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Nursing, as a profession in its own right and a discrete health discipline, is responsible for planning, organizing, implementing and evaluating nursing services as a distinct segment of health care, and for educating practitioners to provide these services. The primary responsibility of nursing is to provide care direct to the patient, client, family or community. Like medicine, it is concerned with maintaining, promoting and protecting health, treating the sick and providing rehabilitation. It deals with the psychosomatic and psychosocial aspects of life as these affect health, illness and dying. In modern health services, nursing care is often best given by a nursing care team which usually consists of two or more categories of workers. These workers together make up the nursing personnel subsystem, which is a distinct entity within the overall health personnel system of a country.

Aim. This paper presents an evaluation of the effectiveness of three search strategies to identify research for a qualitative synthesis of patient experiences of living with a leg ulcer. Background. Systematic reviews of research are increasingly the form of evidence used for evaluation of health care. There are well-established methods for conducting systematic reviews of effectiveness incorporating randomized controlled trials. Methods have been developed for the synthesis of qualitative research, but these are not widely used or evaluated. Searching for qualitative research is one of the least developed and tested areas in systematic reviewing of qualitative research. Method. The replication of three search strategies (free text, thesaurus and broadbased terms) developed for identification of qualitative research papers within electronic databases is described. Each strategy was run in seven electronic databases: MEDLINE, CINAHL, EMBASE, British Nursing Index, Social Science Citation Index, Applied Social Sciences Index and Abstracts, PsychInfo. The effectiveness of these strategies for identifying qualitative research for a synthesis of patients' experiences of living with a leg ulcer is discussed. Findings. Each of the three search strategies produced similar numbers of potentially and actually relevant papers from each of the seven databases. These results were most striking for CINAHL, when all of the papers ultimately included in the review were identified by each search strategy. No other database identified all included papers. Conclusion. A simple search strategy using broad-based terms was as effective as a complex one (free text) in locating qualitative research examining patients' experiences of living with a leg ulcer. For a question with a clear nursing focus, it may be sufficient to search only CINAHL in order to locate qualitative research. This result needs replicating with other nursing topics. [ABSTRACT FROM AUTHOR]

lindsay b. (2004) Journal of Advanced Nursing 45(1), 84–94 Randomized controlled trials of socially complex nursing interventions: creating bias and unreliability? The randomized controlled trial is viewed by many researchers as the ‘gold standard’ research design. It is used increasingly to evaluate the effectiveness of socially complex activities such as nursing interventions. This use is seen by many commentators as problematic, while others are concerned about the quality of many published trial reports. One area of concern is that of intervention bias: the impact that a sentient intervention, such as a nursing one, may have consciously or unconsciously on study outcomes. This paper reports on an analysis of intervention definitions and possible intervention bias in 47 reports of randomized controlled trials of nursing interventions published in 2000 or 2001. This study evaluates four characteristics of the included reports: intervention sample size, intervention definition, involvement of intervention nurses in other aspects of the trial, and the claimed generalizability of results. Reports of randomized controlled trials published in 2000 or 2001 were identified. Full-text versions of 47 papers were obtained and information about the four characteristics was extracted and analysed. Problems relating to possible intervention bias were identified in each of the papers. Inadequate intervention definition was the commonest problem, leading to difficulties in calculating the ‘intervention dose’ and in replicating or generalizing from the studies. None of the included studies met the requirements of the Consolidated Standards of Reporting Trials. Four types of intervention bias were identified, and their possible implications for the reporting of trials of nursing interventions are discussed. This was a small-scale study, limited by time and resources. Its results are suggestive of a major problem of intervention bias but larger-scale investigations are necessary to quantify its extent. Intervention bias is potentially a problem in randomized controlled trials. Lack of detail about interventions in published papers could be corrected by stricter adherence to guidelines such as the Consolidated Standards of Reporting Trials, but this will not correct the underlying problem of inadequate study design that appears to be widespread in randomized controlled trials of nursing interventions. [ABSTRACT FROM AUTHOR]

