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Title. How people live with or get over being suicidal: a review of qualitative studies Aim. To systematically review qualitative research which addresses how people live with suicidality or recover a desire to live. Background. Suicide is a pressing social and public health problem. Much emphasis in suicide research has been on the epidemiology of suicide and the identification of risk and protective factors. Relatively little emphasis has been given to the subjective experiences of suicidal people, but this is necessary to inform the care and help provided to individuals. Data sources. Electronic searches of CINAHL Plus with full text, Medline and PsychArticles (included PsycINFO, Social Services Abstracts and Sociological abstracts) were undertaken for the period from 1997 to April 2007. In addition, the following journals were hand searched (1997-2007): ' Mortality', ' Death Studies', ' Archives of Suicide Research' and ' Crisis: The Journal of Crisis Intervention and Suicide Prevention'. Method. A systematic review of the literature and thematic content analysis of findings. The findings were extracted from selected papers and synthesized by way of content analysis in narrative and tabular form. Findings. Twelve studies were identified. Analysis revealed a number of interconnected themes: the experience of suffering, struggle, connection, turning points and coping. Conclusions. Living with or overcoming suicidality involves various struggles, often existential in nature. Suicide may be seen as both a failure and a means of coping. People may turn away from suicide quite abruptly through experiencing, gaining or regaining the right kind of connection with others. Nurses working with suicidal individuals should aspire to be identified as people who can turn people's lives around. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a review to assess evidence of the effectiveness of massage for patients with cancer, in terms of reducing physical or psychological symptoms, improving quality of life, or producing unwanted side effects. Background. Patients with cancer may use complementary therapies, including massage and aromatherapy massage. However, their use and provision by state-financed healthcare services is controversial. Data sources. A systematic review was carried out, using the Cochrane principles. No meta-analysis was appropriate. An initial comprehensive search of electronic databases search was carried out in 2003 and updated in 2006. Eligible trials were randomized controlled trials, controlled before-and-after (pre-post) studies and interrupted time-series studies. Participants were adults with a diagnosis of cancer and receiving care in any healthcare setting. Interventions were limited to massage and/or aromatherapy massage carried out by a qualified therapist. Outcome measures to be included were patient-reported levels of physical and psychological indices of symptom distress and quality of life (measured using validated assessment tools). Findings. In the review, 1325 papers were considered. Ten trials met the inclusion criteria and their results suggest that massage might reduce anxiety in patients with cancer in the short term and may have a beneficial effect on physical symptoms of cancer, such as pain and nausea. However, the lack of rigorous research evidence precludes drawing definitive conclusions. Conclusion. Further well-designed large trials with longer follow-up periods are needed to be able to draw firm conclusions about the efficacy and effectiveness of massage for cancer patients. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a concept analysis of pain catastrophizing.Background. The importance of pain catastrophizing in the experience of pain and development of chronic pain has been demonstrated. It has been described as a tendency to have a fixation about pain and to feel unable to deal with pain.Data sources. Fifty-one papers containing the keyword 'pain catastrophizing' were selected from the Medline, Embase and Psycinfo indexes between 1996 and 2008. Dimensional analysis methodology was used to make explicit the ways in which the concept is constructed and used. The themes of this approach seem to contribute to the understanding of both nurse and client perspectives.Results. The literature on 'pain catastrophizing' seems to reach a level of middlerange explanatory theory. The focus is on specifying relationships between pain catastrophizing and two or more concepts, and on validating the theoretical hypotheses of 'communal coping' as opposed to 'hypervigilance'. The predominance of correlational and cross-sectional studies testifies to this. The concept's definition includes the curative and preventive approaches. However, only the professional perspective seems to be reflected in the concept's terminology.Conclusion. Nursing theories and qualitative research seem to be avenues for the comprehension of the phenomenon and the broadening of perspectives. They may bring not only a new but also a unique perspective. Nevertheless, the current state of knowledge on pain catastrophizing is important to nurses as they could influence greatly the timing of interventions and prevention of chronic pain. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a review to analyse studies using the BARRIERS Scale to determine (a) if the identification of perceived barriers to research utilization influences nurses' use of research, (b) if the extent of nurses' perceived barriers to research utilization and most frequently cited barriers have changed over the past 15 years and (c) if nurses' most frequently cited barriers to research utilization differ across countries.Background. The BARRIERS Scale has been used to identify nurses' untoward perceptions or barriers to research utilization.Data sources. A computer search was conducted using the Cumulative Index of Nursing and Allied Health Literature, MEDLINE, Dissertation Abstracts International and Academic Abstracts to identify relevant literature from 1991 to 2006. The Internet and citations within studies were also searched.Review methods. Studies were included if they were in English, used the entire BARRIERS Scale and reported nurses' responses. Studies were coded for author(s), publication year, country, population, sample size, response rate, the three-most frequently cited barriers, mean per cent of items rated as moderate or greater, and number of items identified as a barrier by 50% or more of respondents. Quality appraisal of the included papers was not performed.Results. Forty-five studies met the inclusion criteria and predominantly identified the same barriers. No evidence was found that identification of barriers to nurses' use of research influenced nursing practice.Conclusions. It appears that there would be minimal benefit from further descriptive research using the BARRIERS Scale. Research is needed to investigate whether relationships exist between perceptions of barriers to nurses' use of research and the use evidence-based practice. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a dimensional concept analysis of patient safety culture in nursing. Background. Patient safety is an important issue in healthcare organizations. As the release of Institute of Medicine reports in the United States of America, substantial interest has arisen in studying patient safety culture; however, the concept remains poorly defined. Data sources. Multiple databases, including CINAHL, MEDLINE, PsycINFO and Anthropological Index Online, were searched from 1970 to 2006. A keyword search method was employed followed by a combined key word search. Review methods. A concept analysis based on Caron and Bowers' method was carried out using 45 papers, three books and three theses after examination of the abstracts to identify definitions, dimensions, perspectives and consequences needed for content and dimensional analyses. Findings. Nurses' shared values, beliefs and behavioural norms towards patient safety were identified as the overarching dimensions of the patient safety culture. The four sub-dimensions of patient safety culture were synthesized as system, personal, task-associated and interaction. Two main philosophical perspectives, functional and interpretative, were added to the analysis and further clarification was provided. Conclusion. It is expected that understanding the nature, as well as the key elements of the concept, would assist with analysing the existing safety culture and help to determine the strategies to build or shape the safety culture. [ABSTRACT FROM AUTHOR]

