enabling learning.

‘They More or Less Blended in with Society’: Changing Attitudes to European Migrant Workers in Post-war Lancashire

European volunteer workers have received comparatively little attention in the history of British post-war immigration, with greater coverage given to, for example, demobilised members of the Polish Resettlement Corps. This paper is based upon oral history interviews with a group of European immigrants, predominantly European volunteer workers, and local Lancastrians who started work in the Lancashire cotton industry between 1946 and 1951, and examines perceptions of how they integrated into British life in a variety of domains. The paper emphasises that ‘blending-in’ was context-dependent, with a sense of being welcomed and fitting-in applying to certain domains and in certain situations but not necessarily in others. It argues that migration fosters particular cultural attitudes and practices amongst both migrants and hosts as social identities are produced and reproduced, changed and challenged.

'A very valuable fusion of classes': British professional and volunteer nurses of the First World War.

Public perceptions of the work of nurses and VAD-volunteers in the First World War have been heavily influenced by a small number of VAD-writings. The work of trained, professional nurses in supporting and supervised the work of VADs has been largely overlooked. This paper examines several of the writings of both volunteers and professionals, and emphasises the overlooked supervisory, managerial and clinical work of trained nurses. In this centenary year of the First World Wars opening months, the paper also explores the ways in which the British mass-media--notably the BBC--have chosen to cling to a romantic image of the untrained nurse, whilst at the same time acknowledging the significance of trained, professional nursing.

Time enough! or not enough time! An oral history investigation of some British and Australian community nurses' responses to demands for "efficiency" in health care, 1960-2000

Oral history methodology was used to investigate the perspectives of retired British district nurses and Australian domiciliary nurses who had practiced between 1960 and 2000. Interviews yielded insights into the dramatic changes in community nursing practice during the last four decades of the 20th century. Massive changes in health care and government-led drives for greater efficiency meant moving from practice governed by “experiential time” (in which perception of time depends on the quality of experience) to practice governed by “measured time” (in which experience itself is molded by the measurement of time). Nurses recognized that the quality of their working lives and their relationships with families had been altered by the social, cultural, and political changes, including the drive for professional recognition in nursing itself, soaring economic costs of health care and push for deinstitutionalization of care. Community nurses faced several dilemmas as they grappled with the demands for efficiency created by these changes.

'If We Depart from These Conditions…': Trade Union Reactions to European Immigrant Workers in the Textile Industry C. 1946–1952

Trade union attitudes towards European immigrants have rarely been studied in a post-war context. As a response to this, this article focuses on trade union reactions to European workers in the Lancashire cotton industry between 1946 and 1951. Highlighting the merits of local case studies of labour relations, the focus is predominantly on the Amalgamated Association of Operative Cotton Spinners and Twiners. Evidence is presented of a defensive attitude on the part of the Association that limited the number of European workers in individual mills, as well as acting as a barrier to such workers advancing into the echelons of skilled labour. The paper recognises, however, the complexities of the period, characterised as much by the consequences of capitalism and the decline of the cotton industry, as trade union jingoism. It also alludes to the conflicts that existed between individual districts and Executive Committees, between negotiated agreements and circumstances at individual mills and between employer...

The time commitment of the community nursing services to Project 2000

As part of an English National Board funded research study, the authors sent questionnaires to 2500 individuals with community nursing qualifications. The survey was complemented by a series of interviews with community nurse managers. Data indicated that community nurses were spending very considerable amounts of time with students. The number of placements provided per year varied considerably from one respondent to another, as did the average duration of a placement. Community nurses were providing community experience for a variety of types of nursing students, as well as students of other professions, and the time commitment involved placed them under considerable strain. The authors conclude that there is a need to recognise the time given by community nurses to work with students, and the resource implications of this commitment.

Nurses and subordination: a historical study of mental nurses' perceptions on administering aversion therapy for 'sexual deviations'

Nurses and subordination: a historical study of mental nurses’ perceptions on administering aversion therapy for ‘sexual deviations’ This study aimed to examine the meanings that nurses attached to the ‘treatments’ administered to cure ‘sexual deviation’ (SD) in the UK, 1935–1974. In the UK, homosexuality was considered a classifiable mental illness that could be ‘cured’ until 1992. Nurses were involved in administering painful and distressing treatments. The study is based on oral history interviews with fifteen nurses who had administered treatments to cure individuals of their SD. The interviews were transcribed for historical interpretation. Some nurses believed that their role was to passively follow any orders they had been given. Other nurses limited their culpability concerning administering these treatments by adopting dehumanising and objectifying language and by focussing on administrative tasks, rather than the human beings in need of their care. Meanwhile, some nurses genuinely believed that they were acting beneficently by administering these distinctly unpleasant treatments. It is envisaged that this study might act to reiterate the need for nurses to ensure their interventions have a sound evidence base and that they constantly reflect on the moral and value base of their practice and the influence that science and societal norms can have on changing views of what is considered ‘acceptable practice’.