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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]

This article presents consultation papers of the United Kingdom Central Council for Nursing, Midwifery and Health Visiting. Consultation papers prepared by the working groups are now being given a wide distribution throughout the professions of nursing, midwifery and health visiting. The task of the working groups, in considering comments will be greatly assisted if views on the recommendations and proposals in the consultation paper are channelled back through an appropriate professional organization or trade union. The Council has set up seven working groups. Each working group is looking at a particular aspect of the 1979 Act and the related future responsibilities which the Council will inherit.

The interview has, for a long time, been the central method for the assessment of applicants for nurse training in the United Kingdom. The lack of a clear person specification, and, in particular, training in the skills involved in assessing personality, have been excused on the grounds of the universality of types required in nursing. This paper outlines some initial work that has been done on identifying a 'personality mix or constellation' and ways of exploring and assessing it in face-to-face interviews. [ABSTRACT FROM AUTHOR]

This paper presents findings from a national study conducted over a 3-year period (1991-94) which examined the changing role of the nurse teacher. The study used multiple methods to collect data from a wide variety of respondents (nurse teachers, midwife teachers, clinical nurses, health service managers and higher education lecturers). This paper presents the findings relating to the development of the nurse teacher's academic role following the introduction of Project 2000. The issues presented and discussed include specialization within the nurse teacher's role, the nature of this specialization and the development of academic credibility and scholarship. The implications of these changes in terms of the development of nursing as an academic subject area and the opportunity to contribute to the establishment of research based practice are explored. [ABSTRACT FROM AUTHOR]

andrews j. manthorpe j. & watson r. (2004) Journal of Advanced Nursing 46(3), 303–310 Involving older people in intermediate care Intermediate care has become a crucial part of the United Kingdom government's programme for improving services for older people. Older people comprise a substantial part of the user base for these services, and it is increasingly recognized that there is a need for greater user involvement in service development for intermediate care. National initiatives undertaken in intermediate care have sought to widen and deepen the remit of such services, and in this way promote greater independence and improved quality of care for older people. In particular, the government has set out clear plans for reshaping services for older people in the National Health Service Plan and the rationale for greater involvement of older people in service development. This article considers ways in which these national and local objectives may be achieved and considers some of the implications for nursing. This paper aims to explore the concept of intermediate care and to identify trends and existing evidence of user involvement in care. In this way it charts a possible way forward for the development of a more ‘user sensitive’ approach. The following databases were searched: Medline, Cochrane Library, the Social Science Citation Index and CINAHL. Key words were ‘intermediate care’, ‘older people’, ‘formal care’, ‘primary care’, ‘social services’ and ‘geriatrics’, used in combination. The findings from this study indicate that there is considerable scope for increased user involvement in service development for intermediate care. Such challenges may be more effectively met through greater clarity of the concept of intermediate care, and a bridging of user involvement at the practice and policy levels. Nurses are key providers of intermediate care in the community. The involvement of older people in intermediate care service development must be premised on a shared comprehension of the purpose and function of intermediate care. Nurses must be involved in shifting intermediate care from being service-focused to patient-centred. Effective participation eschews the application of global constructs for older people, while supporting greater participation at all levels and robust implementation processes. [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]

Patient satisfaction surveys are seen as an important way of obtaining 'user views' of health service provision. However, there is a growing body of research and theoretical literature that questions the validity of the concept of 'patient satisfaction' and hence the use of this type of survey. A postbereavement survey of people who registered a random sample of cancer deaths in an inner London health authority was undertaken in 1996/7. The survey questionnaire (VOICES) included 14 open-ended questions which asked respondents to add any comments they felt were relevant about the care of the deceased. This paper uses these data to examine the causes of dissatisfaction with hospital-based care. Of the 229 informants responding to the questionnaire, 138 included some written comment about care in hospital. At least one negative comment was made by 59% (82) of those making any comment. Of these, 55% (44) rated the care given by doctors as 'excellent' or 'good' and 63% (50) rated that given by nurses as 'excellent' or 'good'. Qualitative analysis of responses to open questions suggest that expressions of dissatisfaction arise from a sense of being 'devalued', 'dehumanized' or 'disempowered' and from situations in which the 'rules' governing the expected health professional-patient relationships were broken. As such, the causes of dissatisfaction for this particular group of patients are similar to the causes of dissatisfaction with health care in general reported elsewhere. The palliative care approach emphasizes patient- and family-centred care and aims to promote physical and psychosocial well-being. The study findings suggest that adoption of the palliative care approach could reduce the experience of dissatisfaction for many service users, not only those whose deaths are anticipated. [ABSTRACT FROM AUTHOR]