Aim. The paper is a report of a review of the literature on the effects of school-based drama interventions in health promotion for school-aged children and adolescents. Background. Drama, theatre and role-playing methods are commonly used in health promotion programmes, but evidence of their effectiveness is limited. The educational drama approach and social cognitive theory is share the assumption that learning is based on self-reflection and interaction between environment and person. However, educational drama also emphasizes learning through the dialectics between actual and fictional contexts. Data sources. A search was carried out using 10 databases and hand searching for the period January 1990 to October 2006. Methods. A Cochrane systematic review was conducted. Results. Nine studies met the criteria for inclusion. Their topics included health behaviour (five studies), mental health (two) and social health (two). Actor-performed drama or theatre play followed by group activities was the intervention in five studies, and classroom drama in four studies. Four of the studies were randomized controlled trials and five were non-randomized controlled studies. Four reports gave the theory on which the intervention was based, and in eight studies at least some positive effects or changes were reported, mostly concerning knowledge and attitudes related to health behaviour. The diversity of designs and instruments limited comparisons. Conclusion. There is a need for well-designed and theory-based studies that address drama interventions in health promotion for children and families. The challenge is to find or develop a theory, which combines educational, drama and health theories with valid and reliable measurements to examine the effects of the intervention. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to investigate the functionality of different kinds of job resources for managing job stress in nursing. Background. There is increasing recognition that healthcare staff, and especially nurses, are at high risk for burnout and physical complaints. Several researchers have proposed that job resources moderate the relationship between job demands and job-related outcomes, particularly when there is a match between the type of demands, resources, and outcomes. Method. Based on the Demand-Induced Strain Compensation Model, cross-sectional survey data were collected between November 2006 and February 2007 by a paper-and-pencil questionnaire. The final sample consisted of 69 nurses from a Dutch nursing home (response rate 59·4%). Data were analyzed by hierarchical regression analyses. Results. High physical demands had adverse effects on both physical complaints and emotional exhaustion (i.e. burnout), unless employees had high physical resources. A similar pattern was found for high physical demands and emotional resources in predicting emotional exhaustion. The likelihood of finding theoretically-valid moderating effects was related to the degree of match between demands, resources, and outcomes. Conclusion. Job resources do not randomly moderate the relationship between job demands and job-related outcomes. Both physical and emotional resources seem to be important stress buffers for human service employees such as nurses, and their moderating effects underline the importance of specific job resources in healthcare work. Job redesign in nursing homes should therefore primarily focus on matching job resources to job demands in order to diminish poor health and ill-being. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a review of nurses' roles and their perceptions of these roles in decision-making processes surrounding artificial food and fluid administration in adult patients. Background. Of all caregivers, nurses have the closest and most trusting relationship with severely ill patients and their families during the entire end-of-life care process. As a result, nurses become closely involved in complex ethical decision-making processes concerning artificial administration of food or fluids for these patients. Data sources. We searched seven electronic databases (1990-2007) and examined the reference lists of relevant papers. Review methods. This mixed methods review was conducted with guidance of the United Kingdom Centre for Reviews and Dissemination guidelines on systematic reviews. Results. Although their direct impact is limited, nurses play a significant indirect role during decision-making processes. Because of their unique position, they often initiate decision-making processes, function as patient advocates and provide guidance, information and support to patients and families. Although nurses considered their role to be very valuable, they felt that their role was not always defined clearly or appreciated. Whether nurses experience decision-making processes positively depended on several contextual factors. Conclusion. Given their knowledge and practice skills, nurses are in a prime position to contribute valuably to decision-making processes. Nevertheless, they remain sidelined. For nurses to receive sufficient recognition, their decision-making tasks and responsibilities need to be clarified and made manifest to other participants. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a concept analysis of ethical sensitivity. BACKGROUND: Ethical sensitivity enables nurses and other professionals to respond morally to the suffering and vulnerability of those receiving professional care and services. Because of its significance to nursing and other professional practices, ethical sensitivity deserves more focused analysis. DATA SOURCES: A criteria-based method oriented toward pragmatic utility guided the analysis of 200 papers and books from the fields of nursing, medicine, psychology, dentistry, clinical ethics, theology, education, law, accounting or business, journalism, philosophy, political and social sciences and women's studies. This literature spanned 1970 to 2006 and was sorted by discipline and concept dimensions and examined for concept structure and use across various contexts. The analysis was completed in September 2007. FINDINGS: Ethical sensitivity in professional practice develops in contexts of uncertainty, client suffering and vulnerability, and through relationships characterized by receptivity, responsiveness and courage on the part of professionals. Essential attributes of ethical sensitivity are identified as moral perception, affectivity and dividing loyalties. Outcomes include integrity preserving decision-making, comfort and well-being, learning and professional transcendence. Our findings promote ethical sensitivity as a type of practical wisdom that pursues client comfort and professional satisfaction with care delivery. CONCLUSION: The analysis and resulting model offers an inclusive view of ethical sensitivity that addresses some of the limitations with prior conceptualizations. [ABSTRACT FROM AUTHOR]

