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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]

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;

Introduces a series of articles about nursing practice and other related topics.

kearney p.m. & pryor j. (2004) Journal of Advanced Nursing 46(2), 162–170 The International Classification of Functioning, Disability and Health (ICF) and nursing Nursing conceptualizes disability from largely medical and individual perspectives that do not consider its social dimensions. Disabled people are critical of this paradigm and its impact on their health care. The aims of this paper are to review the International Classification of Functioning, Disability and Health (ICF), including its history and the theoretical models upon which it is based and to discuss its relevance as a conceptual framework for nursing. The paper presents a critical overview of concepts of disability and their implications for nursing and argues that a broader view is necessary. It examines ICF and its relationship to changing paradigms of disability and presents some applications for nursing. The ICF, with its acknowledgement of the interaction between people and their environments in health and disability, is a useful conceptual framework for nursing education, practice and research. It has the potential to expand nurses’ thinking and practice by increasing awareness of the social, political and cultural dimensions of disability. [ABSTRACT FROM AUTHOR]

This paper is based on the authors' experience of teaching and supervising the first intake of the management unit of the diploma for charge nurses offered by the Department of Professional Development and Training, Glasgow College of Nursing and Midwifery, Glasgow, Scotland. The students on this course undertake a project comprising of a documented research-based action plan aimed at the achievement of a selected topic for change directly linked with their practice. All the students except one were G grade charge nurses from a wide variety of clinical backgrounds. This paper will briefly consider the work of Barriball et al. who suggest categories of outcomes of continuing professional education. This is contrasted with Scheller, who highlights three problems when attempting to measure the impact of continuing education on practice. Despite these problems, it is beneficial to attempt to consider the impact of continuing professional education on practice. The work of Francke et al. will be featured in which they ascertain the determinants of changes in nurses' behaviour after continuing professional education. The authors believe that the management of change project, undertaken by the students, enhances the possibility that knowledge gained from the management unit will impact on their practice. Two examples of students' projects will be used to support the paper. The first concerns changing to a 12-hour shift pattern in an intensive care setting and the second relates to the implementation of the named nurse system. [ABSTRACT FROM AUTHOR]

The section comments on the article "Is the Professional Code Still the Cornerstone of Clinical Nursing Practice?," by P. Esterhuizen, which appeared in the 1996 issue of the "Journal of Advanced Nursing." It asserts that the paper provided an excellent overview of the problems that confront ethical codes in nursing. It emphasizes the need for more research on nurses' awareness and knowledge of their ethical codes. It focuses on three of the insights provided by Esterhuizen.

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

Aim. This paper is a report of a concept analysis of span of management. Background. Span of management is an important structural variable in evaluating the contributions of nursing managers to healthcare systems. Span of management is typically measured as a ratio. A wide variety of operational definitions have been applied and these differences have not been reconciled. Data sources. A search of CINAHL, PsychINFO and Business Source Premier was completed in 2007 using the terms span of management, span of control, organizational structure, hierarchy, supervisory ratio and work group size. Key publications (1975-2007) and seminal works were included. Review methods. Morse's concept analysis approach was used to determine the pragmatic utility of the concept. A critical appraisal of the literature assessed the use of the concept across disciplines, identified inconsistencies within the concept, and uncovered assumptions and conceptual gaps. Findings. At the organizational level, span represents supervisory capability. At the level of the manager, span may reflect reporting structure, closeness of contact, or scope of the role. At the work group level, span quantifies work group size. At the employee level, span represents employee support. These measures are influenced by units of measurement and by context. Conclusion. A systematic understanding of span of management concepts, measures and determinants will assist nurse executives in selecting parameters to quantify the allocation of managerial resources. Researchers can incorporate these parameters in comparisons across studies and in advancing the science of nursing management. [ABSTRACT FROM AUTHOR]

