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Nursing, as a profession in its own right and a discrete health discipline, is responsible for planning, organizing, implementing and evaluating nursing services as a distinct segment of health care, and for educating practitioners to provide these services. The primary responsibility of nursing is to provide care direct to the patient, client, family or community. Like medicine, it is concerned with maintaining, promoting and protecting health, treating the sick and providing rehabilitation. It deals with the psychosomatic and psychosocial aspects of life as these affect health, illness and dying. In modern health services, nursing care is often best given by a nursing care team which usually consists of two or more categories of workers. These workers together make up the nursing personnel subsystem, which is a distinct entity within the overall health personnel system of a country.

This paper is a report of a systematic review to identify, critique and synthesize nursing studies of the measurement of empathy in nursing research. Background. The profound impact of empathy on quality nursing care has been recognized. Reported empathy levels among nurses range from low to well-developed and there is clearly debate about what constitutes empathy and how it can be measured and improved. Data sources. Searches were made of the CINAHL, MEDLINE and PsycINFO databases, using the terms 'empathy', 'tool', 'scale', 'measure', 'nurse', and 'nursing', singly or in combination to identify literature published in the English language between 1987 and 2007. Methods. A systematic review was carried out. The included papers were critically reviewed, relevant data were extracted, and a narrative synthesis was conducted. Results. Thirty papers representing 29 studies met the inclusion criteria. Three types of studies were identified: descriptive studies ( n = 12), studies of empathy and patient outcomes ( n = 6), and evaluational studies ( n = 11). Twenty scales were used, with more than one tool being applied in some studies, suggesting the need for a systematic review of empathy measures in nursing research. A range of settings were studied but some, such as genetic healthcare, have been neglected. Conclusion. Despite numerous tools being used in nursing research to assess empathy, there appears to be no consistency, suggesting the need to evaluate the rigour of empathy tools appropriately, either to inform education or for application in clinical settings. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a literature review that aimed to analyse the way in which nursing intensity and patient dependency have been considered to be conceptually similar to nursing workload, and to propose a model to show how these concepts actually differ in both theoretical and practical terms. Background. The literature on nursing workload considers the concepts of patient 'dependency' and nursing 'intensity' in the realm of nursing workload. These concepts differ by definition but are used to measure the same phenomenon, i.e. nursing workload. Method. The literature search was undertaken in 2004 using electronic databases, reference lists and other available literature. Papers were sourced from the Medline, Psychlit, CINAHL and Cochrane databases and through the general search engine Google. The keywords focussed on nursing workload, nursing intensity and patient dependency. Findings. Nursing work and workload concepts and labels are defined and measured in different and often contradictory ways. It is vitally important to understand these differences when using such conceptualizations to measure nursing workload. A preliminary model is put forward to clarify the relationships between nursing workload concepts. Conclusion. In presenting a preliminary model of nursing workload, it is hoped that nursing workload might be better understood so that it becomes more visible and recognizable. Increasing the visibility of nursing workload should have a positive impact on nursing workload management and on the provision of patient care. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a concept analysis identifying the attributes, antecedents and consequences of the concept of routine and examining the implications and applications of this concept in the field of nursing. Background. Routine may be a pivotal concept in understanding functional adaptation and wellbeing. Nurses in institutional settings work according to scheduled routines, patient care is largely orchestrated in routines set by organizations and regulations, and persons receiving care have their own life routines determining identity, capacities and frame of reference. However, to date, nursing has paid little attention to the relevance of routine and the role it may play in patient care. Method. A concept analysis was conducted using Rodgers' guidelines. The literature search was based on the following databases: PsycInfo, CINAHL, MedLine, Social Services, and Social Work abstracts. To be included in the analysis, papers had to relate directly and essentially to the concept of routine. Seventy-four papers published from 1977 to 2005 were included in the final stage of the analysis. The analysis included target populations, disciplinary perspectives, type of manuscript, themes and definitions, theoretical models, antecedents and consequences, as well as related terms. Results. Routine is a concept pertaining to strategically designed behavioural patterns (conscious and subconscious) and is used to organize and coordinate activities along different axes of time, duration, social and physical contexts, sequence and order. It emerges from the literature as a strategy that serves adaptation, in general, especially in the face of change and stressful situations. The conceptual structure, relations with other concepts, antecedents and consequences are described. Conclusion. The concept of routine is ill-defined and seldom used in the field of nursing, despite the promise it may hold for a better understanding of a wide range of health-related issues. This concept analysis offers an integrative view of routine and suggests directions for future research and practice. [ABSTRACT FROM AUTHOR]

