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AIM: This paper presents an integrative literature review conducted to describe the utility of the objective structured clinical evaluation (OSCE) as a strategy of measuring one form of clinical competence in nursing. BACKGROUND: The emergence of the OSCE, one form of evaluation of clinical competence used in medicine, is gaining more scrutiny and consideration in nursing education. DATA SOURCES: The review was conducted through an initial search of computerized databases CINAHL, Cochrane Database of Systematic Reviews, Academic Search Premier and MEDLINE for the period from 1960 to 2008. METHODS: An integrative review was performed and 41 papers met the inclusion criteria. RESULTS: The complexities of evaluating clinical competence can be addressed through use of an OSCE process. Concerns related to the conceptual limitations and the lack of psychometric properties of the tools available for measurement in nursing education have been identified. CONCLUSION: Major gaps exist in the nursing literature regarding the examination of the psychometric properties of the OSCE, the suitability of the design of the OSCE structure and tools for nursing to measure clinical competency, and the associated costs in the application of this evaluative method. Research conducted on the psychometric properties of the OSCE tool used and correlations to other evaluative methods currently used to evaluate nursing clinical competence would inform educational practices. [ABSTRACT FROM AUTHOR]

Aim. The aim of this paper is to discuss six issues influencing the introduction of advanced practice nursing (APN) roles: confusion about APN terminology, failure to define clearly the roles and goals, role emphasis on physician replacement/support, underutilization of all APN role domains, failure to address environmental factors that undermine the roles, and limited use of evidence-based approaches to guide their development, implementation and evaluation.Background. Health care restructuring in many countries has led to substantial increases in the different types and number of APN roles. The extent to which these roles truly reflect advanced nursing practice is often unclear. The misuse of APN terminology, inconsistent titling and educational preparation, and misguided interpretations regarding the purpose of these roles pose barriers to realizing their full potential and impact on health. Role conflict, role overload, and variable stakeholder acceptance are frequently reported problems associated with the introduction of APN roles.Discussion. Challenges associated with the introduction of APN roles suggests that greater attention to and consistent use of the terms of the terms advanced nursing practice, advancement and advanced practice nursing is required. Advanced nursing practice refers to the work or what nurses do in the role and is important for defining the specific nature and goals for introducing new APN roles. The concept of advancement further defines the multi-dimensional scope and mandate of advanced nursing practice and distinguishes differences from other types of nursing roles. Advanced practice nursing refers to the whole field, involving a variety of such roles and the environments in which they exist. Many barriers to realizing the full potential of these roles could be avoided through better planning and efforts to address environmental factors, structures, and resources that are necessary for advanced nursing practice to take place.Conclusions. Recommendations for the future introduction of APN roles can be drawn from this paper. These include the need for a collaborative, systematic and evidence-based process designed to provide data to support the need and goals for a clearly defined APN role, support a nursing orientation to advanced practice, promote full utilization of all the role domains, create environments that support role development, and provide ongoing evaluation of these roles related to predetermined goals. [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]

woo h. & twinn s. (2004) Journal of Advanced Nursing 45(6), 595–602 Health needs of Hong Kong Chinese pregnant adolescents The outcomes of adolescent pregnancy have been associated with health risks such as obstetric complications and depression, and educational risks such as school dropout and reduced employment opportunities. These outcomes arise from a range of needs including perceived health needs, which are the focus of this paper. This paper reports a study to identify the perceived needs of Hong Kong Chinese adolescents following confirmation of an unintended pregnancy. An exploratory qualitative approach was used with a purposive sample of 10 Hong Kong Chinese pregnant adolescents. The study was undertaken during their stay in a non-government organization maternal shelter. Semi-structured interviews were used to explore adolescents’ perceptions of their psychological, social and health needs and the extent to which each of these needs was met. Six major categories were identified within the context of need, of which three were related to health needs: acceptance of the pregnancy; psychological reactions to the pregnancy; and use of contraception and health advice. The findings contribute to an understanding of the perceived health needs of Chinese adolescents, in particular those that are culturally determined. Implications for nursing practice indicate the significance of comprehensive health assessments and health promotion strategies to help adolescents increase their knowledge about sexual health and contraception. [ABSTRACT FROM AUTHOR]

