Search

hopkinson j.b., hallett c.e. & luker k.a. (2003) Journal of Advanced Nursing 44(5), 525–533 Caring for dying people in hospital Fifty-four per cent of people who die in England and Wales do so in hospital. Evidence suggests that care delivered to dying people in hospital does not match up to the ideal of a good death. These studies have provided organizational and structural explanations of nurses’ behaviour that support argument for change at the macro level, in order to improve the quality of care delivered to dying people. There has been little study of the perceptions of nurses working in acute medical settings in relation to their experience of caring for dying people. Therefore, there is little evidence on which to base supportive strategies at the level of individual nurses. In this study we set out to develop an understanding of care for dying people in hospital, from the perspective of newly qualified staff nurses in the UK. The purpose was to build a theory of how nurses might be helped to deliver quality care to dying people in hospital. This paper is based on an exploratory study underpinned by phenomenological philosophy. In-depth interviews were conducted with 28 newly qualified nurses, focusing on their experiences of caring for dying people on medical wards in two acute hospitals in England in 1999. The interview transcripts were interpreted using a phenomenological approach. The findings presented in this paper relate to commonalities found to underlie study participants’ perceptions of their experiences. All the nurses’ stories were found to be built around six essences – the personal ideal, the actual, the unknown, the alone, tension and anti-tension. These essences, and the relationships between them, were used to build a model of the experience of caring for dying people in hospital. This descriptive study of the experience of individual nurses does not examine the wider social context. It attempts to complement existing sociological theory of death and dying. The study revealed how a group of newly qualified nurses experienced caring for dying people. We theorize that the model developed has utility as a tool for gaining understanding of the experience of caring for dying people. It is assumed that nurses, through using this model to find explanations for their emotions and behaviours, may gain emotional support that might have a positive impact on the quality of care delivered to dying people in hospital. [ABSTRACT FROM AUTHOR]

Background and aims. This paper draws on recent research conducted in two contrasting NHS hospitals: one a large District General, the other a small Community hospital; to look at hospitals as organizational spaces. This includes both the physical environment as well as how these spaces are inhabited and used. This paper aims to explore the ways in which hospital spaces impact on the working lives of nurses. Methods. The research employed two main methods. Two phases of round the clock non-participant observation were carried out within each hospital, one at the beginning of the research period and one at the end. This generated thick description of the diversity of spaces, as well as individuals' use of space. In addition, more than 50 in-depth unstructured interviews were conducted with both nurses and doctors. Findings. Three aspects of the relationship between nurse and hospital spaces are considered. First, the degree of access that nurses have to the different hospital spaces is limited, and many are confined to the wards in which they work. The high proportion of female nurses working on wards means that there are marked gender differences in access to hospital spaces. There are also marked professional differences when nurses are compared to doctors who have much greater freedom to roam and there are differences in the amount of private space allocated to nurses and doctors. Second, styles of bodily movement in space are also highly differentiated by profession and gender. Third, different spaces have very different meanings attached to them, and this has a strong impact on styles of performance and identity. Attention to space thus offers original insights to nurses working conditions as well as to inter-professional relations. [ABSTRACT FROM AUTHOR]

The relationship between attendance at birth and maternal mortality rates: an exploration of United Nations’ data sets including the ratios of physicians and nurses to population, GNP per capita and female literacy Background. This is the third and final paper drawing on data taken from United Nations (UN) data sets. The first paper examined the global distribution of health professionals (as measured by ratios of physicians and nurses to population), and its relationship to gross national product per capita (GNP) (). The second paper explored the relationships between the global distribution of physicians and nurses, GNP, female literacy and the health outcome indicators of infant and under five mortality rates (IMR and u5MR) (). In the present paper, the global distribution of health professionals is explored in relation to maternal mortality rates (MMRs). The proportion of births attended by medical and nonmedical staff defined as ‘attendance at birth by trained personnel’ (physicians, nurses, midwives or primary health care workers trained in midwifery skills), is included as an additional independent variable in the regression analyses, together with the ratio of physicians and nurses to population, female literacy and GNP. Aim. To extend our earlier analyses by considering the relationships between the global distribution of health professionals (ratios of physicians and nurses to population, and the proportion of births attended by trained health personnel), GNP, female literacy and MMR.

AIMS OF THE STUDY/PAPER: This paper reports the results of a survey of forensic community mental health nurses (FCMHNs) in England and Wales which aimed to ascertain the level of stress and burnout experienced by this group. BACKGROUND/RATIONALE: Several studies have identified that mental health nursing is a stressful activity and the relationship between factors such as age, experience, support, caseload size and perceived stress have been explored. However, until recently, no studies have examined the situation of FCMHNs and this paper extends the analysis of studies completed by the main author, considering issues related to coping abilities and support systems. DESIGN/METHODS: The survey involved respondents completing a demographic questionnaire and a range of standardized validated measures (Maslach Burnout Inventory, General Health Questionnaire and Community Psychiatric Nurse Stress Questionnaire). The population for the study was all identified FCMHNs attached to the 26 National Health Service (NHS) Medium Secure Units in England and Wales (n=104). RESULTS/FINDINGS: A high response rate of 77% (n=80) was achieved. The results identified that a number of respondents were experiencing burnout. Statistically significant associations were found between caseload size and level of stress. The results also suggest that support from managers and colleagues were an important factor in ameliorating the experience of stress and show that individuals in this study experiencing high levels of stress adopted palliative behaviours such as use of alcohol. CONCLUSIONS: The paper concludes by suggesting that such findings should be considered when delivering stress management programmes and reinforce the potential benefit of effective clinical supervision as a means of staff support. [ABSTRACT FROM AUTHOR]

