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Aims of the study. This paper uses the findings of a recent bibliometric analysis of published UK nursing research to ask whether the field is characterized by a fundamental split between two underlying areas of research interest. These can be termed 'endogenous' and 'exogenous'. The former term describes research which tends to be concerned with problems and issues to do with nursing as a profession; the latter is concerned with problems and issues centring around the nursing of patients.Design/methods. Papers in the Wellcome Trust's Research Outputs Database (ROD), a database of UK biomedical research, were analysed. Nursing papers published between 1988 and 1995 numbered 1845, just less than 1% of the total papers in the ROD.Results/findings. Analysis of the subfield identified that nursing research was atypical of biomedical research as a whole in a number of ways. One difference was that usually in biomedical research there is a general correlation between numbers of funders acknowledged on a paper, numbers of authors, and esteem of the journal in which a paper appears. In nursing there was, if anything, a tendency for highly esteemed papers to have fewer authors and be less likely to have acknowledged funding. However, the apparently endogenous and exogenous papers have quite different characteristics. This paper explores this apparent difference and possible reasons for this difference and will briefly compare nursing research with some other newly emerging social and academic groups.Conclusions. Thinking of nursing research outputs in this way can provide insight into the existence of different reward systems influencing nurse researchers. However, it is impossible to draw too confident a differentiation without reading each individual paper and making judgements about whether they are 'endogenous' or 'exogenous', a practice generally beyond the scope of bibliometric practice. [ABSTRACT FROM AUTHOR]

There has been little professional debate in the UK literature about nursing diagnosis and this paper explores some of the reasons why nursing diagnosis has failed to gain momentum among nurses in the United Kingdom. The nursing diagnosis movement has now reached some European countries and in the light of the International Classification of Nursing Project (ICNP) and the Strategic Advisory Group for Nursing Information Systems (SAGNIS) project commissioned by the NHS Executive (NHSE), requires a close examination by British nurses. The unsuccessful attempt by the North American Nursing Diagnosis Association (NANDA) to have its taxonomy accepted for inclusion in the World Health Organization's 10th revision of the International Classification of Diseases, an innovation which would have made the NANDA taxonomy the definitive classification of nursing, should alert British nurses to the importance of nursing diagnosis. Although nurses effectively diagnose as part of the nursing process, adoption of the concept of nursing diagnosis as a driving force for practice evades many of them. This paper reflects upon some of the logistical and conceptual difficulties including issues of culture and terminology. It is suggested that nursing diagnosis has a great deal to offer British nurses in their efforts to improve the quality of care and to provide data in this area for both practice and research. [ABSTRACT FROM AUTHOR]

elliott l., crombie i.k., irvine l., cantrell j. & taylor j. (2004) Journal of Advanced Nursing 45(2), 117–125 The effectiveness of public health nursing: the problems and solutions in carrying out a review of systematic reviews In 1999 the Scottish Office, United Kingdom, intimated that the Chief Nursing Officer would undertake a policy review of nurses’ contribution to improving the public's health. The importance of reviewing the scientific literature on the effectiveness of public health nursing was recognized as a crucial part of the policy review. A final report was expected within a 6-month period. The reason for the short time period was to fit the policy-making schedule. This paper discusses our literature review for this work. The aim was to conduct a review of the international scientific literature that gave the greatest coverage of the role and potential role of nurses in improving the public's health in relation to 14 major health topics. This paper describes the methods used, outlines the rationale underpinning the methods, discusses the problems encountered and offers solutions to some of these problems. The initial search for relevant scientific literature revealed 709 suitable primary papers. Reviewing this number was beyond the time limit set by the funding organization. Therefore, a decision was made to concentrate on the evidence contained in systematic reviews. Reviewing systematic reviews raises a number of methodological problems to which there are often no predetermined solutions, such as ensuring that important interventions are included, assessing the relevance and quality of the reviews, and grading the strength of the evidence. Reviewing systematic reviews provides the scope to increase the number of topics that might be covered. However, it is possible that a number of interventions may be missed, particularly those that are not subject to review or those assessed using qualitative techniques. The definition of public health nursing used in the present study was also restrictive, and could be widened to include community interventions. Finally, assessing the quality of reviews and grading the evidence proved difficult and there is lack of consensus on how these tasks should be achieved. Nevertheless, the review presented policy makers with accessible information on a large number of relevant international studies. [ABSTRACT FROM AUTHOR]

This paper explores the quality of nursing research in 1992. A meta-analysis of the nursing literature was conducted using the Journal of Advanced Nursing, the International Journal of Nursing Studies and the Journal of Clinical Nursing. For comparative purposes the British Medical Journal was selected. The survey examined a number of research indicators such as sample size, sample selection, research methods, country of origin of author and types of study populations. The analysis indicates that nursing and medicine has come mutual concerns and that both professional groups could learn from each other in order to extend the effectiveness of their research. [ABSTRACT FROM AUTHOR]

Five hundred and two items about community psychiatric nursing have been located and classified. The data indicate a continuing rising trend in the number of publications on this subject. The majority of the literature is about the clinical role of the community psychiatric nurse (CPN) and is descriptive/analytical in nature. The second largest proportion is research, the third largest topic is management and administration and the fourth largest is CPN education. The amount of 'clinical' literature as a proportion of the whole has been in decline since the mid-1970s. The majority of papers cannot be classified by the specialism of community psychiatric nursing to which they relate, but a small and significant number have been written about the care of the elderly mentally ill. Overall, the practising CPNs have been the most prolific writers, followed by academic nurses and then nurse managers. Contributions from other professions are miniscule. Over recent years the contribution of nurse managers has declined, and that of academic nurses has risen. The contribution of practising CPNs remains robust. Research publications also continue to rise, the majority being produced by academics, but large contributions are also being made by nurse managers and practising CPNs. In the early years nearly all publications of articles were in populist nursing magazines. In recent years the spread of journals in which items about community psychiatric nursing appear has widened considerably. [ABSTRACT FROM AUTHOR]

AIM: The aim of this paper is to discuss the opinions of the key individuals involved in implementing the integration of nurse education into higher education in the United Kingdom (UK) about why nurse education moved into higher education and why this happened when it did. BACKGROUND: In 1995 the last of the old-style schools of nursing in the UK was fully integrated into higher education and were detached financially, legally and organizationally from District Health Authorities. However, only 6 years before, when Working Paper 10 was produced, there were only a few nursing degree courses located within higher education. What made this move into higher education particularly noteworthy was that there was never a clear statement of intent from the government that this integration of health care education was intended. Despite the fact that this is one of the most significant changes ever to take place in nurse education, there has been relatively little empirical research about why the development occurred. METHODS: A qualitative approach was selected for this study and the methods used were policy analysis and interviews. A purposeful sample of 70 implementers involved in the integration process was selected and asked for their views on this issue. FINDINGS: Participants believed that integration had occurred because of a combination of complex factors, but there was a division between those who thought that it was centrally planned and others who felt that it was an accidental outcome of the particular events of the time. CONCLUSIONS: It is not clear whether policy was influencing action or action influencing policy. Understanding of why this change occurred is needed if health care professionals wish to have greater control over future changes in education. [ABSTRACT FROM AUTHOR]

