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AIM AND OBJECTIVES: To provide an overview of tinnitus, current management and its psychosocial impact offering strategies for managing acute and chronic tinnitus in practice. BACKGROUND: Tinnitus, characterised by the perception of sound in the absence of external stimuli, is experienced by about 10% of the population at some time in their lives. It may be temporary/longstanding; approximately 5% adults experience severe, persistent tinnitus affecting their lifestyle. Although many adjust successfully, others are disabled by the condition. Though often unrecognised, tinnitus affects many patients regardless of their presenting illness. DESIGN: A literature review including descriptive, theoretical and empirical material. Databases were searched using the keyword 'tinnitus' providing diverse information which was used to address the research questions. RESULTS: Tinnitus represents more than 'simple' ringing in the ears and may be accompanied by many distressing changes. It may be acute or chronic. It is difficult to treat, care may be directed towards management rather than cure. Many patients are, however, told that 'nothing can be done'. Relevance to clinical practice. Despite the high prevalence of tinnitus, there is a paucity of relevant nursing literature suggesting that there is an information deficit amongst nurses. The information provided shows that understanding the full impact of the condition and identification of patients' needs are essential to effective care. Strategies to help affected patients are given. CONCLUSIONS: Tinnitus, a widespread, often intractable condition, affects millions of people; there is considerable debate about its causes. Tinnitus is distressing and may be severe enough to affect lifestyle and quality of life. Affected patients need considerable support and advice on healthcare options, encouragement to try different treatments and recognition that help and hope are available. Though patients may have to learn to live with tinnitus, the most important thing is that they recognise that help is available. [ABSTRACT FROM AUTHOR]

The article reports on the range of methods used in the original papers in the "Journal of Clinical Nursing." In this issue of the journal the author included original papers only. He use the content of the abstract to decide what the main methodological feature of the paper was. The author discusses the problems relating to the methodological variety of papers published in nursing journal.

The front cover of the journal is presented along with the issue's editors and information on membership and subscriptions.

The article presents the editorial policy of the journal regarding the subject of authorship.

The author reflects on the aims of the making "Journal of Clinical Nursing" (JCN) be known internationally. The journal is an international scientific journal which seeks to promote the development and exchange of knowledge that is directly significant to nursing and midwifery practice. With manuscripts reviewed internationally and international responses from around the world, these realizes the aim to be known. The research published within are of the international standard and relevance.

Comments on the articles on the importance of place in older people nursing, published in the September 2, 2005 issue of the "International Journal of Older People Nursing." Contextual information provided by geographical gerontology; Potential of geographical gerontology to provide critical and direct evidence for practice; Role of place in the concepts of gerontological nursing practice.

AIM: This paper presents the findings of a review and appraisal of the evidence for the effectiveness of nurse case management in improving health outcomes for patients living either with Diabetes, Chronic Obstructive Pulmonary Disease or Coronary Heart Disease. BACKGROUND: Long term chronic health conditions provide some of the greatest challenges to western health care systems. In the UK, three of the most significant chronic conditions are Diabetes, Chronic Obstructive Pulmonary Disease and Coronary Heart Disease. Patients with these long term conditions are high users of health services who often receive unplanned, poorly co-ordinated, ad-hoc care in response to an exacerbation or crisis. To counter this, the nurse case manager is identified as a central aspect of improving care for these patients. However, the evidence for the effectiveness of nurse case management in improving health outcomes for the chronically ill is scarce. DESIGN: A structured review of the literature. METHOD: The review was undertaken focussing on studies that evaluated nurse case management with one or all of the three major long term chronic conditions. A total of 108 papers were initially reviewed and filtered to leave 75 citations that were appraised. About 18 papers were finally included in the review and subject to thematic analysis based on the health outcomes evaluated in the studies. RESULTS: Significantly positive results were reported for nurse case management impact on five health outcomes; 'objective clinical measurements', 'quality of life and functionality', 'patient satisfaction', 'adherence to treatment' and 'self care and service use'. RELEVANCE TO CLINICAL PRACTICE: The evidence generated in this review suggests that nurse case managers have the potential to achieve improved health outcomes for patients with long term conditions. Further research is required to support role development and create a more targeted approach to the intervention. [ABSTRACT FROM AUTHOR]

Aim. To explore the impact of renal cancer treatment on patients' quality of life.Background. Renal cancer accounts for 95,000 deaths worldwide and its incidence rate is rising. At present there are several therapeutic approaches to the treatment of renal cancer, ranging through surgery, immunological therapies and vaccine treatment. Each of these therapies may have a substantial effect upon patients' quality of life. However, a systematic appraisal of the empirical evidence about treatment impact is lacking.Design. Literature review.Methods. A structured review of the empirical literature on the impact of renal cancer treatment upon quality of life was undertaken. Literature was appraised and themed according to the treatment modalities included in the study.Results. From 873 papers initially identified 52 were retrieved for detailed scrutiny resulting in a final 16 papers being included in the review.Conclusions. This review discusses the complex effect of renal cancer upon a patient's quality of life as treatment modalities change. The need for nursing education and awareness of these issues is therefore highlighted to maximise patient care.Relevance to clinical practice. Understanding the impact of treatment for renal cancer enables nurses to empathise more significantly with patients and also act as mediators in regard to treatment choice and treatment cessation. It also enables nurses to inform and educate renal cancer patients prior to making treatment choices. [ABSTRACT FROM AUTHOR]

Aim. This paper presents qualitative findings from a study that explored nursing students' experience of belongingness when undertaking clinical placements. The aim is to locate the professional and practical implications of the research within an Ascent to Competence conceptual framework.Background. The need to belong exerts a powerful influence on cognitive processes, emotional patterns, behavioural responses, health and well-being and failure to satisfy this need can have devastating consequences. The literature suggests that diminished belongingness may impede students' motivation for learning and influence the degree to which they are willing to conform rather than adopt a questioning approach to clinical practice.Design. A mixed methods, cross national, multi-site case study approach was adopted with third-year preregistration nursing students from three universities (two in Australia and one in England) participating; 362 in the quantitative phase and 18 in the qualitative phase.Findings. Qualitative findings demonstrated that, although the primary purpose of clinical education is to facilitate students' progress towards the attainment of competence, the realisation of this goal is impacted by a wide range of individual, interpersonal, contextual and organisational factors which can be conceptualised hierarchically. By this structuring it is possible to see how belongingness is a crucial precursor to students' learning and success.Conclusion. The framework demonstrates that students progress to a stage where attainment of competence is possible only after their previous needs for safety and security, belongingness, healthy self-concept and learning have been met.Relevance to clinical practice. The future of the nursing profession depends upon the development of confident, competent professionals with a healthy self-concept and a commitment to patient-centred care and self-directed learning. This paper demonstrates that the realisation of this goal is strongly influenced by the extent to which students' clinical placement experiences promote and enhance their sense of belonging. [ABSTRACT FROM AUTHOR]

