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Reports on the research conducted by the author which analyzes articles and research findings published in the 2001 and 2002 issues of the periodical "Journal of Clinical Nursing." Revelation that Great Britain was the highest contributor to the periodical; Information that not a single paper was published from the U.S.; Methodology adopted by the researcher; Details of three broad categories under which research papers by the journal are published.

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]

AIMS: The aim of this paper is twofold. Firstly, it describes hospital nurses' general use of the language function in the nursing discharge notes of patients who will require posthospital home health care. Secondly, it addresses the similarities and differences in completeness, structure and content between paper and electronic nursing discharge notes. BACKGROUND: Previous research has identified gaps in the accuracy and relevance of information communicated between nurses working at different organizational levels. DESIGN AND METHODS: A descriptive design with a text analysis framework was used. RESULTS: The study shows that the text in the nursing discharge notes is information-dense and characterized by technical terms, although the nurses contextualized and individualized the content of the terms to clarify the message. Both similarities and differences were found in range and detail of the information nurses exchanged when they used paper or electronic discharge notes. CONCLUSIONS: The use of structured and standardized templates helped nurses improve the completeness, structure and content of the information in the nursing discharge notes. RELEVANCE TO CLINICAL PRACTICE: Whether paper or electronic documentation is used, the findings in this study highlight the challenges nurses encounter in ensuring continuity of care during patients' trajectory through the health system. The findings may help clarify the appropriateness of the content and language nurses use in the nursing discharge note as a communication medium. This study may also be helpful to nurses planning to use EPRs, as it illustrates some of the issues which should be clarified before this is implemented. [ABSTRACT FROM AUTHOR]

Aims and objectives. To review the literature on inflammatory bowel disease in older and younger people and to identify whether they included a nursing or psychosocial perspective, or were informed by theories of ageing. Background. Inflammatory bowel disease, manifested as Crohn's disease and ulcerative colitis, affects younger and older people and is associated with a range of psychosocial factors. Nurses have an important role to play in caring for people with inflammatory bowel disease. Methods. A systematic review of literature related to inflammatory bowel disease and older people was carried out using the MEDLINE, CINAHL EMBASE and Cochrane databases between 1990-2006. Conclusions. Generally speaking, the clinical features of inflammatory bowel disease are similar in younger and older people, as are indications for surgery, survival and the usual wide spectrum of severity of disease. Corticosteroid treatment carries additional risk for older people. The studies used both retrospective and prospective designs, with the former using patient records, and the latter using follow-up of patients with inflammatory bowel disease. Sample sizes were adequate for statistical analyses but there was no reference to reliability or validity of data collection methods. None of the studies considered psychosocial aspects, or the role of nurses in caring for people with inflammatory bowel disease. A specific gerontological perspective was lacking from the papers reviewed. While the clinical features of inflammatory bowel disease are similar in younger and older people, with the bimodal distribution of age of onset of inflammatory bowel disease, the possibility exists that quality of life and adjustment in older people depend on age of onset. This has not been investigated. Future lines of enquiry taking psychosocial aspects of inflammatory bowel disease into account in older people are explored. Relevance to clinical practice. Nurses play an increasingly important role in the assessment and management of inflammatory bowel disease patients. Little is known about factors which could predict poorer psychosocial health and the impact non-intestinal manifestations may have on this in older people with inflammatory bowel disease. [ABSTRACT FROM AUTHOR]

Editorial. Discusses the topics published in the 2003 issue of the 'Journal of Clinical Nursing.' Quality of published manuscripts; Cost-effectiveness of hospital and home care for patients receiving total joint replacement; Importance of evidence for health care interventions.