This paper describes a district nursing study that considered the experiences and responses of primary health care professionals and their patients to changes taking place within the community. As a qualitative study it employed interviews as the main method of data collection and was informed by both ethnography and interpretative phenomenology. Forty-three study participants were interviewed, eliciting opinion on whether care is more than just a hands-on activity, whether patient need is being met and to what extent service policy is in tune with care delivery. Describing the views of primary health care professionals and patients in order to illustrate the complexity of the district nursing service and professional roles, the paper finds little shared vision between staff and managers of each other's responsibilities. It concludes that a more holistic approach to understanding professional roles is needed in order to satisfy the differing agendas of managers, staff and patients. It propounds the need for closer collaborative practice between health care professionals, for it finds that they value the ability to communicate as an essential element of their jobs. It reflects that, without such collaboration, it will be difficult for nurses to take a lead position on changes shaping community care. [ABSTRACT FROM AUTHOR]

Introduces a series of articles about medical care and nursing.

When concepts and the `paper and pencil' tests used to measure these concepts are developed in fields other than nursing and subsequently arc used for nursing purposes. the perspective mismatch heralds a validity issue. This paper presents a case for clinical construct validity as one method of evaluating whether the substantive meaning of a test captures the nursing meaning. [ABSTRACT FROM AUTHOR]

Aim. This paper is a critique of the use of critical incident technique in nursing and a demonstration of how its development has resulted in inconsistency and confusion. Background. Critical incident technique is used globally by nurse researchers to explore a plethora of nursing issues. Its main strengths are flexibility and adaptability, but its popularity has resulted in ambiguity and confusion. Data sources. A search of the CINAHL database for the period 1956-2007 was performed using the search terms critical incident technique and nursing. Together with hand searching, this produced a total of 59 papers. The papers were analysed according to country of origin, research topic, sample size, data collection method, inclusion/exclusion criteria, data analysis and terminology. We then categorized the results of this analysis depending on similarities and differences in the papers. Discussion. We focus on two areas: methodology and terminology. From a methodological perspective critical incident technique has become inconsistent and in relation to terminology, the diverse language associated with the technique has created confusion. Moreover, issues of rigour may be compromised as a result of this inconsistency. A great deal of inconsistency has been created by nurse researchers' attempts to advance critical incident technique. This has led to confusion, which is not helpful for advancing nursing knowledge. Conclusion. While embracing the continued development of critical incident technique, we advocate a standardized approach to its use. Unless nurse researchers are alert to the methodological and terminological inconsistencies in use of the critical incident technique, it risks becoming an interminable quagmire through which navigation will be impossible. [ABSTRACT FROM AUTHOR]

Title. Is children’s choice in health care rhetoric or reality? A scoping review. Aim. This paper is a report of a scoping review examining children and young people’s health services with respect to choice in order to inform future development of choice initiatives. Background. The importance of including children and young people in the choice agenda reflects the increasing acknowledgement that, individually and collectively, they are important consumers of health care in their own right. Data sources. A scoping review of all major health and medical research databases was undertaken using current guidelines to identify original relevant research papers and grey literature sources from 1990 to 2006. Review methods. Reference Manager software was used to collate, summarize, categorize, store and retrieve the search results. Papers meeting the inclusion criteria were read in full and descriptively summarized using a data extraction sheet. Each paper was repeatedly selected using a snowballing approach until saturation was reached. Results. Children and young people want more say in the planning and development of appropriate hospital and community health services. However, little evaluative research was found about whether these choices are acted upon and lead to more responsive services. Conclusion. Choice for children and young people is viewed as a positive development in health care and many innovative examples of their involvement in decision-making were found. These illustrated that, given the opportunity, children and young people are willing and able to make decisions about their healthcare services. However, there is a long way to go before the rhetoric of the choice agenda is realized. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of an integrative review of research investigating computer assisted learning for clinical skills education in nursing, the ways in which it has been studied and the general findings. Background. Clinical skills are an essential aspect of nursing practice and there is international debate about the most effective ways in which these can be taught. Computer assisted learning has been used as an alternative to conventional teaching methods, and robust research to evaluate its effectiveness is essential. Data sources. The CINAHL, Medline, BNI, PsycInfo and ERIC electronic databases were searched for the period 1997-2006 for research-based papers published in English. Electronic citation tracking and hand searching of reference lists and relevant journals was also undertaken. Findings. Twelve studies met the inclusion criteria. An integrative review was conducted and each paper was explored in relation to: design, aims, sample, outcome measures and findings. Many of the study samples were small and there were weaknesses in designs. There is limited empirical evidence addressing the use of computer assisted learning for clinical skills education in nursing. Computer assisted learning has been used to teach a limited range of clinical skills in a variety of settings. Conclusion. The paucity of evaluative studies indicates the need for more rigorous research to investigate the effect of computer assisted learning for this purpose. Areas that need to be addressed in future studies include: sample size, range of skills, longitudinal follow-up and control of confounding variables. [ABSTRACT FROM AUTHOR]

