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Aim. This paper explores the sexual health interview from a critical perspective, and to demonstrate how the confession ritual involved in this interview is implicated in the construction of subjectivities (meaning identities) as well as in fostering self-surveillance (self-regulation). Background. The concept of public health depends primarily on several surveillance tools that monitor both the incidence and prevalence rates of certain diseases. Within the subgroup of infectious diseases, sexually transmitted infections comprise a group that is closely monitored. As a result, surveillance techniques, including policing sexual practices, are part of the public health worker's mandate. Method. Using a Foucauldian perspective, we demonstrate that confession is a political technology in the sexual health domain. Findings. As one group of frontline workers in the field of sexual health, nurses are responsible for data collection through methods such as interviewing clients. Nurses play an integral role in the sexual health experience of clients as well as in the construction of the client's subjectivity. We strongly believe that a Foucauldian perspective could be useful in explaining certain current client behavioural trends (for example, an avoidance by at-risk groups of interactions with nurses in sexual health clinics) being observed in sexual health clinics across the Western hemisphere. Conclusion. Clinicians need to be aware of the confessional nature of their questions and provide requested services rather than impose services that they determine to be important and relevant. By appreciating that the sexual health interview is an invasive and embarrassing sexual confession, healthcare providers and policy-makers may be better able to design and implement more user-oriented, population-sensitive sexual health services. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a review of nurses' roles and their perceptions of these roles in decision-making processes surrounding artificial food and fluid administration in adult patients. Background. Of all caregivers, nurses have the closest and most trusting relationship with severely ill patients and their families during the entire end-of-life care process. As a result, nurses become closely involved in complex ethical decision-making processes concerning artificial administration of food or fluids for these patients. Data sources. We searched seven electronic databases (1990-2007) and examined the reference lists of relevant papers. Review methods. This mixed methods review was conducted with guidance of the United Kingdom Centre for Reviews and Dissemination guidelines on systematic reviews. Results. Although their direct impact is limited, nurses play a significant indirect role during decision-making processes. Because of their unique position, they often initiate decision-making processes, function as patient advocates and provide guidance, information and support to patients and families. Although nurses considered their role to be very valuable, they felt that their role was not always defined clearly or appreciated. Whether nurses experience decision-making processes positively depended on several contextual factors. Conclusion. Given their knowledge and practice skills, nurses are in a prime position to contribute valuably to decision-making processes. Nevertheless, they remain sidelined. For nurses to receive sufficient recognition, their decision-making tasks and responsibilities need to be clarified and made manifest to other participants. [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]

button l., green b., tengnah c., johansson i.&baker c. (2005) Journal of Advanced Nursing50(3), 315–324The impact of international placements on nurses’ personal and professional lives: literature reviewThis paper presents a critical review of research literature on the impact of international placements on the lives and practice of nurses.Health care institutions are progressively more aware of the need to respond to diverse patient populations and cultivate leaders to enrich the nursing profession, both locally and globally. One response has been to establish international exchange programmes for nursing students to give them experience of different cultures and health care systems.A search of the literature from 1980 to 2003 using electronic databases was undertaken using the databases CINAHL, ERIC, British Nursing Index, Web of Science, the BIDS Social Science Citation Index and Medline. The keywords used were‘international exchange experience’,‘international studies’,‘international education’,‘international placement(s)’,‘exchange programme(s)’, combined with‘nurses/nursing’, combined with‘evaluation’,‘practice’,‘education’ and/or‘policy’. The papers retrieved used both qualitative and quantitative approaches and were scrutinized for recurring themes.Nurses reported significant changes in their personal development, perspectives on nursing practice and critical appraisal of health care systems. They also indicated an increased appreciation and sensitivity towards cultural issues and cross-cultural care. Moreover, differences in placement programmes, such as duration, preparation and debriefing were found to have affected the reported overall international placement experience. However, the primary effects of international placements were identified as personal development and transcultural adaptation.Students should be exposed to a variety of nursing experiences within the host country. This would give them a broad spectrum for comparisons between cultures, nursing practice and health care delivery in those cultures. Therefore, educational institutions are strongly encouraged to provide opportunities for students to participate in nursing care and education in another country. [ABSTRACT FROM AUTHOR]

fitzsimmons d., hawker s.e., simmonds p., george s.l., johnson c.d.&corner j.l. (2005) Journal of Advanced Nursing50(3), 244–252Nurse-led models of chemotherapy care: mixed economy or nurse–doctor substitution?This paper reports a study exploring the perspectives of people affected by cancer (service users) and health care professionals’ about current medical consultant-led services and the acceptability of a proposed nurse-led ambulatory chemotherapy service.A number of studies have evaluated a nurse-led model of cancer care delivery but little work has been undertaken in chemotherapy settings. Furthermore, many of these studies give little information on how the perspective of users was incorporated in the design and evaluation of these services.Service users (n = 26) and health care professionals (n = 22) were recruited across the South East of England. A qualitative study was undertaken... Using a semi-structured interview schedule, participants were asked to give their perceptions of current chemotherapy services and the potential of a nurse-led service. A thematic analysis of data was undertaken.This paper focuses on the theme of the current and future context of a chemotherapy service. Three sub-themes were identified: contextualizing roles, defining therapeutic outcomes, and demonstrating effectiveness. All interviewees saw this role as different but complementary to the role of medical staff. There were mixed opinions from service users and professionals on the acceptability of nurse-led chemotherapy provision. In defining potential outcomes of nurse-led care, service users described benefits in terms of service and economic outcomes. Professionals saw additional benefits in terms of patient-based outcomes. Professionals and service users expressed the need for appropriate education of nurses for this role and rigorous evaluation of any new service before widespread implementation.Understanding the perspective of users is imperative when re-designing cancer nursing services. Implementation of nurse-led models in chemotherapy services should be preceded by staff education and followed by systematic evaluation. [ABSTRACT FROM AUTHOR]