Aims and objectives. The aim of the study was to enable those planning to make submissions to the 2008 Research Assessment Exercise to make informed decisions regarding their research strategies. The objective of the study was to identify the factors that distinguish those units of assessment (Universities and Higher Education Institutions) that were highly rated from those that received a low rating for nursing in the Research Assessment Exercise of 2001. Background. Nursing research differs in kind from other types of biomedical research. There is a tendency for research in nursing to be characterized by an inward-looking focus and dominated by a concern with the profession itself. Design. The examination of the research output of nursing. Methods. Data from the abstracts of journal articles submitted to the 2001 Research Assessment Exercise for nursing were extracted, classified, collated and analysed. Results. The publications submitted by those in the higher-rated units showed a greater tendency than those submitted by those in the lower-rated units to report on a study involving the collection of primary data; to be multi-authored; to use either qualitative methodology or randomized-controlled trials; and to focus upon clinical issues and have patients as the subjects of the research. Conclusion. Nursing research is in a process of change and growth and is still of variable quality. The development of research towards patient care and clinical issues, and away from issues relating to the profession itself, is most evident among those units of assessment rated highly in the 2001 Research Assessment Exercise. Relevance to clinical practice. The study indicates that the best of current nursing research is focused upon clinical issues and patient care. [ABSTRACT FROM AUTHOR]

BACKGROUND: Patients with acute cardiac chest pain receive oxygen as part of their treatment. Oxygen is given in the belief it will help to correct the oxygen demand - supply imbalance of acute myocardial ischaemia. AIMS AND OBJECTIVES: The aim was to review the evidence base for the use of oxygen to treat acute myocardial ischaemia and the objective was to include all evidence of sufficient quality. DESIGN: A systematic review was carried out to provide a thorough, transparent and replicable review process. METHODS: The review included randomized and non-randomized clinical trials; patients with acute coronary syndrome (unstable angina or acute myocardial infarction); and any outcome measurements of myocardial ischaemia. RESULTS: Nine trials were found, of which two were randomized controlled trials and seven non-randomized clinical trials. There were quality assessment concerns over the methodology, size and analysis within the trials. The effectiveness of oxygen in reducing myocardial ischaemia was unclear from the review, as the trials contained data that suggested oxygen reduced myocardial ischaemia, but also data that suggested it increased myocardial ischaemia. CONCLUSIONS: No definite conclusions could be drawn as to whether oxygen reduced, increased or had no effect on acute myocardial ischaemia. The papers were divided as to recommending oxygen use for all patients with acute myocardial ischaemia or not - although all agreed that patients with systemic hypoxaemia should have this corrected by oxygen administration. The key finding of the review was that there was insufficient evidence. RELEVANCE TO CLINICAL PRACTICE: As oxygen is routinely administered to treat acute myocardial ischaemia, the lack of a clear supporting evidence base must be a source of concern. This is especially so as some of the evidence suggested oxygen may increase myocardial ischaemia. There is a need for experimental-design clinical research to test the effectiveness of oxygen in reducing myocardial ischaemia. [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]

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 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 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: 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]

AIMS: The paper gives an overview of nursing research papers published on spiritual care between 1983 and October 2005. It also provides pointers for the future direction of research in this emerging field. BACKGROUND: Spiritual care of patients/clients is expected of nurses and is reflected in nursing codes of ethics, nurse education guidelines, policy documents and nursing guidance. Recent years have seen a proliferation in nursing research in this area, particularly in the UK and North America, and now in other European countries. It seemed timely, therefore, to review this published research. METHOD: Included in the review were 47 original published nursing research papers identified from a CINAHL search and from a collection held by the author since 1983. Papers were sorted into five categories, a template to aid reviewing was produced and a short summary and critique of each paper was written. CONCLUSIONS: Research on spirituality and health needs to move forward in a systematic and co-ordinated way. RELEVANCE TO CLINICAL PRACTICE: Hopefully, the research summarized in this paper will be useful to clinicians and nurse educators as they strive to incorporate spiritual care within their practice. In turn patients/clients and their families should benefit from care which is more holistic and addresses their deepest concerns and needs. [ABSTRACT FROM AUTHOR]

