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This paper describes the processes involved in selecting a sample, from the eight English regional health authorities, of nurse qualifiers from all four branches of the Project 2000 pre-registration diploma course, for a longitudinal study of nurses' careers. A simple random sample was not feasible since accurate information about the population could not be obtained and the study design involved recruiting participants by personal visit. A multi-stage approach was therefore adopted in which 'college of nursing' was taken as the primary sampling unit. Sampling was further complicated by the fact that adult branch students could generally only be visited in larger groups than was ideal. Information obtained during pilot work about the accuracy of data about the population, course completion rates and the proportion of students who were likely to agree to participate was used to calculate required sampling fractions. The final sample was therefore a function of this information and the practicalities of recruiting nurses into the study.

In response to the British government's Review of Mental Health Nursing this paper reports on a study which examined nursing practice in two inner city acute admission wards. Eight nursing staff maintained a record of their activities over a 7-day period according to four operationalized variables. Qualitative detail was also collected to enable the specification of activities. The amount of time available for patient contact work is calculated and those activities which currently restrict opportunities for experienced nursing staff to have therapeutic interactions with their patients are identified. The findings do not differ markedly from earlier studies and some tentative conclusions are drawn concerning the therapeutic milieu within an inner city psychiatric in-patient facility.

As part of a comprehensive study of perceptions of the philosophy and practice of nursing Project 2000 students and newly qualified diplomates were asked to reflect on their Project 2000 course as a preparation for professional practice. Data were collected from both students and diplomates through self-completion questionnaires and a small number of interviews with diplomates in two study centres, one in the north and the other in the south of England. Nurse managers and G grade practitioners were invited in focus group interviews to discuss the Project 2000 preparation and assess the diplomates 'fitness for purpose'. Findings suggest that the majority of students and diplomates acknowledged that the course had prepared them well. They acknowledged the importance of the inter-personal skills component of the course, together with the life sciences input. The diplomates particularly valued the theoretical aspect of the course, being well versed in research and keen to continue their learning. Perceived limitations of the course were the management preparation and course organization. Practical skill deficits were perceived as initial skills deficits only. Managers and practitioners were keen to employ the diplomates, whilst acknowledging their need for support and preceptorship. Three important issues for nursing and nurse education are discussed, including the balance of the Project 2000 course, preceptorship and support, and preparation for a role in the community.

This paper explores differences and similarities between participants who had selected nursing as an occupational choice from childhood and those for whom nursing was not a childhood occupational choice. The implications of the findings are discussed.

Nurses will often be at the forefront in a health care team which decides that it is ethically acceptable to allow a particular patient to die but the possibility of actually killing another patient who requests his own death is met with heartfelt resistance. This paper explores the distinction between killing and letting die and the connection these arguments have with justifications for euthanasia. Two practical examples of killing and letting die are analysed. Various issues are examined including the active-passive distinction, the difference between causing and preventing a death and the probability of outcome. Justifications for euthanasia are then revisited and some concluding remarks made.

Critical incident analysis has been espoused as a valuable method of promoting reflective nursing practice and as a tool for developing curriculum content. Despite an obvious application to mental health nursing, however, there has been little detailed examination of the practicalities and educational value of critical incident analysis within a mental health nursing curriculum. This paper is based on the use of critical incident analysis within the mental health branch of a Project 2000 diploma course. It presents the content of material brought by students, teaching methods used to facilitate learning, and the progressive development of students' reflective processes over the course of a complete branch programme. Using Benner's (1984) From Novice to Expert, the authors explore questions regarding the nature and effects of the critical incident technique in attaining competence in mental health nursing skills. The authors conclude with a theory-based evaluation and analysis of this student-centered experiential approach to learning as a method for developing reflective practice, and suggest areas for educational research.

The UKCC Code of Professional Conduct for nurses, midwives and health visitors stresses the need to have an understanding of the social and cultural determinants of health and illness. There is as yet little evidence of what might constitute good practice in this area and it is difficult to ascertain why this basic philosophy is not translated into action. Indeed, the nursing and midwifery professions' ability to deliver adequate and appropriate health care more generally to Britain's multiracial, multicultural population has been questioned. This literature review presents evidence which strongly suggests that although we are living in a multicultural society patients from minority ethnic groups are additionally disadvantaged because the initiatives by nurses, and others working in the National Health Service, to meet their health care needs are inadequate and often inappropriate.