Education and training consortia: leading the way for the new British NHS In November 1997 The New NHS — Modern, Dependable was published, describing the British Labour government’s plans to introduce major changes to the NHS (National Health Service). Education and Training Consortia (ETCs) were only briefly referred to and no direct changes were proposed to them. It can be argued that this was because they had not fitted well within the Conservative government’s competitive culture of the NHS internal market. Education Consortia members share information, make plans collectively and work collaboratively, activities much more appropriate for the ‘New NHS’ which is underpinned by the concepts of partnership, openness and local ownership. In this paper it is argued that there are many valuable lessons that the key individuals involved in implementing the policies of the New NHS can learn from Education and Training Consortia. Data have been drawn from a qualitative study in which the aim was to explore the development, implementation and management of consortia and contracting for non-medical education and training (NMET) from a stakeholder’s perspective. One of the unexpected themes that emerged from the analysis of the data, was that the development of ETCs could be utilized as a model for many of the innovations in the New NHS, particularly in relation to the formation of primary care groups. [ABSTRACT FROM AUTHOR]

Reflects on the 50th anniversary of the creation of the British National Health Service (NHS) in July 1998. Thoughts on changes in nursing care from the 1940's to the 1990's; The author's experience as a nurse treating tuberculosis patients in the 1950's; Progress in nursing scholarship; Quality of papers submitted to the 'Journal of Advanced Nursing.'

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 article presents information related to nursing. At a reception given by Her Majesty Queen Elizabeth the Queen Mother at St James's Palace, London to mark the thirtieth birthday of The British Commonwealth Nurses War Memorial Fund, future plans were announced. The Council of the Royal College of Nursing of Great Britain has decided to create fellows from amongst its members of at least five years' standing who have made exceptional contributions to the advancement of the science and art of nursing. Fellows will be expected to have completed a course in post-basic nursing education where appropriate, and to present a paper or thesis and/or demonstrate innovation or exceptional competence in advancing nursing.

There is a great deal of interest in the United Kingdom in clinical guidelines as a means of assisting practitioner and patient decision making about care options and in improving the quality of the care provided. Confusion remains, however, over what is meant by a clinical guideline and how it differs from and relates to protocols and standards. This paper was written under the auspices of the Royal College of Nursing Steering Group for the college's work on clinical guidelines, with the aim of clarifying some of the terminology used in the field and introducing ways in which clinical guidelines might be used by practitioners and patients to readers. At the moment just how effective the use of clinical guidelines can be on care is poorly established. What is known, however, is that crucial to their success are the strategies and methods used for their implementation. Such strategies and methods raise questions about how a sense of ownership can be engendered in those using the clinical guidelines and how they may be best operationalized. These questions are considered in this paper. [ABSTRACT FROM AUTHOR]

This paper is concerned with the way in which discussions of the health status of people from minority ethnic groups and the delivery of health care to such groups has been constructed, in the nursing literature in particular, within a culturalist framework which has many serious drawbacks. The paper reviews the argument for a 'multicultural' approach to health care and also discusses some of the main implications of this analysis for the education of health professionals. It suggests that health workers and those responsible for the education of such workers, need to reassess learning needs in the light of a critique of the effects of an analysis based on 'cultural pluralism' and 'ethnic sensitivity'. The paper suggests ways in which the nursing curriculum must be broadened to take into account the limitations of a culturalist approach and to debate the interplay of racism and other structures of inequality and their influence on health and on service delivery. [ABSTRACT FROM AUTHOR]

In the United Kingdom, the provision of health and social care within the community is the subject of major reform. This reform is aimed at reducing the dominance of the state as provider of welfare services whilst encouraging the independent sector to provide the bulk of services through competition and market forces. The purpose of this paper is to discuss the implementation of government policy with respect to health and social care in the community. The policy recommended in the 1989 White Paper Caring for People, which is sanctioned in the National Health Service (NHS) and Community Care Act (1990), is the focus for discussion. Implementation theory is used as a framework to explore the modification and reshaping which inevitably accompanies the translation of government policy into reality. The nature of any actual or potential deficit between stated policy and community care reform in practice is examined against this theoretical background. An historical stance is taken in order to place current policy into the wider context and consider what determinants may have led to the radical proposals for community care, and indeed other sectors of public service. A consideration of predominating philosophies is prudent to an analysis of government policy-making and therefore the values and beliefs of 'new public management' are employed as a conceptual framework underpinning current reform. The feasibility of a quasi-market in the delivery of health and social care is considered and some of the main issues which may result in implementation deficit with respect to the implementation of Caring for People are examined. [ABSTRACT FROM AUTHOR]