BACKGROUND: This paper reviews research that considered the life stories of experienced nurses and the relationships between life experience, the way in which people find meaning in their experience(s), the development of nursing knowledge, and the influence of these events and understandings on the characteristics and clinical practice of experienced nurses. AIMS AND OBJECTIVES: The dominant perspectives in nursing about the place of experience in the development of nurses' practice are considered and the paper argues for a broader understanding of experience; placing experience within the context of nurses' lives, connection with others and their individual understandings about nursing care. RELEVANCE TO CLINICAL PRACTICE: The place of experience in the development of nurses has not been well understood although the nursing discourse continues to value clinical experience highly. Becoming experienced as a nurse is described as a progressive and continuous interaction between experience, meaning and the lived world resulting in a personal and unique understanding of practice. The culture and discourse of nursing have tended to exclude or dampen individual difference and the paper considers a more expansive understanding of the place of experience and individual difference in nursing and the relevance of this perspective for the education of nurses. [ABSTRACT FROM AUTHOR]

arbon p. (2004) Journal of Clinical Nursing 13, 150–157 Understanding experience in nursing This paper reviews research that considered the life stories of experienced nurses and the relationships between life experience, the way in which people find meaning in their experience(s), the development of nursing knowledge, and the influence of these events and understandings on the characteristics and clinical practice of experienced nurses. The dominant perspectives in nursing about the place of experience in the development of nurses’ practice are considered and the paper argues for a broader understanding of experience; placing experience within the context of nurses’ lives, connection with others and their individual understandings about nursing care. The place of experience in the development of nurses has not been well understood although the nursing discourse continues to value clinical experience highly. Becoming experienced as a nurse is described as a progressive and continuous interaction between experience, meaning and the lived world resulting in a personal and unique understanding of practice. The culture and discourse of nursing have tended to exclude or dampen individual difference and the paper considers a more expansive understanding of the place of experience and individual difference in nursing and the relevance of this perspective for the education of nurses. [ABSTRACT FROM AUTHOR]

The article presents the author's comments on the paper "An Adolescent Ward; 'In Name Only'," by A. Hutton, that was previously published in the journal. According to the author, Hutton's paper shows the application of power in the management of adolescents within a clinical area. He agrees with the situation highlighted by Hutton in which adolescent wards are seduced by the provision of adolescent facilities, manned by clinical staff to regulate and monitor adolescent behaviour.

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]

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. 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 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: 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]

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: 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: 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: 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: This paper suggested the need to interrogate the notion of 'integration' to facilitate the retention of migrant nurses. BACKGROUND: The growth in internationally recruited nurses in the UK's health system has led to a raft of policies that aim to ensure that such nurses are well 'integrated' into their 'new environment'. It is assumed that integration will improve the quality of internationally recruited nurses' experience in the UK, improve their retention rates and thus improve the quality of health delivery within the UK. However, most of the steps through which integration is sought tend to move between some version of assimilation and 'respect for difference'. CONTRIBUTIONS: This paper aimed to add to existing literature on the integration of internationally recruited nurses in the UK by suggesting three steps towards rethinking 'integration policies'. It suggests the need to recognize migration as only one of the differentiating factors within the nursing sector, to ensure that integration does actually become a two-way process and to be cognizant of the multiple shapes that racism can take. The first two steps will prevent a slip between integration and assimilation while the last will help rethink any anti-racist training that may form part of integration policies. CONCLUSIONS: There are many factors influencing the experiences of internationally recruited nurses and not all of them can be addressed within current integration policies. RELEVANCE TO CLINICAL PRACTICE: Rethinking integration can help improve the experience of internationally recruited nurses. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: This paper shows that overseas nurses (OSN) recruited to UK hospital trusts become deskilled in technical aspects of clinical practice. BACKGROUND: Existing research reports that many newly recruited OSN are prevented from using technical skills acquired in training abroad, to the detriment of the National Health Service (NHS) and the concern of the nurses themselves. DESIGN: The author conducted case study work in three NHS hospital trusts in the northwest of England. The findings reported are part of a wider investigation into the assimilation(1) of OSN from the Philippines, India and Spain into NHS hospitals. Semi-structured interviews were undertaken with members of four groups of actors: managers, OSN, home nurses (HN) and mentors, which were analysed thematically. Results. The research confirms the finding that many OSN are prevented from using technical skills in the UK, but also suggests reasons why this is so. The finding of deskilling emerged strongly in all three cases and is singled out for discussion in this paper. CONCLUSIONS: The experience of OSN highlights ambiguity surrounding the role of the nurse in British hospitals. This arises partly because OSN tend to be recruited to the bottom grades of nursing in the NHS, where their technical skills are underused. RELEVANCE TO CLINICAL PRACTICE: Segmentation within the nursing hierarchy contributes to the conflicting messages and mismatch of expectations experienced by nurses at the ward level, regarding the role of the nurse. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: This paper explores the perceptions of career progression in the NHS of a group of midwives and nurses trained in Ghana and working in the UK. It draws on semi-structured interviews with nurses, midwives and managers which were conducted as part of the Researching Equal Opportunities for Overseas trained Health Professionals project (REOH). BACKGROUND: Research into overseas nurses in the UK has tended to focus on their experiences of discrimination in relationships with colleagues, managers and patients. There is limited statistical evidence indicating that migrant nurses experience slower career progression than their UK-trained counterparts. However, there is little analysis of their experiences and perceptions of the process of career progression or their understandings of the factors that could account for their limited entry into higher grades. CONCLUSIONS: This paper argues that many Ghanaian nurses and midwives can experience difficulty in progressing into senior positions because of cultural differences and gaps in knowledge. However, this paper indicates that these problems can become institutionalized and entrenched by practices on the ward, particularly support from managers being dispensed as patronage that is not given equally to all. This creates an informal system of promotion to management which is not transparent, is based on subjective and culturally specific criteria and can undermine egalitarian formal procedures and create spaces where discriminatory practices can operate. RELEVANCE TO CLINICAL PRACTICE: These processes can lead to sectors of the workforce becoming demoralized, to the wastage of skills and other resources and problems in staff retention. [ABSTRACT FROM AUTHOR]