AIMS: A 2-year project was carried out to evaluate the use of multi-component, computer-assisted strategies for implementing clinical practice guidelines. This paper describes the implementation of the project and lessons learned. The evaluation and outcomes of implementing clinical practice guidelines to prevent and treat pressure ulcers will be reported in a separate paper. BACKGROUND: The prevalence and incidence rates of pressure ulcers, coupled with the cost of treatment, constitute a substantial burden for our health care system. It is estimated that treating a pressure ulcer can increase nursing time up to 50%, and that treatment costs per ulcer can range from US$10,000 to $86,000, with median costs of $27,000. Although evidence-based guidelines for prevention and optimum treatment of pressure ulcers have been developed, there is little empirical evidence about the effectiveness of implementation strategies. METHOD: The study was conducted across the continuum of care (primary, secondary and tertiary) in a Canadian urban Health Region involving seven health care organizations (acute, home and extended care). Trained surveyors (Registered Nurses) determined the prevalence and incidence of pressure ulcers among patients in these organizations. The use of a computerized decision-support system assisted staff to select optimal, evidence-based care strategies, record information and analyse individual and aggregate data. RESULTS: Evaluation indicated an increase in knowledge relating to pressure ulcer prevention, treatment strategies, resources required, and the role of the interdisciplinary team. Lack of visible senior nurse leadership; time required to acquire computer skills and to implement new guidelines; and difficulties with the computer system were identified as barriers. CONCLUSIONS: There is a need for a comprehensive, supported and sustained approach to implementation of evidence-based practice for pressure ulcer prevention and treatment, greater understanding of organization-specific barriers, and mechanisms for addressing the barriers. [ABSTRACT FROM AUTHOR]

kearney p.m. & pryor j. (2004) Journal of Advanced Nursing 46(2), 162–170 The International Classification of Functioning, Disability and Health (ICF) and nursing Nursing conceptualizes disability from largely medical and individual perspectives that do not consider its social dimensions. Disabled people are critical of this paradigm and its impact on their health care. The aims of this paper are to review the International Classification of Functioning, Disability and Health (ICF), including its history and the theoretical models upon which it is based and to discuss its relevance as a conceptual framework for nursing. The paper presents a critical overview of concepts of disability and their implications for nursing and argues that a broader view is necessary. It examines ICF and its relationship to changing paradigms of disability and presents some applications for nursing. The ICF, with its acknowledgement of the interaction between people and their environments in health and disability, is a useful conceptual framework for nursing education, practice and research. It has the potential to expand nurses’ thinking and practice by increasing awareness of the social, political and cultural dimensions of disability. [ABSTRACT FROM AUTHOR]

iley k. (2004) Journal of Advanced Nursing 45(4), 360–370 Occupational changes in nursing: the situation of enrolled nurses The move to one level of qualified nurse in the United Kingdom (UK) is, in part, a consequence of professionalizing strategies. Registered nurses now undertake technical work previously performed by doctors. The role of enrolled nurses, and their career intentions, have not been considered in light of these changes, despite the fact that many still work in the National Health Service. This paper considers the pursuit of professionalization by nurses, illustrating the argument with findings from an empirical study of conversion to registered nurse by enrolled nurses. The paper is based on a secondary analysis of a large data set, originally used to explore ethnic inequalities in nursing. Data from 2968 respondents were analysed to answer a number of research questions relating to the characteristics of different groups of enrolled nurses and predictors of conversion to registered nurse. These included demographic characteristics, markers of career orientation, career progression and job satisfaction. This study used secondary analysis of data and, therefore, exploration of issues was limited, not least because the data were 10 years old. Also, the design was cross-sectional and respondents’ experiences related to different stages of the phenomenon under study and the same group was not studied over time. Enrolled nurses who had converted to registered nurse were more likely than those who had no intention of converting to: be male, be younger, have been nursing longer, not be working on elderly care wards, have a high career orientation, not have taken a career break, and work full-time. Most of these factors predicted likelihood to convert. Although nurses who converted to registered nurse were more likely to anticipate career progression, they were less likely to be satisfied with their work. In attempts to define rewarding nursing work, the importance of ensuring that qualified nurses continue to retain basic nursing care skills should be acknowledged. This may offer an uncomfortable view to those seeking to further the professional status of nursing. [ABSTRACT FROM AUTHOR]

BACKGROUND: This paper's starting point is the recognition (descriptive not normative) that, for the vast majority of day-to-day clinical decision-making situations, the 'evidence' for decision-making is experiential knowledge. Moreover, reliance on this knowledge base means that nurses must use cognitive shortcuts or heuristics for handling information when making decisions. These heuristics encourage systematic biases in decision-makers and deviations from the normative rules of 'good' decision-making. AIMS: The aim of the paper is to explore three common heuristics and the biases that arise when handling complex information in clinical decision-making (overconfidence, hindsight and base rate neglect) and, in response to these biases, to illustrate some simple techniques for reducing the negative influence of heuristics. DISCUSSION: Nurses face a limited range of types of uncertainty in their clinical decisions and draw primarily on experiential knowledge to handle these uncertainties. This paper argues that experiential knowledge is a necessary but not sufficient basis for clinical decision-making. It illustrates how overconfidence in one's knowledge base, being correct 'after the event' or with the benefit of hindsight, and ignoring the base rates associated with events, conditions or health states, can impact on professional judgements and decisions. The paper illustrates some simple strategies for minimizing the impact of heuristics on the real-life clinical decisions of nurses. CONCLUSION: The paper concludes that more research knowledge of the impact of heuristics and techniques to combat them in nursing decisions is needed. [ABSTRACT FROM AUTHOR]

AIM: To discuss the use of patronizing patterns of speech and modified forms of address in conversations between nurses and other health workers, and older people. RATIONALE: The impetus for this paper was the publication of the National Service Framework for Older People, which draws attention to the prevalence of age discrimination and the need to provide individualized care. APPROACH: The literature between 1990 and 2001 was reviewed in a systematic way. Certain key, older texts were also identified. Twenty-four publications were found, which examine the ways in which nurses and other health workers modify their speech when conversing with older people, discuss what older people think about this practice, or otherwise contribute to this issue. RESULTS: The paper uses speech accommodation theory to explain how the language addressed to older people is sometimes modified. The practice of over-accommodation is also described. This happens when older people are addressed in a simplified vocabulary with a high-pitched tone of voice and slow speech. The extent of over-accommodation is discussed, and its impact on older people is considered in terms of fostered dependence and lowered self-esteem. CONCLUSION: The findings of the review in the context of current policy related to older people and implications for nursing education are discussed. [ABSTRACT FROM AUTHOR]

Aim of the paper. The aim of this paper is to examine the extent to which there is a requirement to obtain informed consent prior to nursing care procedures.Rationale. The requirement for nurses to obtain consent prior to nursing care procedures is addressed in various nursing policy documents. It is important that nurses understand the legal and ethical rationale behind the principles of informed consent so that the principles are applied appropriately to the particular context of nursing care. Argument. The ethical and legal rationale behind the concept of informed consent and its relevance to nursing practice are examined. In this paper, it is argued that the function of informed consent is to protect patient autonomy and to promote meaningful decision-making. Given the potential for nursing care procedures to infringe patient autonomy, consent is clearly a relevant concept in nursing. Furthermore, in law, any touching without consent is a potential battery. Informed consent is often associated as a rigid procedure, only relevant to surgical or research procedures. Consent should be obtained prior to nursing care procedures whenever patient autonomy is at stake. However, information-giving should be determined by the needs of the patient and approached in such a way as to facilitate meaningful decision-making. Given the individual nature of infringements to patient autonomy, it is difficult to predetermine all those care procedures that require consent; any list of procedures would fail to be comprehensive.Conclusions. The principles of informed consent should underpin our approach to nursing care procedures, which should not be mechanistic but determined by the needs of individual patients. [ABSTRACT FROM AUTHOR]