Title. Parent–adolescent communication and diabetes: an integrative review. Aim. This paper presents a synthesis of findings from empirical studies about communication and interaction between parents and their adolescents with diabetes. Background. Communication between parent and adolescent is essential in transitioning the adolescent to increased responsibility for diabetes self-management. Nurses are in a pivotal position to enhance the type of parent–adolescent communication that facilitates this transition. Data sources. A search of published studies from 1985 to 2006 featuring communication or interaction between parents and adolescents with type 1 diabetes was implemented through a computerized search. Review methods. Papers were organized by type of evidence and were analysed sequentially. Sources were described based on data elements which were extracted. Findings in the areas of productive and problematic parent–adolescent communications were included. Data elements were compared and critiqued, noting consistencies, and findings were summarized and evaluated. Results. Studies across several countries indicate that maternal support, conflict, control, involvement and emotional expression are important communication concepts that are linked to diabetes outcomes in adolescents. The influences of different family structures and cultural and socioeconomic circumstances, as well as developmental status and gender of adolescents on these types of communication, have not been systematically studied. Conclusion. Nurses caring for adolescents with type 1 diabetes need to consider family relationships and communication patterns in achieving health outcomes. Studies of communication, including perspectives of mothers and fathers, and the influence of family structure, economics and culture are needed to build a framework of parent–adolescent interaction and health outcomes for adolescents with type 1 diabetes. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a concept analysis of empathy. BACKGROUND: It is widely accepted that an empathetic response is necessary for nurses to deliver adequate pain relief and therapeutic care. Previous work suggests that empathy is a learned behaviour, and thus can be blocked if necessary to diminish personal distress. METHODS: A computerized search of the CINAHL, MEDLINE, PsycINFO, and Web of Science databases from 1980 to 2007 was conducted, using the keywords pain and empathy, both alone and in combination. Similar concepts such as sympathy, caring and compathy were included if the database distinguished between these concepts. Twenty-five relevant articles were reviewed and Rodgers evolutionary concept analysis process was used to clarify the concept. FINDINGS: The recent observation that a mirror-like neural response occurs in the brain of a person witnessing another in pain provides compelling evidence that empathetic arousal may occur independent of the previously described attributes of prior experience or learned cognitive appraisal. CONCLUSION: While the empathetic response of care providers plays a central role in the recognition and treatment of pain, nurses are taught that regulation of this response is important to protect themselves against the traumatic effects of seeing patients in pain. However, there is emerging evidence that some elements of empathetic arousal are autonomic and therefore unable to be fully controlled; this may have important implications for nurses' vulnerability. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a review conducted to identify, critically analyse and synthesize the humour literature across a number of fields related to health, health care and nursing. BACKGROUND: The humour-health hypothesis suggests that there is a positive link between humour and health. Humour has been a focus of much contention and deliberation for centuries, with three theories dominating the field: the superiority or tendentious theory, the incongruity theory and the relief theory. DATA SOURCES: A comprehensive literature search was carried out in January 2007 using a number of databases, keywords, manual recursive searching and journal alerts (January 1980-2007) cross-referenced with the bibliographic databases of the International Society of Humor Studies. An inclusion and exclusion criterion was identified. REVIEW METHODS: A narrative review of evidence- and non-evidence-based papers was conducted, using a relevant methodological framework with additional scrutiny of secondary data sources in the latter. Humour theories, incorporating definition, process and impact constituted a significant part of the appraisal process. RESULTS: A total of 1630 papers were identified, with 220 fully sourced and 88 included in the final review. There is a dearth of humour research within nursing yet, ironically, an abundance of non-evidence-based opinion citing prerequisites and exclusion zones. Examination of physician-patient interaction and the humour-health hypothesis demonstrates that use of humour by patients is both challenging and revealing, particularly with regard to self-deprecating humour. CONCLUSION: Nurses and nursing should adopt a circumspect and evidenced-based approach to humour use in their work. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of an analysis of the concept of waiting for health care from the client's perspective. BACKGROUND: Waiting is commonplace in many areas of health care and has become a topical and politically important issue in the provision of healthcare services. Whilst managers and governments search for solutions to this problem, it is important that this aspect of clients' healthcare experience is examined to evaluate its impact and implications for nursing practice. METHODS: The PubMed and CINAHL databases (dating from 1950 and 1982 to 2007 respectively) were searched using the keywords 'health care' and 'waiting'. The reference lists of papers identified were also checked and this revealed literature from a number of other disciplines related to the concept. RESULTS: Waiting for health care is identified as an unspecified yet measurable period of time between identification of a healthcare problem and its diagnosis and treatment, when clients experience uncertainty and powerlessness whilst anticipating a disease outcome. The critical attributes of waiting for health care are: a period of measured time, subjective interpretation of the perceived significance of the measured time, feeling uncertain and powerless and anticipation of a response to the healthcare need. CONCLUSION: Strategies that facilitate contact with clients through pre-assessment clinics and giving written information and a contact point may seem obvious but are currently overlooked in busy healthcare environments. This is an area where nurses can lead in the delivery of person-centred care and could potentially increase satisfaction with how waiting is managed. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a systematic review to identify and analyse the main factors affecting the utilization of antenatal care in developing countries. BACKGROUND: Antenatal care is a key strategy for reducing maternal mortality, but millions of women in developing countries do not receive it. DATA SOURCES: A range of electronic databases was searched for studies conducted in developing countries and published between 1990 and 2006. English-language publications were searched using relevant keywords, and reference lists were hand-searched. REVIEW METHODS: A systematic review was carried out and both quantitative and qualitative studies were included. RESULTS: Twenty-eight papers were included in the review. Studies most commonly identified the following factors affecting antenatal care uptake: maternal education, husband's education, marital status, availability, cost, household income, women's employment, media exposure and having a history of obstetric complications. Cultural beliefs and ideas about pregnancy also had an influence on antenatal care use. Parity had a statistically significant negative effect on adequate attendance. Whilst women of higher parity tend to use antenatal care less, there is interaction with women's age and religion. Only one study examined the effect of the quality of antenatal services on utilization. None identified an association between the utilization of such services and satisfaction with them. CONCLUSION: More qualitative research is required to explore the effect of women's satisfaction, autonomy and gender role in the decision-making process. Adequate utilization of antenatal care cannot be achieved merely by establishing health centres; women's overall (social, political and economic) status needs to be considered. [ABSTRACT FROM AUTHOR]