The British National Health Service has recently undergone the most profound reforms since it was conceived some 50 years ago. In an attempt to contain the rising cost of spending the principles of market competition have been introduced. Similar developments are occurring internationally. This paper describes briefly the history of the reforms in the United Kingdom. It outlines the rationale for a market in health services which is largely publicly funded. The paper then provides an analysis of the serious impact of the new business culture on the control of nurses and nursing work in hospitals. In doing so, it identifies the threats which confront the future well-being of the nursing profession. It concludes with a brief resume of opportunities which the profession must seize if it is to retain its identity. [ABSTRACT FROM AUTHOR]

This paper evaluates the British government's Patients Charter from the perspective of patients admitted via accident and emergency departments. It uses qualitative data obtained about issues of concern to these patients to judge whether the standards set out in the Charter are appropriate to their priorities and, conversely, if there are issues of importance to these patients which the Charter overlooks. Semi-structured interviews were conducted with 83 patients admitted to two London hospitals. It is concluded that the rights and standards outlined in the Patients Charter are generally appropriate to these patients' experiences, although some are defined too narrowly. The study identified a number of issues of importance to patients which are not mentioned in the Patients Charter: pain relief, giving information, receiving information, reception staff, examinations and investigations, physical environment, and other people in casualty. The patient wants rather more than recent British government documents suggest. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a survey to provide an overview of nurse independent prescribing and nurse supplementary prescribing across the United Kingdom. BACKGROUND: Evidence examining the frequency of prescribing by nurses is conflicting, and it is evident that several factors hamper prescribing practice. As of May 2006, legislative changes gave appropriately qualified nurses virtually the same independent prescribing right as doctors. However, there is currently no evidence available about the prescribing practices of these nurses. METHOD: A random sample of 1992 qualified Nurse Independent/Nurse Supplementary Prescribers registered with the Nursing and Midwifery Council was sent a postal questionnaire in 2006. A total of 1400 (70%) questionnaires were returned, of which 1377 were completed. FINDINGS: Eight hundred and ninety-one (65%) respondents worked in primary care, and 333 (24.3%) worked in secondary care. Three quarters of the sample had more than 5-year clinical experience in the area in which they prescribed prior to entering the prescribing programme. One thousand one hundred and seven (87%) participants had used nurse independent prescribing and 568 (44.6%) nurse supplementary prescribing. Restriction of local arrangements, implementation of the Clinical Management Plan and access to doctors hampered or prevented prescribing. CONCLUSION: The adoption of prescribing by nurses in the United Kingdom has increased patient choice with regard to access to medicines. A number of factors which hamper or prevent prescribing require further exploration. [ABSTRACT FROM AUTHOR]

The aim of this paper is to show the way in which the decision trail of a qualitative research process can be maintained. It is argued that the trustworthiness (rigour) of a study may be established if the reader is able to audit the events, influences and actions of the researcher. The actual study containing the recording of this decision trail aimed to express the concerns of older patients who were admitted to the acute care sector. The study took place in two care of the elderly wards in a 1000-bed National Health Service hospital in the UK, in 1991. Eventually, 14 patients were interviewed, each on several occasions, and their concerns are expressed in themes, namely: routine geriatric style of care, depersonalization, care deprivation and geriatric segregation. I describe the preparations that were undertaken before patient interviews could commence. The literature recording the process of the interviewer's experience as data in qualitative research is scarce. I show the researcher's participation in making the data as part of an existential phenomenological research process. Existential phenomenology relies on recording influences while generating data such as significant literature, media reports, my value position and journal data. [ABSTRACT FROM AUTHOR]

coombs m. & ersser s.j. (2004) Journal of Advanced Nursing 46(3), 245–252 Medical hegemony in decision-making – a barrier to interdisciplinary working in intensive care? Health care policy in the United Kingdom identifies the need for health professsionals to find new ways of working to deliver patient-focussed and economic care. Much debate has followed on the nature of working relationships within the health care team. This paper reports on an ethnographic study that examined the nursing role in clinical decision-making in intensive care units. This was chosen as a case for analysis due to the close doctor–nurse relationships that are essential in this acute and complex care setting. Data were collected during two-stages of fieldwork using participant observation, in-depth ethnographic interviews and documentation across three clinical sites. The findings revealed the different types of knowledge used for, divergence of roles involved in and degree of authority in clinical decision-making. Furthermore, conflict arose between doctors and nurses due to these differences and in particular because medicine dominated the decision-making process. The nursing role, whilst pivotal to implementing clinical decisions, remained unacknowledged and devalued. Medical hegemony continues to render nurses unable to influence substantially the decision-making process. This has fundamental ramifications for the quality of team decision-making and the effectiveness of new ways of inter-professional working in intensive care. [ABSTRACT FROM AUTHOR]