Aims. The aim of this paper is to provide an account of the early development of what was originally known as 'mental deficiency' nursing in the UK and Ireland.Background. After a brief review of research literature, it analyses key issues behind the development of a workforce positioned on the margins of nursing in the two jurisdictions through a comparative discussion of similarities and differences.Design. The paper draws on two doctoral studies that examined the development of intellectual disability nursing using an historiographical design.Methods. Primary sources consulted included records of nursing regulatory bodies, national archives, Royal College of Psychiatrists, archives, nursing journals, individual institutional records in both jurisdictions.Results. In both countries, psychiatrists established early training programmes for nurses, although a nursing model was adopted to meet service needs in the 1950s.Conclusions. However, the way in which this branch of nursing developed laid the foundation for tensions as to whether it is appropriately located within the discipline of nursing. Ireland's colonial past and postcolonial position, the role of the church, welfare systems and diverse socio-political drivers for change represent key differences between the two jurisdictions.Implications. What eventually became known as learning or intellectual disability nursing poses a continued challenge for the profession as a whole in regard to its breadth, role and focus in working with marginalised groups in society. The paper considers the risks for UK and Irish intellectual disability nurses for marginalisation in nursing should they forge closer links to other disciplines concerned with common threads of disability, education or social care. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: This paper explores the range of models of involvement which are drawn upon in an empirical study and which are invoked in the literature and policy. The results and discussion of the study help to excavate and explore the muddle of conceptualisations of involvement and how this leads to difficulties for practitioners, patients and managers in implementing the relevant policy. BACKGROUND: Patient and public involvement has developed an important profile internationally within health and social care policy. However, its importance as a rhetorical device has not been accompanied by adequate developments in how it is operationalised. DESIGN: Cross-sectional study, with an intervention conducted at three sites, and non-intervention measures taken at two control sites. METHODS: This paper draws on an empirical study of involvement. Focus groups were conducted with a lung cancer team and people affected by cancer at five health boards across Scotland. Chief executives of each of these five health boards also took part in individual interviews. Participants were asked to describe their ideas of what involvement is and their application of it. RESULTS: A range of ways of conceptualising involvement were apparent. Few of these moved beyond the use of patient satisfaction questionnaires. At times, troubling understandings were articulated, for example, using public meetings to communicate decisions about service closures to the public. CONCLUSION: The slow escalation of involvement is in part because of the myriad ways in which it is conceptualised and discussed. Thus, we conclude that one of the greatest barriers to truly integrating patient involvement into health services, policy and research is the conceptual muddle with which involvement is articulated, understood and actioned. RELEVANCE TO CLINICAL PRACTICE. Clinicians need to be supported to seek clarity in the use and operationalisation of involvement if the agenda is to be truly adopted and strengthened. [ABSTRACT FROM AUTHOR]

Aim. To discuss the problem of poor attendance at cardiac rehabilitation from the alternative perspective of patient ambivalence. Background. Evidence supports the benefits of cardiac rehabilitation as a means for secondary prevention of coronary heart disease, yet current literature continues to document poor attendance at these programmes. Whilst extrinsic factors, such as transportation and lack of physician support have been identified as barriers, patients who choose not to attend these programmes are often described as lacking motivation or being non-compliant. However, it is possible that non-attendance is the result of ambivalence - the experience of simultaneously wanting to and yet not wanting to, or the 'I want to, but I don't want to' dilemma. Design. Discussion paper. Method. This discussion paper draws on the literature of ambivalence and decision-making theory to reframe the issue of poor attendance at cardiac rehabilitation. Conclusions: This paper has demonstrated that the problem of poor attendance may be explained from the perspective of patient ambivalence and that using strategies such as the decisional balance may assist these individuals in exploring their ambivalence to engage in secondary prevention programmes. Relevance to clinical practice. Understanding the dynamics of ambivalence provides an alternative to thinking of patients as lacking motivation, being non-compliant, or even resistant. Helping patients to explore and resolve their ambivalence may be all that is needed to help them make a decision and move forward. [ABSTRACT FROM AUTHOR]

Aims. To offer a detailed discussion of the issue of 'lack of critique' in the literature on spirituality in nursing. The discussion will include the limited use of sources from theology and religious studies and the demand to separate spirituality and religion and will go on to examine the consequences of the resulting approach. The drive for unique knowledge to further professionalisation and the demands of inclusiveness are suggested as possible reasons for the development of the current model. The dangers and pitfalls of definition are explored. The paper suggests that theology could provide insights into explaining spirituality. Background. The last four decades have seen a proliferation of definitions of spirituality in the nursing literature. Recently, in response to their own concerns and prompts from outside the 'spirituality' community authors have suggested that we revisit this literature with a more critical stance. This paper is in response to that suggestion. During the course of a PhD supervised from a department of practical theology I have critically analysed the literature from several perspectives and this paper is one result of that review. Design. Literature review. Methods. Critical reflection on how spirituality has been defined. Conclusion. The lack of critique has produced a bias in the literature towards broad, generic, existential definitions which, together with the intentional divorce from religion and theology have led to definitions which have the tendency to result in a type of spiritual care which is indistinguishable from psychosocial care, hard to explain to patients and difficult to put into practice. Relevance to clinical practice. The acceptance of a diverse range of understandings of spirituality and a greater focus on practical ways of using it in nursing care are the direction the profession should be moving into. [ABSTRACT FROM AUTHOR]

Aims. This paper reviews the role of cardiac nursing in China and the potential of this professional group to take an important role in secondary and tertiary prevention initiatives. Background. China is undergoing unprecedented economic growth, yet globalisation of Chinese society has caused an increase in the prevalence of chronic conditions, particularly cardiovascular disease. Studies recognise that health providers and members of the public are not fully aware of the risks associated with cardiovascular disease and consequently are not equipped to deal with this looming epidemic. Design. Position paper. Method. This position paper summarises and discusses the burden of cardiovascular disease in China within the context of evidence for nurse-coordinated interventions. Barriers and facilitators to developing the nursing role in contemporary China are discussed. Conclusions. A key strategy for promoting the role of nurse-led programmes in China is increasing research skills among Chinese nurses to promote independent, collaborative interdisciplinary research. Promoting doctoral education in China, increasing the status of nursing in interdisciplinary teams, collaborating with cardiovascular nurses internationally and increasing the public's awareness of cardiovascular disease are critical steps in promoting nurse-led programmes to improve the health and well-being of the community. Relevance to clinical practice. Given the positive relationship between knowledge and skill levels of nurses and clinical outcomes, China's investment in the education and training of its nursing workforce is critical in improving practice and outcomes in cardiovascular disease. [ABSTRACT FROM AUTHOR]

Aims and objectives. This paper aims to explore the concept of risk in pregnancy. Background. Notions of risk and 'not knowing' have always surrounded pregnant women, although in the last two decades trends of increased consumer confidence and midwifery activism have together promoted a greater appreciation of pregnancy as a normal life event. At the same time, advances in pregnancy-related technologies have contributed new levels of concern related to an increasing ability to detect minor abnormalities by ultrasound. This, in turn, causes a concordant rise in the number of women referred to high-risk pregnancy care to monitor suspect findings. Overall, it seems likely that this increasing emphasis on abnormality detection and risk may have serious implications for women. Design. Concept analysis. Method. In this paper, I undertake an exploration of the concept of risk as understood by health professionals and pregnant women. Then, using Deborah Lupton's understanding of a 'discourse of risk', I discuss the ways pregnant women both contribute to and are enmeshed in, this discourse. In the final section, I consider how nurses act informally to shield vulnerable women. Conclusions. Health professionals and pregnant women understand risk differently. Women employ a subjective appraisal of risk, measuring it against their personal values and prior experience, while health professionals evaluate risk in an objective manner. Relevance to clinical practice. As increasing numbers of women are referred to 'at risk' care, it is important that health professionals understand and respond to maternal understandings of risk. Nurses and midwives particularly, have a role to play in assisting women to make sense of risk calculations. In this way, they can act to ameliorate the growing concept of risk for pregnant women. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a project investigating the potential role of the nurse practitioner in aged care across residential, community and acute care venues in the Australian Capital Territory. Background. Australia, like many other countries, faces unprecedented challenges in the provision of health care. Escalating health care costs, an ageing population, increasing prevalence of comorbidities and chronic illnesses, inefficient health care delivery, changing models of health care and shifting professional role boundaries are factors that have contributed to the development of advanced practice roles for nursing. Design. This was a mixed methods study using multiple data sources. Methods. Student aged care nurse practitioners were examined across the continuum of care in the acute, community and residential aged care settings. The potential role of the nurse practitioner in these areas was evaluated qualitatively and quantitatively to identify a model of care to enhance the delivery of efficient and effective health care. Results. The project findings have demonstrated that there is potential for significant improvement in client outcomes arising from a transboundary aged care nurse practitioner model. The improved outcomes are associated with a decrease in acute hospital admissions for residential care clients, timely intervention for a range of common conditions and strengthened multidisciplinary approaches to care provision for older people. Conclusions. Overall the project findings strongly support the potential of a transboundary aged care nurse practitioner role. This role would focus on skilled assessment, timely assessment and intervention, brokering around access to care and clinical leadership and education for nurses. Relevance to clinical practice. This paper offers further evidence of support for the role of nurse practitioners in complementing existing health services and improving delivery of care. [ABSTRACT FROM AUTHOR]