During the 1980s many nurses left the British National Health Service to own and run private residential care homes for elderly people. At the time, a public policy of guaranteed financial support for residents underpinned the rapid expansion in the sector and residential homes were considered as profitable low-risk business ventures. However, since the introduction of the 1990 National Health Service and Care in the Community Act, this automatic funding has been withdrawn and residential homes have had to compete amongst each other for a finite number of clients funded by limited local budgets. The withdrawal of guaranteed state support and the introduction of social care markets have had negative impacts on many residential home businesses. Indeed, many homes are facing financial difficulties. This paper considers the actions and attitudes of former nurse proprietors under the new conditions based on a three-stage survey in Devon, England. Proprietors are experiencing increased levels of stress and many are unhappy with their current work experiences. The paper concludes that although the small business private sector may seem attractive to nurses, any move into private sector ownership has an associated risk. Social policy conditions may change with concurrent consequences for businesses and business owners. [ABSTRACT FROM AUTHOR]

With the growing interest in community-based initiatives, this discussion paper focuses upon the evaluation of community development. It reviews three areas and highlights the complex and contentious nature of evaluation in this field. Commencing with approaches to evaluation, it critically reviews proposed methods and suggests that, rather than provide clarity and guidance, the competing designs are confusing for the potential researcher. Second, the discussion moves to evaluative terms that are applied to community development, suggesting that there is a mismatch between professional and lay interpretations with an ultimate impact upon the validity of their measurement. It uses the terms community and empowerment to make these differences more explicit. Finally, the paper argues that, although the aim of community-based initiatives is to bring about community health gain, gauging the pervasiveness of discreet project work is testing. It concludes by suggesting that a move away from an evaluative model based upon empowerment towards one which considers health and social capital may be a way forward. [ABSTRACT FROM AUTHOR]

This paper presents the results of an appraisal of the evidence for the effectiveness of methods of nutritional assessment currently in use by nurses and from this develops concepts which may be applied to many areas of nursing practice. The paper first shows how the approach to nutritional assessment by nurses has changed over time, producing the present search for methods which are relatively quick and easy to use. It then describes the limited nature of the evidence of effectiveness of these methods and considers the reasons for this situation. It suggests that the difficulty of validation is an important factor and describes the three most common approaches to validation, showing how problems arise from lack of clarity in the definition of terms and the assumption of a simple relationship between the level of risk of nutritional compromise and actual nutritional status. In conclusion, it is suggested that these difficulties illustrate principles applicable to many areas of nursing care, and a definition of 'segments' of care processes, each with well-defined purposes and outcome measures, is proposed. Such an approach will help to demonstrate the complexity and value of nursing activity. [ABSTRACT FROM AUTHOR]

The ‘greying’ of the United Kingdom nursing workforce: implications for employment policy and practice One in five nurses on the United Kingdom (UK) professional register is aged 50 years or older. Over the next few years, the profession will lose, through retirement, many of its most experienced practitioners. The significance for policy makers and for employers of this age-shift is two-fold. Firstly it is clear that greater numbers of nurses and midwives are reaching, or soon will reach, potential retirement age. Secondly many more nurses are now reaching their middle years and they are likely to have different requirements and attitudes to nursing work. This paper examines the employment policy and practice of the ageing of the UK nursing population. The paper examines data from official sources, and information from attitudinal surveys and case studies with employing organizations to assess the major effects of the ageing of the nursing workforce. Key findings are that the age profile of those nurses working in the National Health Service appears to be ‘younger’ than that of the total population, with the age profile of nurses working in nursing homes and as practice nurses being older than that of the NHS nursing workforce. However, the overall age profile of NHS nurses masks considerable variation between specialties and trusts, and the ‘pool’ of potential nurse returners from which the NHS and other employers attempts to recruit, is declining in numbers, as it too ages. Other major issues requiring policy attention are the provision of appropriate flexible hours to older nurses who have caring responsibilities, improving access to continuing professional development, and reducing pension provision inflexibility. [ABSTRACT FROM AUTHOR]

This paper describes how within a study on the experiences of district nurses since the introduction of general practitioner purchasing, participants were encouraged to describe and define the district nursing service. The identification of terminal care by district nurses and others as a significant and defining example of district nursing work is explored and the possible reasons for its emphasis over other aspects of patient care. The extent to which terminal care was used within contract and purchasing discussions to aid general practitioner understanding of district nursing work and achieve extra funding is described. The paper concludes by questioning the extent to which terminal care is a helpful and accurate representation of what district nursing work entails, and the implications there may be in emphasizing one aspect of care within a purchasing environment. [ABSTRACT FROM AUTHOR]

