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There has been little professional debate in the UK literature about nursing diagnosis and this paper explores some of the reasons why nursing diagnosis has failed to gain momentum among nurses in the United Kingdom. The nursing diagnosis movement has now reached some European countries and in the light of the International Classification of Nursing Project (ICNP) and the Strategic Advisory Group for Nursing Information Systems (SAGNIS) project commissioned by the NHS Executive (NHSE), requires a close examination by British nurses. The unsuccessful attempt by the North American Nursing Diagnosis Association (NANDA) to have its taxonomy accepted for inclusion in the World Health Organization's 10th revision of the International Classification of Diseases, an innovation which would have made the NANDA taxonomy the definitive classification of nursing, should alert British nurses to the importance of nursing diagnosis. Although nurses effectively diagnose as part of the nursing process, adoption of the concept of nursing diagnosis as a driving force for practice evades many of them. This paper reflects upon some of the logistical and conceptual difficulties including issues of culture and terminology. It is suggested that nursing diagnosis has a great deal to offer British nurses in their efforts to improve the quality of care and to provide data in this area for both practice and research. [ABSTRACT FROM AUTHOR]

Title. The Internet as a research site: establishment of a web-based longitudinal study of the nursing and midwifery workforce in three countries. Aim. The aim of this paper is to describe the development of a web-based longitudinal research project, The Nurses and Midwives e-cohort Study. Background. The Internet has only recently been used for health research. However, web-based methodologies are increasingly discussed as significant and inevitable developments in research as Internet access and use rapidly increases worldwide. Method. In 2006, a longitudinal web-based study of nurses and midwives workforce participation patterns, health and wellbeing, and lifestyle choices was established. Participating countries are Australia, New Zealand and the United Kingdom. Data collection is handled through a dedicated website using a range of standardized tools combined into one comprehensive questionnaire. Internet-specific data collection and a range of recruitment and retention strategies have been developed for this study. Discussion. Internet-based technology can support the maintenance of cohorts across multiple countries and jurisdictions to explore factors influencing workforce participation. However, barriers to widespread adoption of web-based approaches include website development costs, the need for fast broadband connection for large data collection instruments, and varying degrees of Internet and computer literacy in the nursing and midwifery workforce. Conclusion. Many of the issues reported in this paper are transitional in nature at a time of rapid technological development. The development of on-line methods and tools is a major and exciting development in the world of research. Research via the world-wide web can support international collaborations across borders and cultures. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a study to examine Nurse Independent/Nurse Supplementary Prescribing for people with diabetes and the extent to which these nurses feel prepared for this role. BACKGROUND: An area of care in which nurses, caring for people with diabetes, are involved is the management of medications. There is little or no evidence examining the prescription of medicines by nurses for people with this condition. METHODS: The United Kingdom Nursing and Midwifery Council database was used to select a random sample of 1992 Registered Nurse Independent/Nurse Supplementary Prescribers. Of these, 1400 questionnaires were returned. Medicines for people with diabetes were prescribed by 439 respondents. This paper reports on the findings of these 439 nurses. The data were collected in 2006. RESULTS: Four hundred and nine (95.1%) participants had used independent prescribing and 214 (49.8%) used supplementary prescribing. The majority of respondents were highly experienced and worked in primary care. Some nurses (7.6%) reported that the prescribing programme did not meet their need. The needs of nurses who had undertaken specialist training in diabetes were met to a statistically and significantly greater extent than those without this training. Nurse prescribing was viewed positively by nurses prescribing for people with diabetes. CONCLUSION: Prescribing has extended the role that nurses in the United Kingdom are able to play in the management of diabetes. Specialist training is a prerequisite for nurses adopting this role. There is a need to explore the prescribing programme and the extent to which it meets the needs of nurses prescribing for people with diabetes. [ABSTRACT FROM AUTHOR]

Title. Adequacy of health-related quality of life measures in children under 5 years old: systematic review Aim. This paper is a report of a systematic review to assess the adequacy of measures evaluating generic health-related quality of life outcomes in children less than 5 years old. Background. Evaluating generic health-related quality of life outcomes in children is important to assess the effectiveness of interventions, nursing care and services. Methods. A methodological systematic review was carried out for the period 1980–2005 in accord with the UK Centre of Reviews and Dissemination guidelines on systematic reviews. We searched multiple electronic databases, hand-searched key texts, and contacted investigators. We included all English language publications describing primary empirical research of generic health-related quality of life, health status, functional status or wellbeing measures, with published psychometric evidence. All measures (proxy and/or self-complete) for use in children under 5 years were included; single dimension measures were excluded. Results. Seventy-six papers (70 studies) referring to 16 generic health-related quality of life measures met our inclusion criteria. None of the 16 measures were adequate in terms of their conceptual content or psychometric criteria; quality scores were poor (0–8). No current, generic health-related quality of life measure is both psychometrically and conceptually robust, although the Health Utilities Index has the most comprehensive psychometric data published. However, not all dimensions of health are assessed, with little evidence of reliability in children under 5 years of age. Conclusion. There is a need to develop empirically robust and conceptually comprehensive health-related quality of life measures, particularly in the context of proxy-completion measures for very young children. [ABSTRACT FROM AUTHOR]

AIM: The aim of this paper is to explore some reasons for the lack of focus on ethnicity and sexual health in nursing research, and suggest ways to advance the nursing evidence-base required for practice development. BACKGROUND: The United Kingdom National Strategy for Sexual Health and human immunodeficiency virus published in July 2001 highlighted the continued rise in sexual ill health amongst minority ethnic groups. In order to improve sexual health, research evidence is needed explain why particular ethnic groups appear to be at greater risk of sexual ill health. The Strategy identified nurses as key to bringing about improvements in sexual health. Nursing research includes many studies exploring links between ethnicity and health. However, with the exception of extensive work on human immunodeficiency virus/acquired immunodeficiency syndrome as a specific disease, nursing research into ethnicity has not systematically included sexual health. METHODS: Literature searches were conducted using the BIDS database, World Wide Web and United Kingdom Department of health website between June 2000 and August 2003. Papers written in English incorporating the keywords 'sexual health', 'sexually transmitted infection' and 'health and ethnicity' in the title or abstract were selected for review. FINDINGS: Nursing research into the association between sexual health and ethnicity is rare. It has been hampered by a variety of political and social constraints concerning the nature of sexual health practice in nursing, researching sexual health, and researching ethnicity and health. The result is a dearth of research evidence to support the development of sexual health practice and the education of healthcare professionals to underpin care of minority ethnic clients. CONCLUSIONS: Barriers to researching ethnicity and sexual health by nurses must be addressed through nursing education and practice. Without this, a detailed evidence base will fail to materialize and healthcare practices to implement the priorities to improve sexual health in minority ethnic communities will remain undeveloped. [ABSTRACT FROM AUTHOR]