This study aimed to understand what post-operative patients perceived was important about the nursing care they had experienced. The participants were nine women recovering from total hip replacement surgery which had been performed in a large public, acute care hospital in south Australia. Participants volunteered to be involved in the study and were interviewed pre- and post-operatively and interviews continued in their home environment following discharge. The study took place during 1995 within a 10-month time frame. Methodological guidance was sought from the phenomenology literature, with the ideas from Husserl and Heideggar providing shape for the interpretive framework. The analysis of data utilized Colaizzi’s (1978) seven procedural steps. For the purposes of this paper the authors have selected to focus only on the findings of this study. Two major themes emerged from the conversations with women. Patients described nurses as being engaged or detached with their nursing care. These themes will be explicated in this paper. In the light of these dominant themes the nursing literature around engagement and detachment are examined. The implications for nursing practice are discussed. [ABSTRACT FROM AUTHOR]

This paper describes a district nursing study that considered the experiences and responses of primary health care professionals and their patients to changes taking place within the community. As a qualitative study it employed interviews as the main method of data collection and was informed by both ethnography and interpretative phenomenology. Forty-three study participants were interviewed, eliciting opinion on whether care is more than just a hands-on activity, whether patient need is being met and to what extent service policy is in tune with care delivery. Describing the views of primary health care professionals and patients in order to illustrate the complexity of the district nursing service and professional roles, the paper finds little shared vision between staff and managers of each other's responsibilities. It concludes that a more holistic approach to understanding professional roles is needed in order to satisfy the differing agendas of managers, staff and patients. It propounds the need for closer collaborative practice between health care professionals, for it finds that they value the ability to communicate as an essential element of their jobs. It reflects that, without such collaboration, it will be difficult for nurses to take a lead position on changes shaping community care. [ABSTRACT FROM AUTHOR]

This paper was presented in the context of an international interdisciplinary conference on Priorities in Health Care. The focus of the paper is the relationship between the nurse's role and the demands of patients, now and in the future. The incongruence between patients' needs and their demands is discussed and the question is raised as to whether the nurse's skills and knowledge currently acquired will be appropriate to meet patients' needs and demands in the future. Future patient needs and demands are not the only external pressures on changes in the nurse's role; advances in medical treatment and technology and changing roles of other health professionals are others. The paper highlights the dilemma between the profession having to give way to such external pressures or the risk of preparing nurses for irrelevant roles. A case is made for greater interchangeability of first level health care workers through a common portal of entry. It is suggested that diversion into the various professional fields should occur after the foundation course to health care and suitable counselling. Among the top level professionally qualified nurses should be both generalists and specialists. A speciality of nursing generalism, as a parallel with general medical practice, is advocated. A plea is made for a liberating rather than a restricting interpretation of professionalism so that necessary changes in the nurse's role can be initiated and directed by the profession rather than being forced upon it by external pressures. [ABSTRACT FROM AUTHOR]

Title. Patients’ opinions of acute chest pain care: a qualitative evaluation of Chest Pain Units. Aim. This paper is a report of a study to explore the experiences of individuals receiving Chest Pain Unit care and routine Emergency Department care for acute chest pain. Background. Chest Pain Units were established in the United States of America with the aim of reducing admissions and costs, whilst improving quality of life and care satisfaction. Trials showed these units to be safe and practical; however, there was a need to establish whether Chest Pain Units could be cost-effective in the United Kingdom, and whether use of a nurse-led protocol could be acceptable to patients. Method. We carried out 26 semi-structured interviews in 2005–2006 with patients across seven trial Chest Pain Units in the United Kingdom (14 in intervention sites and 12 in control sites) to explore issues that patients considered were important in their care experiences, and to develop possible explanations for the main trial outcomes. We analysed transcripts using the Framework approach to identify themes relating to care experiences. Findings. Differences in care experiences were more distinct between individual sites than between control and intervention sites. Satisfaction with care was high overall. Interactions with healthcare professionals, in particular specialist nurses, were valued in terms of reassurance, calming effect and competence. Indications for care improvement concerned information-giving about investigations, diagnosis, and self-care advice. Patients with non-cardiac causes needed to feel more supported after discharge. Conclusion. Differences between modes of care may not coincide with identified trial outcomes. Qualitative methods can identify aspects of care that improve patient acceptability. The specialist nurse role appears particularly important in providing satisfactory individualized chest pain care. [ABSTRACT FROM AUTHOR]