This paper examines the research base for 'magnet hospitals'--hospitals that have a good reputation for recruitment and retention of registered nurses. It also assesses the extent to which the concept of the magnet hospital continues to have relevance to nursing in the United Kingdom (UK). The study reviews previous research, examines recent trends in nursing employment, and reports on case studies conducted as fieldwork research. The early research on magnet hospitals, conducted in the 1980s in the United States of America (USA), is reassessed in the light of subsequent cost containment driven changes in the USA nursing labour market and in the organization of USA hospitals. Many of these changes have impacted on nursing staff, with increases in workload, and with changes in skill mix, particularly as a result of increased use of care assistants. Similar developments have been happening in the UK. The paper examines the extent to which the concept of the magnet hospital can retain validity in this changing health care environment. Case studies in 14 USA magnet hospitals were conducted in 1997. The results highlight that, as a result of hospital reorganization and merger, some of these hospitals no longer exhibit core characteristics of 'magnetism', whilst others have retained these characteristics despite organizational change. The paper concludes by cautioning that the concept of the magnet hospital continues to have a relevance to the management of nursing resources, but that the research base, with some notable exceptions, continues to be weak and that there is a need for monitoring and a process of re- accreditation to maintain a 'live' register of magnet hospitals. [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]

This paper focuses on the role of the nurse as both a role model and as a health educator and examines some key areas where tension between these two appear to exist. The context is the changing British National Health Service and the expectations of both the providers of the care and the consumers. The concept of the nurse as a role model for health is explored: the use of the term 'role' and its implications for nurses; what being a role model might mean for nurses and some of the stresses which living up to these role models might impose; the extra burden of an implied healthy role model and the expectations which are placed on nurses from both within and outwith the profession. Communication theory and the view of the nurse as a 'credible source' may add to these pressures and this paper tries to offer to nurses an alternative standpoint from which they may begin to tackle their health promotion/education activities. The traditional role of the nurse as a health educator is examined and a variety of options are offered to encourage nurses to consider their approach to dealing with clients within the context of health education. Some different models of education which are more suitable for the flexible approach which is required for health education are outlined. The paper closes with some discussion points which suggest that self-awareness and personal developments may be among the most important qualities which nurses need to be effective health educators. [ABSTRACT FROM AUTHOR]

Although using research to guide nursing practice has been a long-standing goal for the nursing discipline, the actual merger of research and practice is not yet widespread. There are many possible explanations for the limited progress that has been made in this arena. In this paper, it is suggested that the multiple identities taken on by nurses may stifle actualizing a merger between research and practice. Diverging responsibilities and orientations among identities are depicted by considering the nurse as researcher, clinician, educator and administrator. In addition to elucidating differences among these various nurse identities, the paper addresses their commonalities, the most obvious and important of which is that of nurse. If individuals retain the identity of nurse as the generic and salient characteristic, the multiple nurse identities have the potential to become a complementary array of diverse resources that can empower rather than thwart merging research and practice. [ABSTRACT FROM AUTHOR]

This paper considers the issue of nursing science. Nursing, as an art, has long been accepted as integral to nursing. Nursing, as a science, however, is a more recent concept. Nursing science is viewed as a threat to the profession by its opponents, while the proponents of nursing science see it as a promise for advancement of the discipline. This paper examines the issue of nursing science by looking at its history and development, the definition of science, and five factors critical to the nursing science issue. The author concludes that nursing science is, in varying respects, both a threat and a promise. It is clear that the preponderance of evidence favours the promise nursing science holds for the profession of nursing. It is not a matter of choosing either art or science, but rather skillfully blending both for the betterment of nursing. Both art and science are necessary in nursing -- neither, however, is sufficient. [ABSTRACT FROM AUTHOR]

Course evaluation is defined 'as the collection and use of information in order to make decisions about an educational programme' (Cronbach 1963). The study described in this paper was undertaken by members of the professional and research staff of the Joint Board of Clinical Nursing Studies, Londoa The paper describes how the need for work on course evaluation arose and how a package was developed and piloted in 15 course centres with a total of 205 students. The ways in which the package is being used by schools of nursing and colleges of higher and further education is also described The philosophy that evaluation has an important part to play in developing dynamic and sound educational systems is emphasized Evaluation should be an integral part of every course and planned at the outset with other parts of the detailed course programme, involving both students and teachers in measuring the effectiveness of the course. [ABSTRACT FROM AUTHOR]

Until recently discussion about nursing research centred on the need to get it carried out. Attention is now being focused on how to get nursing research used, since so far, such research findings have not, on the whole, been assimilated into practice. Until this occurs the practice of nursing will not and cannot be research-based in any meaningful way. It is postulated that nursing research findings provide nurses with indicators for practice. This assumes that such findings are available and that the main barrier to their use is the poor communication of this research, (in a form they can understand) to nurse practitioners. However recent research into the use of research findings casts doubt on this assumption and it can be argued that such a view is too simplistic. In this paper therefore, three questions are asked: (1) Are relevant nursing research findings available which provide indicators for practice? (2) What indicators do such findings provide? (3) Are such findings used by nurse-practitioners? Using specific examples from nursing research, ideas and suggestions are put forward which provide a basis for possible answers. Finally the paper discusses the interdependence of research and practice and the need for them to develop together. [ABSTRACT FROM AUTHOR]

This paper argues that the rhetoric of multidisciplinary teamwork is central to the provision of health care generally and geriatric care in particular. Yet the notion of teamwork is poorly defined, and the supposed benefits for patients are not always readily apparent. Looking at teamwork in practice, examples from research are used to illustrate how multidisciplinary decision making and work with patients can, under particular circumstances, take on the appearance of collaboration amongst a team of expert colleagues, which co-opts patients and relatives to the status of team members. But very often, multidisciphnary work with patients is coordinated not by mutual collaboration amongst a team of equals, but by means of established work routines which are broadly applied to whole categories of patients, and by the operation of the traditional hierarchy of social relations in health care. For long stay patients, the pervasiveness of the teamwork mythology and the frequent concurrent withdrawal of other professionals can, at worst, leave the nurses in the invidious position of having responsibility, but no formal or legal authority for caring for their patients: work which no other professional is anxious to do. This leads to negative outcomes for patients as well as for nurses. Finally, it is stressed that analysis of multidisciplinary teamwork both in theory and in practice is vital if we are to understand the conditions under which multidisciplinary teamwork both flourishes, and can be demonstrated to be a necessary condition for the creation of positive care outcomes for geriatric patients in hospital. This paper seeks to raise some of the issues which must be confronted in this endeavour. [ABSTRACT FROM AUTHOR]