This paper presents findings from a national study conducted over a 3-year period (1991-94) which examined the changing role of the nurse teacher. The study used multiple methods to collect data from a wide variety of respondents (nurse teachers, midwife teachers, clinical nurses, health service managers and higher education lecturers). This paper presents the findings relating to the development of the nurse teacher's academic role following the introduction of Project 2000. The issues presented and discussed include specialization within the nurse teacher's role, the nature of this specialization and the development of academic credibility and scholarship. The implications of these changes in terms of the development of nursing as an academic subject area and the opportunity to contribute to the establishment of research based practice are explored. [ABSTRACT FROM AUTHOR]

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]

Title. Making patients safer: nurses’ responses to patient safety alerts. Aim. This paper is a report of a study to determine whether action required by patient safety alerts was effectively taken. Background. Over the last 10 years, there has been a growing awareness of the number of patients unintentionally harmed in the course of their treatment. Safety alerts are designed to reduce the incidence of adverse events by removing these predisposing factors. Method. A multi-method study was carried out in 20 acute, two mental health, four ambulance and 15 primary care provider organizations in the United Kingdom in 2006–2007 using surveys, interviews with senior managers and front-line staff, collection of documentary evidence and equipment audit. The implementation of three safety alerts for nursing action is reported. Findings. Most staff were aware of the dangers posed by gloves to staff with latex allergy, but only 20% were aware of the types of common equipment that posed a danger to sensitive patients. Almost 40% of nurses were unable to give a correct acidity value to allow nasogastric feeding to commence. One alert, on needle-free intravascular connectors, was distributed in only a few organizations as the term used was unfamiliar at all levels of the organization. Conclusion. Healthcare providers have succeeded in setting up successful systems to disseminate alerts to middle management level, but there is evidence that implementation of recommendations by nurses is sub-optimal. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of an integrative literature review to investigate: (a) the extent of entrepreneurial activity by nurses, midwives and health visitors in the United Kingdom and (b) the factors that influenced these activities. Background. Internationally, social and commercial entrepreneurial activity is regarded as important for economic growth and social cohesion. Methods. Seventeen bibliographic databases were searched using single and combined search terms: 'entrepreneur$', 'business', 'private practice', 'self-employ$', 'intrapreneur$' 'social enterprise$' 'mutuals', 'collectives', 'co-op' and 'social capital' which were related to a second layer of terms 'Nurs$', 'Midwi$', 'Visit$'. 'Entrepreneur$' Private Midwi$, Independent Midwi$, and 'nursing workforce'. In addition, hand searches of non-indexed journals and grey literature searches were completed. The following inclusion criteria were: (a) describing nurses, midwife and/or health visitor entrepreneurship (b) undertaken in the UK, and (c) reported between January 1996 and December 2005. Results. Of 154 items included only three were empirical studies; the remainder were narrative accounts. While quality of these accounts cannot be verified, they provide as complete an account as possible in this under-researched area. The numbers of nurses, midwives and health visitors acting entrepreneurially were very small and mirror international evidence. A categorization of entrepreneurial activity was inductively constructed by employment status and product offered. 'Push' and 'pull' influencing factors varied between types of entrepreneurial activity. Conclusion. Empirical investigation into the extent to which nurses and midwives respond to calls for greater entrepreneurialism should take account of the complex interplay of contextual factors (e.g. healthcare legislation), professional and managerial experience and demographic factors. [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]

Aim. This paper reports the findings from a naturalistic enquiry undertaken in the United Kingdom into the extent to which the ideals and values of the preregistration nursing course are adopted by individual newly educated Registered Nurses. Background. Research in several countries provides consistent evidence of the existence of a theory–practice gap in nursing. Clear disparities have been demonstrated between the best practice ideals and values that are taught and those actually encountered in everyday practice. Nurse education ‘Project 2000’ reforms in the United Kingdom were designed, in part, to address this issue. Few studies to date have examined the impact of these reforms on newly qualified Registered Nurses’ ability to translate theory into practice. Methods. A longitudinal study was carried out in three educational institutions in the United Kingdom from 1997 to 2000. Final year nursing students ( n = 72) in three colleges of nursing completed questionnaires to elicit views on their ideals and values for practice. In-depth interviews with a purposive subsample of 26 participants (at 4–6 and 11–15 months postqualification) indicated the extent to which these ideals and values were adopted in practice. Interviews were tape-recorded, transcribed, and data were analysed using constant comparison and negative case analysis. Findings. Although new nurses emerged from their programmes with a strong set of nursing values, a number of professional and organizational factors effectively sabotaged implementation. Professional sabotage includes obeying covert rules, lack of support and poor nursing role models. Organizational sabotage includes structural and organizational constraints such as time pressures, role constraints, staff shortages and work overload. Conclusion. The disparity between nursing as taught and as practised may have profound implications for the future of the profession both in the United Kingdom and internationally, in terms of morale, job satisfaction and retention. Measures to improve resources and reduce the professional–bureaucratic work conflict are discussed. [ABSTRACT FROM AUTHOR]