Caring from Islamic perspectives is not well versed in Eurocentric nursing literature. There is widespread misunderstanding of the concept and practice of Islam within the context of health care and nursing practice. The areas of contention, in the context of health care systems, are whether the western paradigm to nursing care and management are applicable to Muslims and non-Muslims in both Islamic and non-Islamic countries. What is lacking in some of the conceptual frameworks and models of care is not only the fundamental spiritual dimension of care, but also the significance of spiritual development of the individual towards healing. The focus of this paper is to provide an awareness of Islamic health practices, health behaviours, code of ethics and the framework of Islamic perspectives of caring and spirituality. A brief overview of the Muslim world, the historical development in caring and health and the pillars of the Islamic faith provide the context of the paper. The development of a model of care based on the Islamic perspective is suggested. [ABSTRACT FROM AUTHOR]

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

This paper examines general nurses' views of the nursing record and its routine usage in contemporary hospital practice. It draws on ethnographic data generated on a surgical ward and a medical ward in a single District General Hospital in the United Kingdom (UK). A key research finding was ward nurses' equivocal attitudes to the nursing record. On the one hand, because of its links with the nursing process, the nursing record was highly valued as a symbol of professionalism and ward staff were loathe to criticise it directly. On the other hand, however, the nurses in this study clearly found it difficult to reconcile their professional ideals with the ways in which the nursing record was routinely employed on the wards. In this paper it is suggested that at one level, nurses' ambivalence towards the nursing record reflected the distortion of its founding philosophy by the new managerialism in the contemporary UK health care context. At another level, however, there are also difficulties which arise from the tension between the assumptions about the nature of nursing work which underpin the nursing record and the workplace reality on hospital wards. [ABSTRACT FROM AUTHOR]

Comfort is a term that has a significant historical and contemporary association with nursing. Since the time of Nightingale, it is cited as designating a desirable outcome of nursing care. Comfort is found in nursing science, for example in diagnostic taxonomies, and in references to the art of nursing, as when practice is described. Roy, Orlando, Watson, Paterson and others use comfort in major nursing theories. The term can signify both physical and mental phenomena and it can be used as a verb and a noun. However, because comfort has many different meanings, the reader has had the burden of deciding if the term is meant in one of its ordinary language senses or if its context reveals some special nursing sense. The purpose of this paper is to analyse the semantics and extension of the term 'comfort' in order to clarify its use in nursing practice, theory and research. The semantic analysis begins with ordinary language because the common meanings of the term are the primary ones used in nursing practice and are the origin of technical nursing usages. Comfort is discussed as the term is found in nursing, including texts, standards of care, diagnoses and theory. An account of patient needs assessment is used to cull three technical senses of the term from its ordinary language meanings. After contrasting these senses in order to justify their separateness, they are shown to reflect differing aspects of therapeutic contexts. Defining attributes of the three senses are then explicated and presented in table format. The last section of the paper addresses some of the ways that the extensions of the senses can be measured. [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]