This paper is based on an address delivered in Faneuil Hall, Boston, Massachusetts, USA, on 6 May 1975, as part of the American bicentennial celebrations. The history of nursing in America is traced over two centuries-from 1776, when nursing was nothing more than neighbourly assistance rendered by unprepared amateurs, to the present day, when nursing has reached a highly professional status. The influences of the revolutionary and civil wars and legislative and social changes on nursing and the training of nurses are recorded and discussed. The major contribution to the history of American nursing made by the American Nurses' Association is conceded. Its continued contributions to the extension and development of nursing as a profession, to the education of nurses, and to support for the principle that health care is a right, are all documented. The paper is a concise and well-referenced synopsis of the development of nursing in the USA during its first 200-year history, advancing from 'a most indefinite quantity' to 'the largest professional group among the health occupations'. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of preliminary evaluations of an interprofessional education through simulation project by focusing on learner and teacher reactions to the pilot modules. Background. Approaches to interprofessional education vary widely. Studies indicate, however, that active, experiential learning facilitate it. Patient simulators require learners to incorporate knowing, being and doing in action. A theoretically based competency framework was developed to guide interprofessional education using simulation. The framework includes a typology of shared, complementary and profession-specific competencies. Each competency type is associated with an intraprofessional, multiprofessional, or interprofessional teaching modality and with the professional composition of learner groups. Method. The project is guided by an action research approach in which ongoing evaluation generates knowledge to modify and further develop it. Preliminary evaluations of the first pilot module, cardiac resuscitation rounds, among 101 nursing students, 42 medical students and 70 junior medical residents were conducted in 2005-2007 using a questionnaire with rating scales and open-ended questions. Another 20 medical students, 7 junior residents and 45 nursing students completed a questionnaire based on the Interdisciplinary Education Perception scale. Findings. Simulation-based learning provided students with interprofessional activities they saw as relevant for their future as practitioners. They embraced both the interprofessional and simulation components enthusiastically. Attitudinal scores and responses were consistently positive among both medical and nursing students. Conclusion. Interprofessional education through simulation offers a promising approach to preparing future healthcare professionals for the collaborative models of healthcare delivery being developed internationally. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a concept analysis of span of management. Background. Span of management is an important structural variable in evaluating the contributions of nursing managers to healthcare systems. Span of management is typically measured as a ratio. A wide variety of operational definitions have been applied and these differences have not been reconciled. Data sources. A search of CINAHL, PsychINFO and Business Source Premier was completed in 2007 using the terms span of management, span of control, organizational structure, hierarchy, supervisory ratio and work group size. Key publications (1975-2007) and seminal works were included. Review methods. Morse's concept analysis approach was used to determine the pragmatic utility of the concept. A critical appraisal of the literature assessed the use of the concept across disciplines, identified inconsistencies within the concept, and uncovered assumptions and conceptual gaps. Findings. At the organizational level, span represents supervisory capability. At the level of the manager, span may reflect reporting structure, closeness of contact, or scope of the role. At the work group level, span quantifies work group size. At the employee level, span represents employee support. These measures are influenced by units of measurement and by context. Conclusion. A systematic understanding of span of management concepts, measures and determinants will assist nurse executives in selecting parameters to quantify the allocation of managerial resources. Researchers can incorporate these parameters in comparisons across studies and in advancing the science of nursing management. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a study to explore practice nurse involvement in facilitation of self-management for long-term conditions. BACKGROUND: In the United Kingdom chronic disease services have shifted from secondary care to general practice and from general practitioners to practice nurses. A new United Kingdom General Practice contract requires adherence to chronic disease management protocols, and facilitating self-management is recognized as an important component. However, improving self-management is a relatively new focus and little is known about the ways in which nurses engage with patient self-management and how they view work with patients in chronic disease clinics. METHOD: Semi-structured interviews with 25 practice nurses were carried out in 2004-2005. Interviews were audio-taped and transcribed verbatim. Analysis was informed by the 'trajectory model' and 'personal construct' theories. FINDINGS: Main themes in the early stages of work with patients were: categorization of patients, diagnosis, and patient education. First impressions appeared to determine expectations of self-management abilities, although these were amenable to change. Intermediate stages were 'ways of working' (breaking the task down, cognitive restructuring and addressing dissonance, modelling 'good' behaviour, encouragement, listening, involving carers and referral) and maintaining relationships with patients. However, in the longer-term nurses seemed to lack resources beyond personal experience and intuitive ways of working for encouraging effective self-care. CONCLUSION: The ways of working identified are unlikely to be sufficient to support patients' self-management, pointing to a need for education to equip nurses with techniques to work effectively with patients dealing with longer-term effects of chronic illness. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a study to illuminate the meaning of caring for people with malodorous exuding ulcers. BACKGROUND: Managing ulcers is complicated and consensus on assessment and treatment difficult to reach. Nurses need knowledge and skills to provide good care. They must stay close and be exposed to contamination and suffering. They must provide care without violating patients and we need to further explore this challenge. METHOD: A convenience sample of ten participants was recruited. Participants had experience of caring for people with malodorous exuding ulcers and were employed in primary health or hospital care in Sweden. Narrative interviews were conducted during late 2002 to early 2005 and interpreted using a phenomenological-hermeneutic method. FINDINGS: Themes were formulated: 'Facing the wound' when nurses reveal what is meant to be concealed and perceive patients' vulnerability; 'Facing one's own defencelessness' when feeling invaded, helpless and ashamed; 'Struggling to shield one's own defencelessness' was achieved by striving to be in control, striving to endure and seeking a way out. 'Struggling to shield patients' vulnerability' was about alleviating patients' additional suffering by striving to spare patients, pushing boundaries, making uncomfortable decisions and sharing togetherness. When failing to shield their own defencelessness and patients' vulnerability, nurses run the risk of experiencing desolation. CONCLUSION: Physical proximity and bodily suffering affect nurses. Caring for people with ulcers calls for improved interprofessional cooperation in order to provide the best treatments and care. Further education for these nurses is needed, as well as support from managements and organizations. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to assess the impact of nurse absenteeism on the quality of patient care. Background. Nurse absenteeism is a growing management concern. It can contribute to understaffed units, staffing instability, and other factors that could have a negative impact on patient care. The impacts of absenteeism on the quality of nursing care have rarely been studied. Method. Retrospective monthly data from incident reports and staffing records in six inpatient units for 2004 were analysed. Dependent variables were the numbers of restraints, alternatives to restraints, incident reports, deaths, and length of stay. Explanatory variables were nurse absenteeism hours, patient days per nursing staff, and interaction between these variables. Controls were patient acuity and unit characteristics. Fixed effects regressions were analysed as regular or negative binomial models. Findings. Neither high Registered Nurse absenteeism nor high patient load was related to restraint use when taken separately. However, high Registered Nurse absenteeism was related to restraint use when patient load was high. Registered Nurse absenteeism was related to a lower use of alternatives to restraints. Incident reports were increased by high patient load, but not absenteeism, or absenteeism given patient load. When both patient load and absenteeism were high, deaths were higher also. Conclusion. Absenteeism alone may not be a strong factor in lowering quality, but the combination of high Registered Nurse absenteeism and high patient load could be a factor. Staffing and absenteeism may be part of a vicious cycle in which low staffing contributes to unit absenteeism, which contributes to low staffing, and so on. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to investigate the roles and experiences of nurses caring for clients undergoing assisted reproductive technologies. Background. Little has been written on nurses' experiences of assisted reproductive technologies. Such interventions are emotionally fraught for clients, and working in areas of high emotional intensity can also be emotionally difficult for staff. Nurses are in a potentially unique position in the assisted reproductive technology environment in that, unlike other professionals who move in and out during the treatment cycle, they maintain a more constant contact with the client. Method. A qualitative approach was taken and a convenience sample of 15 nurses from New Zealand was interviewed in 2005. Data were analysed using interpretive description. Findings. The overarching theme identified was that of the potential role of the nurse to 'hold together' multiple components of the assisted reproductive technology process: holding together clients' emotional and physical experiences of assisted reproductive technologies; holding together the roles of different specialist team members; and holding together personal own emotions. It encompasses practices such as information-giving, interpreting, supporting and advocating. Conclusion. Assisted reproductive technologies nurses require recognition of their role and how it may positively contribute to clients' experiences, as well as adequate preparation and ongoing support. Nurses need to be educated in both the emotional and medical aspects involved in caring for clients being treated with these technologies. [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]