BACKGROUND: In an era when information technology developments are being harnessed by governments to improve patient care, it is important to consider the issues raised by the use of computers in health care practice and policy. AIM: The aim of this paper is to provide an appraisal of considerations raised by the use of computers in health care. REVIEW FOCUS: Drawing on a range of studies in the social and medical sciences, the paper reviews the considerations. The introduction to the paper maps out the policy context, which is followed by three substantive sections: first, computer hardware and software considerations; second, issues around confidentiality; and third, personal, social and cultural considerations. CONCLUSION: This paper demonstrates that information technology developments must be allied with government or state direction and should be informed by evidence. Whilst the issues discussed are of primary relevance to the United Kingdom National Health Service, they have wider relevance to health care systems internationally. [ABSTRACT FROM AUTHOR]

This paper focuses upon an exploration into the world of the cancer nurse regarding stress and persons with cancer. It is proposed that the cancer nurse's world often is not emphasized or even acknowledged within clinical practice and, for the most part, remains ignored. It is argued that the cancer nurse's world is rich with meaning, and the knowledge, skills and values within this domain need to come to the fore. A phenomenological approach was adopted for the study, because of the inherent emphasis upon meaning and understanding within the cancer nurse's everyday practice. Methodological triangulation involved qualitative interviews with nursing staff on an acute oncology unit, observation of the nursing admission assessments of cancer patients and use of archival sources (nursing kardexes). Content analysis of the interview findings revealed that the common-sense understandings of the cancer nurse were present in relation to stress and the person with cancer. Although these construals have not been adequately studied, the framework of common-sense knowledge involves the informal views and the wealth of knowledge individuals have. Common-sense construals are linked to the nurses' experience, both past and present, and derived from both professional practice and educational experiences. In practice, however, the nurses often failed to rely on this knowledge, apparently because of the mainstream influence of the medical model. The study led to the recommendation reported on in this paper that nurses must bring their common-sense knowledge and values to the fore in order to provide holistic care of persons with cancer. [ABSTRACT FROM AUTHOR]

In the United Kingdom, the audio-visual revolution has steadily gained converts in the nursing profession. Nurse tutor courses now contain information on the techniques of educational technology and schools of nursing increasingly own (or wish to own) many of the sophisticated electronic aids to teaching that abound. This is taking place at a time of hitherto inexperienced crisis and change. Funds have been or are being made available to buy audio-visual equipment. But its purchase and use relies on satisfying personal whim, prejudice or educational fashion, not on considerations of educational efficiency. In the rush of enthusiasm, the overwhelmed teacher (everywhere; the phenomenon is not confined to nursing) forgets to ask the searching, critical questions: 'Why should we use this aid?', 'How effective is it?', 'And, at what?'. Influential writers in this profession have repeatedly called for a more responsible attitude towards published research work of other fields. In an attempt to discover what is known about the answers to this group of questions, an eclectic look at media research is taken and the widespread dissatisfaction existing amongst international educational technologists is noted. The paper isolates out of the literature several causative factors responsible for the present state of affairs. Findings from the field of educational television are cited as representative of an aid which has had a considerable amount of time and research directed at it. The concluding part of the paper shows the decisions to be taken in using or not using educational media as being more complicated than might at first appear. [ABSTRACT FROM AUTHOR]

Title. The Internet as a research site: establishment of a web-based longitudinal study of the nursing and midwifery workforce in three countries. Aim. The aim of this paper is to describe the development of a web-based longitudinal research project, The Nurses and Midwives e-cohort Study. Background. The Internet has only recently been used for health research. However, web-based methodologies are increasingly discussed as significant and inevitable developments in research as Internet access and use rapidly increases worldwide. Method. In 2006, a longitudinal web-based study of nurses and midwives workforce participation patterns, health and wellbeing, and lifestyle choices was established. Participating countries are Australia, New Zealand and the United Kingdom. Data collection is handled through a dedicated website using a range of standardized tools combined into one comprehensive questionnaire. Internet-specific data collection and a range of recruitment and retention strategies have been developed for this study. Discussion. Internet-based technology can support the maintenance of cohorts across multiple countries and jurisdictions to explore factors influencing workforce participation. However, barriers to widespread adoption of web-based approaches include website development costs, the need for fast broadband connection for large data collection instruments, and varying degrees of Internet and computer literacy in the nursing and midwifery workforce. Conclusion. Many of the issues reported in this paper are transitional in nature at a time of rapid technological development. The development of on-line methods and tools is a major and exciting development in the world of research. Research via the world-wide web can support international collaborations across borders and cultures. [ABSTRACT FROM AUTHOR]

Title. Adequacy of health-related quality of life measures in children under 5 years old: systematic review Aim. This paper is a report of a systematic review to assess the adequacy of measures evaluating generic health-related quality of life outcomes in children less than 5 years old. Background. Evaluating generic health-related quality of life outcomes in children is important to assess the effectiveness of interventions, nursing care and services. Methods. A methodological systematic review was carried out for the period 1980–2005 in accord with the UK Centre of Reviews and Dissemination guidelines on systematic reviews. We searched multiple electronic databases, hand-searched key texts, and contacted investigators. We included all English language publications describing primary empirical research of generic health-related quality of life, health status, functional status or wellbeing measures, with published psychometric evidence. All measures (proxy and/or self-complete) for use in children under 5 years were included; single dimension measures were excluded. Results. Seventy-six papers (70 studies) referring to 16 generic health-related quality of life measures met our inclusion criteria. None of the 16 measures were adequate in terms of their conceptual content or psychometric criteria; quality scores were poor (0–8). No current, generic health-related quality of life measure is both psychometrically and conceptually robust, although the Health Utilities Index has the most comprehensive psychometric data published. However, not all dimensions of health are assessed, with little evidence of reliability in children under 5 years of age. Conclusion. There is a need to develop empirically robust and conceptually comprehensive health-related quality of life measures, particularly in the context of proxy-completion measures for very young children. [ABSTRACT FROM AUTHOR]

Midwives’ perceptions of the use of technology in assisting childbirth in Northern Ireland Aim of the paper. The aim of this paper is to report a survey of midwives’ views on the use of technology in assisting births. Background. The research was designed to provide a deeper understanding of the integration of technology into midwives’ practice and to identify and examine aspects of training needs. Methods. Over 400 midwives responded to a questionnaire seeking information on their experiences and perceived competence with labour ward technology, with a particular focus on the use of cardiotocograph machines (CTGs) for electronic foetal monitoring. The survey sought views on the extent to which midwives trust the technology, their perceived levels of training and competence, their awareness of policy relating to technological intervention and the issue of women’s choice in whether the progress of their delivery is technologically monitored. Findings. The majority of midwives in this survey trust the use of technology but have concerns about issues of safety in relation to potential faults, and to their perceived lack of training in technology usage. The majority also indicated that they prefer a nontechnological birth although many point to the benefits of technological support when difficulties are encountered. The use of technology is seen as multi-professional and there was much support among the respondents for multi-disciplinary training in the use of technologies in future curricula. Conclusions. If the various findings of this sample survey were to be consolidated for midwives as a whole, they suggest that provisions for continuing professional development may need to address technological awareness and competence in a more focused manner than is discernible at present. [ABSTRACT FROM AUTHOR]