Aims and objectives. This paper draws upon an evaluation of the first group of nurse consultants in Scotland. The evaluation aimed to identify the extent to which they fulfilled the remit of their posts which comprised four core functions. One of these functions was to provide professional leadership and this paper focuses on this element of the role and aims to explore it in relation to the attributes of transformational leadership. Background. Nurse consultants were introduced in the UK in 2000. Their purpose was to achieve better outcomes for patients and strengthen leadership. Nursing research identifies leadership as a key element of the role, with postholders adopting transformational leadership approaches. Research from the fields of sociology and psychology identifies difficulties in formulating a coherent theory of leadership, arguing for better understanding of leadership processes. Design. Qualitative. Methods. This paper draws on 31 semi-structured interviews with four nurse consultants who were interviewed twice over six to nine months and 23 other 'stakeholders' who worked with them. Results. Varied leadership activity at ward, NHS Trust and strategic levels was identified. Postholders used approaches that resonated with the attributes of transformational leadership. Leadership processes included developing a vision for the service, acting as mediator and champion, and exerting control over complex change initiatives. Techniques of leadership included taking a 'softly softly' approach, pacing change initiatives and arguing assertively with those in senior positions. Interview findings also identified the level of preparation that was required to meet the remit of the posts, highlighting the importance of interpersonal skills and intellectual effort in achieving outcomes. Conclusions. Nurse consultants require considerable technical expertise, cognitive and interpersonal skills, and the ability to take risks. The data suggest that the leadership attributes required are transformational in nature but that they also exceed those identified in much of the literature. These posts require appropriate support if they are to be sustainable. Relevance to clinical practice. This paper adds to our understanding of the complexity of the nurse consultant role and highlights the challenge of providing appropriate professional development for postholders. [ABSTRACT FROM AUTHOR]

Aim. The purpose of this paper is to critically explore the sequential explanatory mixed method research design and how it can enhance our understanding of pain management. Background. The general prevalence of pain after surgery has not changed significantly over several decades despite the widespread introduction of new pain relieving technologies. The majority of postoperative pain studies use quantitative methods which offer little understanding of the underlying processes of care. Understanding can be illuminated by using an explanatory mixed method research design. Design. Discursive paper. Method. This paper focuses on the methodological considerations when using a mixed method design. Two previously published mixed methods studies illustrate how findings can inform practice. In the first, 85 women undergoing surgery completed questionnaires to measure pain, anxiety and depression. Telephone interviews explored their pain experiences. The second study considered frequency and patterns of anxiety in the immediate pre and postoperative period. Semi-structured telephone interviews, identified contributing events/situations amenable to nursing intervention. Discussion. Reasons for growing popularity, criticisms, paradigmatic considerations and epistemological roots of pragmatism are explored. The two explanatory mixed method studies provide examples of these studies and how 'inferences' from quantitative and qualitative data can inform practice. Conclusion. This paper connects quantitative and qualitative data, drawing on two research studies, to give greater understanding to the management of pain. Knowledge of the processes responsible for inadequate pain management can be illuminated by using explanatory mixed methods research designs. Relevance to clinical practice. Nursing requires knowledge which reflects the complexity of human health. The explanatory mixed method study can elucidate the problem under scrutiny, e.g. prevalence of pain or anxiety. The qualitative phase can generates an understanding of contributing factors and insights for care delivery. The implicit desire to change and influence practice makes it relevant for those closely aligned to practice. [ABSTRACT FROM AUTHOR]

Aims and objectives. This paper provides a context for this special edition. It highlights the scale of the challenge of nursing shortages, but also makes the point that there is a policy agenda that provides workable solutions. Results. An overview of nurse:population ratios in different countries and regions of the world, highlighting considerable variations, with Africa and South East Asia having the lowest average ratios. The paper argues that the 'shortage' of nurses is not necessarily a shortage of individuals with nursing qualifications, it is a shortage of nurses willing to work in the present conditions. The causes of shortages are multi-faceted, and there is no single global measure of their extent and nature, there is growing evidence of the impact of relatively low staffing levels on health care delivery and outcomes. The main causes of nursing shortages are highlighted: inadequate workforce planning and allocation mechanisms, resource constrained undersupply of new staff, poor recruitment, retention and 'return' policies, and ineffective use of available nursing resources through inappropriate skill mix and utilisation, poor incentive structures and inadequate career support. Conclusions. What now faces policy makers in Japan, Europe and other developed countries is a policy agenda with a core of common themes. First, themes related to addressing supply side issues: getting, keeping and keeping in touch with relatively scarce nurses. Second, themes related to dealing with demand side challenges. The paper concludes that the main challenge for policy makers is to develop a co-ordinated package of policies that provide a long term and sustainable solution. Relevance to clinical practice. This paper highlights the impact that nursing shortages has on clinical practice and in health service delivery. It outlines scope for addressing shortage problems and therefore for providing a more positive staffing environment in which clinical practice can be delivered. [ABSTRACT FROM AUTHOR]

AIM: This paper examines the hitherto mostly unrecognised relationship between gender, health and children; its significance for nursing practice and how it has been considered in nursing research. BACKGROUND: Holistic nursing practice with children requires adequate assessment and consideration of all potential influences on children's lives. Socioeconomic disparities have received widespread attention and gender inequalities in adult health have been studied in some depth. The links between gender, health and children, however, have received little consideration. The paper first considers this context in depth; it then applies the context to research in practice. DESIGN: Systematic review. METHODS: A systematic literature search was undertaken on four mainstream nursing research journals over 38 months up to February 2007. A total of 567 articles met the key word searches. Duplicates, opinion pieces and articles not focusing on children were removed. The remaining 23 nursing studies relevant to child health were examined for their gender sensitivity. RESULTS: Full consideration of gender issues was found largely to be absent in nursing research on children. Eight studies gave specific consideration to gender relevance, where boys and girls may have responded differently to care. Only six studies specifically addressed gender sensitivity. Allowing children a voice, however, was a strength in these studies, with 18 reflecting children's views directly. CONCLUSIONS: Major gaps still exist in research and theorisation relating to children, health and gender. These need to be acknowledged and investigated, particularly in relation to how they might impact on nursing care. RELEVANCE TO CLINICAL PRACTICE: Nursing practice and research needs to account for all potential health issues, of which gender may often be important. [ABSTRACT FROM AUTHOR]