clouder l. & sellars j. (2004) Journal of Advanced Nursing 46(3), 262–269 Reflective practice and clinical supervision: an interprofessional perspective In the United Kingdom, the drive to encourage reflective practice through clinical supervision, as a means of ensuring quality of provision in nursing and other health care professions, is now well-embedded, not only in policy but also in practice. However, debate and critique of these concepts is limited. The aim of this paper is to draw on research, conducted with undergraduate occupational therapy students and qualified physiotherapists, in order to contribute to the debate about the functions of clinical supervision and reflective practice in nursing and other health care professions. Upholding the notion that clinical supervision has the potential to constitute a form of surveillance, we counter the assumption that it is inevitably confessional in nature. A social constructionist perspective is used to illustrate how clinical supervision might involve a complex interplay of factors that dispel notions of predictability, control and rationality. Despite acknowledging tensions, we argue that clinical supervision is both necessary and beneficial. It can be advantageous to individual practitioners and professional groups in enhancing practice and accountability, and promoting professional development. [ABSTRACT FROM AUTHOR]

Children’s rights: a decade of dispute Aim. This paper attempts to raise issues surrounding children’s rights against a backdrop of ethical principles and their subsequent interpretation and application in practice. Method. Key words have been used to search a selection of electronic databases and a range of ‘grey’ literature has been reviewed. Background. Over a decade ago the United Nations (1989) Convention on the Rights of the Child was ratified, with the exception of two member states (UNICEF 2000). The Human Rights Act (Department of Health 1998) became law in October 2000 in the United Kingdom (UK). Despite a decade of recommendations, guidelines and legislation, children’s rights, particularly consent to health care, remain complex and inconsistent. As we move into a new era of human rights involving all members of society, it is timely for nurses in the UK to reflect on the challenges created in attempting to interpret the philosophy of such legislation because such complexity surrounds the interpretation of human rights for many other vulnerable clients within health care. Findings. The interpretation of children’s rights continues to be influenced by the evolution of the meanings of childhood. Adults view children’s rights from multiple perspectives of best interest, which are determined by their beliefs about children’s ability to understand and consent to health care and treatment. An ability and right to consent appears not to be balanced by the right to withhold consent. Inconsistency and ambiguity persist in the law and its interpretation. Adults need to develop a more pragmatic approach to children’s rights. This requires better understanding of children and their experiences of health care. Conclusion. Until adults develop a more pragmatic ideology in relation to children’s rights then a true respect for children’s autonomy will not be achieved. Consent will therefore... [ABSTRACT FROM AUTHOR]

This paper reports on a quasi-experimental case study of two care pathways--a midwifery-led maternity pathway and a breast disease pathway developed within one British National Health Service Trust. Of the aspects evaluated, those reported here are: a comparison of clinical care delivered before (the control group) and after the introduction of the two pathways; a comparison of patient satisfaction levels before (the control group) and after the introduction of the two pathways; and views of staff involved in the development and operation of the two pathways. The results are mixed. In the breast disease pathway five of 12 clinical indicators showed change, but only two of these showed statistically significant changes; three were considered of clinical significance but could not be tested statistically. In the maternity pathway, after allowing for the effect of gravid status, five of 10 indicators showed changes between the pre-pathway and pathway users and of these four showed statistically significant changes. Patient satisfaction levels showed little overall change--only 15% of the questions for breast disease and 9% for maternity showed any statistically significant change. However, both surveys indicated precise areas where a change resulting from the introduction of the pathway could be linked to an increase in satisfaction. The clinical staff interviewed highlighted many positive features of the tool (26/40 comments). The most frequently cited favourable comment was its ability to make staff focus on the clinical care they were providing and how this could be improved. It also highlighted some areas for concern, in particular the introduction of pathway documentation. [ABSTRACT FROM AUTHOR]