AIM OF THE PAPER: To examine the application of the decision tree approach to collaborative clinical decision-making in mental health care in the United Kingdom (UK). BACKGROUND: While this approach to decision-making has been examined in the acute care setting, there is little published evidence of its use in clinical decision-making within the mental health setting. The complexities of dual diagnosis (schizophrenia and substance misuse in this case example) and the varied viewpoints of different professionals often hamper the decision-making process. This paper highlights how the approach was used successfully as a multiprofessional collaborative approach to decision-making in the context of British community mental health care. DESIGN: A selective review of the relevant literature and a case study application of the decision tree framework. CONCLUSIONS: The process of applying the decision tree framework to clinical decision-making in mental health practice can be time consuming and client inclusion within the process is not always appropriate. The approach offers a method of assigning numerical values to support complex multiprofessional decision-making as well as considering underpinning literature to inform the final decision. Use of the decision tree offers a common framework that can assist professionals to examine the options available to them in depth, while considering the complex variables that influence decision-making in collaborative mental health practice. Use of the decision tree warrants further consideration in mental health care in terms of practice and education. [ABSTRACT FROM AUTHOR]

AIMS OF THE PAPER: This paper aims to examine the recent debates in both the general and professional press over the future of preregistration education in England, in the light of the sociological literature on the professions, and the nature of nursing knowledge. The literature on the Project 2000 reforms, although by now well worn, will also be discussed briefly. BACKGROUND/RATIONALE: The bulk of nursing education in England moved into higher education in the 1990s. Unlike other higher education in England, it is not funded by the Department for Education and Employment, but commissioned by the National Health Service (NHS), to which it is expected to be highly responsive. DESIGN/METHODS: This paper is based on a brief literature survey, plus policy documents and media reports. Findings/Conclusion. It will be argued that the process of professionalization is not a straightforward one, and has its potential for reversals of fortune, and that nursing occupies a marginal place in higher education in England. [ABSTRACT FROM AUTHOR]

The relationship between attendance at birth and maternal mortality rates: an exploration of United Nations’ data sets including the ratios of physicians and nurses to population, GNP per capita and female literacy Background. This is the third and final paper drawing on data taken from United Nations (UN) data sets. The first paper examined the global distribution of health professionals (as measured by ratios of physicians and nurses to population), and its relationship to gross national product per capita (GNP) (). The second paper explored the relationships between the global distribution of physicians and nurses, GNP, female literacy and the health outcome indicators of infant and under five mortality rates (IMR and u5MR) (). In the present paper, the global distribution of health professionals is explored in relation to maternal mortality rates (MMRs). The proportion of births attended by medical and nonmedical staff defined as ‘attendance at birth by trained personnel’ (physicians, nurses, midwives or primary health care workers trained in midwifery skills), is included as an additional independent variable in the regression analyses, together with the ratio of physicians and nurses to population, female literacy and GNP. Aim. To extend our earlier analyses by considering the relationships between the global distribution of health professionals (ratios of physicians and nurses to population, and the proportion of births attended by trained health personnel), GNP, female literacy and MMR.

The importance of conducting and reporting pilot studies: the example of the Scottish Births Survey Background. In many research papers, pilot studies are only reported as a means of justifying the methods. This justification might refer to the overall research design, or simply to the validity and reliability of the research tools. It is unusual for reports of pilot studies to include practical problems faced by the researcher(s). Pilot studies are relevant to best practice in research, but their potential for other researchers appears to be ignored. Objective. The primary aim of this study was to identify the most appropriate method for conducting a national survey of maternity care. Methods. Pilot studies were conducted in five hospitals to establish the best of four possible methods of approaching women, distributing questionnaires and encouraging the return of these questionnaires. Variations in the pilot studies included (a) whether or not the questionnaires were anonymous, (b) the staff involved in distributing the questionnaires and (c) whether questionnaires were distributed via central or local processes. For this purpose, five maternity hospitals of different sizes in Scotland were included. Results. Problems in contacting women as a result of changes in the Data Protection Act (1998) required us to rely heavily on service providers. However, this resulted in a number of difficulties. These included poor distribution rates in areas where distribution relied upon service providers, unauthorized changes to the study protocol and limited or inaccurate information regarding the numbers of questionnaires distributed. Conclusions. The pilot raised a number of fundamental issues related to the process of conducting a large-scale survey, including the method of distributing the questionnaire, gaining access to patients, and reliance on ‘gatekeepers’. This paper highlights the lessons learned as well as the balancing act of using research methods in the most optimal way under the combined pressure of time, ethical considerations and the influences of stakeholders. Reporting the kinds of practical issues that occur during pilot studies might help others avoid similar pitfalls and mistakes. [ABSTRACT FROM AUTHOR]

AIM OF THE PAPER: The aim of this paper is to examine individualized health visiting care and compare it to corporate working within a consensual management style. Corporate working has been discussed and used in many different ways since the idea first came to light at the end of the 1980s. Resource management makes it an appealing model, however, analysing how corporate working functions in the practice setting reveals the complexity of this method of service provision. BACKGROUND: This paper is based on a method of practice developed by health visitors in Haywards Heath, West Sussex, who implemented the process. The article examines individualized health visiting care and compares it to corporate working within a consensual management style. Important in this analysis are the elements of reflexivity, active listening, reflection and the application of 'praxis' within the corporate caseload approach. METHODS: Rogers' evolutionary concept model was used to illuminate and explain the different ways of delivering the health visiting service. FINDINGS: There are benefits in working corporately: shared workload, increased professional support and improved accountability. Alongside the integrated supervision of this model is the opportunity offered to practitioners to innovate. This offsets any initial difficulty experienced in setting up this method and makes it a worthwhile change of style in health visiting practice. Improved service delivery, enhanced professional growth and increased opportunity for public health work can be demonstrated as outcomes of this model. For professionals this method may prevent 'burn-out', enhance practice and increase innovation in health visiting practice. Using this method as a blueprint, practitioners can develop their own style of corporate working that offers a service that is equitable, proactive, efficient and accessible to clients. [ABSTRACT FROM AUTHOR]