AIMS: The aim of this paper is to share our experiences of dealing with chaos and complexity in interview situations in the home with children and young people. We highlight dilemmas relevant to dealing with multiple interruptions, building a rapport, consent and confidentiality. Furthermore, we discuss issues regarding the locus of power and control and offer some solutions based on our experiences. BACKGROUND: Creating a safe environment is essential for qualitative research. Participants are more likely to open up and communicate if they feel safe, comfortable and relaxed. We conclude that interviewing parents and their children with cystic fibrosis in their own homes, is chaotic and appears to threaten the rigour of data collection processes. Limited attention or print space is paid to this issue, with published articles frequently sanitising the messiness of real world qualitative research. DESIGN: Position paper. METHODS: In this position paper, we use two case studies to illustrate ethical and pragmatic challenges of interviewing out in the field. These case studies, typical of families we encountered, help emphasise the concerns we had in balancing researcher-participant rapport with the quality of the research process. CONCLUSIONS: Dealing with perceived chaos is hard in reality, but capturing it is part of the complexity of qualitative enquiry. The context is interdependent with children's perceived reality, because they communicate with others through their environment. RELEVANCE TO PRACTICE: This paper gives researchers an insight into the tensions of operating out in the field and helps raise the importance of the environmental 'chaos' in revealing significant issues relevant to peoples daily lives. Knowing that unexpected chaos is part and parcel of qualitative research, will equip researchers with skills fundamental for balancing the well being of all those involved with the quality of the research process. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: The aim of this paper is to reflect on how an acute hospital trust involved a youth council comprising 17 young people aged 11-18 years to improve children's service delivery in one NHS trust in the UK. BACKGROUND: Over the last decade, there has been an increased emphasis on the active involvement and participation of children and young people in the decision-making processes that affect them. However, one challenge in involving users in acute hospital trusts is how their views are used to develop services. For this reason, University Hospitals Coventry and Warwickshire NHS Trust, UK (University Hospitals Coventry and Warwickshire NHS Trust have given permission to have their name cited in the publication of this article) recognising the emerging national patient and public involvement agenda, planned and developed a youth council for the Trust in 2006. PROCESS: The process of setting up the youth council is outlined. An evaluation workshop took place with 15 members of the youth council and their views are incorporated around three specific areas: Evidence that their involvement has improved trust services; Barriers to young people's voices being heard in service delivery; What could promote young people's involvement in healthcare services. CONCLUSION/RELEVANCE TO CLINICAL PRACTICE: This paper describes the setting up of a youth council but also discusses the potential barriers and how to overcome them to promote young people's involvement in hospital trust service planning and development. Whilst the focus of the council was young people, the principles are of use to a wide range of clinical professionals faced with similar challenges. [ABSTRACT FROM AUTHOR]

Aims of the paper. In this paper I hope to, at least partially, succeed in demystifying the research process, especially as it may be perceived by clinicians, encourage their involvement and participation in clinical research and propose practical and rewarding strategies that all children’s nurses can adopt to begin to create a vibrant research culture in any clinical area. Background. The professional and organisational expectation that all nurses will, in some way, be involved in research is growing and will not go away. Despite the historic, toxic dualism that has seen research as essentially the prerogative of ‘The Academy’, clinicians are beginning to take more of an interest and role in research, despite the many obstacles that they face. In today’s health care system, children’s nurses cannot afford to abdicate responsibility for research or to postpone their involvement until the ideal conditions for their engagement come along. This paper suggests approaches and strategies that clinicians, educators, managers and researchers can use as a basis for productive and mutually beneficial collaborative research initiatives. Design. Position paper. Conclusions. Developing clinical-focused, collaborative, interdisciplinary research is now a worldwide policy and practice imperative. There is no reason why children’s nurses cannot take a leading role in this movement. Previous models of research where research has been undertaken by academics and then ‘disseminated’ to clinicians who are expected to ‘implement’ it (and who are then subsequently blamed for failure) has been less than successful and small wonder. Relevance to clinical practice. Where clinicians are directly involved as genuine research partners in both the research process and the project from day 1, there is a real prospect that both the benefits of the inquiry process and any research findings will be more readily adopted by the clinical areas concerned. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of this paper is to reflect on how an acute hospital trust involved a youth council comprising 17 young people aged 11–18 years to improve children’s service delivery in one NHS trust in the UK. Background. Over the last decade, there has been an increased emphasis on the active involvement and participation of children and young people in the decision-making processes that affect them. However, one challenge in involving users in acute hospital trusts is how their views are used to develop services. For this reason, University Hospitals Coventry and Warwickshire NHS Trust, UK (University Hospitals Coventry and Warwickshire NHS Trust have given permission to have their name cited in the publication of this article) recognising the emerging national patient and public involvement agenda, planned and developed a youth council for the Trust in 2006. Process. The process of setting up the youth council is outlined. An evaluation workshop took place with 15 members of the youth council and their views are incorporated around three specific areas: • Evidence that their involvement has improved trust services; • Barriers to young people’s voices being heard in service delivery; • What could promote young people’s involvement in healthcare services. Conclusion/Relevance to clinical practice. This paper describes the setting up of a youth council but also discusses the potential barriers and how to overcome them to promote young people’s involvement in hospital trust service planning and development. Whilst the focus of the council was young people, the principles are of use to a wide range of clinical professionals faced with similar challenges. [ABSTRACT FROM AUTHOR]

Aim. In this position paper, the self-efficacy model of medication adherence in chronic mental illness is presented, and its application to antipsychotic medication adherence is considered. Background. Poor adherence to antipsychotic medications is common in chronic mental illness. Major implications of this are relapse and re-hospitalisation. Several conceptual frameworks have been developed about adherence and, in some instances, have been incorporated in medication taking studies, but have resulted in inconsistent outcomes. Method. This paper draws on a review of literature from databases to inform the development of the self-efficacy model of medication adherence. Inclusion and exclusion criteria were developed from primary and secondary research questions. Results. The model places the person with chronic mental illness as an active participant central to the process of medication taking. It has three components: core factors, contextual influences and a continuum. The factors comprise a central factor, self-efficacy and four interrelated supporting influences: perceived medication efficacy; access to, and relationships with, health professionals; significant other support and supported living circumstances. The factors are affected by three broad contextual influences - personal issues, medication side-effects and complexity, and social stigma - which affect the way individuals take their medications. A continuum exists between adherence and non-adherence. Conclusion. The model positions service users at the heart of adherence by giving prominence to self-efficacy, medication efficacy and to immediate social, psychological and environmental supports. Further work is needed to validate, refine and extend the model. Relevance to clinical practice. For practitioners involved in prescribing and medication management in people with chronic mental illness, the model provides a theoretical framework to strengthen adherence. It highlights the need to consider broader influences on medication taking. Moreover, it places the person with chronic mental illness as an active participant at the centre of strategies to enhance adherence. [ABSTRACT FROM AUTHOR]

Aims and objectives. This paper reviews and summarises the literature on assessment, diagnosis and management of personality disorder in people with intellectual disability. It will proceed to argue the implications of a mental health nurse practitioner in clinical practice. Background. Personality disorder is a potentially severe and disabling condition causing significant distress as well as presenting considerable challenges for service providers. Diagnosis in people with intellectual disability is controversial. However, it is considered that this population is at greater risk of these disorders. There is, however, little research on which to base clinical interventions or service planning. Design. Systematic review. Methods. A literature search of electronic data was undertaken in April 2007 using CINAHL, AMED, Medline, PsycINFO, EMBASE and Cochrane Library. Other sources included Google Scholar, hand searching of reference lists and texts and search of relevant websites. Results. The literature on personality disorder in intellectual disability is notable for its paucity. The limited evidence available suggests that this population is at greater risk of personality disorder and that assessment and diagnosis is complex and often overshadowed by the intellectual disability. Few papers address treatment, there are no trial-based studies and it has not been established whether results can be extrapolated from research in the general population. Conclusions. The issue of personality disorder in people with intellectual disability is shrouded in controversy with a dearth of robust evidence to inform assessment or therapeutic care. Personality disorder does, however, provide a basis for decisions on type and intensity of support required for this population who have significant levels of unmet need. Relevance to clinical practice. Some people with an intellectual disability and personality disorder can live in the community with specialist support. The mental health nurse practitioner has the potential to provide people with dual diagnostic support needed to enhance the capacity of the service system to meet the needs of this complex and difficult population. [ABSTRACT FROM AUTHOR]

