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

Aim. This paper is a critique of the use of critical incident technique in nursing and a demonstration of how its development has resulted in inconsistency and confusion. Background. Critical incident technique is used globally by nurse researchers to explore a plethora of nursing issues. Its main strengths are flexibility and adaptability, but its popularity has resulted in ambiguity and confusion. Data sources. A search of the CINAHL database for the period 1956-2007 was performed using the search terms critical incident technique and nursing. Together with hand searching, this produced a total of 59 papers. The papers were analysed according to country of origin, research topic, sample size, data collection method, inclusion/exclusion criteria, data analysis and terminology. We then categorized the results of this analysis depending on similarities and differences in the papers. Discussion. We focus on two areas: methodology and terminology. From a methodological perspective critical incident technique has become inconsistent and in relation to terminology, the diverse language associated with the technique has created confusion. Moreover, issues of rigour may be compromised as a result of this inconsistency. A great deal of inconsistency has been created by nurse researchers' attempts to advance critical incident technique. This has led to confusion, which is not helpful for advancing nursing knowledge. Conclusion. While embracing the continued development of critical incident technique, we advocate a standardized approach to its use. Unless nurse researchers are alert to the methodological and terminological inconsistencies in use of the critical incident technique, it risks becoming an interminable quagmire through which navigation will be impossible. [ABSTRACT FROM AUTHOR]

AIM: This paper explores practical methodological issues which arise from the application of systematic review and meta-synthesis techniques to qualitative research studies in the context of a pragmatic health services research question. BACKGROUND: The emphasis on, and volume of, qualitative research is increasing. As a result, there is a need to integrate and disseminate qualitative research findings. However, relatively little has been written about the methodology of systematically reviewing and meta-synthesizing qualitative research studies, and about the practical issues which arise in the course of these processes. METHODS: A systematic review and meta-synthesis was undertaken of qualitative research studies reporting data relevant to the pragmatic health services research question: 'What factors facilitate or impede role development and/or effective practice as a clinical nurse specialist, nurse practitioner, advanced nurse practitioner or consultant nurse based in acute hospital settings?' FINDINGS: The identification of relevant studies is substantially more time-consuming than the identification of relevant studies for a systematic review of randomized controlled trials. A substantially larger proportion of papers has to be retrieved for full reading. Articles with unclear titles which lack abstracts cannot be dismissed as irrelevant. Study appraisal and data analysis, being iterative processes, are also more time-consuming than the appraisal and meta-analysis of quantitative studies. It may be possible to reduce the frustrations inherent in the distance between the reviewer and the participants in the primary research by using full project reports rather than published articles. CONCLUSIONS: Conducting a systematic review and meta-synthesis of qualitative research studies is a rewarding but demanding activity, and adequate time and resources must be made available. Some recommendations are made which may facilitate those processes. [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]

The aim of this paper is to demonstrate the utility of qualitative methods for nursing research, to this end a case is made for the use of fieldwork methods. The paper focuses upon a study which was concerned with student nurses' accounts of their experience of being learners of nursing. An overview of the students' construction of their nursing world is given and then the discussion moves to one particular aspect described as `nursing in the dark'. This is a conceptual category which deals with the data pertaining to the student's difficulties concerning what they could say to patients. The reader is thus furnished with a substantive as well as a methodological view of the study. The analysis draws upon the work of Glaser & Strauss, both in the attempt to generate ground theory and by reference to their work concerning awareness contexts. [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 conducted to examine whether continuous interface pressure monitoring of postoperative patients in an intensive care unit is feasible in clinical practice. BACKGROUND: The interface pressure between skin and surfaces is generally evaluated for pressure ulcer prevention. However, the intensity and duration of interface pressure necessary for pressure ulcer development remains unclear because the conventional interface pressure sensors are unsuitable for continuous monitoring in clinical settings. METHODS: A total of 30 postoperative patients in an intensive care unit participated in this study in 2006-2007. A sensor was built into a thermoelastic polymer mattress. The whole-body interface pressure was recorded for up to 48 hours. Pressure ulcer development was observed during the morning bed-bath. For analysis, the intensity and duration of the maximal interface pressure was evaluated. FINDINGS: The mean age of the study group was 62.0 +/- 15.4 years. Two participants developed stage I pressure ulcer and blanchable redness at the sacrum. The longest duration of pressures greater than 100 mmHg were 487.0, 273.5 and 275.7 minutes in the pressure ulcer, blanchable redness and no redness groups respectively. CONCLUSION: Continuous monitoring of the intensity and duration of whole-body interface pressure using the KINOTEX sensor is feasible in intensive care patients. [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]