Subject positions theory – its application to understanding collaboration (and confrontation) in critical care Background. Doctors and nurses do not usually take a collaborative approach to the ethical challenges of the critical care environment. This leads to the stresses that produce moral anguish and burnout – both for nursing and medical staff. A more collegial relationship between nurses and physicians should improve patient care. If we are to promote this collegiality, one way to proceed is to investigate the interactions between health care professionals in order to develop an understanding of the barriers to, and supports for collaboration. Aim. Subject positions theory offers a method of explaining and elucidating the interactions between nurse and physician in terms of power dynamics, mutual expectations and the discourse available to each individual. This paper aims to demonstrate how subject positions theory can facilitate the interpretation of the interactions between health professionals in terms of the power dynamics influencing those interactions. Discussion. This paper will use the example of a case study from my own research to demonstrate the application of this theory and its usefulness in the analysis of the interactions between health care professionals. Conclusions. Application of this theory is used to demonstrate the author’s argument that the current political and cultural structure of the health care system does not support the subject position – nurse advocate. [ABSTRACT FROM AUTHOR]

Women’s anxieties surrounding breast disorders: a systematic review of the literature A systematic review of the research literature published in English between 1990 and 1999 was carried out to discover whether women with benign breast disorders suffer similar amounts of anxiety to women with breast cancer in the time between discovery of the problem and receiving a diagnosis, to include the immediate postdiagnosis phase. The study was limited to primary research papers with explicit methodology applicable to hospital specialist breast clinics where the main focus of the papers was anxiety and/or psychological distress. Studies focusing exclusively on routine breast screening or exclusively on women with previously diagnosed breast cancer were omitted. A protocol for the review was agreed at the outset, addressing selection criteria, search procedures, methods of data extraction and analysis, and dissemination. Search terms were refined as the study progressed. A data extraction tool was constructed based on Benton and Cormack’s framework (, pp. 80–81). An initial search revealed 89 papers. Fourteen papers were found to meet the criteria for inclusion. The main findings were that women with benign breast disorders and those with breast cancer suffered from similar levels of anxiety and psychological distress in the period from first being aware of the problem up to the time of receiving a diagnosis. Anxiety levels were found to fall more quickly in women with benign disorders postdiagnosis. Methodological flaws were detracted from the rigour of many of the studies. Implications for practice are discussed. [ABSTRACT FROM AUTHOR]

The scheduling of nursing time on hospital wards is critical to the delivery of patient care, resource utilization and employee satisfaction. Over the past decade many hospital wards in the United Kingdom (UK) have moved away from the traditional planning of rosters by a single manager, towards more participative processes known as self-rostering and team rostering. This paper tests the hypothesis, developed from the literature, that the three types of rostering approach may be positioned along a continuum. Self-rostering at one extreme, is conducive to staff empowerment, motivation and roster effectiveness, whilst departmental rostering, at the other, leads to perceived autocracy, reduced empowerment, lower levels of staff motivation and roster effectiveness. Team rostering is positioned mid-way on this continuum. This paper reports the findings of an empirical study of nurse rostering practices in the UK National Health Service (NHS), with a view to developing an understanding of the implications of implementing these three rostering approaches and testing the above hypothesis. The survey of rostering practices in 50 NHS wards, and in-depth case studies of seven wards, revealed that each of the three rostering approaches has benefits and limitations and a picture emerges quite different from that implied by the research hypothesis. Whilst the literature suggests that the choice of rostering approach determines the level of perceived autocracy, staff motivation and roster effectiveness, it is proposed in this paper that selection of rostering approach should be contingent upon operational context. The paper concludes with a framework which stipulates that the choice of rostering approach for a ward should be determined on the basis of four contingent variables, namely, ward size, demand variability, demand predictability, and complexity of skill mix. It is recommended that departmental rostering be applied in large wards with complex rostering problems, whilst team rostering is more appropriate for medium sized wards, and self-rostering appropriate for small wards. [ABSTRACT FROM AUTHOR]

The purpose of this literature review is to identify those factors which might affect the research capacity of departments of nursing based in higher education, and to make recommendations based upon the findings to enable departments to develop their capacity to undertake research. There is a dearth of published research which directly addresses this issue and therefore publications were reviewed which related to: the impact on nurse educators of the integration of nursing into higher education; nurse educators' attitudes towards research and their research role; analysis of the results of the 1992 and 1996 Research Assessment Exercises and commentaries on them; developing research within nursing generally; and factors affecting research productivity within nursing and related disciplines. The papers were analysed according to the following themes: academic qualifications; research skills; time available for research; motivation to undertake research; a culture of research; subject specialization; subject areas for research; research quality; and a nursing research council. The conclusions are first, that whilst there is a dearth of literature which relates directly to research capacity development in academic departments of nursing, there is much advice which can be drawn upon. Second, the article concludes that the factors affecting research capacity development are numerous and complex and it is not something which can only take place at the departmental level. There are also issues which require consideration nationally, as well as factors which depend upon the individual academic, and these impact upon the research capacity of academic departments of nursing. The factors are summarized at the end of the paper in the conclusions and recommendations. [ABSTRACT FROM AUTHOR]

During the 1980s many nurses left the British National Health Service to own and run private residential care homes for elderly people. At the time, a public policy of guaranteed financial support for residents underpinned the rapid expansion in the sector and residential homes were considered as profitable low-risk business ventures. However, since the introduction of the 1990 National Health Service and Care in the Community Act, this automatic funding has been withdrawn and residential homes have had to compete amongst each other for a finite number of clients funded by limited local budgets. The withdrawal of guaranteed state support and the introduction of social care markets have had negative impacts on many residential home businesses. Indeed, many homes are facing financial difficulties. This paper considers the actions and attitudes of former nurse proprietors under the new conditions based on a three-stage survey in Devon, England. Proprietors are experiencing increased levels of stress and many are unhappy with their current work experiences. The paper concludes that although the small business private sector may seem attractive to nurses, any move into private sector ownership has an associated risk. Social policy conditions may change with concurrent consequences for businesses and business owners. [ABSTRACT FROM AUTHOR]

With the growing interest in community-based initiatives, this discussion paper focuses upon the evaluation of community development. It reviews three areas and highlights the complex and contentious nature of evaluation in this field. Commencing with approaches to evaluation, it critically reviews proposed methods and suggests that, rather than provide clarity and guidance, the competing designs are confusing for the potential researcher. Second, the discussion moves to evaluative terms that are applied to community development, suggesting that there is a mismatch between professional and lay interpretations with an ultimate impact upon the validity of their measurement. It uses the terms community and empowerment to make these differences more explicit. Finally, the paper argues that, although the aim of community-based initiatives is to bring about community health gain, gauging the pervasiveness of discreet project work is testing. It concludes by suggesting that a move away from an evaluative model based upon empowerment towards one which considers health and social capital may be a way forward. [ABSTRACT FROM AUTHOR]

This article presents consultation papers of the United Kingdom Central Council for Nursing, Midwifery and Health Visiting. Consultation papers prepared by the working groups are now being given a wide distribution throughout the professions of nursing, midwifery and health visiting. The task of the working groups, in considering comments will be greatly assisted if views on the recommendations and proposals in the consultation paper are channelled back through an appropriate professional organization or trade union. The Council has set up seven working groups. Each working group is looking at a particular aspect of the 1979 Act and the related future responsibilities which the Council will inherit.