Title. The essence of nursing care: Polish nurses’ perspectives Aim. This paper is a report of a study to identify Polish nurses’ definition of the concept of nursing care. Background. Polish nursing currently is in a period of scientific research focusing on development of precise definitions of concepts. Definitions of nursing are influenced by culture, social expectations and healthcare systems. Accepted scientific definitions of concepts should be based on empirical verification that takes theoretical and practical perspectives into account. Methods. A survey questionnaire was constructed from analysis of a random sample of 27 essays about nursing care that had been completed by 300 Polish nurses. The survey questionnaire, which was designed to measure the essence of nursing care, was completed by 324 Polish nurses during 2004 and 2005. Findings. Analysis of survey questionnaire responses revealed that the essence of nursing care encompasses providing care, communicating, supporting, helping, assisting, accompanying and managing. Participants indicated that nursing care recipients include healthy persons, ill persons and persons at risk for disease. Conclusion. The concept of nursing care encompasses several traits or characteristics that can be applied to both well and ill people. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to explore the experiences of 'almost old' women as they grow older while living with a chronic condition. Background. Little is known about the contextual effects of ageing and how it shapes and is shaped by a woman's chronic illness experience. Nurses' understanding of this phenomenon can have positive effects on how their client accesses and responds to healthcare. Method. Seven women aged between 50 and 58 years participated in this interpretive descriptive study that explored the issues of ageing with a chronic condition. Three focus groups were held between March 2003 and March 2004. Transcriptions were analyzed after each focus group. Participants were given the opportunity to respond to the findings as the analysis progressed. Findings. The experience of living with a chronic illness foreshadowed what was to come with ageing and embodied the ageing process: it was just part of their lives. Alongside this, the women now felt less out of place. Their peers were catching up and beginning to experience aspects of participants' everyday reality. The women, however, experienced double jeopardy because ageing amplified the ongoing vulnerabilities of living with a chronic condition. Conclusion. Nurses who recognize the resourcefulness and expertise of women who live with a chronic condition can effectively be co-strategists in their helping them to age well. [ABSTRACT FROM AUTHOR]

Title. Relationship of nurses’ spirituality to their understanding and practice of spiritual care Aim. This paper reports a study to examine the relationship of nurses’ spirituality to their understanding and practice of spiritual care. Background. Continued debate surrounds the concept, practice and teaching of spirituality, highlighting the complexity and importance of understanding spirituality and the delivery of spiritual care. Spirituality is defined in this study as the relationship with the self and a dimension beyond the self. Method. A convenience sample of 61 nurses from a part-time Bachelor of Science degree programme in nursing in Hong Kong, more than half of whom reported their religious affiliations, completed a newly developed, 27-item five-point Likert scale questionnaire. The data were collected in 2002. Descriptive statistics were calculated. Correlations were used to determine relationships among self, understanding and practices of spiritual care. The Mann–Whitney U and Kruskal–Wallis tests were used to examine differences between demographic variables and spirituality, understanding and practices of spiritual care. Multiple linear regression was used to determine factors contributing to understanding and practices of spiritual care. Findings. A positive statistically significant correlation was found between self and the following three variables: dimension beyond self ( r = 0·35, P < 0·001), understanding of spiritual care ( r = 0·57, P < 0·001), and practice of spiritual care ( r = 0·26, P < 0·05). The relative contributions of self to understanding (beta = 1·06, | t| = 10·74, P < 0·001) and practice of spiritual care (beta = 0·68, | t| = 3·62, P = 0·001) were statistically significant. There was no statistically significance difference between any of the demographic variables and understanding and practice of spiritual care, except for a negative relationship between religious affiliations and the dimension beyond self ( P < 0·001). Conclusion. Through continuously seeking self-awareness and connecting to a dimension beyond the self for inner resource, the contented whole self will be able to provide spiritual care. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of the findings of a survey in which people with multiple sclerosis identified what they believed would be helpful in meeting their current needs. Background. People with multiple sclerosis have low levels of satisfaction with the health and social care that they receive, but previous studies suggest that they have a broad range of physical, psychological and social needs. Method. A total of 714 people with different levels of disease impact who were participating in a prospective study evaluating multiple sclerosis specialist nurses were asked, 'What one thing would be most helpful in meeting your current needs'? The question was included in the postal questionnaire used for the study (mailed in 2001 and 2002). The overall response rate for usable returns (at both time points) was 42%. Descriptive statistics on the frequency of codes and categories generated by content analysis were compiled and compared in relation to demographic and disease characteristics. Findings. A total of 445 people responded to the question. Seven categories were identified: medical treatment (29%, n = 126); socio-environmental support and adaptation (19%, n = 81); enhanced care provision (18%, n = 79); information provision (9%, n = 38); rehabilitation therapies (7%, n = 29); non-professional care (6%, n = 28); and psychological support (3%, n = 15). Nine per cent of responses (n = 39) were not coded as their meanings were unclear. Socio-environmental support, rehabilitation and non-professional care were more frequently identified by those with greater disease impact. Information was identified as a stronger need for those in lower disease impact groups. Conclusion. The findings could provide the basis for developing a multiple sclerosisspecific service satisfaction tool. This could be helpful in assessing the quality of provision, given current variations in the coverage and quality of care provided. Nurses could use such a tool to assess the quality of care in a given population, thereby highlighting gaps in service provision. [ABSTRACT FROM AUTHOR]