The section introduces several papers which deal with issues and innovations in nursing practice.

AIM: This paper explores practical methodological issues which arise from the application of systematic review and meta-synthesis techniques to qualitative research studies in the context of a pragmatic health services research question. BACKGROUND: The emphasis on, and volume of, qualitative research is increasing. As a result, there is a need to integrate and disseminate qualitative research findings. However, relatively little has been written about the methodology of systematically reviewing and meta-synthesizing qualitative research studies, and about the practical issues which arise in the course of these processes. METHODS: A systematic review and meta-synthesis was undertaken of qualitative research studies reporting data relevant to the pragmatic health services research question: 'What factors facilitate or impede role development and/or effective practice as a clinical nurse specialist, nurse practitioner, advanced nurse practitioner or consultant nurse based in acute hospital settings?' FINDINGS: The identification of relevant studies is substantially more time-consuming than the identification of relevant studies for a systematic review of randomized controlled trials. A substantially larger proportion of papers has to be retrieved for full reading. Articles with unclear titles which lack abstracts cannot be dismissed as irrelevant. Study appraisal and data analysis, being iterative processes, are also more time-consuming than the appraisal and meta-analysis of quantitative studies. It may be possible to reduce the frustrations inherent in the distance between the reviewer and the participants in the primary research by using full project reports rather than published articles. CONCLUSIONS: Conducting a systematic review and meta-synthesis of qualitative research studies is a rewarding but demanding activity, and adequate time and resources must be made available. Some recommendations are made which may facilitate those processes. [ABSTRACT FROM AUTHOR]

Aim. This paper explores the sexual health interview from a critical perspective, and to demonstrate how the confession ritual involved in this interview is implicated in the construction of subjectivities (meaning identities) as well as in fostering self-surveillance (self-regulation). Background. The concept of public health depends primarily on several surveillance tools that monitor both the incidence and prevalence rates of certain diseases. Within the subgroup of infectious diseases, sexually transmitted infections comprise a group that is closely monitored. As a result, surveillance techniques, including policing sexual practices, are part of the public health worker's mandate. Method. Using a Foucauldian perspective, we demonstrate that confession is a political technology in the sexual health domain. Findings. As one group of frontline workers in the field of sexual health, nurses are responsible for data collection through methods such as interviewing clients. Nurses play an integral role in the sexual health experience of clients as well as in the construction of the client's subjectivity. We strongly believe that a Foucauldian perspective could be useful in explaining certain current client behavioural trends (for example, an avoidance by at-risk groups of interactions with nurses in sexual health clinics) being observed in sexual health clinics across the Western hemisphere. Conclusion. Clinicians need to be aware of the confessional nature of their questions and provide requested services rather than impose services that they determine to be important and relevant. By appreciating that the sexual health interview is an invasive and embarrassing sexual confession, healthcare providers and policy-makers may be better able to design and implement more user-oriented, population-sensitive sexual health services. [ABSTRACT FROM AUTHOR]

The section comments on the article "Beyond Empathy: Expanding Expressions of Caring," by J. M. Morse, et al, which appeared in the 1992 issue of the "Journal of Advanced Nursing." It expresses opinion on the opening sentence of the paper which suggests that empathy has been touted as appropriate and desirable. It asserts that the paper is unsatisfying and, from a contemporary perspective, seems naive. It states the reasons for the paper's lack of substance.