Aims and objectives. This paper explores the perceptions of career progression in the NHS of a group of midwives and nurses trained in Ghana and working in the UK. It draws on semi-structured interviews with nurses, midwives and managers which were conducted as part of the Researching Equal Opportunities for Overseas trained Health Professionals project (REOH). Background. Research into overseas nurses in the UK has tended to focus on their experiences of discrimination in relationships with colleagues, managers and patients. There is limited statistical evidence indicating that migrant nurses experience slower career progression than their UK-trained counterparts. However, there is little analysis of their experiences and perceptions of the process of career progression or their understandings of the factors that could account for their limited entry into higher grades. Conclusions. This paper argues that many Ghanaian nurses and midwives can experience difficulty in progressing into senior positions because of cultural differences and gaps in knowledge. However, this paper indicates that these problems can become institutionalized and entrenched by practices on the ward, particularly support from managers being dispensed as patronage that is not given equally to all. This creates an informal system of promotion to management which is not transparent, is based on subjective and culturally specific criteria and can undermine egalitarian formal procedures and create spaces where discriminatory practices can operate. Relevance to clinical practice. These processes can lead to sectors of the workforce becoming demoralized, to the wastage of skills and other resources and problems in staff retention. [ABSTRACT FROM AUTHOR]

Aims. The aims of this paper were (1) to raise awareness of the issues in questionnaire development and subsequent psychometric evaluation, and (2) to provide strategies to enable nurse researchers to design and develop their own measure and evaluate the quality of existing nursing measures. Background. The number of questionnaires developed by nurses has increased in recent years. While the rigour applied to the questionnaire development process may be improving, we know that nurses are still not generally adept at the psychometric evaluation of new measures. This paper explores the process by which a reliable and valid questionnaire can be developed. Methods. We critically evaluate the theoretical and methodological issues associated with questionnaire design and development and present a series of heuristic decision-making strategies at each stage of such development. The range of available scales is presented and we discuss strategies to enable item generation and development. The importance of stating a priori the number of factors expected in a prototypic measure is emphasized. Issues of reliability and validity are explored using item analysis and exploratory factor analysis and illustrated using examples from recent nursing research literature. Conclusion. Questionnaire design and development must be supported by a logical, systematic and structured approach. To aid this process we present a framework that supports this and suggest strategies to demonstrate the reliability and validity of the new and developing measure. Relevance to clinical practice. In developing the evidence base of nursing practice using this method of data collection, it is vital that questionnaire design incorporates preplanned methods to establish reliability and validity. Failure to develop a questionnaire sufficiently may lead to difficulty interpreting results, and this may impact upon clinical or educational practice. This paper presents a critical evaluation of the questionnaire design and development process and demonstrates good practice at each stage of this process. [ABSTRACT FROM AUTHOR]