Aim. In this paper we present a theory-based taxonomy of the methods used to implement change in practice. Background. Implementation research is characterized by inconsistent terminology for the methods employed and inattention to differences in the relevance of methods across different disciplines. Studies of the effectiveness of implementation have yielded mixed results. Positive effects shown have been small. The limited success of many efforts to implement change in practice may be due, in part, to the absence of a framework to guide the use of implementation methods. Method. A provisional taxonomy of implementation methods, derived from theory and existing taxonomies, was used to content analyse a convenience sample of 43 reports of empirical studies of the implementation of one or more research-based practice changes involving nurses that had been published between 1995 and 2005. This taxonomy was revised throughout the course of analysis to capture more completely the information in each report. Findings. Following the analysis, nine of the 11 methods in the provisional taxonomy were retained, two were removed and five new methods were identified. The final taxonomy includes 14 implementation methods organized into five categories: (a) increasing coordination; (b) raising awareness; (c) persuasion via interpersonal channels; (d) persuasion via reinforcing belief that behaviour will lead to desirable results and (e) increasing behavioural control. Conclusions. The taxonomy presented here differs from prior taxonomies by focusing on nursing and by providing a clear and mutually exclusive guide to implementation methods. By deriving the initial coding strategy from theory, the taxonomy links the methods to theoretical constructs that may inform the selection of methods across different practice changes and settings. [ABSTRACT FROM AUTHOR]

AIM: The paper reports a study to develop and test a tool for assessing a range of factors influencing the development of evidence-based practice among clinical nurses. BACKGROUND: Achieving evidence-based practice is a goal in nursing frequently cited by the profession and in government health policy directives. Assessing factors influencing the achievement of this goal, however, is complex. Consideration needs to be given to a range of factors, including different types of evidence used to inform practice, barriers to achieving evidence-based practice, and the skills required by nurses to implement evidence-based care. METHODS: Measurement scales currently available to investigate the use of evidence in nursing practice focus on nurses' sources of knowledge and on barriers to the use of research evidence. A new, wider ranging Developing Evidence-Based Practice questionnaire was developed and tested for its measurement properties in two studies. In study 1, a sample of 598 nurses working at two hospitals in one strategic health authority in northern England was surveyed. In study 2, a slightly expanded version of the questionnaire was employed in a survey of 689 community nurses in 12 primary care organizations in two strategic health authorities, one in northern England and the other in southern England. FINDINGS: The measurement characteristics of the new questionnaire were shown to be acceptable. Ten significant, and readily interpretable, factors were seen to underlie nurses' relation to evidence-based practice. CONCLUSION: Strategies to promote evidence-based practice need to take account of the differing needs of nurses and focus on a range of sources of evidence. The Developing Evidence-Based Practice questionnaire can assist in assessing the specific 'evidencing' tendencies of any given group of nurses. [ABSTRACT FROM AUTHOR]

Until recently discussion about nursing research centred on the need to get it carried out. Attention is now being focused on how to get nursing research used, since so far, such research findings have not, on the whole, been assimilated into practice. Until this occurs the practice of nursing will not and cannot be research-based in any meaningful way. It is postulated that nursing research findings provide nurses with indicators for practice. This assumes that such findings are available and that the main barrier to their use is the poor communication of this research, (in a form they can understand) to nurse practitioners. However recent research into the use of research findings casts doubt on this assumption and it can be argued that such a view is too simplistic. In this paper therefore, three questions are asked: (1) Are relevant nursing research findings available which provide indicators for practice? (2) What indicators do such findings provide? (3) Are such findings used by nurse-practitioners? Using specific examples from nursing research, ideas and suggestions are put forward which provide a basis for possible answers. Finally the paper discusses the interdependence of research and practice and the need for them to develop together. [ABSTRACT FROM AUTHOR]