AIM: This paper presents an integrative literature review conducted to describe the utility of the objective structured clinical evaluation (OSCE) as a strategy of measuring one form of clinical competence in nursing. BACKGROUND: The emergence of the OSCE, one form of evaluation of clinical competence used in medicine, is gaining more scrutiny and consideration in nursing education. DATA SOURCES: The review was conducted through an initial search of computerized databases CINAHL, Cochrane Database of Systematic Reviews, Academic Search Premier and MEDLINE for the period from 1960 to 2008. METHODS: An integrative review was performed and 41 papers met the inclusion criteria. RESULTS: The complexities of evaluating clinical competence can be addressed through use of an OSCE process. Concerns related to the conceptual limitations and the lack of psychometric properties of the tools available for measurement in nursing education have been identified. CONCLUSION: Major gaps exist in the nursing literature regarding the examination of the psychometric properties of the OSCE, the suitability of the design of the OSCE structure and tools for nursing to measure clinical competency, and the associated costs in the application of this evaluative method. Research conducted on the psychometric properties of the OSCE tool used and correlations to other evaluative methods currently used to evaluate nursing clinical competence would inform educational practices. [ABSTRACT FROM AUTHOR]

This paper is a report of a systematic review to identify, critique and synthesize nursing studies of the measurement of empathy in nursing research. Background. The profound impact of empathy on quality nursing care has been recognized. Reported empathy levels among nurses range from low to well-developed and there is clearly debate about what constitutes empathy and how it can be measured and improved. Data sources. Searches were made of the CINAHL, MEDLINE and PsycINFO databases, using the terms 'empathy', 'tool', 'scale', 'measure', 'nurse', and 'nursing', singly or in combination to identify literature published in the English language between 1987 and 2007. Methods. A systematic review was carried out. The included papers were critically reviewed, relevant data were extracted, and a narrative synthesis was conducted. Results. Thirty papers representing 29 studies met the inclusion criteria. Three types of studies were identified: descriptive studies ( n = 12), studies of empathy and patient outcomes ( n = 6), and evaluational studies ( n = 11). Twenty scales were used, with more than one tool being applied in some studies, suggesting the need for a systematic review of empathy measures in nursing research. A range of settings were studied but some, such as genetic healthcare, have been neglected. Conclusion. Despite numerous tools being used in nursing research to assess empathy, there appears to be no consistency, suggesting the need to evaluate the rigour of empathy tools appropriately, either to inform education or for application in clinical settings. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a literature review that aimed to analyse the way in which nursing intensity and patient dependency have been considered to be conceptually similar to nursing workload, and to propose a model to show how these concepts actually differ in both theoretical and practical terms. Background. The literature on nursing workload considers the concepts of patient 'dependency' and nursing 'intensity' in the realm of nursing workload. These concepts differ by definition but are used to measure the same phenomenon, i.e. nursing workload. Method. The literature search was undertaken in 2004 using electronic databases, reference lists and other available literature. Papers were sourced from the Medline, Psychlit, CINAHL and Cochrane databases and through the general search engine Google. The keywords focussed on nursing workload, nursing intensity and patient dependency. Findings. Nursing work and workload concepts and labels are defined and measured in different and often contradictory ways. It is vitally important to understand these differences when using such conceptualizations to measure nursing workload. A preliminary model is put forward to clarify the relationships between nursing workload concepts. Conclusion. In presenting a preliminary model of nursing workload, it is hoped that nursing workload might be better understood so that it becomes more visible and recognizable. Increasing the visibility of nursing workload should have a positive impact on nursing workload management and on the provision of patient care. [ABSTRACT FROM AUTHOR]

