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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. 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]

How can we achieve evidence-based practice if we have a theory–practice gap in nursing today? ¶The purpose of this paper is to discuss how nursing can achieve evidence-based practice when a theory–practice gap exists in nursing today. The paper commences with an introduction to the concept of evidence-based practice and a discussion of the relationships between theory, practice and the theory–practice gap. An analysis of the two concepts will then be presented from within the four pillars of nursing, namely management, practice, research and education. The paper will conclude with a discussion of whether evidence-based practice can be achieved in view of the theory–practice gap. [ABSTRACT FROM AUTHOR]

In this paper the constructs `stress' and `coping' as defined in an earlier paper (Clarke 1984) are used as a perspective for the interpretation of disease processes. The second half of the paper is devoted to an examination of the nurse's role which is seen as concerned with helping patients in the reduction or avoidance of stress and the strengthening of coping. General hospital nursing and district nursing is analyzed in greater depth than other types of nursing. [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]

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]

This paper addresses the place, position and potential of what is characterized as the `Learning Resources Movement' in nurse education. It is based on experiences drawn from 10 years viewing resource use in general and nursing education, and, more recently, on observations arising from a research project looking at the growth within the school of nursing, of organizational structures for their development. It dims that the true potential of the movement has nowhere been fully realized It sees the present position as indeterminate and misconceived It claims that further development of such resources as are and will be available is intricately tied up with the professional development of nursing in a `chicken-and-egg' situation. It argues that the stage has now been reached where the successful development of the one cannot proceed without the successful development of the other. Drawing on a fairy-tale analogy the paper views the Learning Resources Movement as a powerful tool for seeing through the shining surfaces of what to many are new curricular clothes and dealing with the basic truths of the situation underneath. [ABSTRACT FROM AUTHOR]

This paper is concerned with the evaluation of a workshop for teachers of nursing devoted to an individualized teaching and learning strategy. The paper gives a brief account of the history of such workshops and continues by defining individualized teaching. Following this the characteristics of the Keller Plan strategy are outlined. This is followed by details of the course organization; its aims and objectives, and the characteristics of the course members. Finally, the method of evaluation is described and results are discussed. [ABSTRACT FROM AUTHOR]

The proposition of this paper is principally that if the term 'reassurance' is used by nurses its meaning should be clearly stated and the methods by which it may be achieved should be clearly identified. The author begins by attempting to identify a workable definition of the term and by arguing a case for taking the approach that it is a nursing interpersonal skill rather than a nursing psychotherapy. Using this as the basis for the rest of the discussion he then suggests that as an interpersonal skill it is open to analysis and behaviours can be identified which help to achieve a restoration of the patient's confidence. Further to this, learning objectives are stated in the hope that the concept of reassurance can be seen as a skill which can be enhanced by educational processes. Full competence in the use of interpersonal skills is not a stable feature in all human beings; in every individual nurse there is scope for the development and training of interpersonal skills. Finally, the author attempts to achieve the major aim of the paper--stating nursing actions which may be employed in order to achieve this reassurance of the patient. [ABSTRACT FROM AUTHOR]

This paper offers an ideal type process which considers any patient, his intimates and hospital chaplain in the wider setting of personal care. It calls attention to an important aspect of patient care which offers a starting point from which to begin assessing the needs of any patient from a complementary perspective. The paper reveals two important consequences of the features of any patient situation for the structuring of whole patient care. The first is that the ill person can be susceptible to certain fundamental characteristics which bring him face-to-face with situations in which established practices display an insufficiency for providing mechanisms of adjustment. The second is that spiritual support can be a most important mechanism of adjustment to the aleatory and frustrating facts of these basic characteristics of the patient's existence. Also, it is not only that the ill person may have a need to be helped in this way, but that the appropriate general pattern of action in regard to the source of help is often related to evaluation by nursing and other health service personnel--who are inexpert in this field of care--of the general requirements of any patient situation. This evaluation may have important consequences regarding the completeness of patient care. [ABSTRACT FROM AUTHOR]