This paper presents the results of an appraisal of the evidence for the effectiveness of methods of nutritional assessment currently in use by nurses and from this develops concepts which may be applied to many areas of nursing practice. The paper first shows how the approach to nutritional assessment by nurses has changed over time, producing the present search for methods which are relatively quick and easy to use. It then describes the limited nature of the evidence of effectiveness of these methods and considers the reasons for this situation. It suggests that the difficulty of validation is an important factor and describes the three most common approaches to validation, showing how problems arise from lack of clarity in the definition of terms and the assumption of a simple relationship between the level of risk of nutritional compromise and actual nutritional status. In conclusion, it is suggested that these difficulties illustrate principles applicable to many areas of nursing care, and a definition of 'segments' of care processes, each with well-defined purposes and outcome measures, is proposed. Such an approach will help to demonstrate the complexity and value of nursing activity. [ABSTRACT FROM AUTHOR]

This paper develops a framework of empowerment within which to examine the commissioning process for nurse education arising from market reform of the British National Health Service (NHS). The paper argues that an imbalance in this commissioning process favours theoretical products, such as the diploma-level nursing curricula (Project 2000). Also, the university setting of nurse education is seen as clinically de-skilling both nurse teachers and student nurses as well as influencing the discourses on clinical skills. The paper further argues that the effects of such trends are a captive market in nurse education contracting and a displacement of nursing knowledge. An approach to commissioning nurse education is described which may counter such trends and positively impact on NHS organizational development and quality. Further reform of the commissioning process is described in context of pragmatic health legislation. [ABSTRACT FROM AUTHOR]

This paper presents findings from a national study conducted over a 3-year period (1991-94) which examined the changing role of the nurse teacher. The study used multiple methods to collect data from a wide variety of respondents (nurse teachers, midwife teachers, clinical nurses, health service managers and higher education lecturers). This paper presents the findings relating to the development of the nurse teacher's academic role following the introduction of Project 2000. The issues presented and discussed include specialization within the nurse teacher's role, the nature of this specialization and the development of academic credibility and scholarship. The implications of these changes in terms of the development of nursing as an academic subject area and the opportunity to contribute to the establishment of research based practice are explored. [ABSTRACT FROM AUTHOR]

The diagnosis of foetal distress is complex: it is influenced by a number of factors which range from the physical examination of the mother and foetus to the psychological and social world in which the mother, the midwife and other health care professionals work. The consequences of an incorrect diagnosis of normality or foetal distress are potentially serious for both mother and baby. Recent changes in the practice and delivery of midwifery care have placed more responsibility on midwives. It is therefore imperative that midwives become more aware of the complexity of the diagnosis as well as of some of the factors which can improve the quality of their diagnosis. This paper reviews the literature associated with the diagnosis of foetal distress, physiological and pathological changes during pregnancy and labour, and the usefulness and limitation of the tools readily available to midwives for the diagnosis. It also examines the limits of the relationship that exists between intra-uterine and neonatal markers. The purpose of this paper is to provide background information that would support midwives in the diagnosis of foetal distress in the hope that the false positive diagnoses can be reduced for the benefit of mothers and babies. Ultimately an improvement in outcome should be reflected in the more efficient and effective use of resources available to maternity services. [ABSTRACT FROM AUTHOR]

This paper critically examines the recent work of Tom Kitwood and his colleagues at the Bradford Dementia Group. After initial details relating to Kitwood's early work and the development of the research group, the paper sets out Kitwood's ideas regarding the nature of dementia and dementia care. Four areas of contribution made by Kitwood are outlined. Problems relating to Kitwood's research methods are then put forward. In conclusion, it is suggested that while Kitwood's work will undoubtedly help enhance the care given to elderly demented people, more work needs to be done to ensure the validity of his methods. [ABSTRACT FROM AUTHOR]

The aim of this paper is to describe part of the findings of a research study which explored the health visitor's role in identifying and working with vulnerable families in relation to child protection. One objective of the study was to describe and analyse the work which health visitors undertake with vulnerable families aimed at preventing crisis, ill-health and child abuse. This paper outlines this aspect of the research and looks specifically at health visitors' perceptions of their work and interventions with vulnerable families and children. Health visitors working in an inner city area and a suburban area were sampled and pilot work was undertaken in a third suburban area. Stage one involved a postal survey of 102 health visitors, in which a response rate of 58 (57%) was obtained. Stage two involved 12 in-depth interviews with health visitors. One major finding of this study highlighted the fact that the health visitor's role when working with vulnerable families appears to be one of diversity and conflict. In the light of the current National Health Service reforms it seems of paramount importance that health visitors illustrate to others, both managers and other health/social service professionals alike, the important function of their work with these vulnerable groups. This is essential to ensure that health visitors' work with vulnerable families in relation to child protection is understood and valued and that the needs of vulnerable families continue to be identified. This paper contributes to the knowledge base of health visiting and raises some important issues for professional health visiting practice. [ABSTRACT FROM AUTHOR]

The introduction of pre-registration nursing degree and diploma programmes in the United Kingdom has provoked considerable scrutiny of a range of issues such as funding arrangements, links between colleges of nursing and midwifery and higher education and the impact of the new courses on education and service provision. Less attention has been devoted to the changing orientations and values of diploma and undergraduate students during their courses of study. The parallel commencement in 1991 of 3-year undergraduate and diploma programmes in Leicestershire provided an opportunity to chart the changing orientations (personal, political, ethical, professional and academic) of two cohorts of students matched by age, gender and branch programme. Research is being undertaken, a primary aim of which is to assess the changes that occur in these orientations over time and to relate these to the educational progression of the students through successive phases of their respective courses. The focus of the research concerns the student's personal experience and developing insights into health, nursing and care delivery. This paper seeks to provide an overview of the literature relevant to the study. [ABSTRACT FROM AUTHOR]

Primary nursing is a relatively new phenomenon in the organization of ward-based nursing. This paper seeks to answer the question of what lies behind primary nursing's sudden and startling rise in popularity. Factors within nursing which are implicated include most importantly the adoption of the nursing process, and the attempt to provide truly individualized patient care. Nursing's search for professional status has played its part, primary nursing frequently being seen as a key strategy in its achievement. Other areas of wider social change have also had an impact, from the nascent dominance of new right political/social values, to the micropolitical scene within the British National Health Service. While appearing to be the ideal answer to some of nursing's current problems, primary nursing contains some inherent contradictions, most evident being those surrounding the concept of accountability. It may also threaten the cohesiveness of the nursing team on the ward, and may lead to the uncovering of conflicts between doctors and nurses. Finally, perhaps one of the major reasons for its continuing success is the way it brings together the various nursing interest groups and current managerialism in the NHS. [ABSTRACT FROM AUTHOR]

The interview has, for a long time, been the central method for the assessment of applicants for nurse training in the United Kingdom. The lack of a clear person specification, and, in particular, training in the skills involved in assessing personality, have been excused on the grounds of the universality of types required in nursing. This paper outlines some initial work that has been done on identifying a 'personality mix or constellation' and ways of exploring and assessing it in face-to-face interviews. [ABSTRACT FROM AUTHOR]

Editorial. Comments on a consultation paper about the rights and welfare of incapable adults in Great Britain. Number of incapable adults; Overview of the paper; Benefits from the paper.