AIM: To review systematically qualitative studies, which were found during a literature search for a Cochrane systematic review of the use of family centred care in children's hospitals. BACKGROUND: Family centred care has become a cornerstone of paediatric practice, however, its effectiveness is not known. No single definition exists, rather a list of elements that constitute family centred care. However, it is recognized to involve the parents in care planning for a child in health services. A new definition is presented here. METHODS: The papers were found in wide range of databases, by hand searching and by contacting the authors where necessary, using terms given in detail in the protocol in the Cochrane Library, in 2004. Qualitative studies could not be used for statistical analysis, but are still important to the review and so are described separately in this paper. RESULTS: Negotiation between staff and families, perceptions held by both parents and staff roles influenced the delivery of family centred care. A sub-theme of cost of family centred care to families and staffs was discovered and this included both financial and emotional costs. CONCLUSION: Further research is needed to generate evidence about family centred care in situations arising from modern models of care in which family centred care is thought to be an inherent part, but which leave families with the care of sick children with little or no support. RELEVANCE TO CLINICAL PRACTICE: Family centred care is said to be used widely in practice. More research is needed to ensure that is it being implemented correctly. [ABSTRACT FROM AUTHOR]

Aims. To review and reflect on the literature on recognition-primed decision (RPD) making and influences on emergency decisions with particular reference to an ophthalmic critical incident involving the sub-arachnoid spread of local anaesthesia following the peribulbar injection. Background. This paper critics the literature on recognition-primed decision making, with particular reference to emergency situations. It illustrates the findings by focussing on an ophthalmic critical incident. Design. Systematic literature review with critical incident reflection. Methods. Medline, CINAHL and PsychINFO databases were searched for papers on recognition-primed decision making (1996-2004) followed by the 'snowball method'. Studies were selected in accordance with preset criteria. Results. A total of 12 papers were included identifying the recognition-primed decision making as a good theoretical description of acute emergency decisions. In addition, cognitive resources, situational awareness, stress, team support and task complexity were identified as influences on the decision process. Conclusions. Recognition-primed decision-making theory describes the decision processes of experts in time-bound emergency situations and is the foundation for a model of emergency decision making ( Fig. 2 ). Relevance to clinical practice. Decision theory and models, in this case related to emergency situations, inform practice and enhance clinical effectiveness. The critical incident described highlights the need for nurses to have a comprehensive and in-depth understanding of anaesthetic techniques as well as an ability to manage and resuscitate patients autonomously. In addition, it illustrates how the critical incidents should influence the audit cycle with improvements in patient safety. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: The aim of this paper is to share reflectively how my empirical studies on spirituality and culture have had an impact upon nurse education. BACKGROUND: Spirituality and cultural dimensions of care are considered to be integral to holistic care. The healing potentials of spiritual and cultural care are well documented. The commitment to the research programme came due to the concern within early literature on nursing that the provision of spiritual care for patients is inadequate. METHODS: The research programme used action research comprising largely qualitative approaches. As the holistic and multiperspective nature of spirituality and culture requires a multidisciplinary approach and flexibility of methodology, various research techniques were used. RESULTS: The findings from the research programme led to the development of theories, models and conceptual literature on spiritual and cultural care. In particular, two models evolved from the studies: the ASSET for spiritual cares education and training and the ACCESS for transcultural care practice. The critical incident studies provide insights into nurses' roles in spiritual care interventions. The phenomenological study highlights that chronically ill patients use spiritual strategies in coping with their illness. CONCLUSION: Overall, the paper offers a body of evidence that has an impact upon curriculum development in nurse education and nursing practice. RELEVANCE TO CLINICAL PRACTICE: The ASSET model offers a framework for spiritual care education. The ACCESS model offers a framework for transcultural care practice. The critical incident studies map out nurses' roles in spiritual and cultural care with scope for development of care intervention models for the future. The coping mechanisms study highlights how patients use spiritual coping strategies such as prayer and other resources to cope with their chronic illnesses. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: This paper aims to provide a critical engagement with the subject of transcultural spirituality and nursing practice in the context of dying and bereavement. BACKGROUND: There has been considerable interest in the subject of spirituality over the past decade, and a particular association between the study of death and the study of spirituality. The nursing literature has been at the forefront of these developments amongst health and social care professionals. Some of this literature has begun to address the issues raised for culturally competent practice and the significance of patients' belief systems in the diverse cultural contexts with which nurses must engage in contemporary health care. However, the author argues that understanding of the range of contemporary spiritualities and transcultural practice is at an early stage. METHODS: Transcultural spirituality is explored through a critical review of the literature, including the author's own published research on spiritual and philosophical issues in death, dying and bereavement. CONCLUSION: The conclusion is drawn that some common themes and approaches can be found which offer a framework to guide nursing practice with the individual patient and family. RELEVANCE TO CLINICAL PRACTICE: In the absence of guidance, nurses struggle with implementing spiritual care in the fluid and complex context of contemporary spiritualities and frequently resort to broad categorizations. This paper opens up a way of connecting with the unique spiritual position of each patient. [ABSTRACT FROM AUTHOR]