GAVIN J.N. (1997) Journal of Advanced Nursing 26, 692-697 Nursing ideology and the 'generic carer' A review of the concept of ideology in a nursing context is presented. The meaning of a nursing ideology is explored and that meaning compared to the proposals for the future of nursing contained in the 1996 report on The Future Healthcare Workforce published by the University of Manchester, England. The paper suggests a number of core beliefs and values that are generally supported in nursing and their implications for the future development of the profession. These include a commitment to the role of science in nursing, the concept of caring in nursing practice and the continued pursuit of the professional project. The paper will demonstrate the extent to which the proposals contained within the report for a 'generic carer' compliment or conflict with the suggested ideology of nursing. It concludes with a reference to the policy-making process at local and national levels and the opportunities available to nurses to influence the direction of change. The paper reflects the volatility of the current political climate in health care and the extent to which nurses operating in that climate feel empowered or disenfranchised. [ABSTRACT FROM AUTHOR]

This paper discusses the way in which quality of care has been measured and in particular draws attention to the vagueness of concepts such as autonomy, individuality and dignity. In our research we have put forward a number of indicators for the quality of care received by patients and, in addition, we have constructed a method by which they can be measured, through the use of standardized observation schedules. This paper therefore describes our indicators and the data collection process followed. This aspect of our work is part of a larger study into work satisfaction and quality of care in psychogeriatric wards in Scotland. Ultimately, the data will allow us to identify factors affecting high and low levels of job satisfaction as well as factors influencing good and bad quality of care. Further, we will be able to examine any association between work satisfaction and the quality of care delivered to patients. The results of this research are due to be published shortly. [ABSTRACT FROM AUTHOR]

The development of community care policy and the inadequacies of professional responses to the needs of informal carers were described in an earlier paper. A qualitative analysis of carers' replies to a questionnaire survey demonstrated that the most potent stressors, contrary to what has previously been assumed, were linked more to subjective perceptions of events or circumstances than to the objective features of the events and circumstances themselves. This paper presents a quantitative analysis of data from the same survey which confirm the impressions gained from the analysis of the qualitative data. These findings prompt a reconceptualization of carer burden within a transactional model of stress, which is then considered as a basis for understanding how carers adapt to stress in their lives. Practice implications are assessed. [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 is concerned with the phenomenon of human suffering and is an attempt to justify and begin theoretical development of this phenomenon for nursing science. The paper is divided into three sections. The first section describes the interest of nursing science in the phenomenon and critically examines relevant literature in order to further conceptualize development and clarification. This section concludes with a theoretical definition of suffering derived from this critique. Suffering is defined as an individual's experience of threat to self and is a meaning given to events such as pain or loss. The second section elaborates on this definition and examines how it can inform theoretical discussion in two areas with import for nursing -- the patient's experience of suffering and the nurse's experience of patient suffering. The final section briefly considers some implications for clinical research. [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]

Aim. This paper is a report of a study to evaluate the influence of interdisciplinary seminars for undergraduate nursing and social work students on development of their understanding of the meaning of caring. Background. There is growing international interest in interprofessional education, which is believed to have the potential to improve patient care. If interprofessional education and subsequent collaboration are truly to be patient-centred, it is important to identify a value base which creates a healthcare professional identity that facilitates collaboration. Caring, as a humanistic value, is found in both nursing and social work professionals. Method. A mixed method approach, primarily qualitative but with a quantitative component, was chosen for evaluation of the interprofessional seminars. The data were collected between 2007--2008 by videotape recordings of the sessions, followup telephone interviews and a questionnaire. Findings. There was cultivation in the nursing students of a deeper understanding of caring based on openness and a non-judgmental approach, learned from their social work counterparts. Reciprocally, social work students learned about the nursing students' daily activities as they observed the natural process of trust and communication in the context of caring. Conclusion. Enhanced understanding of caring in practice is not possible via learning through a uni-professional approach. Students' reflections and dialogue enable their development of relation-centred caring, particularly in the realm of biomedical and technical environments. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a concept analysis of letting go within the context of family caregivers and end-of-life care. Background. The term 'letting go' has been used in an informal manner by nurses and other clinicians working with patients and families with terminal illnesses to depict a lack of acceptance of a loved one's impending death. Data sources. The CINAHL, Ovid Medline and PsychInfo databases were searched for the period of 1995-2007 for literature published in English in peer-reviewed journals from a variety of disciplines, using the specific keywords letting go or to let go. Methods. The Walker and Avant method of concept analysis was used, and the study was guided by Zerwekh's family caregiving model of core competencies for hospice nurses. Results. Letting go before the death of a loved one involves a shift in thinking in which there is acknowledgement of impending loss without impeding its natural progression. An emotional attachment and recognition that everything has been carried out usually precede the concept, followed by a peaceful death and acknowledgement of change. Conclusion. The concept of letting go has been explored in many contexts but the core essence of the awareness and work towards the acceptance of an impending loss appears to be a universal domain. Research is needed to further explore and identify patterns of this phenomenon in family caregivers in the context of death of a loved one. [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]