Title. Missed nursing care: a concept analysis. Aim. This paper is a report of the analysis of the concept of missed nursing care. Background. According to patient safety literature, missed nursing care is an error of omission. This concept has been conspicuously absent in quality and patient safety literature, with individual aspects of nursing care left undone given only occasional mention. Method. An 8-step method of concept analysis - select concept, determine purpose, identify uses, define attributes, identify model case, describe related and contrary cases, identify antecedents and consequences and define empirical referents - was used to examine the concept of missed nursing care. The sources for the analysis were identified by systematic searches of the World Wide Web, MEDLINE, CINAHL and reference lists of related journal articles with a timeline of 1970 to April 2008. Findings. Missed nursing care, conceptualized within the Missed Nursing Care Model, is defined as any aspect of required patient care that is omitted (either in part or in whole) or delayed. Various attribute categories reported by nurses in acute care settings contribute to missed nursing care: (1) antecedents that catalyse the need for a decision about priorities; (2) elements of the nursing process and (3) internal perceptions and values of the nurse. Multiple elements in the nursing environment and internal to nurses influence whether needed nursing care is provided. Conclusion. Missed care as conceptualized within the Missed Care Model is a universal phenomenon. The concept is expected to occur across all cultures and countries, thus being international in scope. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to describe nurses' practices, knowledge, and attitudes related to evidence-based nursing, and the relation of perceived barriers to and facilitators of evidence-based practice. Background. Evidence-based practice has been recognized by the healthcare community as the gold standard for the provision of safe and compassionate healthcare. Barriers and facilitators for the adoption of evidence-based practice in nursing have been identified by researchers. Healthcare organizations have been challenged to foster an environment conducive to providing care based on evidence and not steeped in ritualized practice. Methods. A descriptive, cross-sectional research study was conducted in 2006-2007 with a convenience sample of 458 nurses at an academic medical center in California (response rate 44·68%). Two reliable and valid questionnaires were electronically formatted and administered using a secured website. Relationships between responses to the two instruments were examined and results compared with previously published data. Results. Organizational barriers (lack of time and lack of nursing autonomy) were the top perceived barriers. Facilitators were learning opportunities, culture building, and availability and simplicity of resources. Statistically significant correlations were found between barriers and practice, knowledge and attitudes related to evidence-based practice. Conclusion. Similar barriers to the adoption of evidence-based practice have been identified internationally. Educators must work with managers to address organizational barriers and proactively support evidence-based practice. [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 survey to provide an overview of nurse independent prescribing and nurse supplementary prescribing across the United Kingdom. BACKGROUND: Evidence examining the frequency of prescribing by nurses is conflicting, and it is evident that several factors hamper prescribing practice. As of May 2006, legislative changes gave appropriately qualified nurses virtually the same independent prescribing right as doctors. However, there is currently no evidence available about the prescribing practices of these nurses. METHOD: A random sample of 1992 qualified Nurse Independent/Nurse Supplementary Prescribers registered with the Nursing and Midwifery Council was sent a postal questionnaire in 2006. A total of 1400 (70%) questionnaires were returned, of which 1377 were completed. FINDINGS: Eight hundred and ninety-one (65%) respondents worked in primary care, and 333 (24.3%) worked in secondary care. Three quarters of the sample had more than 5-year clinical experience in the area in which they prescribed prior to entering the prescribing programme. One thousand one hundred and seven (87%) participants had used nurse independent prescribing and 568 (44.6%) nurse supplementary prescribing. Restriction of local arrangements, implementation of the Clinical Management Plan and access to doctors hampered or prevented prescribing. CONCLUSION: The adoption of prescribing by nurses in the United Kingdom has increased patient choice with regard to access to medicines. A number of factors which hamper or prevent prescribing require further exploration. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a study to develop a research-informed model of the service parameters and an analysis framework for advanced practice nursing roles. Background. Changing patterns of health care are forcing service planners to examine new service delivery models. Apparent is the call for nursing service that incorporates expanded levels of autonomy, skill and decision-making. A number of nursing roles conform to this description under the generic title of advanced practice nurse. However, there is confusion in the health service community internationally about nomenclature, role and scope for advanced practice nursing roles. An emerging priority in response to recent developments in the nurse practitioner role is to establish service parameters for advanced practice nursing and to differentiate operationally between advanced practice and practitioner nursing roles. Methods. We conducted an interpretive, qualitative examination of the practice of a random sample of nine advanced practice nurses working in three acute care hospitals in south east Queensland, Australia in 2006. Data collection involved individual in-depth interviews, which were deductively analysed and tested against published advanced practice nursing models. Results. The data most comprehensively supported the Strong Model of Advanced Practice as representing the practice experiences of the research participants. This model supports definition of the service parameters and the design of an operational framework for implementation and evaluation of advanced practice nursing roles. Conclusion. The findings differentiate advanced practice nurse and nurse practitioner roles, and offer an operational framework to identify, establish and evaluate advanced and extended nursing positions. Subject to further validation, this outcome can provide operational information for implementing innovative nursing roles appropriate to consumer needs and specific health service models. [ABSTRACT FROM AUTHOR]