Over the last two decades, the health care professions in the United Kingdom have seen an unparalleled expansion of continuing professional education (CPE) and development (CPD) programmes; however, there is little empirical evidence that these enhance the care delivered to patients. Further research is also needed to demonstrate that these initiatives are linked to improved patient outcomes. If health care educators are to move towards an 'evidence-based curriculum', some restructuring of courses may be needed. Priorities should be set and decisions made, based on the results of reliable and valid research into the clinical outcomes of CPE. To evaluate courses and demonstrate educational effectiveness solely in terms of student satisfaction is not enough; to survive in the world of evidence-based care, educators must also demonstrate their contribution to clinical effectiveness. However, the neoteric field of impact evaluation lacks not only validated research methods, but also an agreed agenda for future research. Drawing on interviews undertaken with nurses who have participated in education evaluations and the relevant literature, this paper discusses the available data collection instruments and the development of viable research designs and methods, which are urgently needed to assess the outcomes of professional education programmes. [ABSTRACT FROM AUTHOR]

Psychiatric nursing in prison: the state of the art? Psychiatric nursing in prisons has received criticism from within and outside the profession in recent years. In England and Wales this amongst other issues has prompted a review of forensic health care by the United Kingdom Central Council for Nursing, Midwifery & Health Visiting (UKCC). The status of forensic psychiatric nursing as a specialty has also been disputed in the literature and the role of nurses working in this field is seen by some to be more about social control than caring. These arguments are set in the present situation of increasing numbers of mentally ill individuals in the prison system and a crisis in the availability of beds in secure units, a situation that is paralleled throughout the western world. The standard expected of health care services in prisons is equivalence with the service the public receives from the National Health Service (NHS). The number of prisoners needing transfer to hospital has increased during the last decade, resulting in competition for a limited number of suitable beds. The effect on health care centres (HCCs) in English prisons is that they now must provide long-term care for seriously mentally ill prisoners. This paper outlines the development of British psychiatric services in prisons. It then describes the HCC in Her Majesty’s prison (HMP) Belmarsh and reports on recent radical changes in the management structure of this service. The aim of these changes is to produce a clinical environment in which psychiatric nurses can deliver high quality care in an area beset with difficulties for clinicians and managers and to further progress towards the goal of equivalence. These advances have been achieved through a shift of emphasis in management structure that increases the number of clinical posts and minimizes administrative and security-based responsibilities held by clinical grades. We conclude that although external contracts are necessary, much can be achieved through internal review and changes in policy. [ABSTRACT FROM AUTHOR]

In recent years, patient advocacy has been claimed as an integral part of the nurse's role in health care delivery in the United Kingdom (UK). Support from the nursing leadership/elite is seen as important in the promulgation and diffusion of any 'new' role in nursing. This paper explores the perceptions and attitudes of nurse leaders in the UK to the adoption of the patient advocate role as an 'innovation' in nursing. Using a qualitative methodology, semi-structured interviews with six of nursing's 'elite' were conducted over a period of 5 months. Results revealed contradictions and paradoxes within the views of the elite. Although leaders recognized patient advocacy as a role integral to the moral value system in nursing enhanced by the nurse-patient relationship, they objected to the professionalization of the role, seeing an exclusive claim to patient advocacy as intensifying interprofessional conflicts in health care. It is argued that unless professionalized, the individual nurse will continue this potentially risky activity without adequate authority or support systems. The results overall question the role of the nursing leadership in the diffusion of innovations in nursing. [ABSTRACT FROM AUTHOR]

This paper is based on the Nursing Lecture 1977, delivered on the occasion of the Annual General Meeting of the Royal College of Nursing in London on November 23, 1977. The author traces the history and discusses the implications of the EEC Nursing Directives, put into the perspective of the nursing histories of the nine countries within the European Economic Community. She focuses, in particular, on the strengths of the nursing profession in the United Kingdom and argues that the Nursing Directives can lead to enhancement of nursing services and nursing education, better cooperation between health care professions and a stronger voice for the nursing profession, throughout the EEC. [ABSTRACT FROM AUTHOR]

This article presents information on developments in the field of nursing and health care. The Lynly S. Aitken Fellowship for 1978 was awarded to Margaret M. Overell, a nurse at the Coburg Centre, Royal Melbourne Hospital, Australia. She used the award to study the nursing services in Great Britain and North America and observed community nursing care programmes with particular interest. The third biennial report of Edinburgh University's nursing research unit for the period January 1976 to December 1977 has recently been published. The report contains details about research projects completed, ongoing research and educational activities and future plans.