Aim. This paper is a comparison of nursing's patterns of knowing with the systems identified by cognitive science, and evaluates claims about the equal-status relation between scientific and non-scientific knowledge. Background. Ever since Carper's seminal paper in 1978, it has been taken for granted in the nursing literature that there are ways of knowing, or patterns of knowing, that are not scientific. This idea has recently been used to argue that the concept of evidence, typically associated with evidence-based practice, is inappropriately restricted because it is identified exclusively with scientific research. Method. The paper reviews literature in psychology which appears to draw a comparable distinction between rule-based, analytical cognitive processes and other forms of cognitive processing which are unconscious, holistic and intuitive. Findings. There is a convincing parallel between the 'patterns of knowing' distinction in nursing and the 'cognitive processing; distinction in psychology. However, there is an important difference in the way the relation between different forms of knowing (or cognitive processing) is depicted. In nursing, it is argued that the different patterns of knowing have equal status and weight. In cognitive science, it is suggested that the rule-based, analytical form of cognition has a supervisory and corrective function with respect to the other forms. Conclusions. Scientific reasoning and evidence-based knowledge have epistemological priority over the other forms of nursing knowledge. The implications of this claim for healthcare practice are briefly indicated. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a concept analysis of renal supportive care. Background. Approximately 1.5 million people worldwide are kept alive by renal dialysis. As services are required to support patients who decide not to start or to withdraw from dialysis, the term renal supportive care is emerging. Being similar to the terms palliative care, end-of-life care, terminal care and conservative management, there is a need for conceptual clarity. Method. Rodgers' evolutionary method was used as the organizing framework for this concept analysis. Data were collected from a review of CINAHL, Medline, PsycINFO, British Nursing Index, International Bibliography of the Social Sciences and ASSIA (1806-2006) using, 'renal' and 'supportive care' as keywords. All articles with an abstract were considered. The World Wide Web was also searched in English utilizing the phrase 'renal supportive care'. Results. Five attributes of renal supportive care were identified: available from diagnosis to death with an emphasis on honesty regarding prognosis and impact of disease; interdisciplinary approach to care; restorative care; family and carer support and effective, lucid communication to ensure informed choice and clear lines of decision-making. Conclusion. Renal supportive care is a dynamic and emerging concept relevant, but not limited to, the end phase of life. It suggests a central philosophy underpinning renal service development that allows patients, carers and the multidisciplinary team time to work together to realize complex goals. It has relevance for the renal community and is likely to be integrated increasingly into everyday nephrology practice. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of an exploration of the concept of service user involvement in mental health nursing using a discourse analysis approach. Background. Service user involvement has come to be expected in mental health nursing policy and practice. This concept, however, is often applied somewhat ambiguously and some writers call for a clearer understanding of what service users actually want. Method. A Foucauldian discourse analysis was conducted in 2005, examining literature and health policies published by the United Kingdom government and service users. The discursive perspectives of both were explored and conceptual themes were generated from the data. Findings. Concepts occurring within government discourse include language relating to service users, the notion of service user involvement and power. Concepts from the service user discourse include power, change and control, theory, policy and practice, and experiential expertise. Differences in perspectives were found within these themes which distinguished government from service user discourses. Greater flexibility in ideas and perspectives was demonstrated by service users, with a seemingly greater range of theoretical underpinnings. Conclusion. Greater awareness is needed of the significance of language, of how subtle inferences may be drawn from the rhetorical language of policies, of how these might affect the involvement of service users, and of the implications for the role of mental health nurses. Nurses need to be aware of these tensions and conflicts in managing their practice and in creating a mental health nursing philosophy of 'involvement'. If true 'involvement' is to ensue, nurses may also need to consider the transfer of power to service users. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a concept analysis of forgiveness. Background. Worldwide interest in and funding for forgiveness research has brought about a body of knowledge from many disciplines that could be clinically useful to nursing. At this time, nurse scholars are beginning to challenge one another to focus on this important area of inquiry. To date, however, most scholarship on forgiveness has been conducted in related disciplines, rather than in nursing. Conceptual and theoretical work is needed in nursing to promote knowledge development in this area. Method. The CINAHL, Medline and PsycInfo databases were searched for papers published between 1990 and 2007 using the keywords, forgiveness, forgive, or reconciliation in the title or abstract. The non-linear evolutionary process of concept analysis was used to identify the concept of interest, its origins, realm, attributes and context, characteristics, and implications. Forgiveness was also explored from an international multi-cultural perspective. An exemplar is included to illuminate the concept. A total of 34 scholarly works from a variety of disciplines were included in the analysis. Findings. A definition of forgiveness emerged from the analysis, as well as a multicultural understanding of the concept. Three important attributes of forgiveness are that it is the relinquishing of a negative response, replacing the negative response with a benevolent response, and a process that occurs over time. Multi-cultural attributes centre on group harmony, re-establishing harmonious connections between people, and the morality of considering others as worthy of love and understanding. Conclusion. A multi-cultural understanding of forgiveness may provide the impetus for further theory development and research in nursing, and could be used to educate nurses on beginning interventions in this area. [ABSTRACT FROM AUTHOR]