Title. The effect of nurses’ use of the principles of learning organization on organizational effectiveness Aim. This paper is a report of a study to describe the effect on organizational effectiveness of nurses’ use of the principles of learning organization. Background. Since Senge proposed the learning organization model in 1990, the principles of learning organization have been considered as a new organizational vision. However, there is little empirical evidence that shows how nurses’ use of the principles of learning organization affects organizational effectiveness in healthcare settings. Method. A cross-sectional survey was used and the data were collected in 2003. Participants were 629 professional nurses who had worked full-time for more than 1 year in the general units of nine tertiary medical hospitals in South Korea. A questionnaire was distributed to nurse managers of nine hospitals, who distributed it to 665 nurses, 635 of whom responded (response rate 95·5%). Six returns were discarded due to incomplete responses, leaving 629 for data analysis. Results. There was a statistically significant positive relationship between nurses’ use of the principles of learning organization and organizational effectiveness. Hierarchical multiple regression analysis revealed that the concept explained an additional 24·9% of organizational commitment and a further 22·6% of job satisfaction. The learning organization principles of shared vision and team learning were statistically significant predictors for organizational effectiveness. Conclusion. Individual nurses can use the principles of learning organization to enhance organizational effectiveness. Intervention programmes that integrate and strengthen shared vision and team learning may be useful to enhance organizational effectiveness. Further research is required to identify other factors related to the principles of learning organization. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a study exploring nurses’ perceptions of the shift handover and the possible reasons for reported dissatisfaction in 10 European countries. Background. The nursing handover fulfils a number of purposes and has important consequences for the continuity of patient care and nurses’ satisfaction with the quality of care they are able to provide. However, the performance and function of shift handovers in health care is a widely neglected topic in practice and research. Method. The Nurses’ Early Exit Study ( ) investigates the working conditions of nurses and variables influencing nursing retention. The data for this analysis were collected between 2002 and 2003 by self-report questionnaires in 10 European countries. Findings. The percentage of nurses dissatisfied with shift handovers ranged from 22% in England to 61% in France. In most countries the main reason for dissatisfaction with shift handovers was ‘too many disturbances’, followed by ‘lack of time’. Most countries showed similar associations of dissatisfaction with qualification level and occupational seniority, but not with position and type of shift. ‘Poor quality of leadership’ and ‘poor support from colleagues’, were strongly associated with dissatisfaction. Conclusions. In several (but not all) European countries, shift handovers may be a frequent cause for nurses’ irritation. The underlying causes appear to be of an organizational nature. The findings have implications for solutions. Further debate and research should clarify the different purposes of shift handovers and relate them to handover style and to the quality of patient care. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a study investigating the psychometric properties of the Multifactor Leadership Questionnaire among nurses. Background. Although the Multifactor Leadership Questionnaire is one of the most widely used instruments to measure the multifactor leadership theory in organizational sciences, inconsistent research findings have been reported for its psychometric properties. Little is known about these properties. Method. Data were gathered by postal questionnaires in 2001-2002 with nurses working in different healthcare organizations in Finland. A follow-up study was performed 1-year later. The sample consisted of 601 nurses and nurse leaders, and the follow-up study had 78 respondents. The internal consistency of the Multifactor Leadership Questionnaire was explored using Cronbach's alpha coefficient and itemanalysis, and the test-retest reliability using Pearson product moment correlation coefficient and intra-class correlation coefficient (single measure intra-class correlation coefficient). The factor structure was studied using exploratory and confirmatory factor analyses. Results. The internal consistencies of the leadership subscales were satisfactory. The Multifactor Leadership Questionnaire was fairly stable measured at the 1-year interval. Although the data fail to support the full nine-factor model, a reduced set of items from the Multifactor Leadership Questionnaire appears to show evidence of the three- and six-factor structures. Exploratory factor analysis showed evidence for the three-factor structure consisting of three distinctive, yet partly related leadership subscales. Confirmatory factor analysis showed evidence for the sixfactor structure. Conclusion. The psychometric data suggest that a modified version of the Multifactor Leadership Questionnaire is a highly suitable instrument to measure multidimensional nursing leadership. Validity and reliability were supported. The results can be used in studies applying the Multifactor Leadership Questionnaire. [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]

Aims. This paper reports a study which aimed to explore service users’ views and experiences of the processes associated with the prescription and administration of ‘as needed’ (p.r.n.) psychotropic medications in acute mental health settings. Background. Few studies have explored the use of ‘as needed’ medication in acute mental healthcare settings. Such medication is frequently requested by service users, but the literature is unclear about the reasons for these requests or service users’ experiences of this treatment. Method. A convenience sample of 22 inpatients participated in face-to-face semi-structured interviews exploring their treatment experiences of ‘as needed’ psychotropic medication in acute mental health settings in a large city in the United Kingdom in 2005. Thematic content analysis was carried out. Results. Interviewees highlighted the value of ‘as needed’ medications. However, the process associated with their use was perceived as confusing and stigmatizing. Service users had limited understanding of and felt unsupported in attempts to use alternatives approaches. Additionally, the decision-making and information-giving processes were unclear to them, which raises issues of power and control in acute mental health settings. Conclusions. Nurses should take account of the issues of power and control when administering ‘as needed’ medication. The provision of adequate treatment information should be a priority to enable informed choices to be made about this form of medication. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a study of male nurses’ experiences of providing intimate care for women clients. Background. The number of men entering the nursing profession has increased worldwide. As a consequence of the move to a more gender-balanced profession, debate has ensued over how intimate care should be performed when this requires male nurses to be physically close to women clients. As there was little previous work on this topic, we wished to provide nurses, clients and other healthcare professionals with a better understanding of male nurses’ experiences of working with women clients and within a healthcare system where they often feel excluded. Method. Semi-structured, open-ended interviews were conducted with male nurses working in various clinical settings in Western Australia. Latent content analysis was used to analyse the interviews, which were carried out between June and July 2004. Findings. Three themes were identified: the definition of intimate care, the emotional experience associated with providing intimate care and strategies used to assist in the delivery of intimate care for women clients. Providing intimate care for women clients was a challenging experience for male nurses. Participants described how it required them to invade these clients’ personal space. Consequently, they often experienced various negative feelings and used several strategies to assist them during care delivery. Conclusions. Nurse educators should assist male nurses to be better prepared to interact with women clients in various settings. Furthermore, workplace environments need to provide additional support and guidance for male nurses to enable them to develop effective coping strategies to manage challenging situations. [ABSTRACT FROM AUTHOR]