elliott l., crombie i.k., irvine l., cantrell j. & taylor j. (2004) Journal of Advanced Nursing 45(2), 117–125 The effectiveness of public health nursing: the problems and solutions in carrying out a review of systematic reviews In 1999 the Scottish Office, United Kingdom, intimated that the Chief Nursing Officer would undertake a policy review of nurses’ contribution to improving the public's health. The importance of reviewing the scientific literature on the effectiveness of public health nursing was recognized as a crucial part of the policy review. A final report was expected within a 6-month period. The reason for the short time period was to fit the policy-making schedule. This paper discusses our literature review for this work. The aim was to conduct a review of the international scientific literature that gave the greatest coverage of the role and potential role of nurses in improving the public's health in relation to 14 major health topics. This paper describes the methods used, outlines the rationale underpinning the methods, discusses the problems encountered and offers solutions to some of these problems. The initial search for relevant scientific literature revealed 709 suitable primary papers. Reviewing this number was beyond the time limit set by the funding organization. Therefore, a decision was made to concentrate on the evidence contained in systematic reviews. Reviewing systematic reviews raises a number of methodological problems to which there are often no predetermined solutions, such as ensuring that important interventions are included, assessing the relevance and quality of the reviews, and grading the strength of the evidence. Reviewing systematic reviews provides the scope to increase the number of topics that might be covered. However, it is possible that a number of interventions may be missed, particularly those that are not subject to review or those assessed using qualitative techniques. The definition of public health nursing used in the present study was also restrictive, and could be widened to include community interventions. Finally, assessing the quality of reviews and grading the evidence proved difficult and there is lack of consensus on how these tasks should be achieved. Nevertheless, the review presented policy makers with accessible information on a large number of relevant international studies. [ABSTRACT FROM AUTHOR]

croghan e. & johnson c. (2004) Journal of Advanced Nursing 45(2), 155–161 Occupational health and school health: a natural alliance? The United Kingdom National Health Service aims to provide a holistic ‘cradle to grave’ service. In order to achieve this, systems are in place for effective communication between providers of services for babies and children. However, when children leave school, communication between the school health services and workplace health services to protect and promote the health of the new workforce is rare. Working together is a commonly-stated rhetoric of contemporary nursing theory, but often this is not applied in practice. School health and occupational health have similar aims and objectives and, by working together, may be able to improve the health of large populations for a lifetime. This paper aims to examine the similarities in principles and practices between school health and occupational health nurses, and to identify areas of overlap in which collaboration could improve care for clients of both services. The paper examines the nature of nursing in occupational and school settings, and similarities and differences in policy, law and principles. It also examines these two areas of practice within a public health framework, looking for areas of overlap. A basis is suggested for collaborative working between the two areas, and barriers, facilitators and benefits of this practice are examined. We conclude that there does exist a natural alliance between occupational and school health nursing, and that the two should work together to provide continuity of care for clients on leaving school, and to prepare children and young people for the workplace and any special health issues in their chosen careers. [ABSTRACT FROM AUTHOR]

hopkinson j.b., hallett c.e. & luker k.a. (2003) Journal of Advanced Nursing 44(5), 525–533 Caring for dying people in hospital 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. 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. 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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

AIM: The aim of this paper is to discuss the opinions of the key individuals involved in implementing the integration of nurse education into higher education in the United Kingdom (UK) about why nurse education moved into higher education and why this happened when it did. BACKGROUND: In 1995 the last of the old-style schools of nursing in the UK was fully integrated into higher education and were detached financially, legally and organizationally from District Health Authorities. However, only 6 years before, when Working Paper 10 was produced, there were only a few nursing degree courses located within higher education. What made this move into higher education particularly noteworthy was that there was never a clear statement of intent from the government that this integration of health care education was intended. Despite the fact that this is one of the most significant changes ever to take place in nurse education, there has been relatively little empirical research about why the development occurred. METHODS: A qualitative approach was selected for this study and the methods used were policy analysis and interviews. A purposeful sample of 70 implementers involved in the integration process was selected and asked for their views on this issue. FINDINGS: Participants believed that integration had occurred because of a combination of complex factors, but there was a division between those who thought that it was centrally planned and others who felt that it was an accidental outcome of the particular events of the time. CONCLUSIONS: It is not clear whether policy was influencing action or action influencing policy. Understanding of why this change occurred is needed if health care professionals wish to have greater control over future changes in education. [ABSTRACT FROM AUTHOR]

BACKGROUND: In an era when information technology developments are being harnessed by governments to improve patient care, it is important to consider the issues raised by the use of computers in health care practice and policy. AIM: The aim of this paper is to provide an appraisal of considerations raised by the use of computers in health care. REVIEW FOCUS: Drawing on a range of studies in the social and medical sciences, the paper reviews the considerations. The introduction to the paper maps out the policy context, which is followed by three substantive sections: first, computer hardware and software considerations; second, issues around confidentiality; and third, personal, social and cultural considerations. CONCLUSION: This paper demonstrates that information technology developments must be allied with government or state direction and should be informed by evidence. Whilst the issues discussed are of primary relevance to the United Kingdom National Health Service, they have wider relevance to health care systems internationally. [ABSTRACT FROM AUTHOR]

Background and aims. This paper draws on recent research conducted in two contrasting NHS hospitals: one a large District General, the other a small Community hospital; to look at hospitals as organizational spaces. This includes both the physical environment as well as how these spaces are inhabited and used. This paper aims to explore the ways in which hospital spaces impact on the working lives of nurses. Methods. The research employed two main methods. Two phases of round the clock non-participant observation were carried out within each hospital, one at the beginning of the research period and one at the end. This generated thick description of the diversity of spaces, as well as individuals' use of space. In addition, more than 50 in-depth unstructured interviews were conducted with both nurses and doctors. Findings. Three aspects of the relationship between nurse and hospital spaces are considered. First, the degree of access that nurses have to the different hospital spaces is limited, and many are confined to the wards in which they work. The high proportion of female nurses working on wards means that there are marked gender differences in access to hospital spaces. There are also marked professional differences when nurses are compared to doctors who have much greater freedom to roam and there are differences in the amount of private space allocated to nurses and doctors. Second, styles of bodily movement in space are also highly differentiated by profession and gender. Third, different spaces have very different meanings attached to them, and this has a strong impact on styles of performance and identity. Attention to space thus offers original insights to nurses working conditions as well as to inter-professional relations. [ABSTRACT FROM AUTHOR]

Background. Health care professionals in the United Kingdom (UK) appear to have higher absence and sickness rates than staff in other sectors, and stress may be a reason for nurses leaving their jobs. These problems need to be addressed, particularly in the mental health field, if current service provision is to be maintained. Aim. The aim was to identify stressors, moderators and stress outcomes (i.e. measures included those related to stress, burnout and job satisfaction) for mental health nurses, as these have clear implications for stress management strategies. Method. A systematic review of research published in English between 1966 and 2000 and undertaken in the UK that specifically identified participants as mental health nurses was carried out to determine the effectiveness of stress management interventions for those working in mental health nursing. Studies from non-UK countries were examined as potential models of good practice. The study was limited to primary research papers that specifically involved mental health nurses, where the health outcomes measured were stressors, moderators and stress outcomes and where sufficient data was provided. Results. The initial search identified 176 papers, of these 70 met the inclusion criteria. Seven studies have been reported since the completion of the review and have been included in this article. Sixty-nine focused on the stressors, moderators and stress outcomes and eight papers identified stress management techniques. Relaxation techniques, training in behavioural techniques, stress management workshops and training in therapeutic skills were effective stress management techniques for mental health nurses. Methodological flaws however, were detracted from the rigour of many of the studies. Conclusions. The review demonstrated that a great deal is known about the sources of stress at work, about how to measure it and about the impact on a range of outcome indicators. What was found to be lacking was a translation of these results into practice, into research that assessed the impact of interventions that attempt to moderate, minimize or eliminate some of these stressors. [ABSTRACT FROM AUTHOR]