AIM: This paper aims to describe caring needs associated with existential aspects of living with addiction. BACKGROUND: Spirituality is considered a driving force within and the concept relates to self, others and God and the relationships between them. The spiritual dimension is of great importance in both the addiction itself as well as in recovery and addressing caring needs relating to spirituality is important in nursing. DESIGN: Hermeneutic inquiry was used to explore caring needs related to peoples experiences of living with addiction. METHOD: This paper is a hermeneutic expansion of findings presented in Part I. Existential themes in the form of spiritual challenges and caring needs are reflected upon as a process between figure and background. RESULTS: The themes presented are: meaning - meaninglessness, connectedness - loneliness, life - death, freedom - adjustment, responsibility - guilt, control - chaos. Caring needs associated with them are identified as; the need to create a new frame of reference for interpreting of life, the need to experience coherence in life, a restored dignity as well as the need for a sense of community and attachment, confirmation and acceptance. The caring need for forgiveness and reconciliation is also identified as well as the need for continuity, comprehensibility and manageability. CONCLUSIONS: When caring for patients suffering from addiction nurses should address patients' spirituality. The caring communion is vital, as it is the foundation for meeting the patients' needs. Intervention by nurses should focus on aspects that will help patients feel alive and in communion with others. RELEVANCE TO CLINICAL PRACTICE: Understanding and being able to identify patients' caring needs associated with existential aspects of living with addiction will enable nurses to provide professional care and promote patient's recovery. [ABSTRACT FROM AUTHOR]

Aim. This paper aims to describe caring needs associated with existential aspects of living with addiction. Background. Spirituality is considered a driving force within and the concept relates to self, others and God and the relationships between them. The spiritual dimension is of great importance in both the addiction itself as well as in recovery and addressing caring needs relating to spirituality is important in nursing. Design. Hermeneutic inquiry was used to explore caring needs related to peoples experiences of living with addiction. Method. This paper is a hermeneutic expansion of findings presented in Part I. Existential themes in the form of spiritual challenges and caring needs are reflected upon as a process between figure and background. Results. The themes presented are: meaning – meaninglessness, connectedness – loneliness, life – death, freedom – adjustment, responsibility – guilt, control – chaos. Caring needs associated with them are identified as; the need to create a new frame of reference for interpreting of life, the need to experience coherence in life, a restored dignity as well as the need for a sense of community and attachment, confirmation and acceptance. The caring need for forgiveness and reconciliation is also identified as well as the need for continuity, comprehensibility and manageability. Conclusions. When caring for patients suffering from addiction nurses should address patients’ spirituality. The caring communion is vital, as it is the foundation for meeting the patients’ needs. Intervention by nurses should focus on aspects that will help patients feel alive and in communion with others. Relevance to clinical practice. Understanding and being able to identify patients’ caring needs associated with existential aspects of living with addiction will enable nurses to provide professional care and promote patient’s recovery. [ABSTRACT FROM AUTHOR]

AIM AND OBJECTIVES: This paper aims to present a theoretical account of professional nursing challenges involved in providing care to patients suffering from chronic obstructive pulmonary disease. The study objectives are patients' and nurses' expectations, goals and approaches to assisted personal body care. BACKGROUND: The provision of help with body care may have therapeutic qualities but there is only limited knowledge about the particularities and variations in specific groups of patients and the nurse-patient interactions required to facilitate patient functioning and well-being. For patients with severe chronic obstructive pulmonary disease, breathlessness represents a particular challenge in the performance of body care sessions. DESIGN: We investigated nurse-patient interactions during assisted personal body care, using grounded theory with a symbolic interaction perspective and a constant comparative method. METHODS: Twelve cases of nurse-patient interactions were analysed. Data were based on participant observation, individual interviews with patients and nurses and a standardized questionnaire on patients' breathlessness. FINDINGS: Nurses and patients seemed to put effort into the interaction and wanted to find an appropriate way of conducting the body care session according to the patients' specific needs. Achieving therapeutic clarity in nurse-patient interactions appeared to be an important concern, mainly depending on interactions characterized by: (i) reaching a common understanding of the patient's current conditions and stage of illness trajectory, (ii) negotiating a common scope and structuring body care sessions and (iii) clarifying roles. CONCLUSION: It cannot be taken for granted that therapeutic qualities are achieved when nurses provide assistance with body care. If body care should have healing strength, the actual body care activities and the achievement of therapeutic clarity in nurses' interaction with patients' appear to be crucial. RELEVANCE TO CLINICAL PRACTICE: The paper proposes that patients' integrity and comfort in the body care session should be given first priority and raises attention to details that nurses should take into account when assisting severely ill patients. [ABSTRACT FROM AUTHOR]

Aim. The aim of this paper is to highlight the significance of care planning and to encourage the integration of a consistent and systematic planning process into nursing practice. Background. Many factors contribute to the successful achievement of clinical outcomes, including patient-practitioner rapport, comprehensive client assessment, accurate differential diagnosis, evidence-based care and the objective evaluation of client progress. One element that is of equal importance to these aforementioned factors is the planning of patient care. However, there are concerns that some practitioners may not be adopting a planned approach to client care, possibly because of a lack of understanding, time, skill or interest in care planning. Method. This is a position paper on the planning of patient care. Results. The planning of patient care can be effectively implemented using a two-stage process. In brief, the first step involves the construction of a general goal, which is the overall, desired outcome of care. The expected outcome, or specific goal, forms the second part of the planning process, which clearly directs clinical care by specifically indicating how and when an individual will achieve the general goal of treatment. Conclusion. This paper highlights the importance of care planning and that the use of a clear, systematic planning framework may help to deliver a more transparent and consistent approach to patient care, which may greatly improve patient health and well-being by hastening the achievement of clinical outcomes. Relevance to clinical practice. The knowledge and strategies contained in this paper can be easily adopted by nurses and other clinicians to modify or build upon existing practice. This knowledge may help foster a more client-centred, participative, individualised approach to care, which may lead to improvements in patient outcomes. [ABSTRACT FROM AUTHOR]

Aim. To review the literature on attitudes of health care professionals to termination of pregnancy and draw out underlying themes. Background. The controversy surrounding therapeutic abortion is unremitting with public opinion often polemic and unyielding. Nurses and midwives are at the centre of this turmoil, and as more termination of pregnancies are being performed using pharmacological agents, they are becoming ever more involved in direct care and treatment. Attitudes towards termination of pregnancy have been found to vary depending on the nationality of those asked, the professionals involved, experience in abortion care, as well as personal attributes of those asked such as their obstetric history and religious beliefs. The reasons for women undergoing abortion were also found to influence attitudes to a greater or lesser extent. Conclusion. This paper explores research studies undertaken into attitudes of health care professionals towards termination of pregnancy, to appreciate the complexity of the debate. It is possible that the increased involvement of nurses in termination of pregnancy, that current methods demand, may lead to change in attitudes. Consideration is given to a number of remedies to create an optimum environment for women undergoing termination of pregnancy. Relevance to clinical practice. This paper establishes via a literature review that attitudes in those working in this area of care depend upon a variety of influences. Suggestions are made for measures to be put into place to foster appropriate attitudes in those working in termination of pregnancy services. [ABSTRACT FROM AUTHOR]