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]

Aim. This paper is a report of a literature review to explore issues influencing condom use in heterosexual adolescents and young people. Background. Sexually transmitted infections (STIs) are a major international health issue and adolescents and young people are particularly vulnerable. Efforts to address the rapid spread of STIs have largely focused on promoting the use of condoms as a protective 'safer sex' measure. However, use of the male condom is still inconsistent and the incidence of STIs continues to increase. Method. A search of the literature using EBSCO Host databases was undertaken in 2006, with a focus on women, young people, condoms and STIs. Papers published in English from 1992 to 2006 were sought. Only research papers are included in this review. Results. Factors impeding decisions to use protection by young people include lack of knowledge about prevalence of STIs, ambiguity around contraception and safer sex practices, and the difficulty faced by young women in particular in negotiating safer sex. The notion of romantic love confounds the assessment of risk and can render young people, particularly young women, ineffective in negotiating safer sex practices. Conclusion. Adolescents and young adults are particularly vulnerable in relation to STIs. There is a need to ensure that accurate messages are delivered about safer sex and contraception to this very vulnerable group. Furthermore, it is important to recognize that romantic love comprises strong emotions that have a role in decisionmaking and options for reducing personal-health risk during sexual activity. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a concept evaluation of transience and its relevance to palliative care. Background. A qualitative study into palliative care patients' experiences of transition revealed a gap between current definitions of transition and their expression of the palliative care experience. Transience appears to offer a better definition but remains conceptually weak, with limited definition in a healthcare context. Methods. A qualitative conceptual evaluation of transience was undertaken using two case examples, interview data and the literature. Multiple sources were used to identify the literature (1966-2006), including a search on Cumulative Index to Nursing and Allied Health Literature Medline, and Ovid and Arts and Humanities Index using the keywords 'transience' and 'palliative care'. Thirty-one papers related to transience were retrieved. Analysis and synthesis formulated a theoretical definition of transience relative to palliative care. Findings. Transience is a nascent concept. Preconditions and outcomes of transience appear contextually dependent, which may inhibit its conceptual development. Transience depicts a fragile emotional state related to sudden change and uncertainty at end-of-life, exhibited as a feeling of stasis. Defining attributes would seem to include fragility, suddenness, powerlessness, impermanence, time, space, uncertainty, separation and homelessness. Conclusions. Transience is potentially more meaningful for palliative care in understanding the impact of end-of-life experiences for patients than current conceptualizations of transition as a process towards resolution. As a nascent concept, it remains strongly encapsulated within a framework of transition and further conceptual development is needed to enhance its maturity and refinement. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a study to determine nurses' levels of agreement using a standard 5-point triage scale and to explore the influence of task properties and subjectivity on decision-making consistency. Background. Triage scales are used to define time-to-treatment in hospital emergency departments. Studies of the inter-rater reliability of these scales using paperbased simulation methods report varying levels of consistency. Understanding how various components of the decision task and individual perceptions of the case influence agreement is critical to the development of strategies to improve consistency of triage. Method. Simulations were constructed from naturalistic observation, cue types and frequencies were classified. Data collection was conducted in 2002, and the final response rate was 41.3%. Participants were asked to allocate an urgency code for 12 scenarios using the Australasian Triage Scale, and provide estimates of case complexity, levels of certainty and available information. Data were analysed descriptively, agreement between raters was calculated using kappa. The influence of task properties and participants' subjective estimates of case complexity, levels of certainty and available information on agreement were explored using a general linear model. Findings. Agreement among raters varied from moderate to poor (kappa = 0.18-0.64). Participants' subjective estimates of levels of available information were found to influence consistency of triage by statistically significant amounts (F 5.68;