Title. Turkish adaptation of the parental health beliefs scale Aim. This paper reports an adaptation of the English version of the Parental Health Beliefs Scale for use with Turkish parents and an evaluation of its psychometric properties. Background. As a profession, nurses are particularly concerned with cross-cultural influences that affect the health beliefs of populations. Although the international literature describes questionnaires and specific scales in health promotion and health beliefs, adequate Turkish-language instruments are scarce. Therefore, suitable instruments need to be developed or adapted for the Turkish parents. Method. This was a psychometric study. A convenience sample ( n = 257) was recruited in 2003 from parents who attended a primary healthcare centre in Erzurum, Turkey. Translation and back-translation of the original English instrument and content validation by an expert panel were the first two steps. The third step was psychometric testing of the adapted instrument to establish internal consistency, inter-item correlation and construct validity. Data were collected using the Parental Health Beliefs Scale. Socio-demographic data were also collected. The investigators visited the centre every workday, and interviewed the samples. The parents read and self-completed the questionnaire. Findings. Content validity procedure resulted in a final scale that consisted of 20 items. Cronbach's alpha was 0·75. Factor analysis yielded three factors related to chance, internality and powerful others. Conclusion. Although acceptable levels of reliability and validity of the Turkish version of the Parental Health Beliefs Scale for parents were reached, cultural factors appeared to play a role in the applicability of the scale. Further validation research is therefore needed before the scale can be recommended for use in nursing research and practice. [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]

Aims. The aims of this paper are to add clarity to the discussion about paradigms for nursing research and to consider integrative strategies for the development of nursing knowledge. Background. Paradigms are sets of beliefs and practices, shared by communities of researchers, which regulate inquiry within disciplines. The various paradigms are characterized by ontological, epistemological and methodological differences in their approaches to conceptualizing and conducting research, and in their contribution towards disciplinary knowledge construction. Researchers may consider these differences so vast that one paradigm is incommensurable with another. Alternatively, researchers may ignore these differences and either unknowingly combine paradigms inappropriately or neglect to conduct needed research. To accomplish the task of developing nursing knowledge for use in practice, there is a need for a critical, integrated understanding of the paradigms used for nursing inquiry. Methods. We describe the evolution and influence of positivist, postpositivist, interpretive and critical theory research paradigms. Using integrative review, we compare and contrast the paradigms in terms of their philosophical underpinnings and scientific contribution. Findings. A pragmatic approach to theory development through synthesis of cumulative knowledge relevant to nursing practice is suggested. This requires that inquiry start with assessment of existing knowledge from disparate studies to identify key substantive content and gaps. Knowledge development in under-researched areas could be accomplished through integrative strategies that preserve theoretical integrity and strengthen research approaches associated with various philosophical perspectives. These strategies may include parallel studies within the same substantive domain using different paradigms; theoretical triangulation to combine findings from paradigmatically diverse studies; integrative reviews; and mixed method studies. Conclusion. Nurse scholars are urged to consider the benefits and limitations of inquiry within each paradigm, and the theoretical needs of the discipline. [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]

Aim. The aim of this paper was to provide insight into the Delphi technique by outlining our personal experiences during its use over a 10-year period in a variety of applications. Background. As a means of achieving consensus on an issue, the Delphi research method has become widely used in healthcare research generally and nursing research in particular. The literature on this technique is expanding, mainly addressing what it is and how it should be used. However, there is still much confusion and uncertainty surrounding it, particularly about issues such as modifications, consensus, anonymity, definition of experts, how 'experts' are selected and how non-respondents are pursued. Discussion. This issues that arise when planning and carrying out a Delphi study include the definition of consensus; the issue of anonymity vs. quasi-anonymity for participants; how to estimate the time needed to collect the data, analyse each 'round', feed back results to participants, and gain their responses to this feedback; how to define and select the 'experts' who will be asked to participate; how to enhance response rates; and how many 'rounds' to conduct. Conclusion. Many challenges and questions are raised when using the Delphi technique, but there is no doubt that it is an important method for achieving consensus on issues where none previously existed. Researchers need to adapt the method to suit their particular study. [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]