The paper begins with a review of the nature of theory-based practice and how it is evidenced. This is then used to demonstrate that theory is based upon practice and that there is not a gap between theory and practice but rather there is a theory-theory gap which is evidenced by a lack of experiential knowledge. The paper continues by exploring ways in which theory can be integrated in practice to provide the student with experiential knowledge and the challenge this creates for nurse teachers. It finishes with a proposal for the way in which the nurse teacher might develop his/her clinical role to address the gap whilst securing their basis for the future in higher education. [ABSTRACT FROM AUTHOR]

Title. Benefits of nurse prescribing for patients in pain: nurses’ views. Aim This paper is a report of a study to explore nurses’ views on the benefits of adopting the role of prescribing for patients with acute and chronic pain. Background. It was envisioned that the advent of nurse prescribing would be beneficial to the efficiency and effectiveness of the United Kingdom National Health Service. Research to date does indeed indicate that nurse prescribing can be beneficial to patients, nurses and the health service in general. Despite the expansion of nurse prescribing, there is little evidence of its impact according to nurses working in specialist areas, such as with patients in acute and chronic pain. Method. Interviews were conducted during 2006 and 2007 with 26 nurses qualified to prescribe medicines for patients in acute and chronic pain. This was a qualitative study and a thematic analysis was conducted. Findings. Nurses reported a number of benefits, including faster access to treatment, improved quality of care, more appropriate prescribing of medication, improved safety, improved relations and communication with patients, greater efficiency and cost effectiveness. Nurses benefited from increased job satisfaction, credibility with patients and healthcare professionals and also gained knowledge through prescribing. Conclusion. There is potential for the benefits of nurse prescribing to be expanded beyond the United Kingdom in settings where nurses hold similar roles in the treatment of pain, although further research using a wider range of research methods is recommended to substantiate these findings. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a study to explore practice nurse involvement in facilitation of self-management for long-term conditions. BACKGROUND: In the United Kingdom chronic disease services have shifted from secondary care to general practice and from general practitioners to practice nurses. A new United Kingdom General Practice contract requires adherence to chronic disease management protocols, and facilitating self-management is recognized as an important component. However, improving self-management is a relatively new focus and little is known about the ways in which nurses engage with patient self-management and how they view work with patients in chronic disease clinics. METHOD: Semi-structured interviews with 25 practice nurses were carried out in 2004-2005. Interviews were audio-taped and transcribed verbatim. Analysis was informed by the 'trajectory model' and 'personal construct' theories. FINDINGS: Main themes in the early stages of work with patients were: categorization of patients, diagnosis, and patient education. First impressions appeared to determine expectations of self-management abilities, although these were amenable to change. Intermediate stages were 'ways of working' (breaking the task down, cognitive restructuring and addressing dissonance, modelling 'good' behaviour, encouragement, listening, involving carers and referral) and maintaining relationships with patients. However, in the longer-term nurses seemed to lack resources beyond personal experience and intuitive ways of working for encouraging effective self-care. CONCLUSION: The ways of working identified are unlikely to be sufficient to support patients' self-management, pointing to a need for education to equip nurses with techniques to work effectively with patients dealing with longer-term effects of chronic illness. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a study to describe scholarly nursing practice from the perspectives of experienced nurses. BACKGROUND: Theoretically, nursing scholarship has been well-described in the literature and flourishes in academic environments. Nursing organizations and nurse leaders worldwide have embraced the value of and need for scholarship to advance the profession. However, the concept of scholarship has yet to be empirically examined within the practice setting from the perspectives of experienced nurses. METHOD: A qualitative descriptive research design was used. Semi-structured interviews were conducted with 36 experienced nurses purposively sampled from four acute care hospitals in north-eastern United States of America. The focus of the interviews was to understand how these nurses viewed themselves and their practice. The data were collected between 2004 and 2006 and analysed using content analysis. FINDINGS: Participants clearly articulated personal attributes and professional behaviours that characterized scholarly nursing practice. Two overarching inter-related categories emerged: 'Who I Am' and 'What I Do'. Themes within 'Who I Am' were Active Learner, Out of the Box Thinker, Passionate about Nursing, Available and Confident. Themes within 'What I Do' were Being a Leader, Caring, Sharing Knowledge with Others, Evolving and Reflecting on Practice. CONCLUSION: Scholarly nursing practice needs to be empirically examined worldwide. Additional studies should focus on scholarly nursing practice with nurses in varying stages of career development, in various types of practice settings, and in different cultures. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to assess the impact on nursing practice of critical care skills training for ward-based nurses. Background. Following a government review in the UK of adult critical care provision, new ways of working were advocated to ensure that critical care services depended on the needs of the patient, not their location in the hospital. A reconceptualization beyond service provision in high dependency units and intensive care units was required in order to deliver an integrated service. This has ramifications for training requirements. Methods. Semi-structured interviews were used to explore perceived learning and learning transfer from a range of courses. The data were collected from course attendees (n = 47) and line-managers (n = 19) across two sites between 2005 and 2006. Findings. Learning was closely associated with the clinical application of new skills and knowledge. Commonly, course attendees and line-managers quoted increased knowledge and confidence, better assessment skills and improved interprofessional working. Time with competency assessors, availability of expanding roles, and supernumerary time were key factors for successful learning transfer. Barriers were financial pressures on hospitals, lack of perceived relevance of the course to staff or nursing practice, and lack of time to practice skills or work with clinical skills facilitators. Conclusion. Course design should be a collaborative activity between education providers and commissioners to ensure the impact of training on practice. Relevance of material, time to practise skills and new learning, and organizational, rather than merely individual, support are essential for successful training interventions. [ABSTRACT FROM AUTHOR]

