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EBN engages through a range of Online social media activities to debate issues important to nurses and nursing. EBN Opinion papers highlight and expand on these debates.

EBN Perspectives brings together key issues from the commentaries in one of our nursing topic themes

The survey undertaken here at EBN last year suggested that our online and print readerships were different. Many of our readers who subscribe to the print edition of the journal do not access our online content. One of our most successful online features, not available in the print edition, is our weekly blogs. The blogs are written by a wide range of professionals with diverse interests. Bloggers comment on their concerns and challenges of delivering health in an increasingly complex world; they all have a passion for nursing and health. In this special edition, we are featuring some of our blog content within the journal to provide print subscribers with a flavour of the content. To access our blogs visit: http://blogs.bmj.com/ebn/. The blogs are normally posted once a week and provide another perspective on how evidence can be applied in practice.

In England, the bursary for student nurses was removed in 2017 when they also became liable to pay tuition fees.1 The aim was to reduce the cap on student nurse numbers. While the cynics among us may think the real reason was to reduce the £1 billion spent on non-medical pre-registration education each year, the Council of Deans of Health (CoDH) supported the move. They argued that in addition to removing the cap on numbers the change in financing nurse education would leave student nurses better off financially during their pre-registration nursing course.2 The CoDH later acknowledged that the subsequent reduction in applicants was more than expected.3 The bursary was means-tested with a student living away from home, outside of London with no dependents entitled to £39664 per annum. Most pre-registration nursing courses run over 42 weeks per year (rather than the standard 30 weeks) meaning that students incur additional expenses as well as not having a long vacation over the summer to earn money. This results in many student nurses taking on additional debt. The take home message is that student nurses in England were struggling financially even before the bursary was removed.4–7 Indeed, since then hardship payments to student nurses have risen8 and financial hardship has been identified as one of the key reasons for student attrition from pre-registration courses.9 Under the new system, the maximum (means-tested) maintenance loan available for a student outside London is £8700 per year (£725 per month) plus the payment of tuition fees directly from the student loan company (SLC) to the relevant Higher Education Institute. It is indisputable that student loans provide greater income during the programme of study than the old system. However, there is a need for student loans to be repaid following …

Healthcare is all about understanding and meeting the needs of the patient. We talk about holistic care, or being able to appreciate and support a patient from a biopsychosocial perspective, but there are constraints on healthcare services that encourage individuals and organisations to think of patients more as commodities or units. Patients are described as hindering effective use of healthcare resources by ‘blocking beds’, seeking treatment from the ‘wrong’ environment and failing to take responsibility for maintenance of health and well-being. High workloads lead to an increasingly task-based delivery of care1 and disengagement of nurses from patients as a form of self-protection.2 Not regarding patients as individuals helps us to make strategic plans and to design system-wide changes to address the imbalance in supply and demand, but it leaves patients' feeling unsupported and anxious,3 unfairly treated,4 suffering and uncared for.5 The antithesis of task-based care is compassionate care, which is based on empathy and concern not just for a patient’s biopsychosocial needs but also the wider context of that patient’s situation. To deliver compassionate care, we need to understand what it is like to be a patient, which requires knowledge of the patient’s experience and empathy. A number of strategies can be used in the higher education setting to help promote student …

Qualitative research methods allow us to better understand the experiences of patients and carers; they allow us to explore how decisions are made and provide us with a detailed insight into how interventions may alter care. To develop such detailed and rich information, qualitative research requires data which are holistic, rich and nuanced, allowing themes and findings to emerge through careful analysis. This article provides an overview of the core approaches to data collection in qualitative research, exploring their strengths, weaknesses and challenges.

Each year the International Association for the Study of Pain (IASP) runs a campaign to bring attention to an aspect of pain management. This year the Global Year is for Excellence in Pain Education (see: https://www.iasp-pain.org/GlobalYear). The aim of the year is to bridge the gap between knowledge and practice. There are some useful factsheets available on the website to help promote excellence in pain education including: Current Status of Pain Education and Implementation Challenges; Pain Curriculum Design Models and Implementation Approaches; and Pain Education Assessment and Evaluation Strategies.

Case study is a research methodology, typically seen in social and life sciences. There is no one definition of case study research. However, very simply… ‘a case study can be defined as an intensive study about a person, a group of people or a unit, which is aimed to generalize over several units’. A case study has also been described as an intensive, systematic investigation of a single individual, group, community or some other unit in which the researcher examines in-depth data relating to several variables.

‘When I use a word,’ Humpty Dumpty said, ‘it means just what I choose it to mean—neither more nor less’. ‘The question is,’ said Alice, ‘whether you can make words mean so many different things’. (Carroll L 1872. Alice through the looking glass) Palliative sedation is a term used to describe the use of sedative drugs in dying patients to induce a state of decreased or absent awareness (unconsciousness) in order to relieve intolerable suffering from refractory symptoms.1 ,2 Perhaps, for many of us, this conjures up an image of an agitated patient who is rendered unconscious in the last hours of life as a result of the need for repeated doses of sedative drugs. However, in the literature, ‘palliative sedation’ is used more broadly, sometimes as an umbrella term for all levels and patterns of sedation in those close to death.3 ,4 For example, a systematic review about palliative sedation includes a report of sedatives prescribed to 68/102 patients at some point in the last week of life,5 for whom ‘sublingual lorazepam tablets and clonazepam drops were commonly used and efficacious’. (This is the source …

As I sat down to write this editorial, the song The Times They Are a-Changin’ started playing. This could not be truer for nurse education in the UK at the moment. Indeed, it would be easy to feel overwhelmed by the amount and scope of change. In my current role, I am responsible for overseeing the implementation of a preregistration nursing curriculum based on the new Nursing and Midwifery Council (NMC) standards.

Observational studies often draw on the principles of ethnography. Ethnographic approaches to data collection were first used in anthropology and involve describing a culture and learning about the ‘native's point of view’.1 ,2 To gain an understanding of the culture being examined, the researcher is immersed in the field collecting data over a prolonged period of time, often for a year or more. Sometimes time constraints mean it is not possible to undertake a prolonged period of data collection nor is this always appropriate. However, to gain an understanding of what is happening in practice, adopting some of the principles of ethnography can be useful. (N.B. cohort, cross-sectional and case-control studies are also described as observational studies in the scientific literature. These specific methodologies are not within the scope of this paper).

The European Patients’ Academy (EUPATI) is a pan-European Innovative Medicines Initiative project of 33 organisations, led by the European Patients’ Forum with partners from patient organisations (the European Genetic Alliance, the European AIDS Treatment Group and EURORDIS), universities and not-for-profit organisations, along with a number of European pharmaceutical companies. EUPATI aims to help patients to be more educated and involved in the research and development process of new medicines, by offering reliable, objective, comprehensive lay-friendly information and training on the research and development process of medicines. EUPATI increases the capacity of patients to be effective advocates with meaningful involvement in areas like drug discovery and non-clinical testing, planning and conduct of clinical trials, regulatory affairs, assessment of safety of medicines, benefit-risk assessment, as well as principles of health technology assessment. The first EUPATI Patient Expert …

The World Health Organization (WHO) has defined palliative care as an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.1 Globally, it is estimated that every year over 20 million people will require palliative care at the end of life. Of these 69% are adults over 60 years.