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This study describes the types of statements made by nurses as first impressions (hypotheses) of patient problems treatable by nurses in response to limited information (cues). Subjects were nine groups of nurses (n = 243), who varied in length of experience and in educational level from diploma students through masters students. / Completion of a paper and pencil task yielded 4199 hypotheses which were classified into 13 categories. Major differences were found between types offered by a group of master's students who had studied the diagnostic process and the remaining groups. Of the former's hypotheses, 85.6% were nursing diagnoses compared with a range of 35.5 - 61.4% from the latter. / Possible reasons for nurses' inability to make nursing diagnoses are failure to hypothesize the presence of appropriate problems and a lack of distinction between a nursing diagnosis, a medical diagnosis, data and plans for care.

A posttest only experimental design was used to determine the effect of specific training in human relations skills on empathic understanding, self-concept, and the clinical performance of sophomore student nurses in a baccalaureate program.Forty-six students were randomly assigned to one of two treatment groups, or a control group. The Microcounseling System of Ivey and Gluckstern was used to provide two levels of human relations training in ten one-hour sessions. Experimental group 1 (El) received training through group exercises, manual and videotaped models, practice including videotaping, and evaluation and feedback. Experimental group 2 (E2) was only provided with a manual and videotaped materials. The control group (Cl) met for the same number of sessions, but did not receive any training.Carkhuff's Index of Discrimination (SEU) was used to measure empathic understanding. Four subscales of the Tennessee Self-Concept Scale (TSCS), total positive, self-criticism, net conflict, and total conflict were used to assess self-concept. The Clinical Evaluation Tool (CET) used to measure clinical performance was developed from Myrick and Kelly's Counselor Evaluation Rating Scale and the current sophomore clinical evaluation form.Six hypotheses were tested with significance for all tests set at the .05 level. A single classification analysis of variance was used on all data to determine whether groups differed on any test variable. The results of the statistical analyses failed to reach significance.Post hoc comparisons were then carried out to determine if El>C1 on any test variable. These tests revealed significance (p<.05) in empathic understanding, in TSCS self-criticism, and in clinical performance.The following conclusions were drawn:1. Sophomore student nurses exposed to specific training in human relations skills demonstrated a higher level of empathic understanding.2. Sophomore student nurses exposed to specific training in human relations skills were more aware of self-critical perceptions.3. Sophomore student nurses exposed to specific training in human relations skills received higher ratings on clinical performance.As a result of this study a decision was made to include human relations training for student nurses at the sophomore and junior levels.

Chapter one reviews the literatures on psychological studies of aggression, problems of aggression within the Social Services and the National Health Service, and nurse-patient communication. A number of issues are raised which are addressed by the current research. In chapter two nurses' theories about what defuses and what aggravates aggression are explored. It was found that nurses believe that by remaining calm, gentle and firm they will defuse both physical and verbal aggression. In the case of physical aggression they believe it to be aggravated by being authoritarian, demeaning and defensive, while in the case of verbal aggression they believe it to be aggravated by becoming angry or attempting to deflect it. In chapter three nurses' real-life experiences of what defuses and what aggravates physical and verbal aggression are compared with their theories. The nurses' experiences largely support their theories. It was also found that there are very few methods for dealing effectively with physical aggression, while there are a relatively large number of methods for dealing effectively with verbal aggression. Moreover, those nurses who believe themselves to be more capable of dealing with aggression suffer fewer emotional after-effects than those nurses who do not. Chapter four examines individual differences between nurses and relates these differences to their ability to recover from the emotional aftermath of aggression. It was found that nurses who are highly stressed and who bottle-up their feelings of anger suffer emotionally after aggressive incidents. In contrast, nurses who are assertive, extravert and who exercise interpersonal control are not so distressed by aggressive incidents. In chapter five nurses' attributions are related to their ability to select effective methods of dealing with aggression as well as their ability to recover from it emotionally. It was found that those nurses who have a tendency to blame themselves are both emotionally vulnerable and less capable of selecting effective methods of responding to aggression. In addition, a new method of measuring attribution was developed and tested, and was found to be preferable to the usual method of measuring attribution. Chapter six presents the two-day aggression training programme. The training was designed to incorporate the findings of the current research as well as theoretical issues. The training was carefully evaluated with a control group, pre-post measures of both subjective and objective change, and a seven week follow-up. The aggression training group was no different to the control group before training, but was different on all measures after training. It was concluded that the training model has been shown to make a significant difference to objective skills and subjective evaluations, and that the causal influence of some of the findings described in chapters two to five has been demonstrated. Chapter seven summarises the findings of the research, explores their theoretical and practical implications, and suggests directions for future research.