BACKGROUND: Almost 10 years ago senior United Kingdom nurses met at Heathrow Airport to discuss the challenges and opportunities facing nursing. One aspect of this 'Heathrow Debate' was to encourage nurses to work closer with members of the public. The resulting report stated that nurses have not been effective in working outside their professional area and, in particular, they have not been adept at working in partnership with the public. AIM: The aim of this paper is to report a study to obtain the views of general practitioners (GPs), community nurses and members of the public on how the public perceive community nursing. A further aim was to explore the perceptions of senior health care managers and policymakers about public involvement in primary care. METHODS: A two-stage Delphi investigation was undertaken with community nurses (n = 38), GPs (n = 14) and members of the public (n = 8). In addition, one-to-one interviews were carried out with 34 senior health service managers and policymakers. FINDINGS: There was agreement on the following issues: community nurses must work more closely with members of the public; there is a lack of public understanding on the roles of community nurses and specialist nurses; there is public support for nurse prescribing; there is a preference for seeing the community nurse as opposed to the GP; and people prefer one nurse to care for them rather than a variety of nurses. Comments from managers and senior policymakers showed agreement on the public being involved in primary care, but an acknowledgement that this was problematic. A number of recommendations are outlined. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although the successful retention of National Health Service (NHS) nursing staff is a policy concern, evidence suggests that substantial numbers of registered nurses continue to leave the profession, and some to own and run small caring-related business. At the same time, private complementary medicine has undergone a rapid expansion in recent years, and initial impressionistic evidence suggests that many therapists are former nurses. AIMS: The paper investigates the motivations and experiences of nurses who have either left nursing altogether, or substantially reduced their involvement, and who now practise complementary medicine in the private sector. It also investigates the issue of whether they would consider returning to practise complementary medicine within the NHS. METHODS: A combined questionnaire (n = 63) and semi-structured interview (n = 11) survey was used to collect detailed attitudinal data from respondents. The analytical approach to the interview data used a form of constant comparative analysis which was derived from the principles of grounded theory. In particular, the interviews were developed and refined from each other as they progressed. RESULTS: The majority of therapists operate independently, either from their own homes or from small rented premises. They were originally motivated by a disillusionment with the health service and particular aspects of their former jobs. However, equally they were attracted by the therapies themselves, the conceptual paradigms which underpin them and the different experiences of practice. Despite stating a disillusionment with the NHS, most respondents expressed a cautious willingness to potentially re-enter the NHS to practise complementary medicine. CONCLUSIONS: Many practising complementary therapists are registered nurses who may be willing to re-enter the formal health service. It is therefore argued that a greater synergy between orthodox and complementary medicine may be one way of addressing shortages of nursing labour, and in particular this form of drop-out, whilst meeting evolving consumer health care demands. [ABSTRACT FROM AUTHOR]

Research information in nurses’ clinical decision-making: what is useful? Aim. To examine those sources of information which nurses find useful for reducing the uncertainty associated with their clinical decisions. Background. Nursing research has concentrated almost exclusively on the concept of research implementation. Few, if any, papers examine the use of research knowledge in the context of clinical decision-making. There is a need to establish how useful nurses perceive information sources are, for reducing the uncertainties they face when making clinical decisions. Design. Cross-case analysis involving qualitative interviews, observation, documentary audit and Q methodological modelling of shared subjectivities amongst nurses. The case sites were three large acute hospitals in the north of England, United Kingdom. One hundred and eight nurses were interviewed, 61 of whom were also observed for a total of 180 hours and 122 nurses were involved in the Q modelling exercise. Results. Text-based and electronic sources of research-based information yielded only small amounts of utility for practising clinicians. Despite isolating four significantly different perspectives on what sources were useful for clinical decision-making, it was human sources of information for practice that were overwhelmingly perceived as the most useful in reducing the clinical uncertainties of nurse decision-makers. Conclusions. It is not research knowledge per se that carries little weight in the clinical decisions of nurses, but rather the medium through which it is delivered. Specifically, text-based and electronic resources are not viewed as useful by nurses engaged in making decisions in real time, in real practice, but those individuals who represent a trusted and clinically credible source are. More research needs to be carried out on the qualities of people regarded as clinically important information agents (specifically, those in clinical nurse specialist and... [ABSTRACT FROM AUTHOR]

The nature of United Kingdom (UK) nursing education has changed significantly as the responsibility has been transferred from hospitals to the University sector. More information is needed on the outcome of the Project 2000 diploma and degree courses given the rapidly changing health care context. This paper focuses on the role socialization of graduate and diploma nurses. As part of a larger study, this research investigated the role orientations of 52 nursing graduates and 28 diplomates from two different universities at three time points; on graduation and at 6 and 12 months postgraduation. The Corwin Role Orientation Scale was selected and modified for the study. It comprised of three separate scales measuring professional, bureaucratic and service orientation. The data from the two groups of nurses were examined to identify nurses' ideal role orientations and role discrepancies over the transitionary period from graduate to qualified nurse. Although the results showed observed differences between the groups over time, none of these differences were statistically significant. The findings raise a number of questions about the value of the instrument as a measure in the contemporary nursing context. Furthermore, each of the Corwin subscales had a low internal reliability. A possible explanation may be that the instrument, which was developed in the United States of America (USA) in the 1960s, and modified, for this study, has little relevance for contemporary UK nursing. The study findings are also limited by the small size of the sample. In spite of these limitations, the study suggests there are few differences between the role orientations and socialization experiences of UK nursing graduates and diplomates. Indeed, both programmes commonly take place in university settings and students receive the same amount of clinical experience. Further instrument development and exploratory research is recommended to identify the role socialization and orientations of UK nurses through larger national studies. [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]