Rationale. Nurse cadet schemes are locally developed initiatives which prepare participants for entry to preregistration nurse education. The paper discusses the political context in which modern day nurse cadet schemes have developed in the British National Health Service and explores the diversity of schemes currently operating in the United Kingdom (UK). Background. Nursing recruitment is a high priority for the National Health Service in the UK which, in common with many countries, is facing a nursing shortage. In addition, the government is committed to increasing flexibility in the education and recruitment of staff. The entry gate to health professional education needs to be widened to improve access for hitherto under-represented groups. Methods. The paper provides a critical commentary on key issues in the development of nurse cadet schemes as discussed in a range publications, together with information gathered from ‘grey’ literature and personal contacts in nurse education. A wide range of health care and social science databases was used to collect material for the discussion. Findings. Approximately 800 cadets are currently engaged in around 60 cadet schemes in a number of localities in Britain, and it is proposed that these will be expanded to over 2000 nurse cadets by 2004. Nurse cadet schemes have developed to meet local needs and priorities and, in the absence of a strong national framework, a wide diversity of participants, curricula and funding arrangements have emerged. Conclusions. Serious consideration needs to be given to further standardization in the structure and funding of schemes to reduce the degree of inequality which currently exists for cadets, together with development of national benchmarks to ensure that a set of minimum standards is met. Any future development must be built on a systematic evaluation of current schemes, which has yet to be undertaken. [ABSTRACT FROM AUTHOR]

Background and aims. In contrast to women's experiences of motherhood, there has been comparatively little research investigating men's experience of the transition to fatherhood and how changing cultural perspectives contribute to the contemporary experience of fathering. This paper draws on the findings of a larger ethnographic study of men's transition to fatherhood in the United Kingdom (UK) and discusses men's experiences of pregnancy confirmation. Methods. A longitudinal ethnographic approach was chosen to investigate men's ‘real life’ accounts of their transition to fatherhood. A mixture of ‘novice’ and experienced fathers ( n = 18) were recruited from antenatal classes in the north of the UK during 1998. Semi-structured interviews were conducted on three occasions, twice during their partner's pregnancy and once afterwards. Findings. Framed by the context of the contemporary construction of involved fatherhood, the men frequently spoke of their desire to be ‘involved’ with their partner's pregnancy and yet reported difficulty in engaging with its reality. They nevertheless participated in a range of activities – body-mediated-moments – which brought them closer to their partner's pregnant body and therefore their unborn baby. These activities centred on pregnancy confirmation, announcement, foetal movements, the ultrasound scan, and culminated in their presence during labour and delivery. This paper discusses their involvement in the process of pregnancy confirmation. Conclusion. The men's experiences of early pregnancy were marked forcefully by their involvement in the confirmation process. This activity gave men entry into a physical dimension, helping them forge an involvement in the pregnancy and shape their early transition to fatherhood. Implications for practice. The study has provided insight into expectant men's experiences of pregnancy and contributed to the understanding of the changing... [ABSTRACT FROM AUTHOR]

Supporting and policing mothers: an analysis of the disciplinary practices of health visiting Aim. This paper draws on the notion of disciplinary power developed by Michel Foucault to discuss whether the professional practices inherent in British health visiting can be understood in terms of support or surveillance. Background. The notion of disciplinary power embedded within Foucault's writings has been widely applied to the sociological analysis of health care professions. While a number of studies have focused on nursing practice, there has been little empirical work developing these ideas in the context of British health visiting. Methods. A qualitative approach using interviews with 24 health visitors and 16 women who had experienced domestic violence was used. For reasons of confidentiality, the women were not matched to the health visitors. Data analysis was continuous with data collection and led to identification of a number of categories. The theoretical framework of feminist poststructuralism underpinned the analysis. Findings: The women who participated in this research described their engagement in a number of disciplinary practices. These included the discursive production of themselves as good mothers, subjects and objects of the health visiting gaze, as well as their practices of resistance to health visiting work. Analysis of the health visitors' interview data provided further evidence concerning the exercise of disciplinary power in their everyday work of providing support and health care to women and children. Conclusions. The paper highlights tensions within the health visitor's role between welfare and surveillance, as well as differences between lay and professional perspectives. [ABSTRACT FROM AUTHOR]

Midwives’ perceptions of the use of technology in assisting childbirth in Northern Ireland Aim of the paper. The aim of this paper is to report a survey of midwives’ views on the use of technology in assisting births. Background. The research was designed to provide a deeper understanding of the integration of technology into midwives’ practice and to identify and examine aspects of training needs. Methods. Over 400 midwives responded to a questionnaire seeking information on their experiences and perceived competence with labour ward technology, with a particular focus on the use of cardiotocograph machines (CTGs) for electronic foetal monitoring. The survey sought views on the extent to which midwives trust the technology, their perceived levels of training and competence, their awareness of policy relating to technological intervention and the issue of women’s choice in whether the progress of their delivery is technologically monitored. Findings. The majority of midwives in this survey trust the use of technology but have concerns about issues of safety in relation to potential faults, and to their perceived lack of training in technology usage. The majority also indicated that they prefer a nontechnological birth although many point to the benefits of technological support when difficulties are encountered. The use of technology is seen as multi-professional and there was much support among the respondents for multi-disciplinary training in the use of technologies in future curricula. Conclusions. If the various findings of this sample survey were to be consolidated for midwives as a whole, they suggest that provisions for continuing professional development may need to address technological awareness and competence in a more focused manner than is discernible at present. [ABSTRACT FROM AUTHOR]

The Data Protection Act (1998): implications for health researchers Aims. This paper reports on the methods used in two studies to obtain access to subjects to comply with the common law duty of confidence laid out in the Data Protection Act (1998) and discusses the researchers’ problems in interpreting the procedures. Rationale. The amendments to the United Kingdom (UK) Data Protection Act (1998) are causing confusion within the health service and academic institutions. There is a need to balance patient confidentiality with the requirement to conduct vital, unbiased research in which health service professionals are not subject to ethical dilemmas. This paper examines the recruitment methods used in two studies in which the researchers’ attempts to adhere to the requirements lengthened the study costs and may have produced less reliable results. Methods. The methodological difficulties in two studies are presented. In Study 1, the difficulties encountered when the Multicentre Research Ethics Committee refused permission for researchers to recruit patients directly to a multicentre randomized controlled trial are discussed. In Study 2, the method used to compile a sampling frame for a national questionnaire survey following the eight principles of the Act are described. Findings. Our experience has shown that health care professionals are increasingly required to recruit patients to intervention trials, and that researchers are not allowed access to the names of patients or other subjects to ask them for consent to participate in a study. The requirement for researchers to use ‘intermediaries’ to obtain consent from and recruit subjects to studies increases the risk of selection bias, may expose the practitioner to ethical difficulties and may compromise the external validity of trial results. There is also a danger that research costs will soar when the Data Protection Act (1998) is fully realized. Conclusion. The Data Protection Act (1998) is currently being interpreted in a number of different ways. We conclude there is an urgent need for consensus within the health service and academic communities. [ABSTRACT FROM AUTHOR]

AIM: This paper critically examines the research literature relating to the psychological aspects of breast reconstruction. Particular attention is given to the role of specialist breast care nurses in supporting women faced with the decision of whether or not to opt for reconstructive surgery. BACKGROUND: Breast reconstruction is intended to offer psychological benefits (e.g. improvements to quality of life, body image, anxiety and depression) to women treated by mastectomy following diagnosis of breast cancer. METHODS: A literature search was carried out on the PSYCHINFO, MEDLINE and CINAHL databases using the terms 'breast reconstruction', 'mastectomy', 'reconstructive surgery', 'breast surgery', 'breast implants', 'transverse rectus adominis myocutaneous (TRAM) flap' and 'Lat-dorsi'. Further relevant articles were identified from the reference lists of papers detected by this literature search. Finally, proceedings of recent psychological and surgical meetings were scrutinized to identify any conference papers on this topic. FINDINGS: A thorough search of the existing literature revealed a lack of theoretically based studies examining breast reconstruction in terms of relevant psychological constructs, especially in relation to coping and decision-making. This review highlights the methodological flaws with much of the existing research in this area, in particular the reliance upon retrospective designs and the inappropriate use of randomised controlled trials. Suggestions are given for further research in this topical area. CONCLUSIONS: Existing research into the psychological aspects of breast reconstruction is limited and not sufficiently conclusive to inform changes to policy and the provision of care. More methodologically rigorous research is needed. [ABSTRACT FROM AUTHOR]