This thesis is about patient/nurse interaction in a community practice. My aim is to advance sociologically informed understandings about patient/nurse interaction. The key areas of inquiry in my grounded theory study are: The meanings and understandings expressed in patient/nurse interaction. The influence of socio-cultural characteristics in patient/nurse interaction. My study was conducted in a community practice setting using the traditional discovery methodology of Glaser and Strauss (1967). The community practice setting is four health centres with social and geographical differences. The participants in the study are patients attending those health centres and practice nurses who work there. Research methods are observations, informal interviews and semi-structured interviews. Constant comparative analysis supports my research process. My substantive theory is constructed from the generation of two categories: Investment and Experience. The category of Investment relates to the social assets and resources brought to patient/nurse interaction. The category of Experience relates to the historically crafted meanings and understandings that individuals bring to patient/nurse interaction. Together, these categories contribute to understandings of patient/nurse interaction in a community practice setting. I argue in this thesis that the meanings and understandings that patients and nurses bring to interaction provide the social dimension that is quintessential and foundational in their relationship. I also argue that the social construction of reality of being a patient or a nurse is related to the socio-cultural characteristics that they bring to their performance in patient/nurse interaction. I show that performance as a patient or a nurse is initiated and achieved via processes of acting and reacting to each other in relation to socio-cultural characteristics. I demonstrate that the meanings and understandings patients and nurses generate from experiences beyond and including their situated need/care interaction are pivotal in the negotiation of their relationship. Empowerment plays a central role in processes of negotiation and is connected to the social construction of reality in patient/nurse interaction. My substantive theory contributes to understanding of patient/nurse interaction and raises the visibility of negotiation, empowerment, and the influential role of socio-cultural characteristics. The implications of my substantive theory relate to the involvement and participation of stakeholders in health care practice and delivery. In nurse education, the standards of proficiency for eligibility to register with the NMC should be revised to include the social dimension of patient/nurse interaction as a domain of practice. I conclude by arguing that sociologically informed understandings need to be expanded and applied in health care and nursing with contemporary social policy and current priorities for health in mind.

Thesis (M Nursing)--University of South Australia, 1998

The phenomenon of human globalisation has led to the creation of a new social world, one which is characterised by its cultural diversity. Health services constitute one of the most fundamental of social organisations, so with this change, has come a need for nurses to provide relevant and appropriate care to the multiplicity of peoples who now live in contemporary social communities. Providing appropriate nursing care today is demanding new skills of nurses and to ensure that they can meet this demand, new knowledge and understanding is required. To do this well, constitutes one of the greatest contemporary challenges facing nursing. The aim of this study was to identify and analyse the theories and models of nursing that hold authority on and guide cross-cultural care giving in nursing. The thesis underlying this study was to respond to the question - when nurses have had access to cultural care theory and its related literature for some 30 years, why has this not, as yet, had a significant impact on nursing? The intent being to explore the genesis and development of the knowledge used to underpin cross-cultural care in nursing and by doing so assist nurses to better understand, in the fullest sense, the meanings that are being created and conveyed. To achieve this, a qualitative methodology was employed to make possible the description and interpretation of existing theory with a critical approach being taken towards that text. Understanding and unmasking the theory revealed both overt and covert beliefs and ideas intrinsic to the discourse, which have the potential to shape and configure nurses’ attitudes, opinions and perspectives. This research has considered, explored and analysed contemporary theories of cross-cultural nursing to provide clarification and enhance the capacity of nurses to gain a fuller understanding of cross-cultural care. It offers new insights into the viewpoints being advanced and opens up fresh possibilities for the development of a deeper understanding of Western scholarship on culture in nursing. The findings also identify areas for continued inquiry, which if focused upon and developed into the future, could contribute to improvements in nursing and greater understanding of the complex domain of cross-cultural care.

The phenomenon of human globalisation has led to the creation of a new social world, one which is characterised by its cultural diversity. Health services constitute one of the most fundamental of social organisations, so with this change, has come a need for nurses to provide relevant and appropriate care to the multiplicity of peoples who now live in contemporary social communities. Providing appropriate nursing care today is demanding new skills of nurses and to ensure that they can meet this demand, new knowledge and understanding is required. To do this well, constitutes one of the greatest contemporary challenges facing nursing. The aim of this study was to identify and analyse the theories and models of nursing that hold authority on and guide cross-cultural care giving in nursing. The thesis underlying this study was to respond to the question - when nurses have had access to cultural care theory and its related literature for some 30 years, why has this not, as yet, had a significant impact on nursing? The intent being to explore the genesis and development of the knowledge used to underpin cross-cultural care in nursing and by doing so assist nurses to better understand, in the fullest sense, the meanings that are being created and conveyed. To achieve this, a qualitative methodology was employed to make possible the description and interpretation of existing theory with a critical approach being taken towards that text. Understanding and unmasking the theory revealed both overt and covert beliefs and ideas intrinsic to the discourse, which have the potential to shape and configure nurses’ attitudes, opinions and perspectives. This research has considered, explored and analysed contemporary theories of cross-cultural nursing to provide clarification and enhance the capacity of nurses to gain a fuller understanding of cross-cultural care. It offers new insights into the viewpoints being advanced and opens up fresh possibilities for the development of a deeper understanding of Western scholarship on culture in nursing. The findings also identify areas for continued inquiry, which if focused upon and developed into the future, could contribute to improvements in nursing and greater understanding of the complex domain of cross-cultural care.