A discussion of the legal aspects of female genital mutilation The purpose of this paper is to examine the position of the nurse/midwife in the United Kingdom when involved with the care of a woman or female child who has suffered genital mutilation, which is an illegal practice in this country and most other areas of the world. The types of circumcision commonly practised are introduced, the prevalent reasons for the continuation of the practice among certain ethnic groups are presented, and the range of issues to be considered by the nurse is examined. These include international and national legal aspects which do not exist in isolation and are considered in context with cultural, medical, human rights and gender issues. Nursing legal issues include child protection, consent, advocacy and confidentiality, which invoke the Code Of Professional Conduct of the United Kingdom Central Council for Nursing Midwifery & Health Visiting. Midwives and nurses working in the field of gynaecology have raised questions regarding possible courses of action to take when presented with this issue. Increased knowledge can help to inform those decisions. Therefore, implications for future practice are addressed, together with recommendations to assist nurses with decision making when faced with this scenario in the future. [ABSTRACT FROM AUTHOR]

The changing nature of nurses’ job satisfaction: an exploration of sources of satisfaction in the 1990s This paper focuses on the changing nature of nurses’ job satisfaction. It compares the major sources of satisfaction and dissatisfaction experienced by acute ward nurses in the English National Health Service (NHS) in the early 1990s, with sources identified in previous research. In the light of findings from a pilot study, the suitability of existing research approaches and measurement tools for portraying nurses’ contemporary work experiences is examined. The study comprised content analysis of a random sample of 130 nurses’ comments about ward organizational issues, collected as part of a national survey. Findings suggest that new measurement tools need to be developed, because new sources of satisfaction and dissatisfaction emerged, directly associated with change arising out of the introduction of the NHS internal market. These include pressures associated with new roles, role conflict, lack of job security, ‘tight’ resources, using new technology, a perceived lowering of standards of patient care, coping with increased amounts of paperwork, and the experience of working in a rapidly and constantly changing environment. Findings also suggest that the nature of nurses’ job satisfaction is increasingly being shaped by their position within the organization, denoted by clinical grade, and the organizational culture of individual NHS Trusts. Ward leaders experience dissatisfaction as a result of role conflict and strain, while nurses of lower clinical grades are increasingly concerned with managerial and resource constraints on their ability to provide good quality care. Nurses’ satisfaction with management and morale were found to be significantly different between NHS Trusts. While findings may be specific to England, it is argued that they have relevance for the wider, international nursing community. This is because developing an understanding of the changing nature of nurses’ job satisfaction may help to resolve recruitment and retention problems. [ABSTRACT FROM AUTHOR]

‘The Awful Rowing Toward God’: therapeutic conversations with a woman following major surgery ¶ Listening is a complex event requiring skills and competencies that encompass the personhood of the listener. This paper explores a clinical conversation with a woman experiencing serious illness. The ideas of Klein offer the theoretical means for understanding exchanges. Reflexivity is addressed through exploring the writer’s thoughts and feelings in response to significant events. The benefits of supervision, as support and guidance, are discussed in context. The discussion concludes with the suggestion that although many layers of interpretation are possible, and can be informed by various ways of knowing, the act of listening offers potential benefits. [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]

This paper draws on empirical data from a study undertaken to explore the outcomes of the applied physiology component of a post-registration diploma in nursing (DN). Most students completing the DN were utilizing their new bioscience knowledge in clinical practice, and reported increased participation in interprofessional discussions and team decisions. Respondents found themselves better able to monitor and evaluate doctors' decisions and this led to friction with some medical colleagues. However, the strongest resistance came from senior nurses, very few of whom had completed advanced nursing courses in bioscience and who were generally unwilling to allow respondents to develop new roles. General managers were also perceived as a major barrier to change. There is little evidence of tangible benefits to the nurses themselves: most saw the DN qualification as a way of protecting their status as professional nurses in the face of managerially driven organizational change, rather than as a route to occupational advancement. [ABSTRACT FROM AUTHOR]

This paper concerns one of the main problems facing continuing nurse education, that of matching the learning needs of the individual nurse with the needs of the care setting. This endeavour is inescapable because of the necessity for giving high quality care within financial restraint. Modern information technology, it is suggested, can be helpful in fulfilling the task more easily. A theoretical framework is introduced as a possible solution for developing a computer program which, it is the hope of the author, will be available in the not so far future. [ABSTRACT FROM AUTHOR]

Drawing upon the writings of disabled people, this paper explores some of the issues which nurses working with disabled people are trying to address, in particular the barriers model of disability. Traditionally disability has been regarded as a personal tragedy afflicting the individual, hence the response to disability has been via the charity, health and welfare systems. Disabled people over the past two decades have substantially challenged this view of disability and the responses it prompts, arguing that disability is created by social barriers and barriers in the built environment. This requires a different response. Nurses working with disabled people, such as learning disability nurses, have struggled to develop more appropriate responses to disability, for example by developing working alliances with people with learning difficulties in order to both promote health and address disabling barriers. The issues these nurses face and some of the lessons disabled people have taught them are relevant to the nursing profession's wider struggle to shed its medical and dependency image. [ABSTRACT FROM AUTHOR]