AIM OF THE PAPER: To examine the application of the decision tree approach to collaborative clinical decision-making in mental health care in the United Kingdom (UK). BACKGROUND: While this approach to decision-making has been examined in the acute care setting, there is little published evidence of its use in clinical decision-making within the mental health setting. The complexities of dual diagnosis (schizophrenia and substance misuse in this case example) and the varied viewpoints of different professionals often hamper the decision-making process. This paper highlights how the approach was used successfully as a multiprofessional collaborative approach to decision-making in the context of British community mental health care. DESIGN: A selective review of the relevant literature and a case study application of the decision tree framework. CONCLUSIONS: The process of applying the decision tree framework to clinical decision-making in mental health practice can be time consuming and client inclusion within the process is not always appropriate. The approach offers a method of assigning numerical values to support complex multiprofessional decision-making as well as considering underpinning literature to inform the final decision. Use of the decision tree offers a common framework that can assist professionals to examine the options available to them in depth, while considering the complex variables that influence decision-making in collaborative mental health practice. Use of the decision tree warrants further consideration in mental health care in terms of practice and education. [ABSTRACT FROM AUTHOR]

AIMS OF THE PAPER: This paper aims to examine the recent debates in both the general and professional press over the future of preregistration education in England, in the light of the sociological literature on the professions, and the nature of nursing knowledge. The literature on the Project 2000 reforms, although by now well worn, will also be discussed briefly. BACKGROUND/RATIONALE: The bulk of nursing education in England moved into higher education in the 1990s. Unlike other higher education in England, it is not funded by the Department for Education and Employment, but commissioned by the National Health Service (NHS), to which it is expected to be highly responsive. DESIGN/METHODS: This paper is based on a brief literature survey, plus policy documents and media reports. Findings/Conclusion. It will be argued that the process of professionalization is not a straightforward one, and has its potential for reversals of fortune, and that nursing occupies a marginal place in higher education in England. [ABSTRACT FROM AUTHOR]

The relationship between attendance at birth and maternal mortality rates: an exploration of United Nations’ data sets including the ratios of physicians and nurses to population, GNP per capita and female literacy Background. This is the third and final paper drawing on data taken from United Nations (UN) data sets. The first paper examined the global distribution of health professionals (as measured by ratios of physicians and nurses to population), and its relationship to gross national product per capita (GNP) (). The second paper explored the relationships between the global distribution of physicians and nurses, GNP, female literacy and the health outcome indicators of infant and under five mortality rates (IMR and u5MR) (). In the present paper, the global distribution of health professionals is explored in relation to maternal mortality rates (MMRs). The proportion of births attended by medical and nonmedical staff defined as ‘attendance at birth by trained personnel’ (physicians, nurses, midwives or primary health care workers trained in midwifery skills), is included as an additional independent variable in the regression analyses, together with the ratio of physicians and nurses to population, female literacy and GNP. Aim. To extend our earlier analyses by considering the relationships between the global distribution of health professionals (ratios of physicians and nurses to population, and the proportion of births attended by trained health personnel), GNP, female literacy and MMR.

AIMS OF THE STUDY/PAPER: This paper reports the results of a survey of forensic community mental health nurses (FCMHNs) in England and Wales which aimed to ascertain the level of stress and burnout experienced by this group. BACKGROUND/RATIONALE: Several studies have identified that mental health nursing is a stressful activity and the relationship between factors such as age, experience, support, caseload size and perceived stress have been explored. However, until recently, no studies have examined the situation of FCMHNs and this paper extends the analysis of studies completed by the main author, considering issues related to coping abilities and support systems. DESIGN/METHODS: The survey involved respondents completing a demographic questionnaire and a range of standardized validated measures (Maslach Burnout Inventory, General Health Questionnaire and Community Psychiatric Nurse Stress Questionnaire). The population for the study was all identified FCMHNs attached to the 26 National Health Service (NHS) Medium Secure Units in England and Wales (n=104). RESULTS/FINDINGS: A high response rate of 77% (n=80) was achieved. The results identified that a number of respondents were experiencing burnout. Statistically significant associations were found between caseload size and level of stress. The results also suggest that support from managers and colleagues were an important factor in ameliorating the experience of stress and show that individuals in this study experiencing high levels of stress adopted palliative behaviours such as use of alcohol. CONCLUSIONS: The paper concludes by suggesting that such findings should be considered when delivering stress management programmes and reinforce the potential benefit of effective clinical supervision as a means of staff support. [ABSTRACT FROM AUTHOR]

AIM OF THE PAPER: The aim of this paper is to examine individualized health visiting care and compare it to corporate working within a consensual management style. Corporate working has been discussed and used in many different ways since the idea first came to light at the end of the 1980s. Resource management makes it an appealing model, however, analysing how corporate working functions in the practice setting reveals the complexity of this method of service provision. BACKGROUND: This paper is based on a method of practice developed by health visitors in Haywards Heath, West Sussex, who implemented the process. The article examines individualized health visiting care and compares it to corporate working within a consensual management style. Important in this analysis are the elements of reflexivity, active listening, reflection and the application of 'praxis' within the corporate caseload approach. METHODS: Rogers' evolutionary concept model was used to illuminate and explain the different ways of delivering the health visiting service. FINDINGS: There are benefits in working corporately: shared workload, increased professional support and improved accountability. Alongside the integrated supervision of this model is the opportunity offered to practitioners to innovate. This offsets any initial difficulty experienced in setting up this method and makes it a worthwhile change of style in health visiting practice. Improved service delivery, enhanced professional growth and increased opportunity for public health work can be demonstrated as outcomes of this model. For professionals this method may prevent 'burn-out', enhance practice and increase innovation in health visiting practice. Using this method as a blueprint, practitioners can develop their own style of corporate working that offers a service that is equitable, proactive, efficient and accessible to clients. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Burnout in nursing is of both individual and organizational concern with ramifications for well-being, job performance, absenteeism and turnover. Burnout is rarely assessed as part of a comprehensive model of occupational stress, a short-coming which this paper attempts to redress. METHOD: A randomly selected sample of 510 psychiatric nurses from one Scottish Trust completed a questionnaire based on a psychological model of occupational stress which included the Maslach Burnout Inventory (MBI) as the dependent variable. FINDINGS: The respondents reported average, low and average levels of emotional exhaustion, depersonalization and personal accomplishment, respectively. The study sample had significantly lower scores on emotional exhaustion and depersonalization than normative data but also significantly lower levels of personal accomplishment than a normative group of physicians and nurses. Only 2.0% of the study sample could be categorized as having high burnout overall (i.e. high emotional exhaustion, high depersonalization, low personal accomplishment) and they differed significantly from the rest only in terms of males being over-represented. Hierarchical regression analysis revealed that selected explanatory variables accounted for 41.9% of emotional exhaustion, 16.4% of depersonalization and 25.6% of personal accomplishment in the study sample. IMPLICATIONS: The paper discusses the implications of the findings in terms of a comprehensive approach to intervention aimed at minimizing the risk of burnout in psychiatric nurses. Such an approach will involve interventions at the organizational and individual level. [ABSTRACT FROM AUTHOR]