Aim. This paper presents a concept analysis of the phenomenon of postoperative recovery. Background. Each year, millions of patients throughout the world undergo surgical procedures. Although postoperative recovery is commonly used as an outcome of surgery, it is difficult to identify a standard definition. Method. Walker and Avant's concept analysis approach was used. Literature retrieved from MEDLINE and CINAHL databases for English language papers published from 1982 to 2005 was used for the analysis. Findings. The theoretical definition developed points out that postoperative recovery is an energy-requiring process of returning to normality and wholeness. It is defined by comparative standards, achieved by regaining control over physical, psychological, social and habitual functions, and results in a return to preoperative level of independence/dependency in activities of daily living and optimum level of psychological well-being. Conclusion. The concept of postoperative recovery lacks clarity, both in its meaning in relation to postoperative recovery to healthcare professionals in their care for surgical patients, and in the understanding of what researchers in this area really intend to investigate. The theoretical definition we have developed may be useful but needs to be further explored. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a concept analysis identifying the attributes, antecedents and consequences of the concept of routine and examining the implications and applications of this concept in the field of nursing. Background. Routine may be a pivotal concept in understanding functional adaptation and wellbeing. Nurses in institutional settings work according to scheduled routines, patient care is largely orchestrated in routines set by organizations and regulations, and persons receiving care have their own life routines determining identity, capacities and frame of reference. However, to date, nursing has paid little attention to the relevance of routine and the role it may play in patient care. Method. A concept analysis was conducted using Rodgers' guidelines. The literature search was based on the following databases: PsycInfo, CINAHL, MedLine, Social Services, and Social Work abstracts. To be included in the analysis, papers had to relate directly and essentially to the concept of routine. Seventy-four papers published from 1977 to 2005 were included in the final stage of the analysis. The analysis included target populations, disciplinary perspectives, type of manuscript, themes and definitions, theoretical models, antecedents and consequences, as well as related terms. Results. Routine is a concept pertaining to strategically designed behavioural patterns (conscious and subconscious) and is used to organize and coordinate activities along different axes of time, duration, social and physical contexts, sequence and order. It emerges from the literature as a strategy that serves adaptation, in general, especially in the face of change and stressful situations. The conceptual structure, relations with other concepts, antecedents and consequences are described. Conclusion. The concept of routine is ill-defined and seldom used in the field of nursing, despite the promise it may hold for a better understanding of a wide range of health-related issues. This concept analysis offers an integrative view of routine and suggests directions for future research and practice. [ABSTRACT FROM AUTHOR]

Provides an overview of articles on issues and innovations in nursing practice.

Presents a list of several studies related to nursing and healthcare management. "Analysis of the Moral Habitability of the Nursing Work Environment," by E. H. Peter, A. V. Macfarlane and L. L. O' Brien-Pallas; "Implementing Local Pay Systems in Nursing and Midwifery," by E. Meerabeau, S. Corby, J. Druker and G. White; "Nurses' Attitudes Towards Lesbians and Gay Men," by G. Röndahl, S. Innala and M. Carlsson.

Presents summaries of articles on issues and innovations in the nursing practice worldwide as of May 2004. "Medical Hegemony in Decision-Making - A Barrier to Interdisciplinary Working in Intensive Care?," by M. Coombs and S. J. Ersser; "The Postmodern Heart: War Veterans' Experiences of Invasive Cardiac Technology," by C. C. Anderson; "Rational Suicide: Uncertain Moral Ground," by K. L. Rich and J. B. Butts.