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 an evaluation of the use of case study methods, drawing on three research studies conducted by the authors in end-of-life care and bereavement. BACKGROUND: Case study methods have their origins in social anthropology and draw on the principles of naturalistic inquiry. They have been used in a number of disciplines, including qualitative sociology, management science, education and organizational psychology for the understanding and evaluation of complex social systems. They are an appropriate research design for examining processes and outcomes in dynamic healthcare organizations, where it is important to obtain multiple perspectives. METHOD: We explore issues in case study research design, recruitment and data collection drawing on three studies conducted between 2000 and 2005 in six community hospitals, five adult hospice bereavement services and eight childhood bereavement services in the United Kingdom. Quantitative and qualitative data were collected using interviews, focus groups, observations, documentary analysis, standardized measures and questionnaires. DISCUSSION: The process of case study design is described, including building upon a clear rationale for the selection of cases, collection of data, preparation of single case reports, cross-case analysis and interpretation. In a critical discussion of recruitment, we recommend identification of a key contact person at each site to facilitate access and minimize misunderstanding, disruption to clinical services and 'gate-keeping'. Three principal methods of data collection: interviews, observation and documentary data analysis form the foundation of the rich data set necessary to explore cases in their situational contexts. CONCLUSION: Case study methods may be empowering for participants because they value their experiences and reveal how their work contributes to teamwork within organizations. They can therefore be both affirming and challenging, as they may expose both conflicts and tensions. [ABSTRACT FROM AUTHOR]

The section introduces several papers which deal with issues and innovations in nursing practice.

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. 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]

Aims. This paper reports a study that aimed to determine Nigerian nurses' knowledge, attitudes and overall level of comfort in giving nursing care to acquired immune deficiency syndrome patients; determine the relationship between these variables; and identify the sociodemographic variables that influence nurses' attitudes and how comfortable they are giving nursing care to patients with acquired immune deficiency syndrome. Background. There is little information on sub-Saharan African nurses' knowledge, attitude and feeling of comfort in providing care to patients living with acquired immune deficiency syndrome. Methods. Two hundred and seventy-seven nurses in two teaching hospitals and two general hospitals in Nigeria were surveyed in 2003. The survey questionnaire had two parts. Part I elicited demographic information and information on previous encounters with acquired immune deficiency syndrome patients and Part II consisted of three subscales assessing knowledge, attitude and level of comfort administering certain nursing procedures to acquired immune deficiency syndrome patients. Results. Respondents demonstrated low levels of knowledge and poor attitudes towards people with acquired immune deficiency syndrome. Attitudes appeared to be influenced by the nurse's speciality, rank, prior education and experience with patients with acquired immune deficiency syndrome. The responding nurses showed low levels of comfort in giving care to patients with acquired immune deficiency syndrome. Conclusions. The findings suggest that Nigerian nurses will hesitate to care for patients with acquired immune deficiency syndrome, and that there is potential for avoidance behaviour towards them. Periodic continuing education and curriculum enhancement to include clinical clerkship, structured experience, guided discussion on ethical scenarios and attitude exploration are suggested in order to achieve and maintain adequate knowledge and a positive attitude. University-based professional and postprofessional nursing education, which could enhance acquisition of a broad knowledge base, therefore represents the future direction. [ABSTRACT FROM AUTHOR]