AIM(S) OF THE PAPER: This paper questions the validity of a boundary presumed to exist between technology and humane care. It argues the need for reconciliation of presumed tension(s) between technology and person focused care and the need to reconsider our ways of understanding the relations between technology and nursing. BACKGROUND/RATIONALE: Recent scholarship in the social sciences related to reproductive and imaging technologies and emergency resuscitation are examined and arguments are presented that question the appropriateness of a humanist view that emphasizes technology on the nonhuman and nonnatural side of a human/nonhuman, nature/artifice divide. It is argued that what determines experiences such as dehumanization is not technology per se but how individual technologies are used and operate in specific user contexts, the meanings that are attributed to them, how individuals or cultural groups define what is human, and the organizational, human, political and economic technological system (technique) that creates rationale and efficient order within nursing, health care and society. CONCLUSION: The paper concludes by asking whether the commonplace appeal to resolve tensions between humane care and technology has erroneously highlighted technology as the reason for impersonal care, and encourages re-examination of the relationship(s) between technology, humane care and nursing practice. [ABSTRACT FROM AUTHOR]

The importance of conducting and reporting pilot studies: the example of the Scottish Births Survey Background. In many research papers, pilot studies are only reported as a means of justifying the methods. This justification might refer to the overall research design, or simply to the validity and reliability of the research tools. It is unusual for reports of pilot studies to include practical problems faced by the researcher(s). Pilot studies are relevant to best practice in research, but their potential for other researchers appears to be ignored. Objective. The primary aim of this study was to identify the most appropriate method for conducting a national survey of maternity care. Methods. Pilot studies were conducted in five hospitals to establish the best of four possible methods of approaching women, distributing questionnaires and encouraging the return of these questionnaires. Variations in the pilot studies included (a) whether or not the questionnaires were anonymous, (b) the staff involved in distributing the questionnaires and (c) whether questionnaires were distributed via central or local processes. For this purpose, five maternity hospitals of different sizes in Scotland were included. Results. Problems in contacting women as a result of changes in the Data Protection Act (1998) required us to rely heavily on service providers. However, this resulted in a number of difficulties. These included poor distribution rates in areas where distribution relied upon service providers, unauthorized changes to the study protocol and limited or inaccurate information regarding the numbers of questionnaires distributed. Conclusions. The pilot raised a number of fundamental issues related to the process of conducting a large-scale survey, including the method of distributing the questionnaire, gaining access to patients, and reliance on ‘gatekeepers’. This paper highlights the lessons learned as well as the balancing act of using research methods in the most optimal way under the combined pressure of time, ethical considerations and the influences of stakeholders. Reporting the kinds of practical issues that occur during pilot studies might help others avoid similar pitfalls and mistakes. [ABSTRACT FROM AUTHOR]

Subject positions theory – its application to understanding collaboration (and confrontation) in critical care Background. Doctors and nurses do not usually take a collaborative approach to the ethical challenges of the critical care environment. This leads to the stresses that produce moral anguish and burnout – both for nursing and medical staff. A more collegial relationship between nurses and physicians should improve patient care. If we are to promote this collegiality, one way to proceed is to investigate the interactions between health care professionals in order to develop an understanding of the barriers to, and supports for collaboration. Aim. Subject positions theory offers a method of explaining and elucidating the interactions between nurse and physician in terms of power dynamics, mutual expectations and the discourse available to each individual. This paper aims to demonstrate how subject positions theory can facilitate the interpretation of the interactions between health professionals in terms of the power dynamics influencing those interactions. Discussion. This paper will use the example of a case study from my own research to demonstrate the application of this theory and its usefulness in the analysis of the interactions between health care professionals. Conclusions. Application of this theory is used to demonstrate the author’s argument that the current political and cultural structure of the health care system does not support the subject position – nurse advocate. [ABSTRACT FROM AUTHOR]

Aims of the study. This paper uses the findings of a recent bibliometric analysis of published UK nursing research to ask whether the field is characterized by a fundamental split between two underlying areas of research interest. These can be termed 'endogenous' and 'exogenous'. The former term describes research which tends to be concerned with problems and issues to do with nursing as a profession; the latter is concerned with problems and issues centring around the nursing of patients.Design/methods. Papers in the Wellcome Trust's Research Outputs Database (ROD), a database of UK biomedical research, were analysed. Nursing papers published between 1988 and 1995 numbered 1845, just less than 1% of the total papers in the ROD.Results/findings. Analysis of the subfield identified that nursing research was atypical of biomedical research as a whole in a number of ways. One difference was that usually in biomedical research there is a general correlation between numbers of funders acknowledged on a paper, numbers of authors, and esteem of the journal in which a paper appears. In nursing there was, if anything, a tendency for highly esteemed papers to have fewer authors and be less likely to have acknowledged funding. However, the apparently endogenous and exogenous papers have quite different characteristics. This paper explores this apparent difference and possible reasons for this difference and will briefly compare nursing research with some other newly emerging social and academic groups.Conclusions. Thinking of nursing research outputs in this way can provide insight into the existence of different reward systems influencing nurse researchers. However, it is impossible to draw too confident a differentiation without reading each individual paper and making judgements about whether they are 'endogenous' or 'exogenous', a practice generally beyond the scope of bibliometric practice. [ABSTRACT FROM AUTHOR]

AIMS OF THE PAPER: This paper aims to explore through historical analysis some of the means by which medicine successfully appropriated and medicalized pregnancy and childbirth and to consider the impact that this has had on women's experiences within maternity care. BACKGROUND AND RATIONALE: The appropriation and medicalization of pregnancy and childbirth by men are rooted in a patriarchal model that has been centuries in the making. A model that perceives women as essentially abnormal, as victims of their reproductive systems and hormones, it is also one that defines pregnancy as inherently pathological - a clinical crisis worthy of active intervention. In both law and medicine men have used their power to define reproduction as a biological defect (LeMoncheck L. 1996 Journal of Clinical Ethics 7, 160--176), requiring both legal regulation and medical intervention, whilst feminist writers have long argued that women's experiences within the health care system at least to some extent reflects their social position. CONCLUSIONS: Male justifications of female inferiority have been developed and nurtured through professional discourses and socialization processes inherent within medical education and practice (Cahill H. 1999 MA Thesis, University of Keele). These assumptions are internalized and reproduced to shape quite profoundly, the nature of doctors' interactions with women in their care. Perhaps more fundamentally, such discursive explanations of women's bodies as inherently defective continue to shape women's position in society. Maternity care is a key area in which women's ability to exercise real choice and make informed decisions is limited and where doctor-patient interactions are themselves constructions of existing gender orders; women's autonomy continues to be violated through both quite subtle and overt discourse and practice. [ABSTRACT FROM AUTHOR]

AIM OF THE STUDY: To explore with practitioners and others, their priorities for and definitions of district nursing. BACKGROUND/RATIONALE: This paper discusses whether the use of metaphor in nursing literature and research can offer particular insights about the situation and experiences of nurses. DESIGN/METHODS: A case study approach was used to examine district nursing during a time of policy change. The study was undertaken in two stages using a range of qualitative methods of enquiry. Participants of the study were district nurses, General Practitioners (GP) and Community Nursing managers. RESULTS/FINDINGS: Qualitative data from interviews and periods of observation revealed that district nurses, and to a lesser extent General Practitioners and nurse managers used a shared group of metaphors to try and capture district nursing work. The paper suggest that this recurring group of metaphors demonstrated coherence between the language used, observed practice and accounts of how district nurses worked which provided useful insights for district nursing. The metaphoric language revealed both negative and positive dimensions of district nursing work. It illuminated the context dependent nature of district nursing work and the conflicting interests they had to accommodate. It also revealed the emotional work, skills and strategies district nurses employed in order to achieve their work. CONCLUSIONS: The paper concludes that an examination of metaphoric language offers an opportunity to examine what otherwise would be tacit or even misunderstood in nursing work. [ABSTRACT FROM AUTHOR]