AIM: The aim of this paper was to explore the issues surrounding the spirit of the unborn child. BACKGROUND: Pregnancy and birth have been recognised to have a spiritual nature by women and health professionals caring for them. Midwives and nurses are expected to have a holistic approach to care. I suggest that for care to be truly holistic exploration is required of the spiritual nature of the unborn fetus. METHODS: Historical, philosophical and religious views of the spirit of the fetus, are explored as well as those of women. Investigation was made of views of the timing of 'ensoulment'. RESULTS: The review demonstrates the value women place on the sacredness of pregnancy and birth, and that the spiritual nature of the unborn should be recognised. CONCLUSION:This paper shows that the views and values women have of pregnancy and birth and the powerful, spiritual relationship they have with the unborn, indicates that further discussion and research needs to be carried out in this area. RELEVANCE TO CLINICAL PRACTICE: It is recommended that all who work with women who are pregnant should recognise the spiritual nature of the unborn when carrying out care. [ABSTRACT FROM AUTHOR]

Aims. This paper reports on organizational influences on nurse consultant post holders. The influence of individual characteristics has been the subject of another paper. Background. Nurse consultant posts were set up in the United Kingdom from the late 1990s onwards and, therefore, there has been little opportunity to report on evaluations of these innovative initiatives. Design. A cross-sectional design, using a convenience sample, was adopted. Methods. Ten nurse consultants working in a variety of settings and specialties participated in in-depth, tape-recorded interviews. The data were analysed using the Framework approach. Findings. Support systems were important influences on nurse consultants' role achievement levels. These took the form of internal trust networks, nurse consultant forums and links with higher education institutions. Post holders both gave and received support and acted to empower other nurses. Thus, relationships were vital to successful role integration. The culture and structures of the National Health System were also a powerful influence in terms of local and national modernization policies, and participants had to be careful in their choice of strategies to deal with the traditional medically dominated culture. Conclusions. The new nurse consultant role is challenging and innovative, but a major area of contention is how much post holders are expected to take on work previously done by doctors rather than developing their nursing role. Organizational support and commitment are needed if nurse consultants are to maximize the benefits of this innovation. Relevance to clinical practice. The findings show that new nursing roles are not always easily accepted in multidisciplinary settings and that holders of such post need to have the appropriate previous knowledge, skills and personal characteristics, as well as the ability to negotiate their way through organizational influences. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: This paper aims to explore the critical elements of advanced nursing practice in relation to policy, education and role development in order to highlight an optimal structure for clinical practice. BACKGROUND: The evolution of advanced nursing practice has been influenced by changes in healthcare delivery, financial constraints and consumer demand. However, there has been wide divergence and variations in the emergence of the advanced nurse practitioner role. For the successful development and implementation of the role, policy, educational and regulatory standards are required. CONCLUSION: The paper highlights the value of a policy to guide the development of advanced nursing practice. Educational curricula need to be flexible and visionary to prepare the advanced nurse practitioner for practice. The core concepts for the advanced nursing practice role are: autonomy in clinical practice, pioneering professional and clinical leadership, expert practitioner and researcher. To achieve these core concepts the advanced nurse practitioner must develop advanced theoretical and clinical skills, meet the needs of the client, family and the community. RELEVANCE TO CLINICAL PRACTICE: In a rapidly changing people-centred healthcare environment the advanced nurse practitioner can make an important contribution to healthcare delivery. The challenges ahead are many, as the advanced nurse practitioner requires policy and appropriate educational preparation to practice at advanced level. This will enable the advanced practitioner articulate the role, to provide expert client care and to quantify their contribution to health care in outcomes research. [ABSTRACT FROM AUTHOR]