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

AIM: The aim of this paper is to explicate the concept of complex adaptive systems through an analysis that provides a description, antecedents, consequences, and a model case from the nursing and health care literature. BACKGROUND: Life is more than atoms and molecules--it is patterns of organization. Complexity science is the latest generation of systems thinking that investigates patterns and has emerged from the exploration of the subatomic world and quantum physics. A key component of complexity science is the concept of complex adaptive systems, and active research is found in many disciplines--from biology to economics to health care. However, the research and literature related to these appealing topics have generated confusion. A thorough explication of complex adaptive systems is needed. METHODS: A modified application of the methods recommended by Walker and Avant for concept analysis was used. FINDINGS: A complex adaptive system is a collection of individual agents with freedom to act in ways that are not always totally predictable and whose actions are interconnected. Examples include a colony of termites, the financial market, and a surgical team. It is often referred to as chaos theory, but the two are not the same. Chaos theory is actually a subset of complexity science. Complexity science offers a powerful new approach--beyond merely looking at clinical processes and the skills of healthcare professionals. CONCLUSION: The use of complex adaptive systems as a framework is increasing for a wide range of scientific applications, including nursing and healthcare management research. When nursing and other healthcare managers focus on increasing connections, diversity, and interactions they increase information flow and promote creative adaptation referred to as self-organization. Complexity science builds on the rich tradition in nursing that views patients and nursing care from a systems perspective. [ABSTRACT FROM AUTHOR]

AIM: This paper describes gender differences in perceived coping, social support and quality of life 1, 4 and 12 months after myocardial infarction. BACKGROUND: There is a shortage of studies with a longitudinal research design investigating coping, social support and quality of life in women and men after myocardial infarction. METHODS: A longitudinal, descriptive and comparative design was used for the study, which included 74 women and 97 men. At 12 months, 60 women and 88 men remained. Data were collected using the Jalowiec Coping Scale, a social support questionnaire, the SF-36 Health Survey (health-related quality of life) and the Quality of Life Index-Cardiac version (quality of life). The data were collected during the period 1999-2001. RESULTS: No statistically significant changes over time in coping assessments emerged in the study group, except for fatalistic coping, which diminished over time in men. Women used more evasive coping than men at 4 and 12 months. The perceived efficiency in coping with physical aspects of the heart disease increased. More women than men perceived available support from grandchildren and staff of the church. Health-related quality of life increased in women and men in physical functioning, role-physical, vitality, social functioning, and role-emotional scales. Moreover, an improvement in the mental health scale was evident in women and a reduction in pain in men. No statistically significant gender differences were found for quality of life at any point in time. CONCLUSIONS: The findings can be used to inform caregivers that optimistic, self-reliant and confrontational coping were the most frequently used by both women and men over the first year after myocardial infarction, and that confrontational coping has been shown to have positive outcomes in the longer term. Nurses should tell women about the importance of seeking prompt treatment and discuss health problems with caregivers and significant others. Care planning should include family members and significant others so that they can support and encourage patients to cope with problems in daily life. [ABSTRACT FROM AUTHOR]

The aim of this paper is to consider alternative approaches to service delivery for patients with chronic life-limiting illnesses other than cancer. It will also discuss the issues that arise when considering specialist palliative care services within a broader public health context in the United Kingdom. Contemporary specialist palliative care in the United Kingdom can be said to have two main client groups: the majority are people with a diagnosis of cancer, and a minority are those with a number of other chronic illnesses. From the evidence to date, patients dying from chronic, non-malignant disease experience a considerable number of unmet needs in terms of symptom control and psychosocial support. Although debates in the literature over the last decade have challenged the focus of specialist palliative care services on patients with a cancer diagnosis, only a minority of those with other chronic illnesses receive specialist palliative care services. Current models of specialist palliative care may not be the most appropriate for addressing the complex problems experienced by the many patients with a non-cancer diagnosis. We suggest that care should be structured around patient problems, viewing specialist palliative care as a service for those with complex end of life symptoms or problems. A role for innovative nurse-led care is proposed. Reframing the approach to specialist palliative care in the United Kingdom will require great effort on the part of all health and social care professionals, not least nurses. Critical and creative thinking are prerequisites to the development of new models of working. We suggest that a more coherent approach to research and education is required, in particular strategies that explore how patients and nurses can work together in exploring experiences of illness in order to develop more proactive approaches to care. [ABSTRACT FROM AUTHOR]