The United Kingdom Central Council's proposals for nurse education (Project 2000: A New Preparation for Practice) were implemented in 13 demonstration districts in England in 1989. In 1991, as part of an English National Board-funded research study, the author conducted 15 interviews with first line managers from three of these demonstration districts. The data were reinterpreted in 1995; the experience of implementing educational change in the community setting was discovered to be a complex and difficult process for the managers involved. They found themselves confronted with sometimes conflicting responsibilities; their perception of their role encompassed the meeting of a range of needs, which are presented in this paper within three categories. Firstly, the managers felt they had an obligation to meet the needs of students and of education in general in order both to provide an adequate experience for each individual student and to safeguard standards in community nursing in the long term. Secondly, they were confronted with the need to mitigate the pressures Project 2000 placed on 'their' staff. The new educational programme meant that community nurses spent much more time with students than formerly, and the difficulties they encountered were exacerbated by uncertainty about their role with these students. Finally, and most importantly, managers were responsible for ensuring that clients' needs were met. In particular, they saw it as their role to ensure that the presence of large numbers of students in the community for long periods of time did not compromise standards in the delivery of community nursing services. [ABSTRACT FROM AUTHOR]

This paper outlines the background to the current United Kingdom educational scene for post-registration nurse education, highlighting the influence of the English National Board (ENB) framework and higher award. The study reported was undertaken with the help of two student cohorts who were registered consecutively on a 6 month ENB course at diploma level. Formal reflection using both individual written and group discussion was introduced focusing on the two summative course assessments. This kind of formal reflection was seen as a learning strategy to influence positively students' educational outcomes and professional practice via six key factors: (a) academic self-concept; (b) task awareness; (c) views of knowledge; (d) the influence of knowledge on behaviour; (e) writing as a learning activity; and (f) generating knowledge by reflecting in and on assessment with discussion. The findings, reported under the six factor-headings, fully support the use of reflection in this way for these purposes. [ABSTRACT FROM AUTHOR]

This paper describes the experiences of eight staff nurses who were students in the first cohort of a Project 2000 course in a pilot district during their post-qualification year. A qualitative approach, informed by phenomenological methodology, was adopted in order to present these experiences alongside the meaning attributed to them by the nurses. Taped, focused group discussions, using semi-structured interviews, were analysed. This yielded five themes which describe the structure of these experiences from 'coming out of school' through to the acknowledgement and confidence in themselves as a different kind of nurse to those trained on previous traditional courses. The findings suggest that the vision of the United Kingdom Central Council in proposing Project 2000 courses is likely to be realized. These nurses had gained the competent technical and clinical skills expected of any nurse. However, they also displayed skills previously absent in newly-qualified nurses, such as evidence of analytical decision-making and confident interpersonal skills, which are likely to enable them to take an equal place amongst other members of the multi-professional team in the future. Although competent practitioners, the process they had undergone to reach this had, at times, been traumatic. The implications arising from the study are that more attention needs to be paid to the personal and professional development needs of Project 2000 nurses, both at the end of the course and in their first post-qualifying year. [ABSTRACT FROM AUTHOR]

The purpose of this study was to understand what impact nurses perceived continuing professional education (CPE) to have on the quality of nursing care. Given that CPE will become mandatory once the necessary legislation has been implemented, the value and worth of CPE with regard to the quality of nursing care, in both a consumer-led and financially-driven NHS, merits serious consideration. Little research has been conducted into the real impact that CPE has on the quality of nursing care and this paper begins by providing an overview of the current debate within the profession. The method chosen for the study was qualitative and 18 nurses from a large hospital in the South of England were interviewed. The data were analysed using the grounded theory method and three categories emerged. The categories are described in detail and reveal some of the problems with which the nursing profession is faced. The study demonstrates how issues of finance were particularly high, with service managers sometimes negating nurses’ CPE needs. However, the study reveals the real importance that nurses attatched to CPE in supporting their professional status and the real impact that CPE and knowledge have on professional competence and the quality of patient care. [ABSTRACT FROM AUTHOR]

A comprehensive search of the research literature was undertaken to explore the relationship between skill substitution and quality of care. It was possible to identify three central assumptions based upon the studies reviewed. The first suggests that a rich skill mix of mostly qualified nurses is often an ineffective and inefficient way of providing health care. The second assumption is based on research which appears to indicate that a skill mix of mostly unqualified staff is an inneffective approach to health care provision. Finally, there is a plethora of research findings which suggest that the most effective and efficient way to provide health care lies in the employment of high numbers of qualified staff. This paper examines the evidence for each of these positions and highlights the inherent limitations of the underlying studies. [ABSTRACT FROM AUTHOR]