Aims. This paper reports a study describing home nurses’ intention and current practices regarding introducing assistive devices, and investigating whether their practice is related to social cognitive factors (attitudes, subjective norms and self-efficacy). Background. Home nurses not only care for patients in particular medical domains, but also educate and guide them towards more independence. Patients with age-related disabilities in mobility and self-care might benefit from the use of assistive devices. A home nurse might be the first and only person to discuss the disability and use of an assistive device. Therefore, home nurses’ beliefs about the introduction of assistive devices could affect their daily practices. Methods. A cross-sectional study was conducted with a convenience sample of 64 home nurses chosen from a random sample of home nursing departments. The home nurses completed a self-administered questionnaire. The Theory of Planned Behaviour framework was used to develop the social cognitive measures regarding each of the six steps distinguished in the introduction of assistive devices. Results. Home nurses had positive attitudes and high levels of intention, subjective norm and self-efficacy towards most steps of the decision process to introduce assistive devices. In a multiple linear regression analysis, attitude and self-efficacy predicted intention to introduce assistive devices to older clients with disabilities. Intention was correlated to home nurses’ current practices. Conclusions. The findings suggest that conditions are present to involve home nurses more explicitly in the introduction of assistive devices to their patients. Social cognitive factors should be taken into account when developing interventions that aim to support home nurses to do this. [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]

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]

aranda k. (2005) Journal of Advanced Nursing 51(2), 131–139 Community nurses’ talk of equality and the discursive constitution of selves The aim of this paper is to explore how stories revealed the discursive constitution of particular selves and to consider the implications for future understandings of equality and practice. Equality has long been an objective of most Western healthcare systems, as enshrined in the principles of equal rights to access, treatment and care. Service users, however, continue to experience inequities, oppression and discrimination. These continuing inequalities have resulted in demands for nurses to tackle discrimination and oppression and promote equality in their practice. Semi-structured interviews were conducted with 14 community nurse students and 14 practice teachers from two universities in England in 1998. Discourse analysis was used to interpret the narratives. Community nurses were actively positioning themselves and were being positioned through dominant and competing discourses. Their narratives revealed stories of equality in health care that were contingent upon complex discursively constituted selves. They were found to take up, rework and in some cases subvert and reject dominant subject positions. The implications of these selves are considered in relation to the development of equality and practice. Educationalists and practitioners need to engage with these discourses and diverse selves and begin to develop approaches which remain open to scrutiny and challenge so that specific and localized understandings of equality and practice can evolve. [ABSTRACT FROM AUTHOR]

verpeet e., dierckx de casterle b., van der arend a. & gastmans c.a.e. (2005) Journal of Advanced Nursing 51(2), 188–195 Nurses’ views on ethical codes: a focus group study This paper reports a study exploring nurses’ views on the ‘potential’ content and functions of an ethical code for nurses in Belgium. The term ‘potential’ is used, because Belgian nurses do not have experience with an ethical code. Ethical codes have been developed to guide nurses’ practice and to improve their professional status. Little empirical research, however, has been undertaken to determine nurses’ views on the content and functions of these codes. The available quantitative studies merely give some information on nurses’ (lack of) knowledge and use of their ethical code. No nursing ethical code currently exists in Belgium. Qualitative research exploring nurses’ views, therefore, was needed in order to find out which functions an ethical code could fulfil and what the code's content could be. Eight focus groups were conducted with 50 nurses in different healthcare settings in Belgium. Data were generated during 2003. According to participants, an ethical code could fulfil several functions, including supporting their professional nursing identity (external function) and giving guidelines for nursing practice (internal function). In addition, some aspects of content were mentioned, including nurses’ responsibilities in a relational context: particular attention should be paid to the personality of the nurse and to the specificity of nursing as a relational activity. Most agreement was reached on the ‘ethical’ function of the code, namely guiding nurses’ professional moral practice. Regarding disciplinary use and the need for legalization of the ethical code, on the contrary, opinions were divergent. It is of utmost importance to take into account nurses’ views when developing an ethical code for their profession. This study gave a first picture of the views of nurses themselves. These initial findings should be completed with nurses’ views on the formulation, dissemination and promotion of the ethical code. Such evidence-based development of an ethical code will probably give more guarantees that the code will meet nurses’ expectations and will function optimally. [ABSTRACT FROM AUTHOR]

AIM: This paper reports a study comparing the outcomes of diabetic patients undergoing either early discharge or routine care. BACKGROUND: The hospital is not the best place to monitor the glycaemic control of patients with diabetes with no other morbidity or complications. It is an unnatural environment in which diet is planned and the activity level is low. The hospital is also an expensive place in which to treat patients. METHODS: This randomized controlled trial was conducted in the medical department of a regional hospital in Hong Kong. A total of 101 patients who needed glycaemic monitoring, but who were otherwise fit for discharge, were recruited. The control group continued to receive routine hospital care. The study group was discharged early and received a follow-up programme which included a weekly or biweekly telephone call from a nurse. FINDINGS: When compared with the control group, the study group had a greater decrease in HbA1c at 24 weeks, although the statistical difference was marginal (7.6 vs. 8.1, P = 0.06), a higher blood monitoring adherence score at both 12 weeks (5.4 vs. 3.6, P < 0.001) and 24 weeks (5.3 vs. 3.5, P < 0.001), and a higher exercise adherence score at 12 weeks (5.3 vs. 3.4, P = 0.001) and 24 weeks (5.5 vs. 3.2, P < 0.001). The study group had a shorter hospital stay (2.2 vs. 5.9, P < 0.001), and the net savings were HK$11,888 per patient. CONCLUSION: It is feasible to integrate treatment into the real life environments of patients with diabetes, and nurse-led transitional care is a practical and cost-effective model. Nurse follow-up is effective in maintaining optimal glycaemic control and enhancing adherence to health behaviours. Management of glycaemic control is better done in the community than in the hospital. [ABSTRACT FROM AUTHOR]

