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There is a great deal of interest in the United Kingdom in clinical guidelines as a means of assisting practitioner and patient decision making about care options and in improving the quality of the care provided. Confusion remains, however, over what is meant by a clinical guideline and how it differs from and relates to protocols and standards. This paper was written under the auspices of the Royal College of Nursing Steering Group for the college's work on clinical guidelines, with the aim of clarifying some of the terminology used in the field and introducing ways in which clinical guidelines might be used by practitioners and patients to readers. At the moment just how effective the use of clinical guidelines can be on care is poorly established. What is known, however, is that crucial to their success are the strategies and methods used for their implementation. Such strategies and methods raise questions about how a sense of ownership can be engendered in those using the clinical guidelines and how they may be best operationalized. These questions are considered in this paper. [ABSTRACT FROM AUTHOR]

AIM: This paper reports a study exploring the impact of advanced heart failure on the lives of older patients and their informal carers. BACKGROUND: Prognosis is poor in heart failure, with more than a third of patients dying within 12 months of diagnosis, and end-of-life symptoms are distressing and poorly controlled. Although end-of-life care for people with heart failure has received increased attention in recent years, there are still few data on the impact of advanced heart failure on the lives of patients and their informal carers. METHODS: Focused interviews were conducted with 10 older people with advanced heart failure and their nominated informal carer identified from one district general hospital in the United Kingdom (UK). Joint interviews were conducted with patients and carers in their own home. Thematic analysis was used to identify themes and subthemes. FINDINGS: Heart failure affected all aspects of the lives of patients and carers and, in particular, curtailed everyday activities. Patients were very concerned about the 'burden' their illness placed on their carer, who in all cases was their partner, although carers did not conceptualize the situation in this way. The socially isolating influence of the condition on both patients and carers was compounded by lack of professional input, and confusion about diagnosis was evident. Concerns about the future were common and, although few participants reported having been explicitly told about their prognosis, many made realistic statements about their limited life expectancy. CONCLUSIONS: This older cohort of people suffering from heart failure appears to have needs not unlike those of patients with 'terminal diseases'. When people are diagnosed with more familiar terminal illnesses, in particular cancer, they are given ongoing explanations, reassurance and support. Similar professional input is needed for patients with advanced heart failure and their carers. [ABSTRACT FROM AUTHOR]

lyall d., hawley c. & scott k. (2004) Journal of Advanced Nursing 46(4), 390–394 Nurses’ Observation Scale for Inpatient Evaluation: reliability update The Nurses’ Observation Scale for Inpatient Evaluation is a 30-item scale designed in 1965 for behavioural and observational rating of psychiatric inpatients. This paper reports a re-evaluation of the Nurses’ Observation Scale for Inpatient Evaluation carried out to confirm that it remains reliable in a modern United Kingdom (UK) setting. The scale is a joint-rated one and we tested the degree of agreement between two individual raters and not, as in previous studies, between two pairs of raters. A total of 100 patients were each rated by two nurses, and a least-squares simple regression model was used to describe the average level of agreement between the pairs of ratings. The correlation in total scale scores was 0·76 ( F = 136, P < 0·0001). The correlations for Negative and Positive Factors were 0·68 ( P < 0·001) and 0·75 ( P < 0·001), respectively. This study has shown that the Nurses’ Observation Scale for Inpatient Evaluation retains satisfactory inter-rater reliability with current clinical populations, and we suggest that it remains a useful tool for everyday clinical practice and a basis for meaningful communication between staff about patient status. [ABSTRACT FROM AUTHOR]

RATIONALE: The area of phase I trials is fraught with ethical dilemmas and controversy. Most existing research focuses on issues of human rights and the informed consent procedure. Little attention has been given to patients' perceptions of participating in such trials. DESIGN: This paper describes a study using qualitative interviews and open-stem questionnaires to begin to explore patients' own perceptions of any benefits from participating in phase I trials. RESULTS: Findings suggest that for some patients, phase I trials fulfil a need to try everything in their fight against cancer. The study also suggests that being on treatment allows some patients to construct their lives meaningfully by providing a supportive structure and enabling hope. Implications for nursing practice and further research are discussed. [ABSTRACT FROM AUTHOR]

This paper reports on a quasi-experimental case study of two care pathways--a midwifery-led maternity pathway and a breast disease pathway developed within one British National Health Service Trust. Of the aspects evaluated, those reported here are: a comparison of clinical care delivered before (the control group) and after the introduction of the two pathways; a comparison of patient satisfaction levels before (the control group) and after the introduction of the two pathways; and views of staff involved in the development and operation of the two pathways. The results are mixed. In the breast disease pathway five of 12 clinical indicators showed change, but only two of these showed statistically significant changes; three were considered of clinical significance but could not be tested statistically. In the maternity pathway, after allowing for the effect of gravid status, five of 10 indicators showed changes between the pre-pathway and pathway users and of these four showed statistically significant changes. Patient satisfaction levels showed little overall change--only 15% of the questions for breast disease and 9% for maternity showed any statistically significant change. However, both surveys indicated precise areas where a change resulting from the introduction of the pathway could be linked to an increase in satisfaction. The clinical staff interviewed highlighted many positive features of the tool (26/40 comments). The most frequently cited favourable comment was its ability to make staff focus on the clinical care they were providing and how this could be improved. It also highlighted some areas for concern, in particular the introduction of pathway documentation. [ABSTRACT FROM AUTHOR]