Title. Nurses’ experiences of drug administration errors Aim. This paper is a report of a study to describe the experiences of nurses who had committed serious medication errors, the meaning these experiences carry, and what kind of help and support they received after committing their error. Background. Medication administration is an important nursing task. Work overload, combined with increased numbers and dosages of medication prescribed, puts nurses at risk of making serious errors. A drug error has the potential for disastrous consequences for patients. What is sometimes disregarded is the effect on the nurse involved. The majority of research on nurses and medication errors is framed within biomedicine, law and management. Methods. An explorative, descriptive design was adopted and 10 in-depth interviews were conducted in 2003 with nurses who had committed a medication error. The text was analysed using a phenomenological method. Findings. Serious medication errors can have a great impact on nurses, both personally and professionally. Reactions from significant others were central to the final outcome for nurses who made drug errors. They wanted to share their experiences, but this required confidence and trust. Nurses were generally willing to accept responsibility for their errors. Conclusion. Strategies should be developed so that errors can be managed in a constructive manner, which includes exploring underlying causes and the counselling and support needs of the nurses involved. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of an investigation of the impact of prescribing on a group of recently qualified nurse prescribers in the United Kingdom. Background. The creation of advanced nursing roles, and specific skills such as nurse prescribing, has resulted in nurses taking on roles that have traditionally been associated with doctors. The non-doctor prescribing initiative is continually developing and many nurses are now able to prescribe independently from almost the same range of medicines as doctors. Despite the advantages that appear to stem from nurses prescribing, some nurse researchers have been cautious about the impact that prescribing may have on the nursing profession. Method. Interviews were conducted during 2005 and 2006 with 45 nurse prescribers. All nurses had successfully qualified and registered as prescribers. Interviews were analysed thematically in line with the principles of grounded theory. Findings. Prescribing allows nurses to overcome difficulties in the healthcare system that previously delayed patients' access to medicines. Prescribing is viewed as more than an 'add on' to current roles, it complements many aspects of nursing and integrates previously diffuse aspects of the nursing role. This enables nurses to adopt a more holistic approach to patient care and prescribing. Prescribing has the potential to increase job satisfaction and autonomous working, with the result that nurses are more likely to involve patients in decision-making about their care. Conclusions. Prescribing enhances nurses' knowledge about medication and increases their confidence to engage in prescribing decisions across the healthcare team. Nurse prescribing has the potential to improve service-user care, enhance collaboration and widen discussions about medicines. However, team members need to be prepared for the impact nurse prescribing could have on the dynamics of the multidisciplinary team. Preparatory information about nurse prescribing should be provided to all team members by trainee nurse prescribers. Information could include details about the proposed scope of future prescribing roles, allowing team members to consider how their roles could develop. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a study to develop and test the psychometric properties of the Nurse-Work Instability Scale (Nurse-WIS). Background. Work Instability describes the extent of any mismatch among functional (in)capacity, work demands and its potential impact on efficiency/productivity at work. Recruitment, retention and migration of nurses are global issues influenced by many factors. It is well documented that musculoskeletal pain and subsequent disability account for a high proportion of sickness absence and premature retirement in the nursing workforce. The challenge to clinicians is to identify such problems early so that appropriate interventions can be targeted to facilitate job retention. Method. Analyses of 48 qualitative interview transcripts conducted with nursing staff during 2003 were used to generate potential items for the Nurse-WIS. Analysis of the psychometric properties of the scale derived from these items was undertaken by using the Rasch model and data generated in postal surveys in 2004. The scale was validated against a gold standard of expert vocational assessment by occupational health physiotherapists/ergonomists. Findings. The resulting self-administered questionnaire consisting of 30 items not only measures the risk of job loss relating to musculoskeletal symptoms, but also captures relevant psychosocial issues. The scaling properties of this questionnaire meet the rigorous psychometric requirements of the Rasch model. Conclusions. The Nurse-WIS is a psychometrically sound method for the early identification of nursing staff experiencing difficulties at work. It offers the prospect of positive proactive management to prevent or minimize sickness absence and potentially prevent loss of nursing staff from the workforce through long-term sickness absence and early retirement. [ABSTRACT FROM AUTHOR]