AIM: This paper reports a concept analysis delineating and clarifying the concept of self-monitoring to facilitate development and evaluation of interventions to enhance self-monitoring. BACKGROUND: The concepts of self-monitoring, self-management, self-care and symptom management are often used in similar or interchangeable ways. Clarification of the concept of self-monitoring is needed for research and theory development. METHOD: Rodgers and Knafl's evolutionary concept analysis process was used to delineate and clarify the concept. The PubMed and CINAHL databases were searched using keywords 'self-monitoring', 'self-management' and 'self-care' (with and without the hyphen) for the years 1998-2005, to update a previous study (not published). Later, searching was refined and the keyword 'self-monitoring' was paired with 'awareness' and 'self-regulation' was added. Approximately half the papers were from nursing (n = 34) and half from other disciplines (n = 32). The sample from 1998 to 2005 was further stratified by chronic condition. Definition, exemplars, usage, attributes, antecedents/consequences and implications for further study were identified. FINDINGS: Self-monitoring was composed of two complementary components (attributes): (1) awareness of bodily symptoms, sensations, daily activities, and cognitive processes and (2) measurements, recordings and observations that inform cognition or provide information for independent action or consultation with care providers. CONCLUSION: Self-monitoring may be an important concept for understanding how people self-manage chronic conditions. This concept analysis may be useful for researchers who wish to measure this dimension and to develop nursing theory in this area. [ABSTRACT FROM AUTHOR]

AIM: This paper reports the findings from a qualitative meta-synthesis concerning people with, or at risk of, tuberculosis, service providers and policymakers and their experiences and perceptions of tuberculosis and treatment. BACKGROUND: Directly observed therapy is part of a package of interventions to improve tuberculosis treatment and adherence. A Cochrane systematic review of trials showed an absence of evidence for or against directly observed therapy compared with people treating themselves. METHOD: Qualitative systematic review methods were used to search, screen, appraise and extract data thematic analysis was used to synthesize data from 1990 to 2002, and an update of literature to December 2005. Two questions were addressed: 'What does qualitative research tell us about the facilitators and barriers to accessing and complying with tuberculosis treatment?' and 'What does qualitative research tell us about the diverse results and effect sizes of the randomized controlled trials included in the Cochrane review?' Findings help explain the diverse trial results in a Cochrane systematic review of directly observed therapy and tuberculosis and consider implications for research, policy and practice. FINDINGS: Five themes emerged from the 1990 to 2002 synthesis: socio-economic circumstances, material resources and individual agency; explanatory models and knowledge systems in relation to tuberculosis and its treatment; the experience of stigma and public discourses around tuberculosis; sanctions, incentives and support, and the social organization and social relationships of care. Two additional themes emerged from the 2005 update. CONCLUSION: The qualitative meta-synthesis improved the relevance and scope of the Cochrane review of trials. The findings make a major contribution to the development of theory concerning global WHO-branded disease control and the practicality of local delivery to people. [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the issue including one on the patient stories of living with a pressure ulcer and another on the heterosexual assumptions in verbal and non-verbal communication in nursing.

The article summarizes the major points of articles in nursing included in this issue. These include "Recognizing and reporting child physical abuse: a survey of primary healthcare professionals," by A. Lazenbatt and R. Freeman and "Health preferences and decision-making needs of disadvantaged women," by H. Bunn, I. Lange, M. Urrutia, M.S. Campos, S. Campos, S. Jaimovich, C. Campos, M.J. Jacobsen and I. Gaboury