Title. The multidimensionality of caring: a confirmatory factor analysis of the Caring Nurse–Patient Interaction Short Scale Aim. This paper is a report of a study to evaluate the construct validity of the four-dimensional Caring Nurse–Patient Interaction–Short Scale using confirmatory factor analysis. Background. Validating theoretical structures of caring is an ongoing challenge in the discipline of nursing. Our previous work has contributed to this literature by the exploration of the dimensionality of the Caring Nurse–Patient Interaction Short Scale via an exploratory factor analysis. The Caring Nurse–Patient Interaction Short Scale comprises 23 items reflecting four caring domains: humanistic care, relational care, clinical care and comforting care. Method. A methodological study was conducted involving a convenience sample of 531 nursing students in a baccalaureate nursing programme (20% were already Registered Nurses). Data were collected in 2002 and 2004. Confirmatory factor analysis of the Caring Nurse–Patient Interaction Short Scale was performed. Findings. As expected with large samples and models, the chi-squared-associated P-value was statistically significant (χ2 = 811·43, d.f. = 224, P < 0·01). However, the other indices reached acceptable levels with 0·054 for the standardized root mean-squared residuals, 0·070 for the root mean-square error of approximation, 0·88 for the goodness of fit index, 0·98 for the comparative fit index and 0·97 for the normal fit index. The factor loadings for all items with their hypothesized factor were ≥0·48 and statistically significant at the 0·01 level. Conclusion. The Caring Nurse–Patient Interaction Short Scale model was judged to fit the data adequately. Although further testing of the scale with different samples of patients is warranted, our model emerged as a middle-range theory during the construct validity process and still reflects Watson’s theory while offering a structure that is testable in clinical research. [ABSTRACT FROM AUTHOR]

Title. ‘Caring for’ behaviours that indicate to patients that nurses ‘care about’ them Aim. This paper is a report of a study to explore what constitutes nurse–patient interactions and to ascertain patients’ perceptions of these interactions. Background. Nurses maintain patient integrity through caring practices. When patients feel disempowered or that their integrity is threatened they are more likely to make a complaint. When nurses develop a meaningful relationship with patients they recognize and address their concerns. It is increasingly identified in the literature that bureaucratic demands, including increased workloads and reduced staffing levels, result in situations where the development of a ‘close’ relationship is limited. Method. Data collection took two forms: twelve 4-hour observation periods of nurse–patient interactions in one cubicle (of four patients) in a medical and a surgical ward concurrently over a 4-week period; and questionnaires from inpatients of the two wards who were discharged during the 4-week data collection period in 2005. Findings. Observation data showed that nurse–patient interactions were mostly friendly and informative. Opportunities to develop closeness were limited. Patients were mostly satisfied with interactions. The major source of dissatisfaction was when patients perceived that nurses were not readily available to respond to specific requests. Comparison of the observation and survey data indicated that patients still felt ‘cared for’ even when practices did not culminate in a ‘connected’ relationship. Conclusion. The findings suggest that patients believe that caring is demonstrated when nurses respond to specific requests. Patient satisfaction with the service is more likely to be improved if nurses can readily adapt their work to accommodate patients’ requests or, alternatively, communicate why these requests cannot be immediately addressed. [ABSTRACT FROM AUTHOR]