Aim. The aim of this paper is to report the development and validation of a self-report measure of knowledge, practice and attitudes towards evidence-based practice (EBP). Background. Evidence-based practice has become increasingly important in health care since the mid-1990s as it provides a framework for clinical problem-solving. However, to date no means exist to quantify the extent to which barriers, such as lack of time in the working day, lack of appropriate skills and negative attitudes, may prevent greater uptake of EBP. Methods. Questionnaire development was based on established psychometric methods. Principal component factor analysis was used to uncover the underlying dimensions of the scale. Internal consistency of the scale was assessed by Cronbach's [alpha]. Finally, construct validity was assessed via convergent and discriminant validity. Results. The final questionnaire comprised three distinct scales (EBP, attitudes towards EBP and knowledge of EBP), which had robust validity and internal reliability. Conclusion. This tool can be used to measure the implementation of EBP. [ABSTRACT FROM AUTHOR]

Aim. The aim of this paper is to report a study conducted to explore the meanings of the lived experiences that Chinese family caregivers in Malaysia ascribed to the care they provided to relatives with severe and persistent mental illness. Background. In the past, many researchers have used quantitative approaches to explore the experiences of family caregivers of relatives with severe and persistent mental illness. However, the results of these studies have been far from conclusive because of serious methodological flaws. In addition, a large majority of these studies were conducted in western cultures, and it has been difficult to transfer the results to family caregivers in oriental cultures. Method. The philosophy of Martin Heidegger underpinned the study. Qualitative data were collected mainly through in-depth interviews with 19 criterion-selected Chinese family caregivers of relatives with severe and persistent mental illness in 2002. Findings. We present the emergent themes reflecting the meaning structures of managing, enduring, and surviving the day-to-day experiences of the Chinese family caregivers. The impact of the stigma of the relatives' mental illness on family caregivers and families is pervasive and strong. As a result, family caregivers tried to avoid talking about their relative's mental illness with extended family or friends in order to protect their families from 'losing face'. In addition, most family caregivers believed that adopting positive behaviours and attitudes helped them cope with caregiving. Conclusion. Mental health nurses need to help Chinese family caregivers to cope with the stresses and stigmas of their relatives' mental illnesses through psychosocial education or family intervention, and to provide them with culturally-congruent care. They should also educate the public about mental health and ill health through health promotion and education. [ABSTRACT FROM AUTHOR]

Aims. This paper reports a study to determine nurses' attitudes towards pain assessment tools and the relationship of these attitudes to education and experience. Background. The issue of pain management is of interest to caregivers nationally and internationally. For example, in the United States of America, the National Health and Medical Research Council set guidelines to assist clinicians in pain management. Research on whether healthcare teams use pain assessment tools has yielded contradictory findings. Methods. Using an open-ended questionnaire developed for this study, which was based on Fishbein and Ajzen expectancy-value model, a convenience sample of 52 nurses on an acute care unit were asked: (1) What do you believe about the assessment of pain? (2) What do you believe about the use of pain assessment tools? and (3) What do you believe about the use of pain assessment tools in improving the patient's outcome? The nurses then rated their attitudes about each belief and how each belief made them feel. The data were collected in 2003. Results. When Fishbein and Ajzen's formula for calculating attitude was used, attitude scores ranged from -6 to 28 with an overall mean score of +8·3. The amount of education and experience of each nurse and the attitude measure in regard to the use of pain assessment tools were compared. Conclusions. The Fishbein and Ajzen model provides a useful way to obtain information on the attitude of nurses towards the use of pain assessment instruments. To provide further information, this study with an open-ended instrument should be followed with a fixed-response survey with a larger sample size and in various settings. [ABSTRACT FROM AUTHOR]