Aim. This paper reports a study to evaluate and increase understanding of contemporary Registered Nurses’ discontents, and to compare these discontents and their effects with those of nurses 20 years ago. Background. In 1986, Turner argued that nurses’ discontents were reflected in a discourse or ‘vocabulary of complaint’ that provided a sense of solidarity amongst practising nurses, and defused their frustrations rather than channelling them into demands for workplace reform. In this paper, we revisit Turner's notion of a vocabulary of complaint in the context of a study of nurse retention in the contemporary Australian healthcare workplace. Methods. This paper draws on the qualitative data from a larger project (completed in 2001) exploring the relationship between job satisfaction and self-concept in both recently graduated and experienced nurses. Here, we elaborate on thematic analyses of the comments of 146 Australian Registered Nurses with more than 5 years’ nursing experience. Findings. There is still a high level of discontent amongst contemporary practising nurses, although the focus of their complaints and their responses to them have changed since Turner's study. Conflicting expectations of nurses and managers and lack of opportunity to provide comprehensive care emerged as the most important issues for experienced nurses today. Rather than contributing to a sense of solidarity as in Turner's study, contemporary nurses’ discontents reflect intense personal frustration and underpin individual nurses’ decisions to leave, or plan to leave, the workforce. Conclusion. There is an urgent need for increasing health service management and community awareness about the relationship between providing comprehensive nursing care and nurses’ job satisfaction. Addressing nurses’ discontents, wider nursing involvement in the international policy arena, and the politicization of nurses worldwide may contribute to alleviating the current global nursing shortage. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a concept analysis of partnership within the context of a professional–patient relationship. Background. The concept of partnership has been previously characterized as immature, with a need for further consensus and consistency. Critical attributes previously reported include relationship, power sharing and negotiation, with empowerment as the primary consequence. Method. Rodgers’ evolutionary method of analysis for concept development was used to re-examine the concept of partnership. Historical documents and previously published conceptual papers were reviewed for context. A search of multidisciplinary literature published between 2000 and 2004 was undertaken using the keywords of ‘partnership’ and ‘partnering’, combined with nurse/professional/physician–client relationship. Attributes, uses, antecedents and consequences were inductively derived from the citations analysed ( n = 62). Results. Previous authors affirmed that partnership involves a process and a consistent set of eight attributes. Relationship, shared power, shared decision-making and patient autonomy are attributes that distinguish partnership from other related concepts. Most of the literature, however, consisted of expert opinion or descriptive research. Little progress has been made in applying theory, developing tools to test the process, identifying when partnerships are needed and what specific outcomes occur when they are present. Conclusion. Partnerships between healthcare providers and patients develop over time. They are created to support patients in having a greater voice in their care and to empower them in self-management. A descriptive model of partnership is proposed to support researchers in generating or applying existing theory to the development of research designs and tools that could test how this process actually works. [ABSTRACT FROM AUTHOR]

The article offers a look at the topics featured in the September 2006 issue of the "Journal of Advanced Nursing." Among the articles featured in the journal are "Patient Satisfaction With Psychiatric Impatient Care," "Deconstruction of a Complex Tailored Intervention to Assess and Treat Discomfort of People With Advanced Dementia" and "A Phenomenological Study of Fatigue in Patients With Primary Biliary Cirrhosis."

The article discusses various reports published within the issue, including one by S. Neville and M. Henrickson on Perceptions of lesbian, gay and bisexual people of primary healthcare services and another by J. Phillips, P. M. Davidson, D. Jackson, L. Kristjanson, J. Daly and J. Curran on Residential aged care: the last frontier for palliative care.

Aim. This paper describes the evolution of Australian practice nursing and documents seminal events in crystallizing the importance of the nursing role in general practice. Background. Internationally, the potential for nurses to improve health in primary care settings is acknowledged. The general practice setting is a focal point for primary care in many health systems. Despite the important role played in the delivery of primary health care by nurses working in general practice in the United Kingdom and New Zealand, the role of nurses in Australian general practice is much less clearly defined, as reflected by the paucity of research and scholarship in this area. Fuelled by the increasing challenges of workforce shortages and the increasing need for multidisciplinary care, interest in the developing role of the Australian practice nurse among clinicians, researchers and policy makers is increasing. Discussion. Australian practice nursing has reached a critical point in its evolution. It is imperative for the promotion of nursing in general practice that knowledge from descriptive, exploratory research be used to inform strategic decision-making in terms of professional development issues, policy, research and scholarship. These data also need to inform systematic outcome studies. To date, the embryonic nature of practice nursing as a discrete professional entity in Australia has inhibited its representation in nursing curricula and professional bodies. Conclusion. In order to advance the Australian practice nurse movement and demonstrate its important contribution to primary health care, nurses need to take the lead in strategic planning of this emerging specialty. As well as leadership from an academic, research and policy perspective, clinical leaders need to be fostered among the ranks of practice nurse clinicians to drive clinical practice development and the delivery of evidence-based primary care. [ABSTRACT FROM AUTHOR]

Introduces a series of articles on advanced nursing practice.

Articles featured in a 2006 issue of the "Journal of Advanced Nursing" are previewed including "Use of Major and Minor Tranquilizers With Older Patients in an Acute Care Hospital: An Exploratory Study," "Nurse-Patient Interaction and Decision-Making in Care: Patient Involvement in Community Nursing" and "Assessing the Need for Certainty in Users of a Clinical Genetic Health Service."

Summarizes a series of articles in the July 2006 issue of the "Journal of Advanced Nursing." "Perspectives and Experiences of Homeless Young People"; "Physical Activity and Physical Self-Concept: Comparison Between Children With and Without Asthma"; "Predictors of Exercise Participation in Female Hospital Nurses"; "Nutritional Counselling: An Intervention for HIV-positive Patients."

This section provides an overview of the articles featured within the June 2006 issue of "JAN." The article titled "Treatment Advice in Primary Care: A Comparative Study of Nurse Practitioners and General Practitioners," by C. Seale, E. Anderson and P. Kimersley, talks about how to use treatment and discussion of side effects contributed most to the difference in treatment talk.

Discusses various reports published within the issue including one on traumatic brain injury and another on alcohol intervention.

Presents an introduction to a series of articles about innovations in nursing practice.