Title. Nurses’ views on the use, quality and user satisfaction with electronic medical records: questionnaire development Aim. This paper is a report of the development of an instrument to measure nurses’ views on the use, quality and user satisfaction with electronic medical records systems. Background. Use of electronic medical records systems in hospitals is steadily increasing, yet no validated instruments have assessed the effectiveness of these systems from the viewpoint of nurses. Method. Items were designed following a literature review based on three main constructs: use, quality and user satisfaction with electronic medical records. Reliability and validity were examined based on responses from 1666 nurses from 42 hospitals in Japan in February 2006. Exploratory factor analysis was conducted to determine the degree to which each item within a construct was associated. The reliability of each resultant factor was computed using Cronbach’s alpha coefficient. Content validity was addressed by basing the items on previous surveys and review of the instrument by a panel of nurses experienced in nursing informatics. Construct validity was examined through factor analysis and correlational analyses. Findings. Extent of ‘use’ of electronic medical records resulted into three factors with good factor loadings, but only two had acceptable reliability. ‘Quality’ of electronic medical records had two factors with good factor loadings and reliability. ‘User satisfaction’ with electronic medical records had three factors, but only one had acceptable reliability. ‘Use’ and ‘quality’ constructs were positively correlated with ‘user satisfaction’. Conclusion. The final instrument incorporates 34 items from the original 44-item pool. Initial validity results were positive and therefore the instrument can be used in evaluating electronic medical records in hospitals. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a study of the perspectives of homeless individuals on their health and healthcare needs. BACKGROUND: Many studies show the high incidence and severity of diseases, physical and mental, amongst the homeless populations. However, the views of homeless people themselves are usually omitted. In order to provide appropriate care, healthcare professionals need to be aware of these perspectives. METHOD: A descriptive, exploratory design, using semi-structured interviews and observational field notes, was chosen for this qualitative study. A convenience sample of 24 participants experiencing homelessness was recruited in one Canadian city in 2005. FINDINGS: Participants described their health and healthcare needs in a holistic sense. They reported concerns about physical illnesses, mental health, addictions and stress. Shelter life promoted spread of diseases and lacked privacy. Violence was rampant in shelters and on the streets, leading to constant fear. There was emotional distress over social exclusion and depersonalization. Participants wanted to work and to be housed, yet felt trapped in a dehumanizing system. CONCLUSION: The recommendations are (a) elimination or mitigation of most health problems of the homeless through safe, affordable housing; (b) reintegration into the community through job counselling, treatment of addictions and employment. Negative societal attitudes towards these clients need to change. Healthcare professionals, particularly community nurses, have opportunities to collaborate respectfully with these clients and work for changes in public policies, such as national housing and addiction treatment policies, and for streamlined, humanized services to smooth the processes of social reintegration. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a study to investigate the nature and prevalence of inpatient aggressive behaviour directed at staff and other patients and, in the case of patient self-harm, the methods used by nursing staff to manage this. Background. Aggressive behaviour poses a threat to the physical and psychological health of psychiatric nursing staff. The fear that results from working in a climate of potential danger can also have a damaging impact on patient care. Methods. Nursing staff on five acute inpatient wards in one hospital in the United Kingdom collected data on aggressive incidents using the Staff Observation Aggression Scale - Revised during a 10 month period from June 2001 to April 2002. Results. There were 254 incidents of aggression recorded. Staff were most commonly targeted and were involved in 57.1% of incidents. The most frequent provocation of the aggression was the patient being denied something such as leave from the ward (29.5% of incidents). The most frequent means used by patients was verbal aggression (60% of incidents), the most frequent outcome for the victim was feeling threatened (59% of incidents), and verbal interventions were used most frequently to manage the aggressive behaviour (43.7%). Despite many incidents involving verbal aggression in both staff- and patient-targeted aggression, 35.9% of incidents involving staff and 25% of incidents involving other patients resulted in seclusion. Conclusion. It is estimated that in a 12 month period at the hospital in this study a nurse would have a one in 10 chance per year of receiving any kind of injury as a result of patient aggression. Despite the predominance of verbal over physical aggression, the fear generated from working in such an environment and a difficulty in understanding the causes of patient aggression may motivate staff to manage aggressive incidents with physical methods such as seclusion and restraint on a frequent basis. [ABSTRACT FROM AUTHOR]