This paper discusses the repertory grid technique, from its development by George Kelly as a means of demonstrating cognitive/perceptual systems in individuals, as postulated in his Personal Construct Theory, to its use in studies in nursing and social work. The original concept having focused on the uniqueness of, and differences between, individuals' perceptions of the world, in recent years it has been applied to the examination of characteristics within groups. The theoretical basis for this is discussed, with reference to a selection of studies of nurses and social workers, including a small comparative study of psychiatric nurses, general nurses and social workers. The degree to which the findings of these studies may be generalized is discussed. In retrospect, some of the applications are considered to be outside the paradigm of the Personal Construct Theory which underlies the repertory grid technique. [ABSTRACT FROM AUTHOR]

Theories of experiential learning, notably the theory of andragogy, can be used to elucidate the process of learning in dementia-carer support programmes. Such theories attach importance to the positive influence of life experience and maturity, and to the salience of personal issues, but their appropriateness needs to be critically analysed. Stress is a common manifestation among dementia carers and its presence can significantly affect openness to learning. As a result of recent policy changes and of demographic shifts, nurses are likely to be increasingly involved in carer support programmes. They need to be aware of the complex issues addressed in this paper. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to examine intraprofessional teamworking between district nurses. Data from an exploratory study, conducted in the United Kingdom, of 130 home visits of 16 district nurses describes intraprofessional relationships in community nursing teams. Participant observation and in-depth interviews were the methods of data collection. The findings suggest that the professional culture of community nursing has led to the development of organizational rules which, in a quest to avoid conflict between team members, potentially militate against patient choice. The data presented here explore three areas of the nurses' practice: committing services, changing care and working unsocial hours. [ABSTRACT FROM AUTHOR]

This paper begins by reviewing the small number of studies of staff nurses’ work satisfaction. Subsequently, an examination is made of the differences in work satisfaction between staff nurses and other grades of nursing staff in psychogeriatric wards in National Health Service hospitals in Scotland. These data are part of a larger study into work satisfaction and the quality of care in these settings. Significant differences in satisfaction at work are identified between the staff nurse group and the other grades taken as a whole. Analysis of the components of job satisfaction suggests that these differences arise from: first, the experience of the work itself; second, the quality of the supervision which takes place; and third, the assessment of hospital policies, such as the transfer of staff to other wards. [ABSTRACT FROM AUTHOR]

British literature related to the care of children in hospital states that they have 'special needs.' This concept is not defined; neither are different writers in total agreement about what these needs may be. This paper attempts to define needs, concluding that they are 'requirements that should be met.' Children are seen as dynamic beings because they are in a state of constant development, both physically and psychosocially. It is this state of development that makes their needs special to them. They have special requirements, which should be met in specific ways. Through the presentation of indicators of behaviours which would enable such needs to be met, it can be demonstrated that children should be cared for by people with the appropriate knowledge and understanding. When children are admitted to hospital there may be a number of different people involved in determining how a need should be met. An important part of this process should be nurses who have been specially educated for work with this age group. [ABSTRACT FROM AUTHOR]

Using information collected from more than 100 district health authorities in England for the year 1989-1990, this paper examines turnover rates amongst a range of nursing and other staff groups in the National Health Service (NHS), and their relationship to the age and length of service characteristics of the labour force. The evidence collected suggests that the NHS employs a significantly younger workforce than is found in the economy as a whole. The age profile of nurses is even more skewed towards younger age groups than that of non-nursing staff working in the NHS. Nurses tend on average to have longer lengths of service than non-nursing staff groups, and it would seem that the average length of service has increased over the last 20 years, certainly amongst registered nurses. Overall, the study found an annual turnover rate amongst all NHS staff of 13.6%. Turnover rates were significantly higher among full-time staff than part-time, and amongst non-nursing staff groups compared with nurses. Broadly, turnover rates decline with age then rise close to retirement. However, there is a more complex relationship between length of service and turnover: turnover rates tend to be high in the first year of service, and to remain high or even rise during the second year of service, before declining. Turnover remains a poorly understood issue in the NHS. The evidence presented here should move some aspects of debate onto a more solid empirical foundation. [ABSTRACT FROM AUTHOR]

With the current emphasis on community care, the importance of dementia as an area for the interventions of community practitioners, especially nurses, cannot be overemphasized. However, despite being the subject of increasing research over recent times, a comprehensive model of the dementia experience from either the sufferer's or carer's perspective has yet to be developed. This is particularly noticeable in the case of people suffering from dementia below the age of 65. This situation is exacerbated by the lack of representative epidemiological studies which relate to the incidence or representative epidemiological studies which relate to the incidence or prevalence of younger onset dementia. In this paper, the current epidemiological literature on younger onset dementia is considered and the findings from previous work are used to suggest prevalence figures for Wales. A longitudinal model of the dementia experience from a sufferer's perspective is then presented as the basis for a research agenda. It is also suggested that this model, subject to empirical testing and refinement, could be used as a guide to interventions for practitioners working with the sufferers and their carers. [ABSTRACT FROM AUTHOR]

Forecasting the demand for nurses is a complex and difficult problem. However, in a climate of economic cutbacks and disadvantageous demographic trends, it is essential that adequate methods are developed to predict both the supply and demand for nurse manpower. To this end a number of methods have been constructed, particualrly in the last decade. In this paper we survey the work that has been done to provide an effective way of forecasting nurse manpower demand. The two most common approaches are from the 'top-down' or 'bottom-up'. However, an evolutionary method which allows for modification and detailed refinement is more likely to provide a means of taking into account the complexities of the system. Finally, we focus on the nursing hours per patient (NHPP) ratio as a possible tool for demand forecasting. This index is easily calculated and is readily adaptable to the bottom-up approach. [ABSTRACT FROM AUTHOR]