AIM: The aim of this paper is to shed light on how nurses describe situations that reflect achievement and provide confirmation that they have done good work. BACKGROUND: Nurses' recognition of good work does not seem to have been the object of direct investigation, but is indirectly reflected in studies focusing on nurses' perceptions on work environments and the multifaceted nature of nursing. However, acknowledging high-quality performance in professional nurses can facilitate nurses in maintaining and strengthening the goals and values of the profession. This in turn can help nurses shoulder the multifaceted responsibilities they have to patients and next of kin. DESIGN: This paper is part of the Professional Learning in a Changing Society project, Institute of Educational Research, University of Oslo, funded by the Research Council of Norway. The project involves four professional groups. This paper, however, focuses on a group of 10 nurses, nine of whom work in hospitals and one in an outpatient clinic. A qualitative approach was chosen to gain insight into how nurses, as well as the other professional groups in the project, engage in processes of knowledge production and quality assurance work. METHODS: Data presented in this paper derive from semi-structured in-depth interviews conducted during spring 2005 and focuses on the recognition of good work. RESULTS: The following themes were identified as essential in confirming that one did good work: securing fundamental needs of patients and next of kin; managing the flow of responsibilities; positive feedback. CONCLUSIONS. Good work seems to be related to specific situations and a sense of achievement by the respondents. RELEVANCE TO CLINICAL PRACTICE: Recognition of good work is not only rewarding and enjoyable; it may also serve as a source of consciousness raising for professional and ethical guidelines in the work place. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: This paper describes the further development of the substantive theory Optimising Personal Control to Facilitate Emotional Comfort. In previous work, emotional comfort was identified as a therapeutic state that was influenced by several factors, one of which was the hospital environment. This paper focuses on aspects within the hospital environment that patients perceive to influence their feelings of personal control. BACKGROUND: A relationship between control and health has been discussed in previous literature. There are indications that aspects of the hospital environment can impact on a patient's perception of control. This project explored personal control in relation to the hospital environment from the perspective of patients. METHOD: Grounded theory method was used. Data were collected from patients' interviews and field observations and analysed using the constant comparative method. Interviews were tape-recorded and transcribed verbatim. A qualitative data computer program was used to manage the data. RESULTS: The results confirmed the findings of the original study where hospitalised patients were found to experience feelings of reduced personal control. The conditions of level of security, level of knowing and level of personal value were described in terms of their contribution to the patient's feelings of personal control. CONCLUSIONS: Specific directions for further research into the development and evaluation of therapeutic hospital environments that promote personal control and the associated emotional comfort are provided. RELEVANCE TO CLINICAL PRACTICE: This research highlights the importance of considering patients' feelings of personal control during their hospital stay. Several directions for establishment of therapeutic environments within hospitals are provided, but more research in this area is recommended. [ABSTRACT FROM AUTHOR]

AIMS: This paper is based on a review of the Australian and International literature relating to the nursing-medical division of labour. It also explores how the division of labour affects patient access to emergency care in small rural health services in Victoria, Australia. BACKGROUND: The paper describes the future Australian health workforce and the implications for rural Victoria. The concept of division of labour and how it relates to nursing and medicine is critically reviewed. Two forms of division of labour emerge - traditional and negotiated division of labour. Key themes are drawn from the literature that describes the impact of a traditional form of division of labour in a rural context. METHODS: This paper is based on a review of the Australian and international literature, including grey literature, on the subject of rural emergency services, professional boundaries and roles, division of labour, professional relationships and power and the Australian health workforce. RESULTS: In Australia, the contracting workforce means that traditional divisions of labour between health professionals cannot be sustained without reducing access to emergency care in rural Victoria. A traditional division of labour results in rural health services that are vulnerable to slight shifts in the medical workforce, unsafe services and recruitment and retention problems. A negotiated form of division of labour provides a practical alternative. CONCLUSION: A division of labour that is negotiated between doctors and nurses and supported by a legal and clinical governance framework, is needed to support rural emergency services. The published evidence suggests that this situation currently does not exist in Victoria. Strategies are offered for creating and supporting a negotiated division of labour. RELEVANCE TO CLINICAL PRACTICE: This paper offers some strategies for establishing a negotiated division of labour between doctors and nurses in rural emergency care. [ABSTRACT FROM AUTHOR]

Aim. The aim of this paper is to shed light on how nurses describe situations that reflect achievement and provide confirmation that they have done good work. Background. Nurses’ recognition of good work does not seem to have been the object of direct investigation, but is indirectly reflected in studies focusing on nurses’ perceptions on work environments and the multifaceted nature of nursing. However, acknowledging high-quality performance in professional nurses can facilitate nurses in maintaining and strengthening the goals and values of the profession. This in turn can help nurses shoulder the multifaceted responsibilities they have to patients and next of kin. Design. This paper is part of the Professional Learning in a Changing Society project, Institute of Educational Research, University of Oslo, funded by the Research Council of Norway. The project involves four professional groups. This paper, however, focuses on a group of 10 nurses, nine of whom work in hospitals and one in an outpatient clinic. A qualitative approach was chosen to gain insight into how nurses, as well as the other professional groups in the project, engage in processes of knowledge production and quality assurance work. Methods. Data presented in this paper derive from semi-structured in-depth interviews conducted during spring 2005 and focuses on the recognition of good work. Results. The following themes were identified as essential in confirming that one did good work: securing fundamental needs of patients and next of kin; managing the flow of responsibilities; positive feedback. Conclusions. Good work seems to be related to specific situations and a sense of achievement by the respondents. Relevance to clinical practice. Recognition of good work is not only rewarding and enjoyable; it may also serve as a source of consciousness raising for professional and ethical guidelines in the work place. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: To discuss findings relating to role extension and loss of nursing care to auxiliary nurses. BACKGROUND: There is ongoing discussion in the literature about what nurses' roles may be and how the extension of role affects patient care. Various models have been devised to measure outcomes and the value of nursing to patients. However, there are limited data on the views of nurses themselves in terms of what they perceive their role to be and what they feel about role change. DESIGN: A qualitative approach was used with the help of the elements of grounded theory. METHODS: Data were analysed using a constant comparative method with core categories identified. The study described in this paper was the final of three. The first two studies involved student nurses and through theoretical sampling, the third sample was chosen to expand the data gained from the students. RESULTS: The findings from the student studies indicated concern that the nursing role was being undertaken by auxiliary nurses. The results of the final study, as discussed in this paper, confirmed this. However, one main difference was that qualified nurses were not necessarily unhappy about auxiliary nurses' role expansion but were concerned that the role of the nurse was moving away from the bedside. CONCLUSIONS: The data suggest that nurses' roles may be hard to define. An abdication of role, as opposed to delegation of role, seems to be occurring. Critical thinking is needed to ensure this is a decision advocated by clinical nurses. RELEVANCE TO CLINICAL PRACTICE: Nurses need to be explicit about what their clinical roles are. This study provides data expressing the views of clinical nurses about role expansion and role abdication and corresponding feelings about it. [ABSTRACT FROM AUTHOR]

AIMS: This paper draws together the personal thoughts and critical reflections of key people involved in the establishment of a 'virtual' practice development unit of clinical nurse specialists in the south of England. BACKGROUND: This practice development unit is 'virtual' in that it is not constrained by physical or specialty boundaries. It became the first group of Trust-wide clinical nurse specialists to be accredited in the UK as a practice development unit in 2004. DESIGN AND METHODS: The local university was asked to facilitate the accreditation process via 11 two-hour audio-recorded learning sessions. Critical reflections from practice development unit members, leaders and university staff were written 12 months after successful accreditation, and the framework of their content analysed. FINDINGS AND DISCUSSION: Practice development was seen as a way for the clinical nurse specialists to realize their potential for improving patient care by transforming care practice in a collaborative, interprofessional and evolutionary manner. The practice development unit provided a means for these nurses to analyse their role and function within the Trust. Roberts' identity development model for nursing serves as a useful theoretical underpinning for the reflections contained in this paper. CONCLUSIONS: These narratives provide another example of nurses making the effort to shape and contribute to patient care through organizational redesign. This group of nurses began to realize that the structure of the practice development unit process provided them with the means to analyse their role and function within the organization and, as they reflected on this structure, their behaviour began to change. RELEVANCE TO CLINICAL PRACTICE: Evidence from these reflections supports the view that practice development unit participants have secured a positive and professional identity and are, therefore, better able to improve the patient experience. [ABSTRACT FROM AUTHOR]