Title. Patients’ accounts of the differences in nurses’ and general practitioners’ roles in primary care Aim. This paper reports a study of patients’ accounts of the differences in nurses’ and general medical practitioners’ roles in primary care. Background. Nurses are now diagnosing and treating illnesses including conducting first contact care consultations. However, the findings of international studies reporting patients’ views of developments in nursing roles are not consistent. Whilst some studies report higher satisfaction following nurse consultations, others suggest that patients do not want nurses to replace general medical practitioners. Healthcare professionals’ views of the boundaries of their roles have been studied, but patients’ views have not been reported. Method. Semi-structured interviews were conducted with 28 adults attending general practices for urgent ‘same day’ appointments during 2004. Participants were interviewed prior to their consultation with either the nurse or general medical practitioner and 19 participants were interviewed after the consultation. Data collection and analysis were concurrent, and based on the constant comparative method. Findings. Participants’ views reflected traditional hierarchies in primary care. They preferred to consult with general medical practitioners if they perceived their symptoms to be serious and with nurses for minor symptoms and reassurance. They thought that nurses had more time for them and were more compassionate. Interpersonal/relational continuity of care was important and for most participants this was with a general medical practitioner who knew them. Participants trusted known practitioners; they also placed trust in professional groups and familiar structures such as the practice. Conclusion. New nursing services should incorporate patients’ views on continuity of care provider when developing models of care delivery. Patient information leaflets in general practices should be used to explain the roles of general practitioners and nurse practitioners/practice nurses. As these roles develop further, more research is needed into all aspects of their implementation and patients’ views should particularly be evaluated. [ABSTRACT FROM AUTHOR]

Aim. This paper reports on structures and processes of hospital care influencing 30-day mortality for acute medical patients. Background. Wide variation in risk-adjusted 30-day hospital mortality rates for acute medical patients indicates that hospital structures and processes of care affect patient death. Because nurses provide the majority of care to hospitalized patients, we propose that structures and processes of nursing care have an impact on patient death or survival. Method. Amodel hypothesizing the impact of nursing-related hospital care structures and processes on 30-daymortality was tested. Patient data from the Ontario, CanadaDischarge Abstract Database 2002-2003, nurse data from the Ontario Nurse Survey 2003, and hospital staffing data from the Ontario Hospital Reporting System 2002-2003 files were used to develop indicators for variables hypothesized to impact 30-day mortality. Two multiple regression models were implemented to test the model. First, all variables were forced to enter the model simultaneously. Second, backward regression was implemented. Findings. Using backward regression, 45% of variance in risk-adjusted 30-day mortality rates was explained by eight predictors. Lower 30-day mortality rates were associated with hospitals that had a higher percentage of Registered Nurse staff, a higher percentage of baccalaureate-prepared nurses, a lower dose or amount of all categories of nursing staff per weighted patient case, higher nurse-reported adequacy of staffing and resources, higher use of care maps or protocols to guide patient care, higher nurse-reported care quality, lower nurse-reported adequacy of manager ability and support, and higher nurse burnout. Conclusion. Just as hospitals and clinicians caring for patients focus carefully on completing accurate diagnosis and appropriate and effective interventions, so too should hospitals carefully plan and manage structures and processes of care such as the proportion of Registered Nurses in the staff mix, percentage of baccalaureateprepared nurses, and routine use of care maps to minimize unnecessary patient death. [ABSTRACT FROM AUTHOR]

Aims. This paper presents an evaluation of a communication enhancement intervention on staff and patients in a complex continuing care facility. Background. The importance of effective communication as a fundamental element of nursing has been emphasized and is regarded as integral to the provision of quality patient care. For people residing in complex continuing care (similar to long-term care facilities), opportunities for socialization occur primarily during interactions or communication with staff, and these interactions have been found to be limited. One way to improve nursing staff communication is through a communication enhancement intervention. Methods. Twenty-one nursing staff members (Registered Nurses, Registered Practical Nurses and healthcare aides) working in a complex continuing care environment and 16 patients participated in this study, conducted in the summer of 2003. A repeated measures design was used to evaluate the effects of the communication enhancement intervention on outcomes. Data were collected from patients and nurses at baseline, 5 weeks into the intervention and at 10 weeks after the intervention. Nurse outcome variables included nurses' job satisfaction and their relationships with patients; patient outcome variables included two measures of patient satisfaction with care. Results. Nursing staff felt closer to their patients (F(2,40) = 3.0, P = 0.045) following the intervention and reported higher levels of job satisfaction (F(2,40) = 4.1, P = 0.02). No changes were found in the level of patient satisfaction with care. Conclusions. Our results suggest that nursing staff can feel better about their job and about their patients as they enhance their communication skills. Understanding the barriers to finding time to talk with patients for a few minutes a day, outside of direct hands-on caregiving, requires further exploration. [ABSTRACT FROM AUTHOR]