AIMS: This paper discusses whether there should be universal or selective provision of health visiting services. The aim is to show the central relevance of the work of the late epidemiologist, Geoffery Rose, to arguments advocating the retention of a universal health visiting service. BACKGROUND: In the United Kingdom (UK), health visiting moved, in the early years of the twentieth century, from being focused on the needs of poor families to becoming a universally provided service. Recent debates about the future of British health visiting have again raised the issue of whether health visiting remains a universal service, or should be targeted only on the most needy. STRUCTURE: Following an exposition of Rose's work, two kinds of problems with which health visitors are concerned, depression and child abuse, are used to illustrate the ways in which Rose's approach can be applied to health visiting. CENTRAL THESIS: Rose argued that the bulk of problems in society arise in the many who are not at especially high risk, rather than in the few who are at high risk. This is because of a very large number of people who are not at especially high risk. Consequently, following Rose, this paper argues that in relation to such problems as depression or child abuse, to target health visiting services only on those at high risk would be to leave untouched a vast burden of health and social problems. In the context of identifying people who are at greatest risk, Rose argued that no screening instrument can ever be sufficiently precise to accurately identify those most likely to suffer problems. In corroboration of Rose's argument, this paper illustrates the pitfalls of health visitors' attempts to screen for families at greatest risk through the use of such instruments as checklists of risk factors. CONCLUSIONS: It is concluded that it is neither possible to screen accurately for those at greatest risk, nor desirable to target services only on those at greatest risk. Therefore, it is advocated that health visiting should remain a universal service. However, it is recognized that within a universally provided service, some clients will require a greater intensity of input than others. In assessing the need for services, it is argued that the professional judgements of health visitors are crucial. [ABSTRACT FROM AUTHOR]

AIMS: The National Health Service (NHS) is the largest employer in Western Europe and the largest employer of minority ethnic workers in Britain. This paper is concerned primarily with an examination of the experiences of nurses from minority ethnic groups. BACKGROUND: Recent research evidence suggests that many minority ethnic nurses face racial harassment from patients and colleagues and that there are continuing problems in recruitment and promotion. The Macpherson Report on the enquiry into the murder of black teenager Stephen Lawrence has stimulated a wide ranging discussion of institutional racism throughout the public sector in the UK, including the NHS. DISCUSSION: This paper discusses the continuing failure of equal opportunities policies to have a sustained impact on the experiences of minority ethnic nurses and discusses a number of reasons for the lack of progress of such policies. It examines the reasons why health care organizations might adopt equal opportunities policies and the pragmatic reasons why implementation has been both slow and patchy. It goes on to consider the concepts of managing diversity and ethnic managerialism as new tools to theorize equal opportunities and considers some of the continuing problems inherent in current strategies. [ABSTRACT FROM AUTHOR]

Women’s anxieties surrounding breast disorders: a systematic review of the literature A systematic review of the research literature published in English between 1990 and 1999 was carried out to discover whether women with benign breast disorders suffer similar amounts of anxiety to women with breast cancer in the time between discovery of the problem and receiving a diagnosis, to include the immediate postdiagnosis phase. The study was limited to primary research papers with explicit methodology applicable to hospital specialist breast clinics where the main focus of the papers was anxiety and/or psychological distress. Studies focusing exclusively on routine breast screening or exclusively on women with previously diagnosed breast cancer were omitted. A protocol for the review was agreed at the outset, addressing selection criteria, search procedures, methods of data extraction and analysis, and dissemination. Search terms were refined as the study progressed. A data extraction tool was constructed based on Benton and Cormack’s framework (, pp. 80–81). An initial search revealed 89 papers. Fourteen papers were found to meet the criteria for inclusion. The main findings were that women with benign breast disorders and those with breast cancer suffered from similar levels of anxiety and psychological distress in the period from first being aware of the problem up to the time of receiving a diagnosis. Anxiety levels were found to fall more quickly in women with benign disorders postdiagnosis. Methodological flaws were detracted from the rigour of many of the studies. Implications for practice are discussed. [ABSTRACT FROM AUTHOR]

Concerns have been expressed that bioscience education is not meeting the needs of nursing students in the UK. This paper explores the situation further by comparing student perceptions with those of experienced practitioners (Part One of the study) and also evaluates the confidence of staff nurses in explaining the rationale for care applied to a common but specific disorder (influenza; Part Two). Questionnaires were used. Responses were elicited from DipHE Nursing (Project 2000) adult/child branch students (n=153) from two universities and from adult/child care staff from their local clinical placements (n=171 in Part One of study; n=266 in Part Two). The questions asked followed two themes: (1) confidence in understanding biological science and (2) issues of teaching and learning. Most questions utilized a rating scale from 1 to 10; this scale provides no central value and a vertical line was drawn to encourage respondents to identify which half of the scale their responses came under (basically, a negative or positive viewpoint). The significance of the data distribution either side of the midline was analysed statistically (simple sign test), as were any differences in distribution between the groups (chi-square test). Median values were also determined. The data do not provide support for views that the biosciences are being significantly diminished by modern curricula, but also show no evidence for a great improvement in the bioscience knowledge base in recent years. What was surprising was the lack of confidence expressed by staff nurses: one illuminating finding was the lack of confidence in articulating their knowledge to patients and, even less so, to other health professionals. The paper reiterates a need for a national teaching and learning strategy for pre- and postregistration education in the biosciences. In particular, a means to raise the level of understanding of staff nurses must be identified urgently so that the mentoring of students in these subjects is improved. [ABSTRACT FROM AUTHOR]

Current health care policy and practice contexts in the UK point to the importance of nurses' ability to make an effective contribution to educating patients about medication, as part of their role in health education and health promotion. Nurses' potential contribution to this important activity will inevitably be dependent on knowledge and skills acquired during preregistration and postregistration programmes of education. Against this backdrop, changes in pre and postregistration nurse education in the UK in the past decade highlight the importance and timeliness of evaluating the adequacy of educational preparation for a medication role. This paper reports on the findings from an evaluation of UK educational preparation for a medication education role in practice. A case study design was used to investigate current educational preparation at three education institutions. Multiple methods of data collection at each site involved focus group discussions with lecturers and practitioners, individual interviews with key personnel, nonparticipant observation of teaching sessions, postobservation interviews with students and curriculum analysis. Findings highlighted the importance of a number of dimensions of preparation for practice of such a role: the need for sufficient taught pharmacology; opportunities for application and integration of prerequisite knowledge and skills; the importance of practice-based learning; the need for an evidence-based curriculum, and the importance of clarifying outcomes and competencies required for a medication education role within pre and postregistration curricula. The paper concludes with a discussion and implications of the findings. [ABSTRACT FROM AUTHOR]

The following paper presents the findings of an exploratory ethnography, the purpose of which was to identify and describe heart health associated beliefs and behaviours of year seven (Y7) and year 10 (Y10) secondary school young people of African and African Caribbean descent in two UK cities. Data were collected by the data collection technique of focus groups. However, eight focus groups were conducted involving 47 Y7 young people and 29 Y10 pupils, 76 pupils in total. The data were analysed utilizing ATLAS/ti qualitative data analysis software. This software is informed by grounded theory. Data from the study formed six themes. The findings informed the development of an interactive health promotion website which can be found at http://www.shef.ac.uk/web/uni/projects/mshhp. The paper argues that in order to provide meaningful programmes of health promotion to be developed by health care providers including school nurses and health visitors, it is essential that interventions are informed by an understanding of the health beliefs and behaviours of African and African Caribbean young people. [ABSTRACT FROM AUTHOR]