AIMS: This paper reports a study to evaluate caregiving demands among mothers and fathers of children with cancer, parents' well-being, and how the parents perceive the health status of their child over a period of 18 months. BACKGROUND: Cancer among children has psychological impact on all family members. Most previous research has focused on distress, coping patterns and social support, and less is known about how parents are dealing with the illness experience over time. No study was found that evaluated caregiving on a daily basis, or the impact of the cancer on wellbeing and perceptions of health within families. METHODS: Data were collected between 1999 and 2001. Parents of 26 Icelandic children under 18 years with cancer completed questionnaires about caregiving activities, general wellbeing and health perceptions. Descriptive statistics and Repeated Analyses of Variance were conducted at baseline, 12 and 18 months. RESULTS: The most time-consuming and difficult caregiving activities for both mothers and fathers were giving emotional support to the child with cancer, and to other children in the family. Mothers also found it difficult and time-consuming to manage behavioural problems and to structure and plan activities for the family. Fathers found it difficult to manage work and organize care for the child at the same time, and to give their partner emotional support. When evaluated over time, mothers' caregiving demands differed statistically significantly from fathers', and fathers' caregiving demands and health perceptions changed statistically significantly over the 18 months of the study. CONCLUSION: These findings underline the long-term impact of children's cancer on their families. Interventions focusing on emotional support, parents' wellbeing, and how families perceive the health of their child with cancer might benefit the family as a whole. [ABSTRACT FROM AUTHOR]

AIMS: The paper reports a study whose aims were to explore the meaning of participation for older people in hospital and their health care workers and ways in which staff can enhance patient participation in their care. BACKGROUND: Participation in care is a concept that is central to nursing practice. However, little is known about patient and staff views of participation and how it takes place in practice. METHODS: Action research was used, and data were collected by means of focus groups and in-depth interviews. Three focus groups and 24 interviews were undertaken with staff, and 19 interviews were undertaken with patients. The main action undertaken with staff aimed at raising their awareness of participation. In addition small changes in practice were introduced, such as the use of a patient biographical booklet. FINDINGS: The findings suggest that participation is a dynamic process that is integral to the work of nurses and carers. The process is enacted through the themes of facilitation, partnership, understanding the person, and emotional work. CONCLUSION: The study demonstrates how nurses can become increasingly aware of the potential for facilitation and creation of opportunities for participation. It is crucial that practitioners working with older people develop a deeper understanding of participation and are also empowered to act in ways that fit with the needs of this specific client group. [ABSTRACT FROM AUTHOR]

AIMS: This paper presents findings from telephone interviews completed with link nurses 2 years into the project to explore how participation progressed achievement of evidence-based practice where the link nurses worked. BACKGROUND: In 2001, an innovative practice development initiative was launched in Scotland. A national network of experienced nurses from across the country was recruited to form the inaugural Community of Practice. This involved describing gerontological nursing, pioneering a nurse-sensitive methodology to craft care guidance that reflects the agreed practice model, and constructing a virtual college based on a situated learning model. METHODS: A volunteer sample of link nurses took part in telephone interviews exploring experiences of using the virtual college and the extent to which the description of gerontological nursing and the first best practice statement on nutrition had influenced practice. FINDINGS: Five components (themes) were identified as facilitating the attainment of evidence-based practice. These focussed on confidence-building and the positive benefits of achieving vision and clarity for gerontological nursing. Membership of a national Community of Practice afforded status and strengthened sense of professional identity. The inclusive knowledge synthesis methodology used to prepare, pilot and support implementation of the best practice statement was highly valued. Progress towards evidence-based practice in all affiliated areas was reported. Major challenges for nurses in participating in the virtual college included the absence of a learning-at-work culture, lack of time and doubts about the legitimacy of internet-based learning. CONCLUSION: The evaluation indicates the potential merits of e-practice development, particularly for nurses who feel geographically and professionally isolated or disenchanted with available continuing professional development opportunities. Participation in the virtual college appeared to enrich practice and foster a culture of change. [ABSTRACT FROM AUTHOR]