Aim. This paper explores nurses' experiences 1 year after an organization's commitment to providing a client-centred and client-empowering partnering approach to care. Background. Historically, nurses' approach to providing care in all nursing contexts has been one of doing for clients, and previous studies have focused more on in-hospital care than on home care. However, the isolation inherent in in-home nursing and nurses' limited professional autonomy and power associated with physician control over patients in home care have been reported, as has their difficulty in finding the meaning and satisfaction of human connectedness and mutuality in nurse-client relationships. Overall, research to date does not inform us about how nurses might make a change toward a more client-centred and client-empowering approach to nursing. Methods. An interpretive phenomenological design was used to elicit in-depth understanding about Registered Nurses' experiences of providing care using this innovative empowerment model. A purposefully selected sample of eight Registered Nurses participated in in-depth interviews. Data were generated during 2002. Hermeneutic analysis was used to elicit themes and patterns emerging from the data. Findings. Caring, client-centredness and the context of in-home care were important in implementing the new partnering approach. Barriers encountered at system, organizational and personal levels distracted nurses from fully comprehending and enacting the approach. After a year, they had begun to contemplate potential strategies for partnering with clients, but had not yet explored the power of their professional autonomy. Conclusion. Nurses are inclined to practise within the expert model of service delivery. They need to work through issues of professional autonomy and rise to the challenge of exercising their autonomy within the current healthcare context if they are to attend more consistently to client-centred empowering partnering. The home care setting offers an excellent environment for achieving these aims. [ABSTRACT FROM AUTHOR]

In this paper, a model describing nurses' responses to patients who are suffering is presented. The nurse's level of engagement with the patient is affected by whether the caregiver is focused on him-/herself or on the sufferer (i.e. embodied with the patient) and whether the caregiver is responding reflexively or with a learned response. Four types of communication patterns are identified: engaged responses (first-level) are used in a connected relationship; when the nurse responses reflexively and is focused on him-/herself, the response is reflected; when the caregiver is patient-focused, a learned response is labelled a professional response; and a self-focused, learned response is labelled detached. Examples of each type of response are provided. [ABSTRACT FROM AUTHOR]

kjellberg k., lagerström m. & hagberg m. (2004) Journal of Advanced Nursing 47(3), 251–259 Patient safety and comfort during transfers in relation to nurses’ work technique The work technique used by health care professionals in patient transfer tasks affects the musculoskeletal load on the professionals, but probably also the safety and well-being of patients being transferred; it is thus a matter of quality of care. The aim of this paper is to report a study exploring the relations between the work technique of nurses in patient transfer tasks, and patients’ perceptions of safety and comfort during the transfers. The work technique used by 102 nurses at orthopaedic wards to perform two common patient transfers: one transfer higher up in bed and one from bed to wheelchair, were examined using video recordings and an observation instrument. A work technique score for each performed transfer was calculated, indicating the level of musculoskeletal safety for the nurse. Nurses assessed their own work technique and patients rated the perceived safety and comfort on bipolar scales directly after each transfer. Patients’ perceptions of safety and comfort were positively correlated to the work technique score in both transfers. Patients felt safer and more comfortable during transfers performed with a safe technique, according to the work technique score, than during those performed with a poor technique. Patients’ ratings of safety in the transfer from bed to wheelchair, and their ratings of comfort in both transfers, were positively correlated to nurses’ assessments of their own work technique. However, the correlation coefficients were rather low. The results support the existence of a relationship between nurses’ skills in patient transfers and quality of patient care. [ABSTRACT FROM AUTHOR]

Discussion in this paper is based on findings drawn from research undertaken within a qualitative framework of analysis, and with the purpose of exploring people's perceptions of living with diabetes, including the nursing care they receive. A major theoretical concern is to demonstrate the importance of placing patients' and clients' experiences at the centre of nursing interest and practice. It is argued that understanding a disease process should of necessity include an understanding of the concerns of those who live with it. Findings related to the following research questions are discussed: first, what are the challenges of living with diabetes? and second, what are people's perceptions of the nursing care they receive? [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]