The scheduling of nursing time on hospital wards is critical to the delivery of patient care, resource utilization and employee satisfaction. Over the past decade many hospital wards in the United Kingdom (UK) have moved away from the traditional planning of rosters by a single manager, towards more participative processes known as self-rostering and team rostering. This paper tests the hypothesis, developed from the literature, that the three types of rostering approach may be positioned along a continuum. Self-rostering at one extreme, is conducive to staff empowerment, motivation and roster effectiveness, whilst departmental rostering, at the other, leads to perceived autocracy, reduced empowerment, lower levels of staff motivation and roster effectiveness. Team rostering is positioned mid-way on this continuum. This paper reports the findings of an empirical study of nurse rostering practices in the UK National Health Service (NHS), with a view to developing an understanding of the implications of implementing these three rostering approaches and testing the above hypothesis. The survey of rostering practices in 50 NHS wards, and in-depth case studies of seven wards, revealed that each of the three rostering approaches has benefits and limitations and a picture emerges quite different from that implied by the research hypothesis. Whilst the literature suggests that the choice of rostering approach determines the level of perceived autocracy, staff motivation and roster effectiveness, it is proposed in this paper that selection of rostering approach should be contingent upon operational context. The paper concludes with a framework which stipulates that the choice of rostering approach for a ward should be determined on the basis of four contingent variables, namely, ward size, demand variability, demand predictability, and complexity of skill mix. It is recommended that departmental rostering be applied in large wards with complex rostering problems, whilst team rostering is more appropriate for medium sized wards, and self-rostering appropriate for small wards. [ABSTRACT FROM AUTHOR]

An earlier study conducted in the United Kingdom, examining the newly qualified nurse's perception of the transition from student to qualified nurse, highlighted the limitations of pre-registration nurse education in respect of failing to provide adequate preparation for the qualified nurse's role. In the intervening years, major reforms in pre-registration nurse education and continuing professional education have occurred. Concomitant with these reforms have been major policy changes in health care delivery that have impacted upon the role of the nurse. Questions now arise as to whether the education reforms have served to equip newly qualified nurses more appropriately with the necessary knowledge, skills and confidence to function in contemporary health care settings. This paper presents the findings of a follow-up study that entailed a secondary analysis of exiting data obtained from in-depth interviews with 10 newly qualified nurses in 1985 and collecting additional data from 25 newly qualified nurses in 1998 in order to ascertain their perceptions of the transition from student to qualified nurse. Interview transcripts from both sources of data were coded and thematically analysed and comparisons made between the two sets of data. The paper focuses on one theme emanating from the original study. Entitled 'fumbling along', it described the haphazard manner whereby the nurses learned to perform their role in the light of what they perceived to be inadequate preparation and lack of support. Similarities and differences in the experiences and perceptions of the two cohorts of nurses are examined in respect of stressful aspects of the role, pre-registration preparation and post-registration development. Data from the follow-up study suggest that although newly qualified nurses still feel inadequately prepared for their role, they have developed a more active style of learning and when supported through a preceptorship scheme appear to find the transition less stressful than nurses in 1985. However, further attention needs to be paid to the development of clinical, organizational and management skills in pre-registration courses and the bridging period between the latter part of the course and the first 6 months post-qualification, in order to enable the neophyte nurse to acclimatize gradually to becoming an accountable practitioner. [ABSTRACT FROM AUTHOR]

The purpose of this literature review is to identify those factors which might affect the research capacity of departments of nursing based in higher education, and to make recommendations based upon the findings to enable departments to develop their capacity to undertake research. There is a dearth of published research which directly addresses this issue and therefore publications were reviewed which related to: the impact on nurse educators of the integration of nursing into higher education; nurse educators' attitudes towards research and their research role; analysis of the results of the 1992 and 1996 Research Assessment Exercises and commentaries on them; developing research within nursing generally; and factors affecting research productivity within nursing and related disciplines. The papers were analysed according to the following themes: academic qualifications; research skills; time available for research; motivation to undertake research; a culture of research; subject specialization; subject areas for research; research quality; and a nursing research council. The conclusions are first, that whilst there is a dearth of literature which relates directly to research capacity development in academic departments of nursing, there is much advice which can be drawn upon. Second, the article concludes that the factors affecting research capacity development are numerous and complex and it is not something which can only take place at the departmental level. There are also issues which require consideration nationally, as well as factors which depend upon the individual academic, and these impact upon the research capacity of academic departments of nursing. The factors are summarized at the end of the paper in the conclusions and recommendations. [ABSTRACT FROM AUTHOR]

This paper describes the development of an innovative research approach which used the complementary methods of simulation and post-simulation interview to examine the knowledge-base involved in community nursing assessment practice in the United Kingdom. The study commenced in 1994 and the main phase of data-gathering took place over a 3-week period in 1995. Having outlined the study's aim, context and theoretical background, this paper focuses on the two main methods of data-gathering used. Detailed description of the simulation method and the post-simulation interview and the rationales for their use are followed by critical discussion which identifies their particular strengths and weaknesses. Threats to validity are also considered. It is argued that the combined use of a simulated assessment and a post-simulation structured interview has great potential as a means of exploring the knowledge involved in community nursing assessment practice. [ABSTRACT FROM AUTHOR]

During the 1980s many nurses left the British National Health Service to own and run private residential care homes for elderly people. At the time, a public policy of guaranteed financial support for residents underpinned the rapid expansion in the sector and residential homes were considered as profitable low-risk business ventures. However, since the introduction of the 1990 National Health Service and Care in the Community Act, this automatic funding has been withdrawn and residential homes have had to compete amongst each other for a finite number of clients funded by limited local budgets. The withdrawal of guaranteed state support and the introduction of social care markets have had negative impacts on many residential home businesses. Indeed, many homes are facing financial difficulties. This paper considers the actions and attitudes of former nurse proprietors under the new conditions based on a three-stage survey in Devon, England. Proprietors are experiencing increased levels of stress and many are unhappy with their current work experiences. The paper concludes that although the small business private sector may seem attractive to nurses, any move into private sector ownership has an associated risk. Social policy conditions may change with concurrent consequences for businesses and business owners. [ABSTRACT FROM AUTHOR]

Clinical supervision is a commonly discussed concept within nursing. There appears to be a common belief that it is a good thing for nursing. Many practitioners, however, are still unsure what clinical supervision is and what is expected of them. A number of definitions and models of supervision have been developed but it remains ill defined. This paper develops a conceptual analysis of clinical supervision using the method developed by Rodgers (1989). A review of the literature precedes description of the attributes, antecedents, consequences and references. A model case is outlined prior to a proposed definition of supervision being given. It is hoped that this paper will stimulate further exploration and study of this concept. [ABSTRACT FROM AUTHOR]

With the growing interest in community-based initiatives, this discussion paper focuses upon the evaluation of community development. It reviews three areas and highlights the complex and contentious nature of evaluation in this field. Commencing with approaches to evaluation, it critically reviews proposed methods and suggests that, rather than provide clarity and guidance, the competing designs are confusing for the potential researcher. Second, the discussion moves to evaluative terms that are applied to community development, suggesting that there is a mismatch between professional and lay interpretations with an ultimate impact upon the validity of their measurement. It uses the terms community and empowerment to make these differences more explicit. Finally, the paper argues that, although the aim of community-based initiatives is to bring about community health gain, gauging the pervasiveness of discreet project work is testing. It concludes by suggesting that a move away from an evaluative model based upon empowerment towards one which considers health and social capital may be a way forward. [ABSTRACT FROM AUTHOR]