There is widespread discussion at the present time of participation--allowing members of an organization to exert an influence on the processes of decision-making. The National Health Service is not isolated from this debate and already a number of experiments have been carried out at various levels of the service to allow a wider range of opinion to influence decisions than hitherto. This paper reports on a study the author carried out into one such exercise, designed to assist a Health Board reach decisions about the long-term pattern of health care in its area. Nurses, paramedical staff and local authority staff, as well as doctors, were appointed to a series of programme planning committees to advise the Health Board on issues of long-term policy. After 2 years of operation, a study was carried out into the operation of the committees and the lessons drawn from the experience should be relevant to actual and potential members of any consultative or decision-making body. [ABSTRACT FROM AUTHOR]

There is considerable evidence to suggest that despite the availability of free medical services under the British National Health Service, there remains a clear social class bias in accessibility to a wide range of health care services. The literature on social class and the use of health services is examined and it is suggested that the greatest inequalities are to be found in the uses of preventive services. In the second half of the paper, some tentative proposals, which might have to reduce existing patterns of inequality, are examined. [ABSTRACT FROM AUTHOR]

This paper is based on the nursing lecture delivered on the occasion of the Royal College of Nursing's Diamond Jubilee Year Annual General Meeting, 24 November 1976. The history of the first sixty years of the college is recorded and discussed and its national and international contributions to the nursing profession and the art and science of nursing are documented. The College's pioneering role in nursing research and post-basic nursing education are also considered as are its influences on the development of the National Health Service and its significant role in representing nurses. [ABSTRACT FROM AUTHOR]

In this paper the author, who is a member of the Royal College of Nursing of the United Kingdom (Ren) Council, discusses the functional and dysfunctional aspects of organizational behaviour and applies this discussion to the organizational problems of the Ren, the main professional organization of nurses in the United Kingdom. In particular, three concepts are considered in some detail: the concepts of oligarchy, elitism and plurality of goals. It is argued that problems which are ignored do not disappear and that dysfunctions which are by definition latent must be made manifest before they can be remedied. The existence of opposition, it is further argued, is essential to keep democracy alive, to buffer oligarchy and to promote change essential for the organization's survival. [ABSTRACT FROM AUTHOR]

In 1994, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) completed its framework for post-registration education and practice. The UKCC's strategy was based upon the two principles of compulsory re-registration for all practising nurses and graduate-level (or equivalent) entry to specialist practice. It may be seen as the culmination of a gradual process of professionalization, as well as a response to changes in the organization and delivery of health care in the late 20th century. This paper uses both primary and secondary sources to trace the development of the new strategy, and its wider implications for the profession. [ABSTRACT FROM AUTHOR]

Psychiatric nurses in the United Kingdom (UK) have begun to reattend to people with 'serious and enduring mental illness'. At the same time research in the USA and UK has refocused much of its attention on neuroscientific theories and models of serious mental illness. Psychiatric nurses are being encouraged to consider the value of biomedical explanations of serious illness, such as schizophrenia, and to accomodate these theories and models in the practice of nursing. This paper will examine the challenge of the biomedical approach for the continued development of psychiatric nursing theory and practice. It is proposed that psychiatric nursing needs to develop further its own 'proper focus', if it is to survive as a key player in the health care field of the 21st century. [ABSTRACT FROM AUTHOR]

Mixed messages in nursing research: their contribution to the persisting hiatus between evidence and practice The current emphasis in the United Kingdom on evidence-based health care requires that medical and non-medical professionals ensure that their clinical practice is founded on scientifically derived findings rather than on intuition and ritual. To this end, many initiatives have been introduced which are intended to increase both the corpus of available research evidence and the extent to which it informs practice. To date, however, there has been a disappointing shortfall in published research in the paramedical domain, which has been largely attributed to a number of structural and organizational issues. This paper suggests that confusion about what constitutes valid and useful research may be an additional significant contributory factor in the documented research/practice hiatus. Moreover, the emphasis on experimentation and Randomized Controlled Trials (RCTs), with the relative marginalization of alternative, more qualitative forms of research may seriously limit the nursing research data-base because of its inappropriateness for many nursing investigations. It is suggested that a more eclectic approach to evidence-based care is considered, with more attention being diverted to qualitative methodologies at the funding and dissemination stages. In this way, a comprehensive and balanced overview of relevant information can be obtained which has the potential to influence some of the less quantifiable aspects of care delivery. [ABSTRACT FROM AUTHOR]

Community health councils (CHCs) were set up in the United Kingdom in 1974 as part of the reorganization of health care delivery. They were intended to have a 'watch dog' function, monitoring the quality of health care in their own district and acting as a link between the providers of care and the public, who are the health care consumers. This paper describes a year-long survey undertaken by one CHC to monitor the quality of information-giving in acute hospital care. A large sample of 1500 discharged patients were sent questionnaires relating to satisfaction with information-giving, and a good response rate was achieved. Results indicate a generally high level of satisfaction, particularly relating to information about surgical and other technical procedures. Information was less satisfactory about non-technical aspects of care and about administrative procedures. [ABSTRACT FROM AUTHOR]