AIMS: This paper critiques the deliberative processes used by the discipline panels of an Australian statutory nurse regulating authority when appraising the alleged unprofessional conduct of nurses and determining appropriate remedies. BACKGROUND: Little is known about the nature and effectiveness of the deliberative processes used by nurse regulating authorities (NRAs) disciplinary panels established to appraise and make determinations in response to allegations of unprofessional conduct by nurses. METHODS: A qualitative exploratory descriptive/pragmatic research approach was used. Data were obtained from two case-orientated sampling units: (1) 84 Reasons for Determination made between 1994 and 2000 and (2) a purposeful sample of 12 former and current nurse regulating authority members, nurse regulating authority staff and a nurse regulating authority representative who had experience of disciplinary proceedings and/or who had served on a formal hearing panel. Data were analysed using content and thematic analysis strategies. RESULTS: Attitudinal considerations (e.g. whether a nurse understood the 'wrongness' of his or her conduct; accepted responsibility for his or her conduct; exhibited contrition/shame during the hearing; was candid in his or her demeanour) emerged as the singularly most significant factor influencing discipline panel determinations. Disciplinary action is taken appropriately against nurses who have committed acts of deliberate malfeasance. NRAs may not, however, be dealing appropriately with nurses when disciplining them for making honest mistakes/genuine practice errors. CONCLUSION: Traditional processes used for appraising and disciplining nurses who have made honest mistakes in the course of their work need to be substantially modified as they are at odds with the models of human error management that are currently being advocated and adopted globally to improve patient safety and quality of care in health care domains. [ABSTRACT FROM AUTHOR]

mason s., fletcher a., mccormick s., perrin j.& rigby a. (2005) Journal of Advanced Nursing 50(4), 425–432 Developing assessment of Emergency Nurse Practitioner competence– a pilot study This paper reports a study evaluating baseline competence levels among Emergency Nurse Practitioners using an Objective Structured Clinical Examination. The study also aimed to document change in competence over time and following an educational intervention. Emergency Nurse Practitioners form an increasingly established part of the minor injury service workforce in the United Kingdom (UK). At present, there is no national requirement for them to undergo formal preparation, gain a formal qualification, have continuing professional development or revalidate. Given that it is certain that the use of these professionals to deliver unplanned emergency care will increase in the UK, skill maintenance and extension of skills need to be considered in order to ensure the continued delivery of a quality service. Objective Structured Clinical Examinations aim to test a wide range of knowledge and skills in an objective fashion and can be developed to serve a number of educational requirements. A competence assessment was planned using an Objective Structured Clinical Examination. It was developed following questionnaire consultation with Emergency Nurse Practitioners and also in conjunction with Emergency Department specialists and experts in medical education. The Objective Structured Clinical Examination was piloted with Emergency Department junior doctors. Baseline Objective Structured Clinical Examination assessment was conducted in 2001. An educational intervention followed and then a further Objective Structured Clinical Examination assessment took place in 2002. A total of 17 of 20 Emergency Nurse Practitioners consented to involvement in the study. Comparison of their performance showed a statistically significant overall improvement in performance between the two assessment periods ( P < 0·05). Participant feedback on the experience of undertaking an Objective Structured Clinical Examination assessment was very positive. The assessment process worked well, and provides a framework for competence assessment that can be compared over time, between practitioners and between departments. [ABSTRACT FROM AUTHOR]

AIM: This paper reports a study identifying the criteria chosen by nurses to evaluate whether to use research in practice. This work is part of a larger project on the process of research use by nurses. BACKGROUND: Prescriptive models of research utilization direct practitioners to evaluate a range of criteria to assess the fit of the research to current practice. Criteria relating to the research, task and nursing context are specified, but it is not known whether nurses use these criteria in practice. METHOD: Three different groups of nurse specialists from a number of health care providers in the North West of England were studied. The specialists were involved in a series of meetings at a local university to construct evidence-based policy recommendations for practice. The discussion was analysed to identify the evaluation criteria they used to assess what should be done in the practical setting. FINDINGS: Three sets of evaluative criteria were identified relating to the research, the task and the fit of the task with the nursing context, and included relevance and quality of the research, effectiveness, practicality, effort and the impact of the task on client and staff, feasibility and fit with the status quo, and the availability of nursing control and feedback from practice. Criteria were domain-, task- and context-specific. CONCLUSIONS: Three frames of reference for decisions relating to the use of research are identified: the debate between efficiency and effectiveness in health care, the difficulties of risk management and the responsibility for risk, and research use as a strategy for control in contested arenas. These frames of reference reflect how nurses are judged in a political and organizational context. Attempts to influence research uptake need to take into account how research is perceived and evaluated by practitioners and how it serves their purposes. [ABSTRACT FROM AUTHOR]

The meaning for elders of receiving family careAims. This paper reports a study undertaken to broaden nurse clinicians', policy-makers', and researchers' understandings of what it means to elders to receive family care. Background. The number of older people receiving assistance at home will increase tremendously in coming decades in proportion to the rapidly increasing aged population. Seventy to 80% of the care received by elders is provided by family members. As more elders with fewer family carers are predicted, nursing's insight into the family care phenomenon becomes even more important. The literature contains reports of specific aspects of family care. Most results include reports of elders dreading giving up their independence in the context of Euro-American United States society's highly valued cultural norm of independence. No studies have explored elders' views of the meaning of receiving family care. Methods. Hermeneutic interpretive phenomenology was chosen, and a sample of nine elders (five women and four men) was interviewed. Participants were asked for descriptions of their day-to-day experiences of receiving family care in two to five interviews, and were observed interacting with their family carers in naturalistic settings. Findings. Elders living at home were found to incorporate help from family members comfortably into their lives. They viewed themselves as autonomous and able to maintain balance between autonomy and dependence on loved ones. Conclusions. Receiving family care may have positive meaning for elders, especially when the care is provided within the context of positive relationships with family carers. These findings are in contrast to previous reports. If validated in further research, they could be used to inform practice and policy in health care systems involved in collaborating with families to develop care arrangements for community-living elders. [ABSTRACT FROM AUTHOR]

AIM: This paper reports a study to explore systematically the usefulness of the International Classification of Functioning, Disability and Health to nurses giving patient care. BACKGROUND: The International Classification of Functioning, Disability and Health has a history of more than 20 years. Although this World Health Organization classification offers multidisciplinary use, nurses are not familiar with it. METHODS: Applications of the International Classification for nursing practice were developed and evaluated in a multi-centre project, composed of a series of 10 projects in a variety of settings. These applications were a variety of tools, such as assessment forms, care plans and transfer forms. The study used information from 653 patients, 469 nurses and 178 others (International Classification experts; other professionals with whom nurses communicate or discuss patient data). FINDINGS: Large sections of the International Classification were used in the 10 projects, revealing a predominant focus on body functions (53% of all three-digit codes and corresponding terms used). Although large sections of the Classification were useful in practice applications, some items were identified that could be added, improved or described with more detail. Positive remarks made by nurses referred to the scope of the International Classification, which encouraged assessing beyond a patient's functional impairments. CONCLUSIONS: The International Classification of Functioning, Disability and Health can be a useful tool in classifying and communicating aspects of patient functioning by nurses. A level of moderate detail within the Classification (three-digit level) seems appropriate for most nursing purposes. Our results on items that could be added or improved can serve as input in future revisions of the Classification. Future use of the International Classification should be encouraged, because of its relevance to nursing and its potential for multidisciplinary use in patient care. [ABSTRACT FROM AUTHOR]