Introduces several articles for the July 22, 2001 issue of the `Journal of Advanced Nursing.' Issues on nurse education in Great Britain; Innovations in nursing practice category; Impact of chronic illness on the sexuality of midlife women.

The author comments on the paper "Centralization and Research Governance: Does it Work?," by M. Howarth, R. Kneafsey, and C. Haigh, published in the same issue. He holds the opinion that the paper does well to remind healthcare researchers about the principles and domains of research governance. He expects the British government to continue the development of research governance framework. He complains about the bureaucracy that surrounds research governance.

Title. Fatigue in patients with rheumatoid arthritis: British and Dutch nurses’ knowledge, attitudes and management. Aim. This paper is a report of a study conducted to compare the knowledge, attitudes and current management of rheumatoid arthritis-related fatigue in British and Dutch rheumatology nurses. Background. After pain, fatigue is the most important symptom for patients with rheumatoid arthritis, but little is known about the current management of this fatigue by healthcare professionals. Methods. A questionnaire was mailed in 2007 to rheumatology nurses who were members of British Health Professionals in Rheumatology ( N = 267) and the Dutch Society of Rheumatology Nurses ( N = 227). Descriptive statistics, independent samples t-test and Pearson chi-square tests were used for statistical analysis. Results. A total of 494 nurses returned questionnaires (response rate 48%). In general, their knowledge about rheumatoid arthritis fatigue was in accordance with the literature and all indicated a positive attitude towards assessing and managing rheumatoid arthritis-related fatigue. However, respondents reported contradictory views about managing fatigue. Although they believed that other team members could help patients, they seldom referred patients on to other professionals. Although nurses believed that other advice besides pacing and balance between activity and rest might help, they did not offer this to patients. Despite acknowledging that there is poor communication about fatigue between patients and nurses, respondents reported that it is patients rather than nurses who raise the issue of fatigue in consultations. Conclusion. British and Dutch rheumatology nurses are sympathetic but do not know how to manage rheumatoid arthritis-related fatigue. Strategies to support self-management for this fatigue, and to increase communication between healthcare professionals and patients, should be initiated to help improve patient outcomes for rheumatoid arthritis-related fatigue. [ABSTRACT FROM AUTHOR]

Title. Making patients safer: nurses’ responses to patient safety alerts. Aim. This paper is a report of a study to determine whether action required by patient safety alerts was effectively taken. Background. Over the last 10 years, there has been a growing awareness of the number of patients unintentionally harmed in the course of their treatment. Safety alerts are designed to reduce the incidence of adverse events by removing these predisposing factors. Method. A multi-method study was carried out in 20 acute, two mental health, four ambulance and 15 primary care provider organizations in the United Kingdom in 2006–2007 using surveys, interviews with senior managers and front-line staff, collection of documentary evidence and equipment audit. The implementation of three safety alerts for nursing action is reported. Findings. Most staff were aware of the dangers posed by gloves to staff with latex allergy, but only 20% were aware of the types of common equipment that posed a danger to sensitive patients. Almost 40% of nurses were unable to give a correct acidity value to allow nasogastric feeding to commence. One alert, on needle-free intravascular connectors, was distributed in only a few organizations as the term used was unfamiliar at all levels of the organization. Conclusion. Healthcare providers have succeeded in setting up successful systems to disseminate alerts to middle management level, but there is evidence that implementation of recommendations by nurses is sub-optimal. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a study to examine Nurse Independent/Nurse Supplementary Prescribing for people with diabetes and the extent to which these nurses feel prepared for this role. BACKGROUND: An area of care in which nurses, caring for people with diabetes, are involved is the management of medications. There is little or no evidence examining the prescription of medicines by nurses for people with this condition. METHODS: The United Kingdom Nursing and Midwifery Council database was used to select a random sample of 1992 Registered Nurse Independent/Nurse Supplementary Prescribers. Of these, 1400 questionnaires were returned. Medicines for people with diabetes were prescribed by 439 respondents. This paper reports on the findings of these 439 nurses. The data were collected in 2006. RESULTS: Four hundred and nine (95.1%) participants had used independent prescribing and 214 (49.8%) used supplementary prescribing. The majority of respondents were highly experienced and worked in primary care. Some nurses (7.6%) reported that the prescribing programme did not meet their need. The needs of nurses who had undertaken specialist training in diabetes were met to a statistically and significantly greater extent than those without this training. Nurse prescribing was viewed positively by nurses prescribing for people with diabetes. CONCLUSION: Prescribing has extended the role that nurses in the United Kingdom are able to play in the management of diabetes. Specialist training is a prerequisite for nurses adopting this role. There is a need to explore the prescribing programme and the extent to which it meets the needs of nurses prescribing for people with diabetes. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of an integrative literature review to investigate: (a) the extent of entrepreneurial activity by nurses, midwives and health visitors in the United Kingdom and (b) the factors that influenced these activities. Background. Internationally, social and commercial entrepreneurial activity is regarded as important for economic growth and social cohesion. Methods. Seventeen bibliographic databases were searched using single and combined search terms: 'entrepreneur$', 'business', 'private practice', 'self-employ$', 'intrapreneur$' 'social enterprise$' 'mutuals', 'collectives', 'co-op' and 'social capital' which were related to a second layer of terms 'Nurs$', 'Midwi$', 'Visit$'. 'Entrepreneur$' Private Midwi$, Independent Midwi$, and 'nursing workforce'. In addition, hand searches of non-indexed journals and grey literature searches were completed. The following inclusion criteria were: (a) describing nurses, midwife and/or health visitor entrepreneurship (b) undertaken in the UK, and (c) reported between January 1996 and December 2005. Results. Of 154 items included only three were empirical studies; the remainder were narrative accounts. While quality of these accounts cannot be verified, they provide as complete an account as possible in this under-researched area. The numbers of nurses, midwives and health visitors acting entrepreneurially were very small and mirror international evidence. A categorization of entrepreneurial activity was inductively constructed by employment status and product offered. 'Push' and 'pull' influencing factors varied between types of entrepreneurial activity. Conclusion. Empirical investigation into the extent to which nurses and midwives respond to calls for greater entrepreneurialism should take account of the complex interplay of contextual factors (e.g. healthcare legislation), professional and managerial experience and demographic factors. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to explore the phenomenon of empowerment cross-culturally by comparing the situations in which nursing students from the United Kingdom and Japan experienced empowerment and disempowerment in clinical practice. Background. Empowerment has been the focus of many studies, but most focus on the experience of Registered Nurses and few have explored the phenomenon crossculturally. Method. This was a cross-cultural, comparative study using the critical incident technique. Anonymous written data were collected from nursing students in Japan and United Kingdom between November 2005 and January 2006. Japanese data were translated and back-translated. Analysis of the transcripts revealed three themes: Learning in Practice, Team Membership, Power. Findings. Nursing students in these countries are exposed to different educational and clinical environments, but their experiences of empowerment and disempowerment are similar. For both, learning in practice, team membership and power are associated with either empowerment or disempowerment; depending on the context. United Kingdom students are aware of the importance of acting as patient advocates, although they cannot always find the voice to perform this. Japanese students however, appear to be unaware of the concept of advocacy. Conclusion. Student nurse empowerment may transcend cultural differences, and learning in practice, team membership and power may be important for the empowerment of nursing students globally. Further cross-cultural exploration is required into the association between advocacy and empowerment. [ABSTRACT FROM AUTHOR]