Aims. This paper draws together the personal thoughts and critical reflections of key people involved in the establishment of a ‘virtual’ practice development unit of clinical nurse specialists in the south of England. Background. This practice development unit is ‘virtual’ in that it is not constrained by physical or specialty boundaries. It became the first group of Trust-wide clinical nurse specialists to be accredited in the UK as a practice development unit in 2004. Design and methods. The local university was asked to facilitate the accreditation process via 11 two-hour audio-recorded learning sessions. Critical reflections from practice development unit members, leaders and university staff were written 12 months after successful accreditation, and the framework of their content analysed. Findings and discussion. Practice development was seen as a way for the clinical nurse specialists to realize their potential for improving patient care by transforming care practice in a collaborative, interprofessional and evolutionary manner. The practice development unit provided a means for these nurses to analyse their role and function within the Trust. Roberts’ identity development model for nursing serves as a useful theoretical underpinning for the reflections contained in this paper. Conclusions. These narratives provide another example of nurses making the effort to shape and contribute to patient care through organizational redesign. This group of nurses began to realize that the structure of the practice development unit process provided them with the means to analyse their role and function within the organization and, as they reflected on this structure, their behaviour began to change. Relevance to clinical practice. Evidence from these reflections supports the view that practice development unit participants have secured a positive and professional identity and are, therefore, better able to improve the patient experience. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: This paper examines how nurses are prepared to be clinically competent and safe at registration, so that they are fit for practice and purpose. It follows up two papers on competence published in 1997 and 1998 and investigates subsequent developments. BACKGROUND: In 1979, major changes in nursing affected nurse education and preparation for competence. In the following two decades, it became clear that nurses lacked clinical skills. This paper examines subsequent changes and asks the question whether this crucial shortcoming has now been remedied. This paper considers the background and context of change in nursing and nurse education in the 1980s. It looks at the new ideology, to prepare the 'knowledgeable doer' and examines the consequences of the change on nursing competency from the 1990s to the present day. METHODS: This is a position paper. Professional policy documents from the English National Board for Nursing, Midwifery and Health Visiting, United Kingdom Central Council for Nursing, Midwifery and Health Visiting and Nursing and Midwifery Council, government reports and legislation on nursing and relevant nursing literature are examined and critically analysed and conclusions drawn. CONCLUSIONS: From 1923-1977, mandatory nursing syllabuses set by the General Nursing Council of England and Wales required the registered nurse to have acquired certain specific clinical skills. These were rigorously tested to an explicit standard set by the General Nursing Council before a nurse was awarded state registration. Twenty-five years later, the loss of this system for ensuring this competence and the implications of this loss, have been widely recognised. As a result, many nurse training institutions have introduced clinical skills laboratories, simulation of practice and the Objective Structured Clinical Examination. However, to the authors' surprise and contrary to their initial expectations, the Nursing and Midwifery Council has not made these systems uniform or mandatory and so still has no way of ensuring all nurse training is producing safe nurses in the United Kingdom. The authors conclude that the untested educational ideology that brought root and branch change to nurse training in 1983 and which failed to produce nurses 'fit for practice and purpose' may still prevail. RELEVANCE TO CLINICAL PRACTICE: The present paper demonstrates that United Kingdom nurse training still has no uniform and mandatory system in place to ensure, as far as is possible, that all registered nurses are clinically competent and safe to practice. [ABSTRACT FROM AUTHOR]

Aims and objectives. To discuss findings relating to role extension and loss of nursing care to auxiliary nurses. Background. There is ongoing discussion in the literature about what nurses’ roles may be and how the extension of role affects patient care. Various models have been devised to measure outcomes and the value of nursing to patients. However, there are limited data on the views of nurses themselves in terms of what they perceive their role to be and what they feel about role change. Design. A qualitative approach was used with the help of the elements of grounded theory. Methods. Data were analysed using a constant comparative method with core categories identified. The study described in this paper was the final of three. The first two studies involved student nurses and through theoretical sampling, the third sample was chosen to expand the data gained from the students. Results. The findings from the student studies indicated concern that the nursing role was being undertaken by auxiliary nurses. The results of the final study, as discussed in this paper, confirmed this. However, one main difference was that qualified nurses were not necessarily unhappy about auxiliary nurses’ role expansion but were concerned that the role of the nurse was moving away from the bedside. Conclusions. The data suggest that nurses’ roles may be hard to define. An abdication of role, as opposed to delegation of role, seems to be occurring. Critical thinking is needed to ensure this is a decision advocated by clinical nurses. Relevance to clinical practice. Nurses need to be explicit about what their clinical roles are. This study provides data expressing the views of clinical nurses about role expansion and role abdication and corresponding feelings about it. [ABSTRACT FROM AUTHOR]

AIMS: This paper explores the ethical, theoretical and methodological implications of predictive testing in studies of child abuse, neglect and harm. BACKGROUND: The use of screening instruments to make predictions about children who may later be abused, neglected or at risk of exclusion is promoted in research and policy. The recent UK Action Plan on Social Exclusion suggests that health visitors and community midwives should be trained to use these tools in practice. METHOD: Position paper. CONCLUSIONS: The accuracy of screening instruments to identify children who will be abused or neglected has not been established. Even if the theoretical and methodological challenges of predictive instruments could be overcome, the ethical implications of their use are very difficult for nurses and midwives. RELEVANCE TO CLINICAL PRACTICE: Nurses, midwives and health visitors require high levels of awareness of risk factors in working with children and families. We have a responsibility to reach professional judgements about risks of harm for individuals. This is best performed through improving skills in working with parents and carers to identify those factors which may impede their ability to offer safe developmental care to their children. [ABSTRACT FROM AUTHOR]

Aims and objectives. To consider the validity and reliability of risk assessment scales for pressure ulcers. Background. Pressure ulcers are a major problem worldwide. They cause morbidity and lead to mortality. Risk assessment scales have been available for nearly 50 years, but there is insufficient evidence to state with any certainty that they are useful. Design. A literature review and commentary. Methods. Bibliographic databases were searched for relevant papers, a critical review was completed on relevant papers. Results. There is contradictory evidence concerning the validity of risk assesment scales. The interaction of education, clinical judgement and use of risk assessment sakes has not been fully explored. It is not known which of these is most important, nor whether combining them results in better patient care. Conclusions. There is a need for further work. A study exploring the complex interaction of risk assessment scales, clinical judgement and education and training is introduced. Relevance to clinical practice. Nurses may be wasting their time conducting risk assessment scoring if clinical judgement and/or education are sufficient to assess pressure ulcers risk. [ABSTRACT FROM AUTHOR]

Aims and objectives. This research aimed to understand the level and scope of practice of the nurse practitioner in Australia and New Zealand further using a capability framework. Background. The original study, from which the present paper was developed, sought to identify competency standards for the extended role of the nurse practitioner in Australia and New Zealand. In doing so the researchers became aware that while competencies described many of the characteristics of the nurse practitioner they did not manage to tell the whole story. In a search of the literature, the concept of capability appeared to provide a potentially useful construct to describe the attributes of the nurse practitioner that went beyond competence. Design. A secondary analysis of data obtained from interviews with nurse practitioners working in Australia and New Zealand was undertaken. These data had previously been obtained in a study to identify nurse practitioner competencies. The analysis described in this paper investigated whether or not the components of capability would adequately explain the characteristics of the nurse practitioner. Methods. Fifteen nurse practitioners were interviewed from Australia and New Zealand. A secondary (deductive) analysis of interview data using capability as a theoretical framework was conducted. Results. The analysis showed that capability and its dimensions is a useful model for describing the advanced level attributes of nurse practitioners. Thus, nurse practitioners described elements of their practice that involved: using their competences in novel and complex situations as well as the familiar; being creative and innovative; knowing how to learn; having a high level of self-efficacy; and working well in teams. Conclusions. This study suggests that both competence and capability need to be considered in understanding the complex role of the nurse practitioner. Relevance to clinical practice. The dimensions of capability need to be considered in the education and evaluation of nurse practitioners. [ABSTRACT FROM AUTHOR]