Aim. This paper presents the findings of a study of the roles of Clinical Nurse Specialists and community nurses working in primary care. Background. Clinical Nurse Specialists are recognized internationally as expert practitioners who could facilitate the implementation of evidence-based practice. However, others may misunderstand their role and greater support may be required if organizations are to capitalize on the skills of Clinical Nurse Specialists. Methods. Elements of ‘Glaserian’ grounded theory in a broadly ethnographic approach were used to gain an understanding of the perspectives of 22 Clinical Nurse Specialists working as tissue viability nurses or continence advisors and 19 district nurses in one health region in the United Kingdom. The data were collected in 2001–02. Findings. Clinical Nurse Specialists were keen to use their expertise to inform the practice of community nurses. However, they encountered difficulties when seeking to introduce changes in practice. Although Clinical Nurse Specialists were acknowledged as enabling rather than deskilling community nurses, receptivity to Clinical Nurse Specialists’ ideas was dependent on what community nurses viewed as their own roles. As advisors, Clinical Nurse Specialists were dependent on the use of persuasion and vicarious power to bring about desired changes. These approaches are consistent with traditional approaches to change management as opposed to contemporary approaches to practice development. Conclusion. If Clinical Nurse Specialists are to reach their full potential and use their expertise to inform the practice of others, organizations need to recognize these posts as central to practice development. In particular, a framework is required which enables practice developers to use more inclusive approaches when seeking to bring about changes in practice. [ABSTRACT FROM AUTHOR]