AIM: The aim of this paper is to explore some reasons for the lack of focus on ethnicity and sexual health in nursing research, and suggest ways to advance the nursing evidence-base required for practice development. BACKGROUND: The United Kingdom National Strategy for Sexual Health and human immunodeficiency virus published in July 2001 highlighted the continued rise in sexual ill health amongst minority ethnic groups. In order to improve sexual health, research evidence is needed explain why particular ethnic groups appear to be at greater risk of sexual ill health. The Strategy identified nurses as key to bringing about improvements in sexual health. Nursing research includes many studies exploring links between ethnicity and health. However, with the exception of extensive work on human immunodeficiency virus/acquired immunodeficiency syndrome as a specific disease, nursing research into ethnicity has not systematically included sexual health. METHODS: Literature searches were conducted using the BIDS database, World Wide Web and United Kingdom Department of health website between June 2000 and August 2003. Papers written in English incorporating the keywords 'sexual health', 'sexually transmitted infection' and 'health and ethnicity' in the title or abstract were selected for review. FINDINGS: Nursing research into the association between sexual health and ethnicity is rare. It has been hampered by a variety of political and social constraints concerning the nature of sexual health practice in nursing, researching sexual health, and researching ethnicity and health. The result is a dearth of research evidence to support the development of sexual health practice and the education of healthcare professionals to underpin care of minority ethnic clients. CONCLUSIONS: Barriers to researching ethnicity and sexual health by nurses must be addressed through nursing education and practice. Without this, a detailed evidence base will fail to materialize and healthcare practices to implement the priorities to improve sexual health in minority ethnic communities will remain undeveloped. [ABSTRACT FROM AUTHOR]

andrews j. manthorpe j. & watson r. (2004) Journal of Advanced Nursing 46(3), 303–310 Involving older people in intermediate care Intermediate care has become a crucial part of the United Kingdom government's programme for improving services for older people. Older people comprise a substantial part of the user base for these services, and it is increasingly recognized that there is a need for greater user involvement in service development for intermediate care. National initiatives undertaken in intermediate care have sought to widen and deepen the remit of such services, and in this way promote greater independence and improved quality of care for older people. In particular, the government has set out clear plans for reshaping services for older people in the National Health Service Plan and the rationale for greater involvement of older people in service development. This article considers ways in which these national and local objectives may be achieved and considers some of the implications for nursing. This paper aims to explore the concept of intermediate care and to identify trends and existing evidence of user involvement in care. In this way it charts a possible way forward for the development of a more ‘user sensitive’ approach. The following databases were searched: Medline, Cochrane Library, the Social Science Citation Index and CINAHL. Key words were ‘intermediate care’, ‘older people’, ‘formal care’, ‘primary care’, ‘social services’ and ‘geriatrics’, used in combination. The findings from this study indicate that there is considerable scope for increased user involvement in service development for intermediate care. Such challenges may be more effectively met through greater clarity of the concept of intermediate care, and a bridging of user involvement at the practice and policy levels. Nurses are key providers of intermediate care in the community. The involvement of older people in intermediate care service development must be premised on a shared comprehension of the purpose and function of intermediate care. Nurses must be involved in shifting intermediate care from being service-focused to patient-centred. Effective participation eschews the application of global constructs for older people, while supporting greater participation at all levels and robust implementation processes. [ABSTRACT FROM AUTHOR]

croghan e. & johnson c. (2004) Journal of Advanced Nursing 45(2), 155–161 Occupational health and school health: a natural alliance? The United Kingdom National Health Service aims to provide a holistic ‘cradle to grave’ service. In order to achieve this, systems are in place for effective communication between providers of services for babies and children. However, when children leave school, communication between the school health services and workplace health services to protect and promote the health of the new workforce is rare. Working together is a commonly-stated rhetoric of contemporary nursing theory, but often this is not applied in practice. School health and occupational health have similar aims and objectives and, by working together, may be able to improve the health of large populations for a lifetime. This paper aims to examine the similarities in principles and practices between school health and occupational health nurses, and to identify areas of overlap in which collaboration could improve care for clients of both services. The paper examines the nature of nursing in occupational and school settings, and similarities and differences in policy, law and principles. It also examines these two areas of practice within a public health framework, looking for areas of overlap. A basis is suggested for collaborative working between the two areas, and barriers, facilitators and benefits of this practice are examined. We conclude that there does exist a natural alliance between occupational and school health nursing, and that the two should work together to provide continuity of care for clients on leaving school, and to prepare children and young people for the workplace and any special health issues in their chosen careers. [ABSTRACT FROM AUTHOR]

hopkinson j.b., hallett c.e. & luker k.a. (2003) Journal of Advanced Nursing 44(5), 525–533 Caring for dying people in hospital Fifty-four per cent of people who die in England and Wales do so in hospital. Evidence suggests that care delivered to dying people in hospital does not match up to the ideal of a good death. These studies have provided organizational and structural explanations of nurses’ behaviour that support argument for change at the macro level, in order to improve the quality of care delivered to dying people. There has been little study of the perceptions of nurses working in acute medical settings in relation to their experience of caring for dying people. Therefore, there is little evidence on which to base supportive strategies at the level of individual nurses. In this study we set out to develop an understanding of care for dying people in hospital, from the perspective of newly qualified staff nurses in the UK. The purpose was to build a theory of how nurses might be helped to deliver quality care to dying people in hospital. This paper is based on an exploratory study underpinned by phenomenological philosophy. In-depth interviews were conducted with 28 newly qualified nurses, focusing on their experiences of caring for dying people on medical wards in two acute hospitals in England in 1999. The interview transcripts were interpreted using a phenomenological approach. The findings presented in this paper relate to commonalities found to underlie study participants’ perceptions of their experiences. All the nurses’ stories were found to be built around six essences – the personal ideal, the actual, the unknown, the alone, tension and anti-tension. These essences, and the relationships between them, were used to build a model of the experience of caring for dying people in hospital. This descriptive study of the experience of individual nurses does not examine the wider social context. It attempts to complement existing sociological theory of death and dying. The study revealed how a group of newly qualified nurses experienced caring for dying people. We theorize that the model developed has utility as a tool for gaining understanding of the experience of caring for dying people. It is assumed that nurses, through using this model to find explanations for their emotions and behaviours, may gain emotional support that might have a positive impact on the quality of care delivered to dying people in hospital. [ABSTRACT FROM AUTHOR]