This paper offers an analysis of some of the challenges of holism, particularly the challenges relating to co-operation and role indeterminacy. It uses the work of one group of nurses (specialist paediatric oncology nurses) to exemplify these issues, and it draws upon some empirical research into their work. These nurses work to provide a link between hospital and home for families with children with cancer, but it is suggested that the fundamental issues they face, (a) in linking the parts of the system, and (b) in linking the parts of care as it is experienced, are shared by anyone who subscribes to the holistic nursing. Issue (a) raises questions of professional boundary crossing, and calls upon diplomatic and micro-political skills. Issue (b) raises questions about the boundaries of health care, and calls upon skills of 'translation' and emotional labour. The value of holism is not questioned but the paper illustrates how aiming for holistic care inevitably opens up philosophical and practical problems and concerns.

This paper examines nurses' health education work from a philosophical perspective. Two key concepts, choice and autonomy, are explored by analysing examples of the health education work of the practice nurse and the health visitor. As a result, the question, 'what changes in health behaviour might nurses logically expect from their health education work?' is considered. The individualistic assumption within nurses' health education work, that individual patients and clients face certain choices and are able to exert some control over their health status, is reviewed. Choices related to healthy eating, for example, are recognized to be constrained by issues such as finance, time and social circumstances. The choice not to smoke is similarly constrained, for example, by social deprivation, cultural patterns and advertising. The paper both rejects an overly determined conception of patients and clients where they are viewed as unable to make any choices, but also cautions against the danger of victim-blaming. Constraints on patients' and clients' autonomy in health education by nurses are also considered. These limitations on health education work include, for example, a lack of scientific knowledge related to an individual's propensity to develop disease. In contrast, health education work within nursing may also be seen as enabling people to be more autonomous in relation to their health by imparting knowledge about health risks. Health education work by nurses thus emerges from the analysis as a constrained but valuable activity.

The link between nursing theory and practice remains a topic of ongoing debate. Related to this issue is the best place to effectively combine the two. The solution may be ward-based teaching programmes as part of formal continuing staff development, involving collaboration between college-based lecturers and acknowledged clinical experts. Using infection control as an example of a topic in need of regular and continual updating for qualified practitioners, it is argued that such programmes would be desirable because they would afford sufficient flexibility to fulfil individual learning needs and could be assessed to indicate whether nursing practice had been enhanced. Participants could be accredited for successful completion of ward-based programmes.

This quasi-experimental study compared the degree of satisfaction with nursing care among patients receiving post-operative pain relief via patient-controlled analgesia (PCA) and those receiving traditional intramuscular injection (IMI) regimes. This study, which involved a total of 79 adult patients (mainly female) undergoing major abdominal surgery, was comprised of two main parts. First, the amount of time taken by nurses to carry out pain control procedures on 11 matched pairs of PCA and traditional patients was recorded. Second, all patients were asked to fill in a questionnaire regarding their satisfaction with the quality of nursing care they had received on their third post-operative day. The findings indicated that PCA did save time and this time saving could improve the nursing care quality of the whole ward, though not necessarily resulting in higher satisfaction amongst those patients who used PCA. Interestingly, younger and the more highly educated patients were found to be especially critical and be less satisfied with care. The implications for nursing practice and management are addressed, with special emphasis placed on the notion that time saved with PCA should be used to increase patient-nurse contact and should not be used to compensate for a reduction in nursing staff.

An interview study was conducted among 173 nurses in two hospitals to explore their views concerning infection risks to themselves and patients and to identify any problems they perceived in safely performing infection control precautions during routine activities. Subjects were interested in the topic of infection control and keen to perform optimally, but perceived difficulties related to lack of expert guidance whether or not they had access to an infection control nurse. In one hospital subjects identified shortages of vital equipment (gloves, appropriate handwashing agents), and this was corroborated on a checklist used independently to document the availability of resources. When the opinions of nurses working in intensive care, surgical and medical units were compared, few differences emerged other than those explained by variation in supplies of equipment, except that intensive care unit nurses were more likely to rate their patients and themselves as particularly at risk of infection, Nurses who had been qualified longer, with more than 3 years experience in their specialty, were more conscious of infection risks.

The informed evaluation of ethnographic reports is essential to the practitioner who is working towards research-based practice. It is also part of the process of developing and refining nursing knowledge. While there are features common to the critical examination of all research, an understanding of ethnographic design and, in particular, of issues of validity and reliability, is a prerequisite for evaluation of ethnographic research reports.