Aim. The aim of this paper is to examine the concepts of opinion leaders, facilitators, champions, linking agents and change agents as described in health, education and management literature in order to determine the conceptual underpinnings of each. Background. The knowledge utilization and diffusion of innovation literature encompasses many different disciplines, from management to education to nursing. Due to the involvement of multiple specialties, concepts are often borrowed or used interchangeably and may lack standard definition. This contributes to confusion and ambiguity in the exactness of concepts. Methods. A critical analysis of the literature was undertaken of the concepts opinion leaders, facilitators, champions, linking agents and change agents. A literature search using the concepts as keywords was conducted using Medline, CINAHL, Proquest and ERIC from 1990 to March 2003. All papers that gave sufficient detail describing the various concepts were included in the review. Several 'older' papers were included as they were identified as seminal work or were frequently cited by other authors. In addition, reference lists were reviewed to identify books seen by authors as essential to the field. Findings. Two similarities cut across each of the five roles: the underlying assumption that increasing the availability of knowledge will lead to behaviour change, and that in essence each role is a form of change agent. There are, however, many differences that suggest that these concepts are conceptually unique. Conclusions. There is inconsistency in the use of the various terms, and this has implications for comparisons of intervention studies within the knowledge diffusion literature. From these comparisons, we concluded that considerable confusion and overlap continues to exist and these concepts may indeed be similar phenomena with different labels. All concepts appear to be based on the premise that interpersonal contact improves the likelihood of behavioural change when introducing new innovations into the health sector. [ABSTRACT FROM AUTHOR]

Introduces a series of articles on nursing research and innovations.

The article provides an overview of several articles about nursing practice. It includes "Mantram Repetition for Stress Management in Veterans and Employees: A Critical Incident Study," by J. E. Bormann et al, "Relational Experiences of Partnered Japanese Immigrant Women With Affect Disorders," by Y. Kozuki et al, "Hospital Staff Perceptions of Parental Involvement in Paediatric Hospital Care," by B. M. Ygge et al, "Searching for Meaning in Negative Events: Concept Analysis," by B. G. Skaggs et al and "HIV/AIDS Knowledge, Attitudes and Beliefs Among Nepalese Adolescents," by G. Mahat et al.

The section introduces a series of articles published within the issue, including "Family Physician/Nurse Practitioner: Stories of Collaboration," by P. Bailey, et al, and "Nursing Attitudes and Beliefs in Pain Assessement and Management," by J. Layman Young, et al.

The article discusses various reports published within the issue, including one by R.A. Tanyi on family nursing and another by M. Takase on nurses' work behavior.

Aim. The purpose of this paper is to provide an overview of the issues we have confronted when generating and analysing dialogue data by using electronic mail. Background. The decision to use email for our research arose from our developing understanding of some of the consequences of illness that people living with chronic illness confront in their lives. As researchers, we recognized the potential of the Internet for computer-mediated communication using email for communication between researchers and research participants. Discussion. We consider the functional aspects of generating data by email, such as the software needed, and then explore the issues encountered during the research process including ethical considerations, fluctuating participation, participants' familiarity with using email, facilitating lurkers towards participation, establishing group norms, and the role of the facilitator. Conclusion. As a collaborative inquiry, email conversation allowed us to spend time with participants over 2 years to explore chronic illness experience. However the scope and viability of computer-mediated communication as a qualitative method of research remains relatively unexplored, hence this paper. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a study analysing the various functions of nurses' documentation of patient assessments. Background. Modes of documentation have received much attention in the nursing press since the integration of the nursing process and nursing models. Previous research has shown that current documentation practices do not consistently promote effective communication and evaluation of patient care. A recent systematic review found no evidence that any particular system of documentation improved this situation. However, nurses' documentation serves not only to communicate information to others, but also has a political function as a presentation of what is important and ethically 'right' to report. Method. A Foucauldian approach to discourse analysis was used to analyse 45 patient records. Findings. The findings indicate that nurses employ three discernible discursive practices in the documentation of patient assessments: medical, nursing and informal. Each practice has an effect on the presentation of nursing in the documentation. Because of the complex interplay between these practices, nurses present themselves as aligned with the medical profession, as distinct and professional, and as informal in their descriptions of non-biological information. The use of these practices appears to be motivated by the type of information being reporting. Conclusion. Existing literature highlights the functional aspects of nursing documentation. In contrast, this paper explores the way in which nurses, through their documentation, constitute themselves and the nursing profession. In this way, nursing documentation is viewed as a social practice and a conduit through which particular power effects are produced and reproduced, rather than simply a matter of, for example, knowledge, individual choice or good practice. [ABSTRACT FROM AUTHOR]

This section summarizes articles on issues and innovations in nursing practice. The articles include "Discursive practices in the documentation of patient assessments," "Client-centred empowering partnering in nursing," "Nurses' perceptions of quality end-of-life care on an acute medical ward," "Profiles of pain after day surgery: patients' experiences of three different operation types" and "Discursive patterns in multiprofessional healthcare teams."

This paper gives a brief description of a research project carried out to test the assumption that there is a relationship between a student nurse's description, on paper, of how she would care for a patient, and the actual observed behaviour. No relationship was found in more than two-thirds of subjects in 19 hospitals. The paper goes on to look at the possible reasons for this phenomenon and suggests alterations in the training programmes for nurses in England and Wales which could create a greater correlation between the theory and practice of nursing. The views expressed are those of the author and not necessarily of any organization. [ABSTRACT FROM AUTHOR]

Presents an introduction to a series of articles about issues and innovations in nursing practice.

Introduces a series of articles focusing on nursing.