Background and aims. This paper draws on recent research conducted in two contrasting NHS hospitals: one a large District General, the other a small Community hospital; to look at hospitals as organizational spaces. This includes both the physical environment as well as how these spaces are inhabited and used. This paper aims to explore the ways in which hospital spaces impact on the working lives of nurses. Methods. The research employed two main methods. Two phases of round the clock non-participant observation were carried out within each hospital, one at the beginning of the research period and one at the end. This generated thick description of the diversity of spaces, as well as individuals' use of space. In addition, more than 50 in-depth unstructured interviews were conducted with both nurses and doctors. Findings. Three aspects of the relationship between nurse and hospital spaces are considered. First, the degree of access that nurses have to the different hospital spaces is limited, and many are confined to the wards in which they work. The high proportion of female nurses working on wards means that there are marked gender differences in access to hospital spaces. There are also marked professional differences when nurses are compared to doctors who have much greater freedom to roam and there are differences in the amount of private space allocated to nurses and doctors. Second, styles of bodily movement in space are also highly differentiated by profession and gender. Third, different spaces have very different meanings attached to them, and this has a strong impact on styles of performance and identity. Attention to space thus offers original insights to nurses working conditions as well as to inter-professional relations. [ABSTRACT FROM AUTHOR]

Background. Health care professionals in the United Kingdom (UK) appear to have higher absence and sickness rates than staff in other sectors, and stress may be a reason for nurses leaving their jobs. These problems need to be addressed, particularly in the mental health field, if current service provision is to be maintained. Aim. The aim was to identify stressors, moderators and stress outcomes (i.e. measures included those related to stress, burnout and job satisfaction) for mental health nurses, as these have clear implications for stress management strategies. Method. A systematic review of research published in English between 1966 and 2000 and undertaken in the UK that specifically identified participants as mental health nurses was carried out to determine the effectiveness of stress management interventions for those working in mental health nursing. Studies from non-UK countries were examined as potential models of good practice. The study was limited to primary research papers that specifically involved mental health nurses, where the health outcomes measured were stressors, moderators and stress outcomes and where sufficient data was provided. Results. The initial search identified 176 papers, of these 70 met the inclusion criteria. Seven studies have been reported since the completion of the review and have been included in this article. Sixty-nine focused on the stressors, moderators and stress outcomes and eight papers identified stress management techniques. Relaxation techniques, training in behavioural techniques, stress management workshops and training in therapeutic skills were effective stress management techniques for mental health nurses. Methodological flaws however, were detracted from the rigour of many of the studies. Conclusions. The review demonstrated that a great deal is known about the sources of stress at work, about how to measure it and about the impact on a range of outcome indicators. What was found to be lacking was a translation of these results into practice, into research that assessed the impact of interventions that attempt to moderate, minimize or eliminate some of these stressors. [ABSTRACT FROM AUTHOR]

Rationale. Nurse cadet schemes are locally developed initiatives which prepare participants for entry to preregistration nurse education. The paper discusses the political context in which modern day nurse cadet schemes have developed in the British National Health Service and explores the diversity of schemes currently operating in the United Kingdom (UK). Background. Nursing recruitment is a high priority for the National Health Service in the UK which, in common with many countries, is facing a nursing shortage. In addition, the government is committed to increasing flexibility in the education and recruitment of staff. The entry gate to health professional education needs to be widened to improve access for hitherto under-represented groups. Methods. The paper provides a critical commentary on key issues in the development of nurse cadet schemes as discussed in a range publications, together with information gathered from ‘grey’ literature and personal contacts in nurse education. A wide range of health care and social science databases was used to collect material for the discussion. Findings. Approximately 800 cadets are currently engaged in around 60 cadet schemes in a number of localities in Britain, and it is proposed that these will be expanded to over 2000 nurse cadets by 2004. Nurse cadet schemes have developed to meet local needs and priorities and, in the absence of a strong national framework, a wide diversity of participants, curricula and funding arrangements have emerged. Conclusions. Serious consideration needs to be given to further standardization in the structure and funding of schemes to reduce the degree of inequality which currently exists for cadets, together with development of national benchmarks to ensure that a set of minimum standards is met. Any future development must be built on a systematic evaluation of current schemes, which has yet to be undertaken. [ABSTRACT FROM AUTHOR]

Background and aims. In contrast to women's experiences of motherhood, there has been comparatively little research investigating men's experience of the transition to fatherhood and how changing cultural perspectives contribute to the contemporary experience of fathering. This paper draws on the findings of a larger ethnographic study of men's transition to fatherhood in the United Kingdom (UK) and discusses men's experiences of pregnancy confirmation. Methods. A longitudinal ethnographic approach was chosen to investigate men's ‘real life’ accounts of their transition to fatherhood. A mixture of ‘novice’ and experienced fathers ( n = 18) were recruited from antenatal classes in the north of the UK during 1998. Semi-structured interviews were conducted on three occasions, twice during their partner's pregnancy and once afterwards. Findings. Framed by the context of the contemporary construction of involved fatherhood, the men frequently spoke of their desire to be ‘involved’ with their partner's pregnancy and yet reported difficulty in engaging with its reality. They nevertheless participated in a range of activities – body-mediated-moments – which brought them closer to their partner's pregnant body and therefore their unborn baby. These activities centred on pregnancy confirmation, announcement, foetal movements, the ultrasound scan, and culminated in their presence during labour and delivery. This paper discusses their involvement in the process of pregnancy confirmation. Conclusion. The men's experiences of early pregnancy were marked forcefully by their involvement in the confirmation process. This activity gave men entry into a physical dimension, helping them forge an involvement in the pregnancy and shape their early transition to fatherhood. Implications for practice. The study has provided insight into expectant men's experiences of pregnancy and contributed to the understanding of the changing... [ABSTRACT FROM AUTHOR]

Supporting and policing mothers: an analysis of the disciplinary practices of health visiting Aim. This paper draws on the notion of disciplinary power developed by Michel Foucault to discuss whether the professional practices inherent in British health visiting can be understood in terms of support or surveillance. Background. The notion of disciplinary power embedded within Foucault's writings has been widely applied to the sociological analysis of health care professions. While a number of studies have focused on nursing practice, there has been little empirical work developing these ideas in the context of British health visiting. Methods. A qualitative approach using interviews with 24 health visitors and 16 women who had experienced domestic violence was used. For reasons of confidentiality, the women were not matched to the health visitors. Data analysis was continuous with data collection and led to identification of a number of categories. The theoretical framework of feminist poststructuralism underpinned the analysis. Findings: The women who participated in this research described their engagement in a number of disciplinary practices. These included the discursive production of themselves as good mothers, subjects and objects of the health visiting gaze, as well as their practices of resistance to health visiting work. Analysis of the health visitors' interview data provided further evidence concerning the exercise of disciplinary power in their everyday work of providing support and health care to women and children. Conclusions. The paper highlights tensions within the health visitor's role between welfare and surveillance, as well as differences between lay and professional perspectives. [ABSTRACT FROM AUTHOR]