Aim. This paper reports on the second phase of a national study in Wales. The research aimed to assess the level of Welsh language awareness amongst healthcare professionals across Wales, and to identify the factors that enhance language choice within service delivery. Background. The literature suggests that language sensitive healthcare practice is central to ensuring high quality care. However, it is evident that language barriers continue to compromise the quality of care within nursing and other health services. One issue that has received little attention is the level of language awareness that healthcare professionals currently demonstrate. Furthermore the factors that influence language choice for bilingual/multilingual speakers are not well explored in the literature. Methods. The study involved semi-structured interviews with a range of healthcare professionals in acute and community settings across Wales. Using a systematic sampling matrix, a purposeful sample of 83 professionals was selected to participate. Twenty-seven of the respondents were nurses, health visitors and midwives. The interviews focussed on the factors that facilitate or impede language sensitive healthcare practice. All interviews were audiotaped and, using a framework analysis approach, conceptual codes were developed and defined and categories and sub-categories were constructed to create thematic charts. Findings. Three main themes were identified: care enhancement, which focussed on the process and outcome of offering language choice to bilingual patients; organizational issues, which reflected issues relating to the infrastructure of service provision; and training implications, which focused on Welsh language learning in health care. Conclusions. Complex dynamics of language use are in operation within bilingual healthcare settings and organizational as well as individual factors are important in facilitating appropriate language use. Many of the issues highlighted are not peculiar to the Welsh context, but apply to healthcare settings across the world, where other minority languages are in use. [ABSTRACT FROM AUTHOR]

Aims. This paper presents the experiences of nurse practitioners and family physicians working in collaborative practice at four Canadian rural primary care agencies. It focuses on the qualitative segment of a larger study examining the impact of an educational intervention on interprofessional practice. Background. Growing awareness of the importance of health promotion and disease prevention, the increased complexity of community-based care, and the need to use scarce human healthcare resources, especially family physicians, far more efficiently and effectively, have resulted in increased emphasis on primary healthcare renewal in Canada. Key to primary healthcare renewal is care delivery through interdisciplinary teams that include nurse practitioners. Methods. Narrative analysis, a form of interpretive analysis that respects the integrity of the stories told by participants, was chosen as the strategy to examine the narrative data gathered in two sets of interviews with the nurse practitioners and family physicians. The study was undertaken during 2000. Results. Thirteen family physicians and five nurse practitioners with diverse educational backgrounds and varied experience with collaboration participated in the qualitative component of the study. A number of issues related to working in a shared practice were identified in nurse practitioner and family physician interviews across the research sites. The themes identified in participants' stories included issues related to the scope of practice, emphasizing the importance of role clarity and trust, the ideological difference regarding disease prevention and health promotion, differences in perceptions about the operation of collaborative practice, and the understanding that collaborative relationships evolve. Conclusions. The placement of nurse practitioners and family physicians in a common clinical practice without some form of orientation process does not produce collaborative practice. Educational strategies related to role expectations are necessary to facilitate the development of care delivery partnerships characterized by interdependent practice. [ABSTRACT FROM AUTHOR]

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

This paper discusses a number of different levels at which the implementation of nursing research findings needs to be addressed and identifies 10 areas of potential difficulty: the complexity of the change process, the genesis of research programmes, the formulation of research questions, differences in theoretical approaches, timescales and planning cycles, information overload, credibility, applicability, response to change and the management of change. An attempt is made to shift the nature of the discourse from the personal to the organizational and from a diffusionist perspective to that of change management. It is suggested that it is simplistic to regard the apparent lack of take-up of research-based practice findings as a failure on the part of individual nurses to respond rationally to the production of new information. The integration of research and practice has to be addressed at all levels within an organization; from policy statements to procedure manuals and from managers, educators and clinicians to support workers within the framework of the management of change. The potential of action research and quality circles in this context is touched on. [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]