baker j.a., richards d.a.&campbell m. (2005) Journal of Advanced Nursing49(5), 522–529Nursing attitudes towards acute mental health care: development of a measurement toolThis paper reports the development, piloting and validation of a tool to measure attitudes for use with nursing staff working in acute mental health care units.The quality of care provided for service users in acute mental health care has come under both scrutiny and severe criticism. The attitudes of staff working in these environments have been cited as a contributory factor in poor care. No measure of attitudes specific to acute mental health has been reported.A 64-question measure was constructed and distributed to a sample of qualified and unqualified nurses drawn from seven mental health care units in the North of England. Exploratory factor analysis and a number of other statistical tests were performed to validate the questionnaire.Preliminary analysis reduced the original 64 questions to 37. Five components were retained, accounting for 42% of the variance, and the five rotated factors were identified. The resultant‘Attitudes Towards Acute Mental Health Scale’ (ATAMHS) achieved good internal reliability, with a Cronbach's alpha of 0·72.The construction and validation of the ATAMHS measure will enable improved understanding of the attitudes of nursing staff working in acute mental health care settings to occur. This measure is available for use in a clinical area of nursing in which attitude change is of fundamental importance for future development of care. [ABSTRACT FROM AUTHOR]

BACKGROUND: Heart disease is a severe long-term illness, which often requires lifestyle changes and self-care and affects the life of the whole family. Perceived family health is highly complex. It combines people's values and everyday experiences, such as knowledge about their own health, what they do to promote their health, how their life progresses, and how they feel physically and emotionally. AIM: The aim of this paper is to report a study to describe the perceived health of families of patients with heart disease and to ascertain factors related to family health. METHODS: Data were collected by questionnaire with a convenience sample of 161 family members of patients receiving treatment on two medical wards of a university hospital in southern Finland. Data were analysed using means and medians and tested by parametric and non-parametric tests. A stepwise regression analysis was also used. RESULTS: The most important predictors of family health were family structural factors, effect of illness symptoms on daily life, and family relationships. The strongest predictor was family structural factors. It was found that the better the family structure and relationships, the better the family health. Similarly, the greater the effect of the illness on the patient's daily life, the worse the family health. CONCLUSION: The findings suggest that supporting family functioning in the families of people with heart disease is an important challenge for family nursing. [ABSTRACT FROM AUTHOR]

gudmundsdottir e., delaney c., thoroddsen a. & karlsson t. (2004) Journal of Advanced Nursing 46(3), 292–302 Translation and validation of the Nursing Outcomes Classification labels and definitions for acute care nursing in Iceland The Nursing Outcomes Classification (NOC), second edition, consists of 260 patient outcomes with definitions. This has been translated into five languages, but has not been clinically validated outside the United States of America (USA). The aim of this paper is to describe the translation of the labels and definitions from the NOC, second edition from English to Icelandic and validation for acute-care nursing in Iceland. A survey that has been designed to identify nurses’ perception of the percentage of patients’ for whom each NOC outcome is relevant in clinical nursing practice was used for clinical validation in this study. The translation procedure involved source to target language translation, parallel comparison, pilot test and field test. Validation included test–retest to measure the reliability for each of the 260 outcome variables. Data collected from 140 clinical nurses from 54 departments within 13 nursing specialties at Landspitali University-Hospital in Iceland, in November 2001, were analysed to establish construct validity by confirmatory factor analysis. Internal consistency was calculated. Translation was successful. Test–retest showed that 181 of the 260 NOC outcomes were significant ( P < 0·05) and moderately or highly correlated ( r > 0·50) (Pearson's correlation). The confirmatory factor analysis showed that 22 of the 29 NOC classes had only one factor at the loading criteria ≥0·30. Of the 260 outcomes, 244 had loading on one factor (≥0·30) within its class. Internal consistency was >0·80 (Cronbach's alpha). Low response rate was a limitation. The indicators of each NOC outcome were not addressed. The Icelandic version of the NOC survey is a comprehensive tool that can be applied to nursing in acute-care for research purposes as well as to prepare for the implementation of NOC in clinical information systems. [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]