This paper describes a research study designed to evaluate a community health service development in one health authority in rural England. The study compared two types of primary care teams working towards the same objectives. Surveys of patients and staff in the health authority were conducted about a range of issues, defined by the original aims of the scheme. Measures were made of care received by people over 75 years of age, consumer satisfaction, staff experiences of the multi-disciplinary team, job satisfaction and liaison with social services personnel. Few differences existed between the two forms of care on all of these measures. This paper contains a discussion of the findings alongside an examination of the implications for future health service developments, particularly flagship enterprises such as nursing development units. The importance of well established baseline measurements is emphasized by both the research findings and the discussion.

The background to the legalization of nurse prescribing is reviewed and a small questionnaire survey of health visitors and district nurses described. Significantly more district nurses than health visitors wanted to become nurse prescribers. Health visitor knowledge of some parasiticidal lotions and antifungal agents was found to be variable and the recommended dose of paracetamol for post-immunization pyrexia was recognized by less than two-thirds of the sample. District nurse knowledge of lactulose was limited in comparison to their knowledge of alginate and hydrocolloid dressings; however, their knowledge of factors other than dressing type which enhance or delay healing was variable. The mean knowledge scores of both the health visitors and district nurses were unacceptably low for prescribing purposes. The majority of the total sample stated that they would like further training, with a preference for such provision in the form of study days.

A review of the literature revealed that the early school nurses were engaged in predominantly screening work and as assistants to the school medical officer. The relatively limited empirical work suggests that they have the potential to make a major contribution to the health of school children; however, their current role appears to vary enormously nationwide and the issues of competency for the role and integration into the school team need addressing. The consumer/outsider view literature indicated a mismatch between expectations and service provision.

This paper describes inter-rater reliability of three quality assessment instruments: Monitor, Senior Monitor and Qualpacs. The work forms part of a Department of Health funded study examining the reliability and validity of these three instruments. Inter-rater reliability is not a fixed entity and therefore should be tested every time raters or the setting change. In this instance, testing was carried out in three wards (one elderly and two surgical). Two methods of analysis were used: percent agreement and intra-class correlation coefficient. Results and some of the techniques that were found to be useful in enhancing reliability are described. Acceptable levels of inter-rater reliability with all three instruments were reached.

This paper analyses the role of problem solving in nursing practice including the process, acquisition and measurement of problem-solving skills. It is argued that while problem-solving ability is acknowledged as critical if today's nurse practitioner is to maintain effective clinical practice, to date it retains a marginal place in nurse education curricula. Further, it has attracted limited empirical study. Such an omission, it is argued, requires urgent redress if the nursing profession is to meet effectively the challenges of the next decade and beyond.

This paper reports the findings of the first phase of a study designed to assess the needs of people with HIV and AIDS and the extent to which these needs are being met by services in Camberwell Health Authority in inner London. The study involves collecting information and opinions from key service providers, clients with HIV/AIDS and their informal carers. It is the service provider data which will be presented here. Semi-structured interviews were conducted with 47 key service providers involved in the care and support of people with HIV/AIDS in the Camberwell Health District. Respondents were drawn from the local health services, local social services departments and a number of locally active voluntary organizations. The aim was to gather respondents' views on their individual roles and the roles of the organizations they represented, the health and social needs of people with HIV/AIDS and the extent to which these were being met by current service provision and the co-ordination of services for people with HIV/AIDS. The data showed that a broad range of services were utilized by people with HIV/AIDS, reflecting a wide variety of health and social care needs. The majority of respondents felt that some of the needs of people with HIV/AIDS were similar to those of people living with other chronic illnesses (such as cancer). However, they also identified a number of problems which were either unique or more severe for people with the virus. Services for people with HIV/AIDS were generally felt to be poorly co-ordinated and a number of areas of overlap and gaps in service provision were identified.

Reviewed literature identifies the importance of continuing professional education and professional development for nurses subsequent to initial registration (including enrolled nurses). However, there is a lack of empirically based work analysing nurses' perceptions of their continuing professional education needs and the perceived outcomes of continuing professional education in terms of changes in knowledge accretion, attitudes, skills, job satisfaction, staff retention and career development. It is suggested that this lack of empirical work needs to be addressed if the proposed plans of the United Kingdom Council for Nursing, Midwifery and Health Visiting (UKCC) to introduce mandatory continuing professional education are to have maximum benefits for clients, nurses and the service.