In this paper the author argues that the development of community psychiatric nursing can be understood as a professional project. However, the case of community psychiatric nursing cannot be adequately understood from mainstream literature on the subject of professionalization within the health care division of labour. The inadequacy of such literature is that it either concentrates upon the pre-eminent case of medicine or regards nursing's professionalization as being unitary. The author posits that the professional projects of general nursing and community psychiatric nursing have different and even opposing interests. To contextualize community psychiatric nurses' (CPNs') professional project the author examines: the history of mental nursing, from which community psychiatric nursing evolved; the development of community mental health care, which allowed for the inception of community psychiatric nursing; CPNs' relationships with both psychiatrists, whose patronage assisted CPNs' initial growth as para-professionals, and general practitioners, who later assisted a more functionally autonomous role for CPNs in primary care; and social policy towards community care that enhanced CPNs' growth. In conclusion the author argues that recent government-led changes in the management of community mental health care now impel CPNs to change the direction of their strategy for occupational survival and advancement. [ABSTRACT FROM AUTHOR]

Ideas currently postulated around the way health care should be delivered and costs controlled, often referred to as health care rationing, are increasingly coming to dominate the agenda of health care in the 1990s. British nursing has yet to take a noticeably visible role in this debate, despite the fact that it poses a serious dilemma for a profession whose cultural ethos has been shaped by the concepts of universal access and comprehensiveness of care and is wedded to the idea of holism. In the USA debate amongst nurses is further advanced and whilst this discourse may be of limited value to British nursing, owing to a differing historical and cultural attitude to health care, recent changes to the organizational values in the NHS are leading to similar issues arising already faced by American nurses. This paper considers the broad parameters of the debate on health care rationing and examines how these parameters have been reflected within relevant North American and British nursing literature, differentiating factors between the two countries. [ABSTRACT FROM AUTHOR]

This paper describes the historical developments and current role of new public management (NPM) in the British National Health Service (NHS). It is argued that NPM concern for efficiency improvements has resulted in threats to equality and needs-based service delivery. The relevance of NPM values to health care and nursing is explored. Finally, comments are provided on how nurses can advocate for a more loving NHS environment, and one which is therefore more conducive to nurse and patient health. [ABSTRACT FROM AUTHOR]

A comprehensive search of the research literature was undertaken to explore the relationship between skill substitution and quality of care. It was possible to identify three central assumptions based upon the studies reviewed. The first suggests that a rich skill mix of mostly qualified nurses is often an ineffective and inefficient way of providing health care. The second assumption is based on research which appears to indicate that a skill mix of mostly unqualified staff is an inneffective approach to health care provision. Finally, there is a plethora of research findings which suggest that the most effective and efficient way to provide health care lies in the employment of high numbers of qualified staff. This paper examines the evidence for each of these positions and highlights the inherent limitations of the underlying studies. [ABSTRACT FROM AUTHOR]

The current socio-political philosophy in the United Kingdom promotes the belief that consumers of health care should exercise choice and express opinions about the care they receive. This view challenges the traditional paternalistic approach to health care which espoused that 'the professional knows best.' In association with general socio-political trends, nursing is undergoing radical reform. The nursing literature widely promotes the importance of a nurse-patient relationship which fosters the involvement of the patient in negotiation and decision-making regarding this care. Nurses who advocate individualized, holistic care must hold such an ideology as a central tenet to their philosophy. However, it is questionable whether this philosophy is widely expressed in the reality of clinical practice. There is also an absence of empirical evidence to support the assumption that patients wish to participate in decision-making. This paper critically reviews some of the debate centred around the concept of nurse-patient negotiation. It is suggested that the issues are complex and that there remains a need for further research which takes into account multiple factors, including the social and organization context of nursing care. [ABSTRACT FROM AUTHOR]

This paper constitutes a discussion of a case of sexual abuse of children by a nurse brought before the UKCC Professional Conduct Committee. Judgement was first deferred, and later the nurse was allowed to remain on the register and to practise as a nurse. The case is considered with reference to guidance from the UKCC in various documents. The case for removal from the register is first established, drawing on the UKCC Code of Professional Conduct and the UKCC document '... With a View to Removal From the Register...'?, and found to be more than adequate. The case for leniency is then considered with further reference to UKCC policy, but is rejected. It is concluded that, on this occasion, the Professional Conduct Committee's findings were erroneous and indefensible. [ABSTRACT FROM AUTHOR]