When concepts and the `paper and pencil' tests used to measure these concepts are developed in fields other than nursing and subsequently arc used for nursing purposes. the perspective mismatch heralds a validity issue. This paper presents a case for clinical construct validity as one method of evaluating whether the substantive meaning of a test captures the nursing meaning. [ABSTRACT FROM AUTHOR]

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

This article focuses on various developments related to nursing. The National League for Nursing has issued an official call for papers for its 1983 biennial convention, the first such call ever to be made by the League in connection with this national meeting. Deadline for abstracts is October 15, 1982, for presentations during the June 1983 convention. A Western Kentucky University junior has received the highest award in Kentucky which goes to a student nurse. Jeana Keating of 520 Cajjewood Drive in Louisville, Kentucky, has been chosen Ideal Nursing Student in Kentucky for 1982 by the Kentucky Association for Nursing Students at its meeting in Fort Mitchell, Kentucky.

This paper explores some of the ideas emanating from recent literature in clinical problem solving and applies it to the nursing process. The aim is to demonstrate that there is congruence between ideas developed in the medical educational literature that support and expand the somewhat 'looser' nursing process model. The conclusion is that the nursing process is further validated by the current literature, particularly the work of Elstein et al. (1978). [ABSTRACT FROM AUTHOR]

This paper attempts to explain some general issues in evaluation and evaluative research in the health care field with specific reference to nursing. The evaluation process and nursing process are contrasted and methods used in evaluative research discussed. The case is made for more emphasis to be placed on the evaluation phase of the nursing process and process-outcome evaluation is advocated as a means of encouraging progress in the hitherto neglected area of evaluative research in nursing. [ABSTRACT FROM AUTHOR]

This paper is a consideration of the philosophy of, and research into, general education. It examines some of the approaches to education and a small part of the research into discovery learning, self-directed study and student-selected goals of learning Proposals are made for a single module of nurse training for admission to the register of general nurses which incorporate the philosophy and research-based ideals of self-directed learning. Finally, problems which may be anticipated in its implementation are discussed but no firm conclusions are drawn until these can be based on fact rather than conjecture. [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]

This paper presents a proposed model for continuing nursing education based on Imogene King's conceptual framework. The rationale for using King's conceptual framework as the foundation underlying this proposed model is three-fold: the concepts--social systems, health, perception, and interpersonal relationships--are relevant in every nursing situation; the interacting levels of operation--individuals, groups, and society-depict a reciprocal relationship between human behaviour and the environment; and the triad of elements-continuing nursing education, nursing practice, and nursing research-are interrelated in the nursing profession. The authors contend that this approach to continuing nursing education is beneficial to participating nurses, the health care consumer, and to the advancement of the nursing profession. Based on its simplicity and flexibility, the proposed intra-systems model described in this article is useful as a systematic guide for continuing nursing education. The authors believe that this proposed model provides an approach for stimulating continued learning, for establishing innovative foundations for nursing practice, and for generating inquiry through research. Utilizing this approach in maintaining the educational standards for professional practice will promote change for the advancement of the nursing profession. [ABSTRACT FROM AUTHOR]

In this paper an account of an opinion survey is reported, which was carried out in order to determine how student teachers of nursing rated aspects of their course. The opinion survey included questions on pedagogical and education studies, teaching practice, research methods, statistics, related science and supporting studies. In the last section the method of course assessment is evaluated. Finally there is a discussion about the implications and limitations of the survey. [ABSTRACT FROM AUTHOR]

This paper deals with the nature of pedagogical studies, starting with a discussion on aspects of the curriculum. This is followed by sections dealing with objectives, lesson presentation and teaching practice. The final sections deal with the assessment of learning and curriculum planning. [ABSTRACT FROM AUTHOR]

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