BACKGROUND: This paper's starting point is the recognition (descriptive not normative) that, for the vast majority of day-to-day clinical decision-making situations, the 'evidence' for decision-making is experiential knowledge. Moreover, reliance on this knowledge base means that nurses must use cognitive shortcuts or heuristics for handling information when making decisions. These heuristics encourage systematic biases in decision-makers and deviations from the normative rules of 'good' decision-making. AIMS: The aim of the paper is to explore three common heuristics and the biases that arise when handling complex information in clinical decision-making (overconfidence, hindsight and base rate neglect) and, in response to these biases, to illustrate some simple techniques for reducing the negative influence of heuristics. DISCUSSION: Nurses face a limited range of types of uncertainty in their clinical decisions and draw primarily on experiential knowledge to handle these uncertainties. This paper argues that experiential knowledge is a necessary but not sufficient basis for clinical decision-making. It illustrates how overconfidence in one's knowledge base, being correct 'after the event' or with the benefit of hindsight, and ignoring the base rates associated with events, conditions or health states, can impact on professional judgements and decisions. The paper illustrates some simple strategies for minimizing the impact of heuristics on the real-life clinical decisions of nurses. CONCLUSION: The paper concludes that more research knowledge of the impact of heuristics and techniques to combat them in nursing decisions is needed. [ABSTRACT FROM AUTHOR]

In this paper the constructs `stress' and `coping' as defined in an earlier paper (Clarke 1984) are used as a perspective for the interpretation of disease processes. The second half of the paper is devoted to an examination of the nurse's role which is seen as concerned with helping patients in the reduction or avoidance of stress and the strengthening of coping. General hospital nursing and district nursing is analyzed in greater depth than other types of nursing. [ABSTRACT FROM AUTHOR]

This paper is concerned with the evaluation of a workshop for teachers of nursing devoted to an individualized teaching and learning strategy. The paper gives a brief account of the history of such workshops and continues by defining individualized teaching. Following this the characteristics of the Keller Plan strategy are outlined. This is followed by details of the course organization; its aims and objectives, and the characteristics of the course members. Finally, the method of evaluation is described and results are discussed. [ABSTRACT FROM AUTHOR]

The article focuses on the International Cancer Nursing Congress, held from September 4-8, 1978, in London, England. The conference was sponsored by the periodical "Nursing Mirror" and the Royal Marsden Hospital. During the week, over 50 papers were delivered at the congress, which focused continually on nursing and the role of the nurse in care, particularly in the care of patients living and dying with cancer. The congress was opened by the Secretary of State for Social Services, David Ennals, MP, who also hosted a reception for the international delegates at the Savoy Hotel, London, later on the first day on behalf of Her Majesty's Government.

Presents information on the "Journal of Advance Nursing." International relevance of the journal; Overview of its establishment; Subscribers and readers of the journal.

The article identifies the factors that have guided the changes and developments of research introduced into the "Journal of Advanced Nursing" since 2003. It also identifies the goals that signal the ever-higher standards that the journal has set. It discusses the significance of improving rigor and quality in reporting research. It also explains the journal's promotion to the media.

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.

Aim. This paper is a report of a concept analysis of community health. Background. Community health is a term that has been broadly used in both research and practice. Although local communities are invested in community health improvement, this process often occurs without a clear definition of the concept of community health. Data sources. Data sources included a sample of 537 papers covering the period 1990 to 2004 and representing the disciplines of nursing, public health, medicine and sociology and landmark works concerning community health, six community health assessment instruments and interviews with seven key community health informants. Review methods. Rodgers' Evolutionary Method of Concept Analysis was used to design the study and analyse the data. The professional literature was analysed and compared with the use of the concept of community health in community health assessment instruments and by key informants. Results. Dynamic and contextual, community health is achieved through participatory, community development processes based upon ecological models that address broad determinants of health. The primary focus of this collaborative work is population-based health promotion and disease prevention. Conclusion. The definition derived from the concept analysis of community health makes explicit the importance of community-based participatory action in local health improvement processes. Identification of the attributes of community health will enhance communication across disciplines involved in community health practice, research and education. [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. 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 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]

Title. Nursing’s ways of knowing and dual process theories of cognition 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 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 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 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

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.