This paper reports a study of nurses' perceptions of the positive and negative features of the work environment and their contribution to satisfaction with nursing. The concept of a 'work space' was developed to describe nurses' mental images of the features of their work environment. Eighty-four final-year student nurses and 75 registered nurses rated questionnaire items designed to examine perceptions of opportunities for professional development, sources of satisfaction, difficulties, time constraints and problematic interactions with other hospital personnel. There was general agreement among nurses about the aspects of their work that they found satisfying, but student nurses were more pessimistic than registered nurses that nursing would give them the opportunities for recognition of their worth. Students returning from practica in critical care wards reported more stressful interactions with other personnel than students returning from general ward practica. Structural equation modelling of the causal relations between sources of satisfaction with nursing revealed that recognition and self-perceptions of work as a nurse were the strongest predictors of overall satisfaction with nursing. Caring for patients contributed only indirectly through its influences on nurses' feelings about themselves. The data indicate the significance of personal and social implications of nursing careers. [ABSTRACT FROM AUTHOR]

Nurses in the United Kingdom spend much time attempting to fit British nursing practice into the theoretical framework of American nursing models. This is often a manipulative process in that it seeks to establish positive links with a care delivery system totally unlike our own. In the present paper the authors detail the process of establishing a new nursing model which integrates nursing curricula, education and practice to meet the needs of patients, staff and students within their own health district. An over-emphasis on lower levels of human need is common within nursing practice, which, although often blamed upon lack of human and financial resources, is also due to practitioners' misconceptions. The latter are invariably the result of a lack of an adequate or overt, practice orientated, conceptual framework. The Human Needs Model of Nursing adapts Maslow's concept of human needs to create such a conceptual framework for practice. It places equal emphasis on those patient problems which arise as the result of unmet needs at higher levels as well as those at lower levels, thereby acknowledging the holistic and dynamic nature of man. [ABSTRACT FROM AUTHOR]

In July 1992, the British government published its White Paper 'The Health of the Nation, a Strategy for Health in England' (HON). The authors contend that this initiative has largely been accepted by the nursing profession with critical response to the HON being minimal. The authors argue that the medicalized negative interpretation of health and the narrow individualistic lifestyle-orientated definition of health promotion contained within the strategy ought to be rejected by nurses in favour of both a positive, holistic conception of health and a more humanistic health promotion methodology acknowledging the impact of structural-material factors influencing individual health related behaviour. [ABSTRACT FROM AUTHOR]

This article presents brief information, related to nursing. The Board of Directors of the International Council of Nurses has named Ingrid Hamelin, Virginia Henderson and Kofoworola Pratt as the members of the first Christiane Reimann Prize Selection Committee. The inaugural meeting of the Joint Professional Committee of Great Britain, for Primary Health Care was held at the Royal College of Nursing on July 05, 1983. This committee has been set up following a series of informal talks among various organizations representing nurses and doctors about the restructuring of the National Health Service in Great Britain and its impact on the community services.

This article presents information related to nursing. Members of the nursing profession, not only in Great Britain but throughout the World, lost a great friend earlier this year when Elise Gordon died on February 4, 1977. She possessed a rare mix of scholarship, charm and warmth, and was editor of Nursing Mirror for 25 years from 1937 to 1963 when she retired. Proposals for a radical and new reorientation of WHO's programme budget policy, to enhance its effectiveness in serving the world's neediest people, were endorsed at the 59th session of the WHO Executive Board held in Geneva this year.

Examines the clinical role of the nurse teachers in Great Britain. Lack of clarity on the role of nurse teachers in the medical care environment; Role of the nurse teacher in assuring quality of the clinical learning environment; Need for a diverse and flexible role.

Reports global developments related to medical care as of February 1996. Assessment on the health of women in midlife by the National Institute of Nursing Research in Bethesda, Maryland; Launch of the Nursing Practice Conference in Adelaide, South Australia; Details on the pilot scheme for academic libraries in Great Britain.

Comments on the definition of patient rights stipulated in the Patients Charter in Great Britain. Impact of the reform in the National Health Service on patient rights; Establishment of standards in patient care delivery; Separation of the purchasing and providing functions of health care delivery.

Presents developments in the field of nursing, as of February 1991. Tenth best American school of nursing; Educational appointments by Royal College of Nursing of the Great Britain; Appeal for professional literature from Czechoslovakian paramedical institute.