AIMS OF THE PAPER: The paper describes the creation of, the rationale behind and the external funding of a collaborative research-clinical practice development position. The paper also demonstrates the benefits of nursing's collaboration with external funding bodies and the value of moving from our traditional position of assuming that 'the hospital' will always provide. BACKGROUND: There is a constant refrain that nursing must become more 'research-based' and develop an active research culture. In harsh financial times however, funding for research development is scarce. Nurses can respond to this by bemoaning the lack of money or by taking an entrepreneurial approach, creating innovative project proposals that develop new partnerships and attract external funding. DISCUSSION: Institutional support for clinical research is often more verbal than financial as most health care systems are experiencing extreme financial stringencies. Nurses need to reconsider the notion that every initiative must automatically be funded by the institution. In this paper we show how in a busy major hospital, clinicians and researchers collaborated to create and fund the kind of innovative research and practice development position that may be impossible to fund through existing budgets. CONCLUSION: With creativity and determination, nurses can challenge the orthodoxy that they are solely dependent on institutional funding. If there is a clear project vision, a convincing rationale, a strongly argued 'business case' and a passionate and persistent team, then innovative new projects and positions can be realized. RELEVANCE TO CLINICAL PRACTICE: Developing clinical focused, practice based research is now a worldwide policy and practice imperative for nurses. Unfortunately, current levels of institutional funding are unlikely to support research promotion positions and initiatives. This paper outlines an approach to securing funding for research initiatives that can create exciting new positions and develop productive partnerships between researchers, clinicians and external agencies. [ABSTRACT FROM AUTHOR]

Aims and objectives. This review aims to explore the research available relating to three commonly used pain rating scales, the Visual Analogue Scale, the Verbal Rating Scale and the Numerical Rating Scale. The review provides information needed to understand the main properties of the scales. Background. Data generated from pain-rating scales can be easily misunderstood. This review can help clinicians to understand the main features of these tools and thus use them effectively. Method. A MedLine review via PubMed was carried out with no restriction of age of papers retrieved. Papers were examined for methodological soundness before being included. The search terms initially included pain rating scales, pain measurement, Visual Analogue Scale, VAS, Verbal Rating Scale, VRS, Numerical/numeric Rating Scale, NRS. The reference lists of retrieved articles were used to generate more papers and search terms. Only English Language papers were examined. Conclusions. All three pain-rating scales are valid, reliable and appropriate for use in clinical practice, although the Visual Analogue Scale has more practical difficulties than the Verbal Rating Scale or the Numerical Rating Scale. For general purposes the Numerical Rating Scale has good sensitivity and generates data that can be statistically analysed for audit purposes. Patients who seek a sensitive pain-rating scale would probably choose this one. For simplicity patients prefer the Verbal Rating Scale, but it lacks sensitivity and the data it produces can be misunderstood. Relevance to clinical practice. In order to use pain-rating scales well clinicians need to appreciate the potential for error within the tools, and the potential they have to provide the required information. Interpretation of the data from a pain-rating scale is not as straightforward as it might first appear. [ABSTRACT FROM AUTHOR]