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."

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.

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]

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."

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

Introduces a series of articles focusing on nursing.

BACKGROUND: Nursing knowledge is a composite of many influences. In an attempt to strengthen nursing knowledge and practice, there have been significant developments in the codification of nursing knowledge as part of the evidence-based practice movement. Using established research techniques; this has the capacity to enhance clinical practice. However, not all knowledge can be incorporated into this type of academic discourse, and there is growing interest in narrative knowledge. This paper contributes to this sometimes implicit and sometimes explicit critique of dominant paradigms. AIM: The aim of this paper is to examine the usefulness of narrative as a means of exploring the world of emergency nursing practice and its contribution to the emotional lifeworld of clinicians. METHOD: A discourse analysis of nursing narratives in their natural settings was carried out. This involved exploration of stories that were not produced for the purposes of research. FINDINGS: Narratives can open up social worlds, which escape or be deliberately erased by more formal methods. Contingent and subversive knowledge can contribute to understanding the emotional impact of emergency care. CONCLUSION: These narratives have their own 'truth', which should be incorporated into an understanding of what constitutes the lifeworld of emergency nurses. [ABSTRACT FROM AUTHOR]

Introduces a series of articles on nursing and medical care and practice.

BACKGROUND: The paper is based on a case study, which was part of a Department of Health commissioned research study covering 10 National Health Service (NHS) trusts in England that had adopted a range of approaches to the employment terms and conditions of nurses, midwives, and other non-medical staff, as the precursor to evaluating Agenda for Change, the modernized pay system for the NHS. AIM: The aim of this paper is to discuss a case study of the effects of changing nurses' pay progression. METHODS: Fieldwork took place in 2000, and included interviews with managers, union representatives and other staff, and analysis of internal documents. FINDINGS: Findings discussed include the constraints on managers when devising a new pay system, the time and detailed work needed and the challenges of assessing their effects (particularly in relation to patient care). Although the latter are difficult to assess, staff involved in the scheme reported benefits from the closer focus on competences which resulted from the scheme. CONCLUSIONS: The effects of changes to pay schemes are difficult to assess, and the evaluation of the proposed national scheme (Agenda for Change) will be challenging. [ABSTRACT FROM AUTHOR]

BACKGROUND: Considerable financial and philosophical effort has been expended on the evidence-based practice agenda. Whilst few would disagree with the notion of delivering care based on information about what works, there remain significant challenges about what evidence is, and thus how practitioners use it in decision-making in the reality of clinical practice. AIM: This paper continues the debate about the nature of evidence and argues for the use of a broader evidence base in the implementation of patient-centred care. DISCUSSION: Against a background of financial constraints, risk reduction, increased managerialism research evidence, and more specifically research about effectiveness, have assumed pre-eminence. However, the practice of effective nursing, which is mediated through the contact and relationship between individual practitioner and patient, can only be achieved by using several sources of evidence. This paper outlines the potential contribution of four types of evidence in the delivery of care, namely research, clinical experience, patient experience and information from the local context. Fundamentally, drawing on these four sources of evidence will require the bringing together of two approaches to care: the external, scientific and the internal, intuitive. CONCLUSION: Having described the characteristics of a broader evidence base for practice, the challenge remains to ensure that each is as robust as possible, and that they are melded coherently and sensibly in the real time of practice. Some of the ideas presented in this paper challenge more traditional approaches to evidence-based practice. The delivery of effective, evidence-based patient-centred care will only be realized when a broader definition of what counts as evidence is embraced. [ABSTRACT FROM AUTHOR]

Presents an overview of articles concerning nursing and health care management and policy. "Is an Expanded Nurse Role Economically Viable?"; "Occupational Stress and Constructive Thinking: Health and Job Satisfaction"; "Nursing Ethics and Conceptualizations of Nursing: Profession, Practice and Work."