AIMS: The aim of this paper is to report a trial to investigate the feasibility of the nurse practitioner role in local health service delivery and to provide information about the educational and legislative requirements for nurse practitioner practice. BACKGROUND: Nurse practitioners have been shown to offer a beneficial service and fill a gap in health care provision. However, the lack of publications describing, critiquing, or defending the way that existing nurse practitioner roles have been developed may lead to a lack of clarity in comparing the nurse practitioner scope of practice internationally. In Australia, credible exploratory research is needed to realize the potential of nurse practitioners to bridge the divide of inequitable distribution of health services. A trial of nurse practitioner services in the Australian Capital Territory provided an excellent opportunity to investigate these scope and continuity issues. METHODS: This was an observational analytic study using multiple data sources. Four models of nurse practitioner service were chosen from a competitive field of applications that were evaluated according to efficacy, feasibility, and sustainability across specified selection criteria. Each model in the trial included a clinical support team, with the nurse practitioner candidate 'working-into-the-role' and collecting demographic, clinical practice, patient outcome, and health service and consumer survey data over a 10 month period. FINDINGS: The trial identified the broad potential of the nurse practitioner role, its breadth and limitations, and its impact on selected health services in the Australian Capital Territory. Data from individual models were compared highlighting generic elements, and formed the basis for the development of the scope of practice for the Australian Capital Territory nurse practitioner models. CONCLUSIONS: This study has validated a research-based, iterative process for initial development of nurse practitioner scope of practice for any Australian specialization. Importantly, the study concluded with the scope of practice as a finding, rather than commencing with it a priori. Although general areas of health care need and under-servicing were identified at the outset, the process tested both the expansion and parameters of the roles. [ABSTRACT FROM AUTHOR]

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

carter h., macleod r., brander p. & mcpherson k. (2004) Journal of Advanced Nursing 45(6), 611–620 Living with a terminal illness: patients’ priorities Our understanding of terminal illness and its consequences has been predominantly based on models derived from expert definition, rather than the patient's perspective. More recently, quality of life tools have been developed to enable patient choice in responses. However, an even broader approach may be needed to help identify goals for care for patients who are terminally ill. The aim of this paper is to report on an exploratory, qualitative study exploring what people living with terminal illness considered were the areas of priority in their lives. Ten people living with terminal cancer were interviewed. Analysis of the interviews incorporated principles of narrative analysis and grounded theory. Over 30 categories were identified and collated into five inter-related themes (personal/intrinsic factors, external/extrinsic factors, future issues, perceptions of normality and taking charge) encompassing the issues of importance to all participants. Each theme focused on ‘life and living’ in relation to life as it was or would be without illness. Practical issues of daily living and the opportunity to address philosophical issues around the meaning of life emerged as important areas. The central theme, ‘taking charge’, concerned with people's levels of life engagement, was integrally connected to all other themes. The findings suggest that the way in which health professionals manage patients’ involvement in matters such as symptom relief can impact on existential areas of concern. Understanding patients' perspectives in relation to each theme may assist health professionals to develop management strategies appropriate to their needs. The findings challenge some aspects of traditional ‘expert-defined’ outcome measures. As this was an exploratory study, further work is needed to test and develop the model presented. [ABSTRACT FROM AUTHOR]