Aims. This paper reports a study which aimed to: (1) investigate the relationship between nurses’ commitment to the nursing profession and organization and their intention to leave; (2) investigate nurses’ perceptions of the possibility of acquiring severe acute respiratory syndrome infection and its moderation of their commitment to the nursing profession and the organization and their consequent intentions to leave the profession and the organization following the severe acute respiratory syndrome outbreak. Background. The outbreak of severe acute respiratory syndrome in 2003 resulted in a fatality rate of approximately 11%. Nurses in hospitals caring for patients with severe acute respiratory syndrome maintained close contact with the infected patients. The high risk of infection and death associated with caring for patients with severe acute respiratory syndrome had a great impact on nurse retention in hospitals. Nurse turnover in many countries where these outbreaks occurred has been high since the first outbreak occurred in March 2003. Methods. Three hundred and thirty nurses working at a Taiwan hospital during the time of the severe acute respiratory syndrome outbreak completed the Meyer, Allen & Smith Organizational and Occupational Commitment Scales, Intention to Leave and Perceived Stress of Infection Scales between July and August 2003. Results. All three components of occupational and organizational commitments were negatively associated with nurses’ intentions to leave the nursing profession and the organization. Nurses’ perceptions of the possibility of acquiring severe acute respiratory syndrome infection through caring for these patients had a moderating effect on the relationship between commitment and the intention to leave. Conclusions. Perceived risk to life from infection has a possible influence on the commitment/intention-to-leave model in hospital nurses caring for patients with severe acute respiratory syndrome, and this information can inform hospital and nursing managers about nurse retention following a severe acute respiratory syndrome outbreak and the management of commitment in the context of nursing human resources management. [ABSTRACT FROM AUTHOR]

Aim. This paper reports on an interview study exploring the self-regulation process in women and men, 5 months after a first-time myocardial infarction. Background. Somatic, psychological and social factors affect readjustment after a first-time myocardial infarction, and studies have demonstrated substantial rates of depression in patients after myocardial infarction Women report poorer mental health and physical condition than do men. Reconstruction of the self begins when disease poses novel problems and is more likely to occur in cases of long-lasting and disruptive illnesses. Experiencing myocardial infarction is likely to alter a person's mental representation of self. However, the self-regulation process following first-time myocardial infarction is not yet fully understood. Method. Twenty-one people (11 women, 10 men) were interviewed 5 months after first-time myocardial infarction. The grounded theory method provided the strategies for data collection and analysis. Findings. Interviewees' definition of themselves as active was threatened by fatigue and other health problems that kept them from taking part in activities as they had done before the heart attack. Although reorienting the active self was central to the process of recovery from myocardial infarction, reorienting was restricted by illness perception and coping. Conclusion. Participants had not established a stable health condition 5 months after first-time myocardial infarction. They mainly preferred to moderate rather than radically change their daily life activities. They needed more knowledge and support. Nurses can help with information and advice on managing daily life activities, including dialogue about lifestyle changes at this phase of readjustment. [ABSTRACT FROM AUTHOR]

In this paper, a model describing nurses' responses to patients who are suffering is presented. The nurse's level of engagement with the patient is affected by whether the caregiver is focused on him-/herself or on the sufferer (i.e. embodied with the patient) and whether the caregiver is responding reflexively or with a learned response. Four types of communication patterns are identified: engaged responses (first-level) are used in a connected relationship; when the nurse responses reflexively and is focused on him-/herself, the response is reflected; when the caregiver is patient-focused, a learned response is labelled a professional response; and a self-focused, learned response is labelled detached. Examples of each type of response are provided. [ABSTRACT FROM AUTHOR]

Aim. This paper describes a participatory, evidence-based, patient-focused process for advanced practice nursing (APN) role development, implementation, and evaluation (PEPPA framework).Background. Despite the growing demand for advanced practice nurses, there are limited data to guide the successful implementation and optimal utilization of these roles. The participatory, evidence-based, patient-focused process, for guiding the development, implementation, and evaluation of advanced practice nursing (PEPPA) framework is an adaptation of two existing frameworks and is designed to overcome role implementation barriers through knowledge and understanding of APN roles and environments. The principles of participatory action research directed the construction of the new framework.Conclusions. The process for implementing and evaluating APN roles is as complex and dynamic as the roles themselves. The PEPPA framework is shaped by the underlying principles and values consistent with APN, namely, a focus on addressing patient health needs through the delivery of coordinated care and collaborative relationships among health care providers and systems. Engaging environmental stakeholders as participants in the process provides opportunity to identify the need and shared goals for a clearly defined APN role. The process promotes increased understanding of APN roles and optimal use of the broad range of APN knowledge, skills, and expertise in all role domains and scope of practice. The steps for planning and implementation are designed to create environments to support APN role development and long-term integration within health care systems. The goal-directed and outcome-based process also provides the basis for prospective ongoing evaluation and improvement of both the role and delivery of health care services. [ABSTRACT FROM AUTHOR]