Research in nurses' communications has concentrated on nurse to patient interactions. Those few studies which focus on nurse to nurse communications seem to be generated by a pragmatic and normative concern with effective information sharing. In this paper, which describes one aspect of a larger case study of a hospital-based therapeutic community, the description and analysis of nurses' reports flows not from a normative model of professional practice, but rather an exploration of how professional practice is articulated as discourse in nurses' written accounts. Foucault's ideas about therapeutic discourse inform the theoretical framework of the research. Ethnomethodological concerns with the importance of documentary analysis provide the methodological rationale for examining nurses' 24-hour report documents, as official discourse, reflecting therapeutic practice in this setting. A content analysis of nurses' reports, collected over a period of 4 months, demonstrated the importance of domesticity and ordinary everyday activities in nurses' accounts of hospital life. Disruption to the 'life as usual' domesticity in the community seemed to be associated with admission to and discharge from the hospital when interpersonal and interactional changes between patients occur. It is suggested that nurses in general hospital wards and more orthodox psychiatric settings might usefully consider the impact of admissions and discharges on the group of patients they manage, and make this a discursive focus of their work. [ABSTRACT FROM AUTHOR]

Careless or confused use of terms such as information giving, teaching and counselling may lead to inadequate understanding and practice. In view of the progress made in this area, designed to help patients cope with illness and treatment, this paper aims to clarify and identify similarities and differences between these activities and discuss their relevance for those in most need of these types of care. Having recognised the complexity and persistence of such needs, patients, their relatives and nurses should perhaps decide their respective roles and work towards improving the quality of and opportunities for such interventions. [ABSTRACT FROM AUTHOR]

Most definitions, or descriptions of nursing emphasize that it is an interpersonal activity focusing on the understanding of the patient as an individual. In addition, such descriptions highlight not only the caring aspect of the role of nursing but also the health maintenance and rehabilitation aspects. The paper discusses the fact that despite these definitions, nursing is still task orientated, largely based on the medical model and hidebound by tradition. Suggestions are made of ways in which this approach may be altered. The use of the nursing process, the concept of the primary nurse and the developing of empathetic understanding being some of the ways in which individualized care may become a reality. The adherence to tradition highlights that nurses are the greatest hindrance to progress in nursing. [ABSTRACT FROM AUTHOR]

In this very critical evaluation of the value and effectiveness of nursing audits, the author shares information about the state of nursing in Australia, gleaned from a recent study. Some myths about nursing practice are debunked. The stark reality is discussed and analysed and a direction for the future is suggested. Although the paper relates exclusively to Australia, its contents will undoubtedly ring true in many other countries. The dichotomy between nursing education and nursing service is considered at length. As are the resulting conflicts of nursing students, clinical instructors and nurse tutors. Teachers of nursing appear to decry the need for them to be clinically involved, as a result nursing education is less meaningful. A particularly strong plea is made for adequate inservice education programmes and a more flexible and thorough approach to change, free from undue commitment to the past. [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]

The paper has three aims: to illustrate ways in which sociology may help nurses to achieve their primary objective: good patient care; to show how nursing can contribute to sociology; and to indicate some conditions for a healthy relationship between the two activities. After a brief discussion of the nature of sociology, intended for non-sociologists, four examples of ways in which sociology may be relevant to nursing are discussed: (i) Implications for nursing of changing patterns of disease, dependency and death; (ii) Social and cultural variations in perceptions of, and responses to, pain and disease; (iii) Organizational analyses, with particular reference to the importance of nurse-patient communication; (iv) Sociological studies of inter-personal relationships, illustrated by a study of student nurse training. Nursing is described as the major caring profession; as such it has inherent interest for sociologists interested in health care. However, its sociological interest is enhanced by the fact that it is permeated by paradoxes. Reference is also made to current debate on the most appropriate model for health care: the traditional medical model places relatively greater emphasis on cure than does nursing, with its relatively greater involvement with care. It is suggested that current patterns of disease and dependency increase the importance of the care model, and that nursing could play a crucial role in such a shift of emphasis. Having shown that sociology can make positive contributions to nursing, attention is drawn to certain dangers. Nursing should thus make sure that the sociology which it welcomes into its domain is academically sound, and not ideology in disguise. It is also suggested that nursing education should encourage more critical thinking, to enliven nurses' appreciation of what sociology has to offer, and to improve their ability to evaluate the quality of health care. [ABSTRACT FROM AUTHOR]