Aims and objectives. This paper provides an overview of nurses’ working conditions in Japan, exploring tensions between nurses’ rights to take leave from work to fulfil family and personal needs and their actual ability to take such leave. It also considers possible effects of being restricted from taking such leave. Background. Little has been written on the specific needs of nurses who are mothers in the Japanese work environment. Research has focussed on the effects of heavy, stressful workloads and long working hours leading to burnout, death from overwork and suicides in Japanese culture. However, research that considers unique cultural and female issues in Japan affecting nursing work has not been published. Method. Discursive. Conclusion. The paper shows that there are many overlapping, complex issues affecting nurses working in Japan and their needs need to be considered and addressed in order to promote a healthier work environment, as well as a more humanistic environment. Relevance to clinical practice. Workplace issues are relevant to recruitment and retention and better conditions are likely to improve hospital functioning. [ABSTRACT FROM AUTHOR]

Aims and objectives. This research aimed to understand the level and scope of practice of the nurse practitioner in Australia and New Zealand further using a capability framework. Background. The original study, from which the present paper was developed, sought to identify competency standards for the extended role of the nurse practitioner in Australia and New Zealand. In doing so the researchers became aware that while competencies described many of the characteristics of the nurse practitioner they did not manage to tell the whole story. In a search of the literature, the concept of capability appeared to provide a potentially useful construct to describe the attributes of the nurse practitioner that went beyond competence. Design. A secondary analysis of data obtained from interviews with nurse practitioners working in Australia and New Zealand was undertaken. These data had previously been obtained in a study to identify nurse practitioner competencies. The analysis described in this paper investigated whether or not the components of capability would adequately explain the characteristics of the nurse practitioner. Methods. Fifteen nurse practitioners were interviewed from Australia and New Zealand. A secondary (deductive) analysis of interview data using capability as a theoretical framework was conducted. Results. The analysis showed that capability and its dimensions is a useful model for describing the advanced level attributes of nurse practitioners. Thus, nurse practitioners described elements of their practice that involved: using their competences in novel and complex situations as well as the familiar; being creative and innovative; knowing how to learn; having a high level of self-efficacy; and working well in teams. Conclusions. This study suggests that both competence and capability need to be considered in understanding the complex role of the nurse practitioner. Relevance to clinical practice. The dimensions of capability need to be considered in the education and evaluation of nurse practitioners. [ABSTRACT FROM AUTHOR]

Aims and objectives. This paper aims to analyse the concept of advanced nursing practice critically and to demonstrate an appreciation of the development of the role of the advanced nurse practitioner in the Irish context. Background. The concept of advanced nursing practice has existed in the US since the 1960s and in the UK since the early 1980s. The first signs of the advanced nurse practitioner began to emerge in Ireland in the late 1990s as a result of increasing demands and changes occurring within nursing and health care. Currently, there are 31 advanced nurse practitioners in the country, many of whom practice in the general setting. Strategies are in place to introduce advanced nursing practice into other nursing disciplines in the future. Methods. A literature review was conducted to address the various issues inherent within this concept. Results. There is a body of evidence indicating that advanced nursing practice has brought about an improvement in patient outcomes. In light of this, the advanced nurse practitioner has a valuable role to play in providing a beneficial contribution and filling a gap in healthcare services. Conclusion. This paper has demonstrated that nursing continues to be a dynamic and ever-changing phenomenon where the onus is firmly on the advanced nurse practitioner as expert, leader and collaborator, to capture the hearts and minds of nurses and healthcare workers, so as to challenge traditional values and transform clinical practice. Failure to do so may allow medicine or other interested parties to shape the future of nursing or even absorb it. Relevance to clinical practice. Nurses working at an advanced level are striving to develop their expertise, initiate nurse-led services and practice, in collaboration with other professionals in an effort to provide the highest quality care to the patient. Although the idea of the advanced nurse practitioner is relatively new to nursing in Ireland, it is the result of an idea whose time has come and there is nothing more powerful than an idea whose time has come. [ABSTRACT FROM AUTHOR]

AIMS: This article offers practical strategies to managers and others for supporting overseas trained nurses and managing cultural diversity in the health workforce. BACKGROUND: Widespread nursing shortages have led managers to recruit nurses from overseas, mainly from developing countries. This paper draws on evidence from the Researching Equal Opportunities for Internationally Recruited Nurses and Other Health Professionals study reported elsewhere in this issue, which indicates that overseas trained nurses encountered widespread discriminatory practices including an overuse of complaints and grievances against them. The researchers also found that the overseas trained nurses responded to their experiences by using various personal strategies to resist or re-negotiate and overcome such discriminatory practices. METHODS: A research workshop was held in June 2005 at the midpoint of the Researching Equal Opportunities for Internationally Recruited Nurses and Other Health Professionals study. Twenty-five participants attended the workshop. They were the Researching Equal Opportunities for Internationally Recruited Nurses and Other Health Professionals study researchers, advisory group members, including the author of this paper and other researchers in the field of migration. The overall aim of the workshop was to share emerging research data from the Researching Equal Opportunities for Internationally Recruited Nurses and Other Health Professionals and related studies. The final session of the workshop on which this paper is based, was facilitated by the author, with the specific aim of asking the participants to discuss and determine the challenges to managers when managing a culturally diverse workforce. The discussion yielded four main themes collated by the author from which a framework of strategies to facilitate equality and cultural diversity management of the healthcare workers may be developed. The four themes are: assumptions and expectations; education and training to include cultural sensitivity, equality and human rights; performance management; and transparent human resource management processes. CONCLUSION: Managing a racially and culturally diverse workforce is complex and challenging for managers. There are no ready-made tools to show them how to do so. Achieving effective management of a culturally diverse workforce comes from an intrinsic motivation to develop the cultural competence to engage with them. IMPLICATIONS FOR PRACTICE: This article, together with others in this special issue, provides a springboard for moving this agenda on. It offers managers a framework of themes, which they can draw on to develop their own best practice for managing racial equality and cultural diversity in the health workforce. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: I will argue that overseas nurse recruitment is the consequence of a care gap, which arose from several policy shifts in the 1990s and in part from the rhetoric of a normative moral discourse in the UK which claims that caring is the moral essence of nursing. I will suggest that this discourse has masked the uncoupling of caring from nursing practice and that this uncoupling places the overseas nurses in a contradictory position. BACKGROUND: In an increasingly competitive global labour market, the UK is faced with a nursing shortage and has been recruiting trained nurses from abroad (NMC 1993-2002). DESIGN AND METHODS: This paper is based on two related, qualitative studies using semi-structured focus groups and individual interviews. The first explored the experiences of overseas nurses in the UK and the second investigated the equal opportunities and career progression of overseas nurses in the UK. RESULTS: The data from these studies challenge the normative UK value that caring is at the heart of nursing. These data are the lens through which we see this contradiction explicitly played out. Overseas nurses observe that caring (as undertaken by health care assistants in care homes) is not nursing yet caring is being passed down the line as a process that marginalizes the overseas nurses and at the same time devalues their skills. I do not argue that overseas nurses care at a higher standard (although this may be the case) just that they care differently, that they expected UK nurses to deliver basic care and, instead, experience UK nursing practice as less autonomous and of a lower standard than they expected. CONCLUSIONS: I argue that the overseas nurses' views help us understand the processes by which the uncoupling of caring from nursing has come about. RELEVANCE TO CLINICAL PRACTICE: This paper discusses a workforce issue which is directly relevant to clinical practice because it focuses on the meaning of care; what is caring, what are caring activities and how are these represented in the discourse on caring in the literature? This paper also reveals significant worries among nursing managers about how to staff the nursing workforce and what nurses should be doing in the clinical areas. [ABSTRACT FROM AUTHOR]