The focus of this paper is the clinical role of the nurse teacher. Using selected findings from a small exploratory study in which a questionnaire was used to gather quantitative and qualitative data from teachers about their role, three areas are discussed. Examination of the number of clinical areas teachers link with identified three different models of clinical contact. The frequency and timing of teachers' visits to clinical are not evenly distributed and some of the reasons for this are discussed. The nature of the clinical role is explored with emphasis on liaison and teachers' perceptions of support of students and clinical staff. Finally, teachers' perceptions of their clinical skill and the implications of this is discussed. It is concluded that all three areas require further analysis if the role of the nurse teacher is to be clarified and made more effective in the future. [ABSTRACT FROM AUTHOR]

This paper constitutes a discussion of a case of sexual abuse of children by a nurse brought before the UKCC Professional Conduct Committee. Judgement was first deferred, and later the nurse was allowed to remain on the register and to practise as a nurse. The case is considered with reference to guidance from the UKCC in various documents. The case for removal from the register is first established, drawing on the UKCC Code of Professional Conduct and the UKCC document '... With a View to Removal From the Register...'?, and found to be more than adequate. The case for leniency is then considered with further reference to UKCC policy, but is rejected. It is concluded that, on this occasion, the Professional Conduct Committee's findings were erroneous and indefensible. [ABSTRACT FROM AUTHOR]

Communication is one of the most important aspects of cancer nursing. Evidence suggests nurses experience communication difficulties and frequently block patients from divulging their worries or concerns. This paper focuses on a study which aimed to determine: (a) the extent to which nurses facilitate or block patients and awareness of their verbal behaviours; (b) whether there is a relationship between nurses'verbal behaviours and levels of anxiety, social support, work support and attitude to death; and (c) nurses' difficulties in caring for cancer patients. The study was conducted in a specialist and non specialist hospital. Fifty-four registered nurses completed three audio-taped histories (one with a new cancer patient, a patient with a recurrence and a patient for pallative care), a self-administered questionnaire and a semi-structured audio-taped interview. The data were analyzed using SPSSX. The findings indicate an overall poor level of facilitative communication, with a patient's recurrence causing most difficulties. There is evidence to suggest the way nurses communicate may depend on the environment created by the ward sister, the nurses' religious beliefs and attitude to death rather than specific education in communication skills. [ABSTRACT FROM AUTHOR]

The numbers of elderly people going home from hospital in the United Kingdom are likely to increase over the next decade. Previous research suggests that this group of people are liable to experience some difficulties on returning home. This paper reports the findings of a study of the outcomes of discharge for 32 elderly people admitted to geriatric wards. A lower level of independence in daily living activities, and an increase in the amount of help needed after hospitalization were found. An increase in the rate of discharge of elderly people will have implications for both formal and informal carers. [ABSTRACT FROM AUTHOR]

Nurses in the United Kingdom spend much time attempting to fit British nursing practice into the theoretical framework of American nursing models. This is often a manipulative process in that it seeks to establish positive links with a care delivery system totally unlike our own. In the present paper the authors detail the process of establishing a new nursing model which integrates nursing curricula, education and practice to meet the needs of patients, staff and students within their own health district. An over-emphasis on lower levels of human need is common within nursing practice, which, although often blamed upon lack of human and financial resources, is also due to practitioners' misconceptions. The latter are invariably the result of a lack of an adequate or overt, practice orientated, conceptual framework. The Human Needs Model of Nursing adapts Maslow's concept of human needs to create such a conceptual framework for practice. It places equal emphasis on those patient problems which arise as the result of unmet needs at higher levels as well as those at lower levels, thereby acknowledging the holistic and dynamic nature of man. [ABSTRACT FROM AUTHOR]

This paper reviews the literature concerned with active learning methods in British nurse education. A case study is presented describing the introduction of assisted independent learning to a cohort of student nurses in a district general hospital school of nursing in England. The implications, advantages and problems associated with such curriculum innovation are discussed and some areas for further study are identified. [ABSTRACT FROM AUTHOR]

In this paper the author, who is an experienced and qualified occupational health nurse, defines occupational health and describes the development of occupational health nursing in the United Kingdom. The extended role of the occupational health nurse is discussed and some comments made about the future. At the same time, the author highlights the difficulties which have been and still are being encountered. [ABSTRACT FROM AUTHOR]

The appearance of this new nursing journal is an exciting and fitting introduction to the last quarter of the twentieth century. It aims to become an international medium for the publication of scholarly nursing papers and a means of documenting the evergrowing body of nursing knowledge. The concept and format of the journal have been developed by an Editorial Board of eminent British nurses supported with enthusiasm by an outstanding Panel of Overseas Advisers. The strength, impact and continued existence of the "Journal of Advanced Nursing" will, however, depend on the willingness of able nurses to document and share their scientific, theoretical and philosophical information with their professional peers.