This paper describes the content and administration of Monitor and Senior Monitor and the difficulties encountered, together with suggestions for avoiding or overcoming these difficulties. This work forms part of a study, funded by the Department of Health, which is examining the reliability and validity of the quality assessment instruments, Monitor, Senior Monitor and QualPacs. The instruments were administered in care of the elderly, medical and surgical wards in two Health Authorities in London. Difficulties encountered with the administration of Monitor and Senior Monitor were to do with the structure of the instruments, accessing required information, interpreting questions and answers, disrupting ward staff, the time required to carry out the procedure and frustrations experienced by the assessors. Although the number of difficulties encountered was considerable, they were not insurmountable. The authors are confident that awareness of these difficulties, and taking steps beforehand to avoid or overcome them, contributes to the reliability and validity of these instruments.

This paper presents an overview of research into the role of paid non-professional nursing helpers. This term refers to auxiliaries, ward clerks, healthcare assistants and support workers. The focus of the review is on work carried out on attitudes of qualified staff to the role of the helper, role descriptions and the role of the helper in different organizational modes of work. Some of the research reviewed in relation to the role description and attitudes to the helper date back to 1978. However, the emphasis of the paper is on research published in the past 3 years. The research is reviewed against the background of two theoretical frameworks, both of which are perceived to be useful in analysing the division of labour between the nurse, the patient and the helper.

Nausea and vomiting are reputed to be two of the most disruptive side-effects associated with chemotherapy. Pharmacological and behavioural interventions are well described in the literature, but sparse attention appears to have been focused upon the role of self-care. This paper outlines the problem of chemotherapy-induced nausea and vomiting. The concept of self-care is described, including possible motivations to perform self-care, and potential relationships between symptom perception and self-care are noted. It concludes with suggestions for theoretical work and future research studies concerning self-care behaviour for nausea and vomiting induced by chemotherapy.

This study focuses upon the experiences of a group of 10 long-stay psychiatric patients as they moved from a large institution to a staffed community hostel. The residents were interviewed 2 weeks prior to moving and again 6 weeks after the move. Areas identified in the first set of unstructured interviews were followed up in the second set. Qualitative analysis of the interviews revealed seven recurrent themes that are discussed in relation to other research studies that consider how people experience the effects of institutionalization. The study tests the feasibility of unstructured interviews as a means of collecting accounts of the perceptions and experiences of a client group from which other research methods have failed to elicit detailed information. Unstructured interviews proved successful when undertaken by a researcher who was well known and accepted by the residents. Familiarity with the residents and the context of the interview was also found to be important in analysing interviews qualitatively and the study casts doubt upon the value of primary qualitative analysis of interview transcripts by researchers who have not also participated in the interviews. The methodological implications for future deinstitutionalization studies are discussed.

Careless or confused use of terms such as information giving, teaching and counselling may lead to inadequate understanding and practice. In view of the progress made in this area, designed to help patients cope with illness and treatment, this paper aims to clarify and identify similarities and differences between these activities and discuss their relevance for those in most need of these types of care. Having recognised the complexity and persistence of such needs, patients, their relatives and nurses should perhaps decide their respective roles and work towards improving the quality of and opportunities for such interventions.

Research in nurses' communications has concentrated on nurse to patient interactions. Those few studies which focus on nurse to nurse communications seem to be generated by a pragmatic and normative concern with effective information sharing. In this paper, which describes one aspect of a larger case study of a hospital-based therapeutic community, the description and analysis of nurses' reports flows not from a normative model of professional practice, but rather an exploration of how professional practice is articulated as discourse in nurses' written accounts. Foucault's ideas about therapeutic discourse inform the theoretical framework of the research. Ethnomethodological concerns with the importance of documentary analysis provide the methodological rationale for examining nurses' 24-hour report documents, as official discourse, reflecting therapeutic practice in this setting. A content analysis of nurses' reports, collected over a period of 4 months, demonstrated the importance of domesticity and ordinary everyday activities in nurses' accounts of hospital life. Disruption to the 'life as usual' domesticity in the community seemed to be associated with admission to and discharge from the hospital when interpersonal and interactional changes between patients occur. It is suggested that nurses in general hospital wards and more orthodox psychiatric settings might usefully consider the impact of admissions and discharges on the group of patients they manage, and make this a discursive focus of their work.