AIMS OF THE STUDY/PAPER: To explore the meaning of nursing time, both as it is represented in the literature and interpreted within nursing practice. To explore how nursing time may be better conceptualized through exploring non-nursing literature and the use of theory derivation. BACKGROUND/RATIONALE: The dynamic of time is one of the most important influences upon nursing behaviour, yet temporal issues have attracted very little attention in the literature regarding nursing practice, theory and research. DESIGN/METHOD: In the course of this literature review an attempt is made, via the process of theory derivation, to clarify the meaning of 'nursing time', and how nursing time is valued and perceived by others. RESULTS/FINDINGS: The literature reveals misconceptions and a lack of value of nursing time, possibly indicative of the dominance of linear models of time (such as clock and calendar time), and the historical ascendancy of medicine and the positivistic sciences over nursing. It is proposed here that nurses exist and practice within nonlinear, complex and parallel temporal worlds; these are considered by examining research data that illustrates a moment in nursing time. Exploring this moment gives an opportunity to introduce some terms and concepts that may be useful in the future conceptualization of nursing time. CONCLUSIONS: It is recommended that attention to such factors as the complex temporal dynamics inherent within health care in general, and nursing in particular, should be considered within the domains of nursing practice and research. This may help in distinguishing the fundamental identity and nature of nursing within health care and health care professions. [ABSTRACT FROM AUTHOR]

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

While scholars in nursing are charged with the responsibility of advancing and structuring a body of knowledge for application in nursing practice, many of the currently utilized theories have been borrowed from other disciplines. Until such knowledge is redefined and synthesized according to the perspective of nursing, borrowed knowledge cannot be adequately understood. The purpose of this paper is to present a comprehensive client-orientated health seeking and coping paradigm. This paradigm is theorized to be a function of 12 factors which include: clients' situational and personal factors, resources, sociodemographic characteristics, cognitive appraisal, health goals, health seeking and coping behaviours, nursing goals and strategies, clients' perceived compliance, clients' perceived coping effectiveness, and immediate and long-term health outcome. The Lazarus Schema of Coping and Adaptation and the Schlotfeldt Health Seeking and Coping Paradigm were the parent conceptualizations from which the Comprehensive Health Seeking and Coping Paradigm (CHSCP) was derived. As a nursing-orientated multidimensional framework, the CHSCP will provide a useful framework for nurses interested in altering, enhancing or promoting the health seeking and coping of clients. By providing an intellectual focus for the initial and ongoing assessment of a multitude of variables which influence health seeking and coping, the specification of appropriate strategies can be developed and enhanced. [ABSTRACT FROM AUTHOR]

Adopting the holistic approach to the definition of nursing as purported by Treece & Treece (1977), this paper presents the findings of the reported efforts of five grades of nursing personnel, directly involved in hospital care in Northern Ireland, to utilize research information in their area of work during the 12 months up to Spring 1979. It draws the conclusion that these groups have not yet begun to identify to any great extent the importance of research to nursing practice, or with the need to devise a process through which research can be implemented and evaluated. [ABSTRACT FROM AUTHOR]

To consider commitment by the nurse requires reflection upon what is the unique and particular role and function of nursing in achieving optimum support for patients requiring the help of health care agencies. Excellence in this role and function can only be judged by the quality of care actually delivered to patients. It is useless to boast of excellent teaching programs, a first class nursing management structure or a flourishing nursing research unit if the standards of nursing practice do not directly reflect the contribution of such agencies. In this paper the author considers the present, apparently subordinate role, of the clinical nurse and suggests that if nurses have a commitment to nursing then they must begin to re-establish the position of the clinical nurse as equal to that of her colleagues in other spheres of nursing. Possible ways in which this can be achieved are outlined together with the support that will be required from colleagues in nursing education, management and research. [ABSTRACT FROM AUTHOR]

The Edinburgh University's Nursing Research Unit, under the direction of a nurse-researcher, was established in October 1971: the first unit of its kind in the United Kingdom, This paper describes its development, philosophy and future strategy. In the first instance attempts were made to identify nursing problems from which a common core of problems was identified. This provided specific pointers for future research activity. The unit offers research training facilities for trained nurses and research appreciation courses have also been provided for nursing students and their teachers. A major bonus to the unit has been the opportunity and facilities for interdisciplinary and collaborative research. The unit's future activities include plans to develop new statistical, computer and data management techniques and information retrieval systems more appropriate to nursing research. [ABSTRACT FROM AUTHOR]

Contributions of nursing research to nursing practice in the USA are increasing rapidly in four major areas: (1) the science of practice; (2) the artistry of practice; (3) the structures needed for optimal delivery of care; and (4) the methodologies needed for measurement and evaluation. Illustrative studies are described in each area, concluding with a plea for implementation of research findings. The authors presented this paper at the Open Forum, National League for Nursing Convention, 21 May 1975, New Orleans, Louisiana, USA, and it was first published In Journal of Nursing Administration (1976) March-April. [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 presents the author's views on her article "Attitudes of Nursing Staff in General Medical Wards Towards Activation of Stroke Patients," which appeared in the 1982 issue of the "Journal of Advanced Nursing." It discusses the significance of the paper in the field of health care. It asserts that the attitudes of carers in society are as important as the attitudes of nursing staff. It also points out that the staff's attitudes matter in the care of stroke-patients.

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

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