AIM: This paper reports on an action research study which raised some questions about the processes of developing a sense of shared ownership in action research in a research environment which does not always have the appropriate mechanisms to support and sustain action research. BACKGROUND: Action research has gained popularity in nursing and healthcare research, offering a way of developing practice-based knowledge, which can assist in changing practice and democratizing inquiry. METHODS: There are other organizational constraints on action research which arise at different levels, and which also require discussion. These can be issues about communication and ownership at a practice level and issues of funding and project management procedures. This paper reports on a study in which these issues came to the fore, and offers some thoughts on how they can affect the processes of action research. CONCLUSION: While the principles of action research appear to offer much towards the development of a practice-rooted body of knowledge for nursing, unless some of the issues of ownership are resolved, it is unlikely to move beyond academic rhetoric. RELEVANCE TO CLINICAL PRACTICE: If nursing is to engage in action research, this must be done critically and reflectively and careful attention paid to developing an inclusive and collaborative approach to knowledge and practice development. Furthermore, to develop in nursing and health care research, it must find ways to meet the requirements of funding bodies. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: This paper discusses the process of change that took place in an intervention study of standardized multidisciplinary assessment guidelines implemented in a female ward for older people in a District General Hospital in South London. This study was one of nine implementation projects in the South Thames Evidence-Based Practice Project. BACKGROUND: The relationship between the worlds of research and healthcare practice is uneasy and contested and, as such, is a breeding ground for challenging questions about how evidence can be used to foment change in clinical practice. Recent literature on change highlights the importance of understanding complexity, which informed our approach and analysis. METHODS: A multifaceted approach to change that comprised evidence-based guidelines, leadership (project leader) and change management was evaluated before and after the implementation by telephone interviews with patients, a postal survey of community staff and interviews with ward staff. A diagnostic analysis of current assessment practice informed the change process. The project leader collected data on adherence. RESULTS: This paper draws on descriptive and qualitative data and addresses the links between contextual issues and the processes and pathways of change, informed by theoretical ideas from the change literature. Key themes emerged: working through others and across boundaries, managing uncertainty and unanticipated challenges. Adherence of ward staff to using the multidisciplinary assessment guidelines was high, with evidence of some dissemination to community staff at follow-up. Three years after the project finished the multidisciplinary assessment is still part of routine clinical practice. CONCLUSIONS: The analysis contributes to understanding about the nursing leadership of change within an interprofessional arena of practice. It highlights the importance of understanding the context in relation to the impact and sustainability of change and thus the utility of conducting a diagnostic analysis in the early stages of implementation. This has implications for developing approaches to change in nursing and interprofessional practice in other settings. RELEVANCE TO CLINICAL PRACTICE: Using research to change practice needs clinical leaders who are supported by the organization and have the skills to implement research evidence, manage uncertainty and build trust with a range of other professionals. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: The aim of this study is to explore the introduction of portfolios into the first year of an MSc in Nursing Programme. BACKGROUND: This paper outlines a framework for portfolio development in postgraduate nursing practice. The framework is being piloted, within the Irish context, with students in the first year of a Masters in Nursing programme and has the potential to be developed for other nursing programmes at postgraduate level. DESIGN AND METHOD: An action research approach has been chosen to study the implementation of the portfolio and the development of a framework to guide this initiative. To date the development of the framework is being piloted as part of the 'taking action' phase of a first action research cycle. RESULTS: In its current stage of development the framework is constructed to embrace the core concepts of specialist nursing practice and the nursing management competencies, from current Irish health care documents. In addition the portfolio is anchored around personal development planning and is supported by the use of action learning tutorials and academic and practice facilitators. The first evaluating phase will take place later this year and will involve the collection of data from students, facilitators and lecturers. CONCLUSION: The introduction of the portfolio at postgraduate level has highlighted, to date, issues of confidentiality in committing experiences to paper, issues around its assessment, and issues around sharing this document with other students. RELEVANCE TO CLINICAL PRACTICE: Portfolio development at postgraduate level emphasizes linking theory and practice and stresses the importance of reflection on practice. The portfolio can also be used by nurses to develop their clinical career pathways and encourage personal development planning. [ABSTRACT FROM AUTHOR]