This paper reviews some of the key policy changes in the United Kingdom in relation to older people that have influenced assessment practice across health and social care, and have implications for nursing within emerging primary care groups. The role of assessment in purchasing care packages raises tensions and paradoxes for health and social care professionals that the paper sets out to elucidate with particular reference to district nurses. The issues for nursing have not been well described previously and questions such as key accountability, rationing, multiagency and interprofessional working, and the consumer voice, are discussed. [ABSTRACT FROM AUTHOR]

The development of clinical guidelines as one means of implementing evidence-based practice is currently a topical issue. The recent Government White Paper, The New NHS. Modern. Dependable, proposes the establishment of a National Institute for Clinical Excellence whose expressed aim will be to produce and disseminate guidelines based upon evidence of clinical effectiveness in health care. There will be an expectation that practitioners adapt these national guidelines for local needs and particularize them to individual patients. There has been considerable debate in the medical press between the critics and advocates of evidence-based medicine surrounding the relative usefulness of clinical guidelines. However, there has been limited corresponding debate within the nursing literature, which has largely limited itself to descriptions of the implementation of guidelines. This paper examines some of the advantages and limitations of clinical guidelines as a means of operationalizing research evidence to promote effective health care. Finally, some recommendations surrounding the implementation of guidelines will be made. [ABSTRACT FROM AUTHOR]

Inequalities in service provision: an examination of institutional influences on the provision of district nursing care to minority ethnic communities This paper reports on the selected findings from a larger ethnographic study of the provision of district nursing care to patients from different ethnic backgrounds. The two-stage study was undertaken in an English community National Health Service (NHS) trust serving an ethnically diverse population. The first stage comprised an organizational profile in order to analyse the local policy context, including specific responses to ethnic diversity. Data were collected by means of in-depth interviews with managers. The second stage entailed a participant observational study focusing on six district nursing teams. Purposive sampling was used to identify four teams with high minority ethnic caseloads and two teams with predominately white ethnic majority caseloads. Interview transcripts and field-notes were analysed by drawing upon the principles of dimensional analysis. The paper focuses upon institutional influences on the provision of care to minority ethnic communities. An analysis of the allocation of district nursing resource to different general practitioner (GP) practices identified marked inequalities in the district nursing provision which impacted upon the services provided to minority ethnic patients. Single-handed, inner city GP practices with a large minority ethnic practice population received a much smaller allocation of nursing staff than single group practices serving a smaller and predominately white practice population. The reasons why this situation existed are explored and an explanation offered as to why it had not been rectified. Observation of caseload management indicated that despite differences in the size of the practice populations served by the respective teams, all patients referred for nursing care received it. However, several covert processes appeared to limit the caseload size of those teams with large practice populations so that it remained manageable within the limited nursing resource available. It is concluded that although nurses at an individual level did not appear overtly to disadvantage minority ethnic patients, institutional forces conspired to perpetuate the disadvantage experienced by minority ethnic communities. [ABSTRACT FROM AUTHOR]

This paper presents the results of an appraisal of the evidence for the effectiveness of methods of nutritional assessment currently in use by nurses and from this develops concepts which may be applied to many areas of nursing practice. The paper first shows how the approach to nutritional assessment by nurses has changed over time, producing the present search for methods which are relatively quick and easy to use. It then describes the limited nature of the evidence of effectiveness of these methods and considers the reasons for this situation. It suggests that the difficulty of validation is an important factor and describes the three most common approaches to validation, showing how problems arise from lack of clarity in the definition of terms and the assumption of a simple relationship between the level of risk of nutritional compromise and actual nutritional status. In conclusion, it is suggested that these difficulties illustrate principles applicable to many areas of nursing care, and a definition of 'segments' of care processes, each with well-defined purposes and outcome measures, is proposed. Such an approach will help to demonstrate the complexity and value of nursing activity. [ABSTRACT FROM AUTHOR]

The ‘greying’ of the United Kingdom nursing workforce: implications for employment policy and practice One in five nurses on the United Kingdom (UK) professional register is aged 50 years or older. Over the next few years, the profession will lose, through retirement, many of its most experienced practitioners. The significance for policy makers and for employers of this age-shift is two-fold. Firstly it is clear that greater numbers of nurses and midwives are reaching, or soon will reach, potential retirement age. Secondly many more nurses are now reaching their middle years and they are likely to have different requirements and attitudes to nursing work. This paper examines the employment policy and practice of the ageing of the UK nursing population. The paper examines data from official sources, and information from attitudinal surveys and case studies with employing organizations to assess the major effects of the ageing of the nursing workforce. Key findings are that the age profile of those nurses working in the National Health Service appears to be ‘younger’ than that of the total population, with the age profile of nurses working in nursing homes and as practice nurses being older than that of the NHS nursing workforce. However, the overall age profile of NHS nurses masks considerable variation between specialties and trusts, and the ‘pool’ of potential nurse returners from which the NHS and other employers attempts to recruit, is declining in numbers, as it too ages. Other major issues requiring policy attention are the provision of appropriate flexible hours to older nurses who have caring responsibilities, improving access to continuing professional development, and reducing pension provision inflexibility. [ABSTRACT FROM AUTHOR]

An evaluative study of clinical supervision based on Proctor’s three function interactive model This paper reports on a study of the benefits reported from participation in clinical supervision by registered nurses (n=201) working in a large English community and mental health NHS Trust. It summarizes the emergent practical and theoretical ‘key ingredients’ of clinical supervision in the United Kingdom and argues that these provide a basis for generalizable research practice. The study is based on Proctor’s three function interactive model previously commended as a guide for supervisory practice and evaluation. Within this study, the three functions underpin instrument design but are also a primary focus of evaluation. The development of this instrument through semi- structured interviews with supervisors and supervisees is described. The study aims to assess and compare reported benefits in each of the three functions of accountability, skill development and support in order to examine the effects of contract use, length of experience of clinical supervision and length of service as a registered nurse on reported benefits by using non-parametric statistical analysis. The results indicate that reported benefits are experienced in almost equal proportion across each of these three functions. Statistical analysis indicates a significant positive correlation between experience of clinical supervision and its reported benefits. An inverse correlation is reported between length of service and overall benefits; however, no similar reduction over time against normative benefits was found. There was no relationship between contract use and reported benefits. Limitations of the study are discussed with reference to bias, interview transcription and overlap between the three functions. The paper concludes that nurses report clear benefits from clinical supervision in each of the three functions. This validates the three function interactive model and demonstrates that clinical supervision is used to critically examine and change nursing practice. The content and usage of contracts is identified as an aspect that merits further study. [ABSTRACT FROM AUTHOR]

This paper examines the issues faced by advanced nurse practitioners in the United Kingdom as they attempt to implement a new role in practice. The discussion draws on evidence gathered during a longitudinal study of a small number of graduates from a Master's degree programme who subsequently took up posts as advanced nurse practitioners. The paper focuses on one of the key findings to emerge from the inquiry, that of the identification of the contingent nature of advanced nursing practice. The data for the study were collected over a 2-year period via interviews, observation of clinical practice and self-report role development diaries. Following analysis it was revealed that, whilst the passage from experienced nurse to advanced nurse practitioner can be considered to be highly individual and complex, practitioners appear to move through three discrete stages during the transitional process. The first of the three stages is represented by a state of 'idealism' on the part of advanced practitioners. During the second phase, termed 'organizational governance', practitioners discover that, in contrast to their initial optimism, the orientation, goal and delivery of their role is controlled by key stakeholders within the organization. The final stage, 'resolution', is only reached when practitioners have been in post for more than 1 year and can be summarized as a state of acquiescence and compromise. A conceptual model is presented which illustrates the contingent nature of advanced nursing practice. [ABSTRACT FROM AUTHOR]