berkhout a.j.m.b., boumans n.p.g., van breukelen g.p.j., abu-saad h.h. & nijhuis f.j.n. (2004) Journal of Advanced Nursing 45(6), 621–632 Resident-oriented care in nursing homes: effects on nurses In a resident-oriented care model the assignment of patients to primary nurses takes place. These primary nurses are responsible for the total nursing care of their patients and make use of the nursing process. According to job demand-control models, these enlarged and enriched jobs can be described in terms of autonomy, job demands and social support, and the presence of these work characteristics has a positive influence on workers’ psychological and behavioural outcomes. This paper reports a study to investigate the extent to which the various features of resident-oriented care were implemented and its effects nurses’ on work characteristics and on psychological and behavioural outcomes in three Dutch nursing homes. In a quasi-experimental design, experimental and control groups were followed over 22 months, using a pretest and two post-tests with questionnaires, interviews and qualitative observations. The quantitative data showed significant increases in resident assignment, the two variables measuring the nursing process and, in the psycho-geriatric experimental group, on resident-oriented tasks. The qualitative data showed that a partly task-oriented division of labour was still used and that the planned delegation of coordination tasks to primary nurses was not fully achieved. Effects on work perceptions were limited. After implementation of the new system, the experimental group showed an increase in job autonomy. The intervention appeared to be only partly successful. Most of the expected results regarding work characteristics and psychological and behavioural outcomes did not materialize. Theoretical and methodological reflections are presented in the light of these findings. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although nurses depend heavily on informal family caregivers to provide care to clients and to be involved in care planning and decision-making, no nursing theories that include the client, the caregiver, and the nurse were available to guide collaborative care planning and decision-making. AIM: The purpose of this paper is to describe the construction and initial testing of the theory of collaborative decision-making in nursing practice for a triad. The theory represents an extension of Kim's theory of collaborative decision-making in nursing practice. Kim's theory was developed to describe and explain collaborative decision-making in a dyad (client and nurse). The inclusion of a third person (family caregiver) in the theory required the addition of concepts about the caregiver, coalition formation, and nurse and caregiver outcomes. The expansion of Kim's dyadic theory to a triadic theory was achieved by means of a modified version of the theory derivation process described by Walker and Avant. CONCLUSIONS: The theory of collaborative decision-making in nursing practice for a triad can be used to guide further research and clinical practice. The theory provides a framework for researchers who are interested in studying the effects of collaboration regarding decision-making among nurses, family caregivers, and clients. The initial testing of the new theory in home health care nursing revealed variety in the nature of the client-caregiver-nurse relationships, the many processes used by the nurses in proceeding with the home visits, a multitude of decisions considered and different collaborative, noncollaborative, and coalition-forming interactions. The limited evidence of the empirical adequacy of the theory precludes development of definitive guidelines for clinical practice at this time. More studies are required before clinical practice guidelines can be developed. [ABSTRACT FROM AUTHOR]

This paper addresses developments regarding new pharmacological treatments for people with Alzheimer's disease such as Donepezil and Rivastigmine. Following a brief discussion of the experience of people in the early stages of Alzheimer's disease, the pharmacology associated with these new treatments is outlined. The implications of these treatments for nurses working with this client-group are fully discussed within the context of assessment, treatment and cessation. It is argued that nurses have an important contribution in the management of these treatments and recommends that descriptive and evaluative research should be undertaken relating to this new specialist area of nursing care. [ABSTRACT FROM AUTHOR]

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

Over the past decade there has been an explosion of interest and activity in the nursing profession directed toward the development of a theory base for nursing education and practice. Although we support the overall thrust of nursing theory development, we have concerns about its utility, scope and stated purposes. We are especially sensitive to the plight of the practising nurse who might attempt to use the current nursing theories to guide and explain choices made in daily practice. In this paper we examine current use of the word 'theory' and describe problems inherent in nursing's efforts to apply educationally derived conceptual frameworks to nursing practice. We identify a need for the development and use of many theories for nursing and argue that there is a logical need for a 'meta-model' which will guide the use of multiple theories in practice. A model is presented which allows the practising nurse to examine the various theories in terms of their applicability to a given client situation. We believe the model is also useful to nurse educators and researchers who may be attempting to use nursing theories for educational purposes or develop nursing's knowledge base through empirical work. [ABSTRACT FROM AUTHOR]

The section comments on the article "Putting Nursing Research Findings into Practice: Research Utilization As an Aspect of the Management of a Change," by J. M. MacGuire, which appeared in the 1990 issue of the "Journal of Advanced Nursing." It comments on how MacGuire explored issues analytically in the paper. It asserts that MacGuire's analysis strangely framed much of the discourse on evidence utilization. It further points out that much of the paper is as true of professional practice in 2005 as it was in 1990.

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 opening sentence of the paper which suggests that empathy has been touted as appropriate and desirable. It asserts that the paper is unsatisfying and, from a contemporary perspective, seems naive. It states the reasons for the paper's lack of substance.

The section presents the author's opinion on her article "Learning for Reality," which appeared in the 1976 issue of the "Journal of Advanced Nursing." It discusses the challenges the author faced while writing the paper. It describes the state of nursing education in the early 1970s when the research was undertaken. The significance of the study was mentioned.

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.