After a discussion of models of nursing, the author focuses on what nurses are and argues that their perceptions are significantly different from those of medical practitioners. The commitment of nurses is discussed, debated and explored and some values shared between newly qualified nurses and the lay public. Commitment is put into the perspective of 'accountability' and its effects on assessing quality of care and nurse-patient relationships are discussed. The author also argues that in certain circumstances she would contemplate defecting from 'being a nurse', particularly with regards to her personal concern for the mentally disordered. But the message that pervades the paper is that once one is a nurse, one is a nurse forever. Finally researchers are admonished to strive for 'an elucidation of the nature of commitment'. [ABSTRACT FROM AUTHOR]

This paper presents a tested and useful method of research in clinical nursing at the doctoral and post-doctoral levels of research skill. Field theory-based, salient variables in patients' experience are inductively arrived at from empirical data. The unitizing of data provides true numbers for measurements of relationships and change in the dependent variable. Descriptive analysis and data-based theory benefit from increased reliability. The authors argue that clinical field research permits a wide choice in designs and observational tools to fit the exigencies of the patient situation under investigation. The method is particularly useful to nurses in direct nursing care situations. [ABSTRACT FROM AUTHOR]

This paper describes the establishment and organization of the Joint Board of Clinical Nursing Studies. It outlines the philosophy which has developed since 1970 and which has formed the basis of the Board's work. The belief that ongoing clinical education should contribute to the quality of patient care, and to the personal and professional development of the nurse and midwife, has been fundamental to the formation of the Board's policies. Factual information is given on various aspects of the work of the Board. The difficulty of assessing the value of the work is recognized, but the importance of this activity is stressed. Formative evaluation is required as an integral part of every course. An attempt is made to assess the value of the Board's work to the patients, the nurses taking the courses, and to the nursing service. [ABSTRACT FROM AUTHOR]

This paper develops an argument that the choice of occupational strategy for nursing in the last century still has implications today. Nurses have retained a hierarchical principle of organization and have, albeit reluctantly, retained an in-service pattern of training. They have been concerned about recurrent shortages of nurses and this has influenced modes of development. These factors contribute to a continuity which is apparent in both 'Salmon' and 'Briggs', the two most influential reports on British nursing in recent decades. Such continuities in nursing development tend to preclude the raising of fundamental questions about the nature of nursing work and the manner in which it might be changed. [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]

Nurses' performance in written examinations often bears little relationship to their level of clinical proficiency in the ward. This paper describes a method of making written exatninations more relevant to the clinical situation. It describes the development of a case history test which confronts students with the kind of information they have to interpret and act upon in the ward, and which requires them to recall the principles of nursing care and apply them in a way similar to real life. Evidence is presented that tests of this type are more closely linked to clinical performance than are conventional written examinations, and guidehnes are given for constructing case history tests. [ABSTRACT FROM AUTHOR]

The section presents the author's views on her article "Attitudes of Nursing Staff in General Medical Wards Towards Activation of Stroke Patients," which appeared in the 1982 issue of the "Journal of Advanced Nursing." It discusses the significance of the paper in the field of health care. It asserts that the attitudes of carers in society are as important as the attitudes of nursing staff. It also points out that the staff's attitudes matter in the care of stroke-patients.

The section comments on the article "Attitudes of Nursing Staff in General Medical Wards Towards Activation of Stroke Patients," by E. Hamrin, which appeared in the 1982 issue of the "Journal of Advanced Nursing." It emphasizes the paper's significance in the field of health care. It details the key components of effective stroke care. And discusses how nurses should manage patients with stroke effectively.

The section comments on the article "Beyond Empathy: Expanding Expressions of Caring," by J. M. Morse, et al, which appeared in the 1992 issue of the "Journal of Advanced Nursing." It expresses opinion on the authors' reference to therapeutic empathy as being a learned communication response. It suggests that there is a need for the nurse to use cognitive-behavioral empathy in order to understand the patient's state of readiness to accept pity. It also discusses the paper's findings.