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Title. Fatigue in patients with rheumatoid arthritis: British and Dutch nurses’ knowledge, attitudes and management. Aim. This paper is a report of a study conducted to compare the knowledge, attitudes and current management of rheumatoid arthritis-related fatigue in British and Dutch rheumatology nurses. Background. After pain, fatigue is the most important symptom for patients with rheumatoid arthritis, but little is known about the current management of this fatigue by healthcare professionals. Methods. A questionnaire was mailed in 2007 to rheumatology nurses who were members of British Health Professionals in Rheumatology ( N = 267) and the Dutch Society of Rheumatology Nurses ( N = 227). Descriptive statistics, independent samples t-test and Pearson chi-square tests were used for statistical analysis. Results. A total of 494 nurses returned questionnaires (response rate 48%). In general, their knowledge about rheumatoid arthritis fatigue was in accordance with the literature and all indicated a positive attitude towards assessing and managing rheumatoid arthritis-related fatigue. However, respondents reported contradictory views about managing fatigue. Although they believed that other team members could help patients, they seldom referred patients on to other professionals. Although nurses believed that other advice besides pacing and balance between activity and rest might help, they did not offer this to patients. Despite acknowledging that there is poor communication about fatigue between patients and nurses, respondents reported that it is patients rather than nurses who raise the issue of fatigue in consultations. Conclusion. British and Dutch rheumatology nurses are sympathetic but do not know how to manage rheumatoid arthritis-related fatigue. Strategies to support self-management for this fatigue, and to increase communication between healthcare professionals and patients, should be initiated to help improve patient outcomes for rheumatoid arthritis-related fatigue. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of an investigation of the impact of prescribing on a group of recently qualified nurse prescribers in the United Kingdom. Background. The creation of advanced nursing roles, and specific skills such as nurse prescribing, has resulted in nurses taking on roles that have traditionally been associated with doctors. The non-doctor prescribing initiative is continually developing and many nurses are now able to prescribe independently from almost the same range of medicines as doctors. Despite the advantages that appear to stem from nurses prescribing, some nurse researchers have been cautious about the impact that prescribing may have on the nursing profession. Method. Interviews were conducted during 2005 and 2006 with 45 nurse prescribers. All nurses had successfully qualified and registered as prescribers. Interviews were analysed thematically in line with the principles of grounded theory. Findings. Prescribing allows nurses to overcome difficulties in the healthcare system that previously delayed patients' access to medicines. Prescribing is viewed as more than an 'add on' to current roles, it complements many aspects of nursing and integrates previously diffuse aspects of the nursing role. This enables nurses to adopt a more holistic approach to patient care and prescribing. Prescribing has the potential to increase job satisfaction and autonomous working, with the result that nurses are more likely to involve patients in decision-making about their care. Conclusions. Prescribing enhances nurses' knowledge about medication and increases their confidence to engage in prescribing decisions across the healthcare team. Nurse prescribing has the potential to improve service-user care, enhance collaboration and widen discussions about medicines. However, team members need to be prepared for the impact nurse prescribing could have on the dynamics of the multidisciplinary team. Preparatory information about nurse prescribing should be provided to all team members by trainee nurse prescribers. Information could include details about the proposed scope of future prescribing roles, allowing team members to consider how their roles could develop. [ABSTRACT FROM AUTHOR]

BACKGROUND: The National Service Framework for Mental Health has emphasized the need to prioritize the provision of cognitive behaviour therapy as the central evidence-based non-pharmacological intervention for mental health problems. For 25 years one programme (English National Board Course No. 650--Diploma in Behavioural Cognitive Therapy, formerly called Nursing in Behavioural Psychotherapy) has trained nurses in such methods. This is the only programme in nursing which qualifies graduates to be fully certified as a cognitive behaviour therapist by the British Association of Behavioural Psychotherapy and by the United Kingdom Council for Psychotherapy. The practice of these nurse therapists (most commonly known as nurse behaviour therapists, NBTs) is the most rigorously evaluated in mental health nursing, with several randomized controlled trials to testify to clinical and economic efficacy. AIM: The aim of this study is to continue the systematic follow-up of all NBT graduates previously undertaken in two earlier surveys published in 1986 and 1994. These previous surveys examined clinical practice, organizational context and career and professional development issues. This up-to-date picture of NBTs will provide useful baselines for the implementation of the National Service Framework, and may be used by the Department of Health, education providers and services. METHOD: A postal survey (using the same template for categories of information as the two earlier surveys) was used and questionnaires were sent to 237 of the 274 trained NBTs whose name appears on the Central NBT Register, maintained at the Institute of Psychiatry/Maudsley Training Centre. RESULTS: One hundred and five of 230 eligible respondents (45.6%) returned questionnaires and additional data were obtained from 27 NBTs who provided information to the Register in the year before the survey. Thus, some data were available for 57% of the sample. As in earlier surveys, it was found that the majority of therapists remain in clinical practice, undertake substantial further education and training and are involved in research and teaching as part of their overall role. The two central developments are an increasing move towards working in primary care and an increased emphasis on cognitive interventions. NBTs complete a substantial number of treatments per year and increasingly treat clients with difficulties not encountered during their basic training. NBTs now receive much more supervision than in previous surveys and continue to use valid and reliable measures of change in practice. However, the number of NBTs remains small and the impact on potential populations who would benefit from effective psychological interventions is minimal. This paper discusses the implications for service delivery. [ABSTRACT FROM AUTHOR]

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