This paper reports findings from a study conducted in one community health care trust where 62 members of the district nursing team (grades B-H) were interviewed. An adaptation of the critical incident technique was used to determine factors which contributed or detracted from high quality care for a number of key areas including palliative care. The centrality of knowing the patient and his/her family emerged as an essential antecedent to the provision of high quality palliative care. Factors enabling the formation of positive relationships were given prominence in descriptions of ideal care. Strategies used to achieve this included establishing early contact with the patient and family, ensuring continuity of care, spending time with the patient and providing more than the physical aspects of care. The characteristics described by the community nurses are similar to those advocated in 'new nursing' which identifies the uniqueness of patient needs, and where the nurse-patient relationship is objectified as the vehicle through which therapeutic nursing can be delivered. The link with 'new nursing' emerges at an interesting time for community nurses. The past decade has seen many changes in the way that community nursing services are configured. The work of the district nursing service has been redefined, making the ideals of new nursing, for example holism, less achievable than they were a decade ago. This study reiterates the view that palliative care is one aspect of district nursing work that is universally valued as it lends itself to being an exemplar of excellence in terms of the potential for realizing the ideals of nursing practice. This is of increasing importance in the context of changes that militate against this ideal. [ABSTRACT FROM AUTHOR]

Patient satisfaction surveys are seen as an important way of obtaining 'user views' of health service provision. However, there is a growing body of research and theoretical literature that questions the validity of the concept of 'patient satisfaction' and hence the use of this type of survey. A postbereavement survey of people who registered a random sample of cancer deaths in an inner London health authority was undertaken in 1996/7. The survey questionnaire (VOICES) included 14 open-ended questions which asked respondents to add any comments they felt were relevant about the care of the deceased. This paper uses these data to examine the causes of dissatisfaction with hospital-based care. Of the 229 informants responding to the questionnaire, 138 included some written comment about care in hospital. At least one negative comment was made by 59% (82) of those making any comment. Of these, 55% (44) rated the care given by doctors as 'excellent' or 'good' and 63% (50) rated that given by nurses as 'excellent' or 'good'. Qualitative analysis of responses to open questions suggest that expressions of dissatisfaction arise from a sense of being 'devalued', 'dehumanized' or 'disempowered' and from situations in which the 'rules' governing the expected health professional-patient relationships were broken. As such, the causes of dissatisfaction for this particular group of patients are similar to the causes of dissatisfaction with health care in general reported elsewhere. The palliative care approach emphasizes patient- and family-centred care and aims to promote physical and psychosocial well-being. The study findings suggest that adoption of the palliative care approach could reduce the experience of dissatisfaction for many service users, not only those whose deaths are anticipated. [ABSTRACT FROM AUTHOR]

This paper reports the results of a study which investigated the experiences of 75 people with chronic non-malignant pain. People with chronic non-malignant pain can find that traditional medical techniques do not help their pain, and they have to learn to live with it. However, pain can affect their lives in many ways. Within this study, qualitative data were collected to illustrate what it meant to people to experience this chronic pain. It was found that pain adversely affected many dimensions of sufferers' lives, and the effects extended to family and friends. It seemed that having others believe the pain was crucial to many patients. Health care professionals can offer these patients much in helping them come to terms with the way in which pain has affected both themselves and their lives. [ABSTRACT FROM AUTHOR]

This paper evaluates the British government's Patients Charter from the perspective of patients admitted via accident and emergency departments. It uses qualitative data obtained about issues of concern to these patients to judge whether the standards set out in the Charter are appropriate to their priorities and, conversely, if there are issues of importance to these patients which the Charter overlooks. Semi-structured interviews were conducted with 83 patients admitted to two London hospitals. It is concluded that the rights and standards outlined in the Patients Charter are generally appropriate to these patients' experiences, although some are defined too narrowly. The study identified a number of issues of importance to patients which are not mentioned in the Patients Charter: pain relief, giving information, receiving information, reception staff, examinations and investigations, physical environment, and other people in casualty. The patient wants rather more than recent British government documents suggest. [ABSTRACT FROM AUTHOR]

In this paper the recently proposed developments in nursing education within the United Kingdom are discussed within a historical context. Since a number of nursing departments already exist within the higher education sector (comprising universities, polytechnics and colleges of technology), it is suggested that use should be made of the experience already gained by nurses working within higher education. The pros and cons of nurse education being provided in or associated with higher education are discussed. Theoretical perspectives from change theory are applied. The importance of educating the practitioner for a holistic and community-based role is stressed. [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]