fagerberg i. (2004) Journal of Advanced Nursing 46(3), 284–291 Registered Nurses’ work experiences: personal accounts integrated with professional identity The work context is important for the development of Registered Nurses’ skills and identity as professionals, but the work context and organization can also hinder their professional development. This paper reports a study whose purpose was to understand the meaning of Registered Nurses’ narratives of their work experience 5 years after graduation. Data were collected in 2001 from interviews with 16 Registered Nurses 5 years after graduation and analysed using a phenomenological hermeneutic method, influenced by the philosophy of Paul Ricoeur. Analyses of the narratives resulted in three themes: ‘The meaning of caring and protection of patients’, ‘The meaning of work organization in nurses’ work’ and ‘The implied meaning of using one's individual attributes in one's professional role’. Since the number of nurses participating in the study is small, it is important to re-contextualize the results when transferring them to other contexts. There is a complex interrelationship between the health care organization, individual attributes of nurses (including self-esteem) and patient care. Provision of adequate resources and support for nurses’ professional and personal development is needed to ensure high quality patient care, and these are political issues. [ABSTRACT FROM AUTHOR]

berkhout a.j.m.b., boumans n.p.g., van breukelen g.p.j., abu-saad h.h. & nijhuis f.j.n. (2004) Journal of Advanced Nursing 45(6), 621–632 Resident-oriented care in nursing homes: effects on nurses In a resident-oriented care model the assignment of patients to primary nurses takes place. These primary nurses are responsible for the total nursing care of their patients and make use of the nursing process. According to job demand-control models, these enlarged and enriched jobs can be described in terms of autonomy, job demands and social support, and the presence of these work characteristics has a positive influence on workers’ psychological and behavioural outcomes. This paper reports a study to investigate the extent to which the various features of resident-oriented care were implemented and its effects nurses’ on work characteristics and on psychological and behavioural outcomes in three Dutch nursing homes. In a quasi-experimental design, experimental and control groups were followed over 22 months, using a pretest and two post-tests with questionnaires, interviews and qualitative observations. The quantitative data showed significant increases in resident assignment, the two variables measuring the nursing process and, in the psycho-geriatric experimental group, on resident-oriented tasks. The qualitative data showed that a partly task-oriented division of labour was still used and that the planned delegation of coordination tasks to primary nurses was not fully achieved. Effects on work perceptions were limited. After implementation of the new system, the experimental group showed an increase in job autonomy. The intervention appeared to be only partly successful. Most of the expected results regarding work characteristics and psychological and behavioural outcomes did not materialize. Theoretical and methodological reflections are presented in the light of these findings. [ABSTRACT FROM AUTHOR]

BACKGROUND: The National Service Framework for Mental Health has emphasized the need to prioritize the provision of cognitive behaviour therapy as the central evidence-based non-pharmacological intervention for mental health problems. For 25 years one programme (English National Board Course No. 650--Diploma in Behavioural Cognitive Therapy, formerly called Nursing in Behavioural Psychotherapy) has trained nurses in such methods. This is the only programme in nursing which qualifies graduates to be fully certified as a cognitive behaviour therapist by the British Association of Behavioural Psychotherapy and by the United Kingdom Council for Psychotherapy. The practice of these nurse therapists (most commonly known as nurse behaviour therapists, NBTs) is the most rigorously evaluated in mental health nursing, with several randomized controlled trials to testify to clinical and economic efficacy. AIM: The aim of this study is to continue the systematic follow-up of all NBT graduates previously undertaken in two earlier surveys published in 1986 and 1994. These previous surveys examined clinical practice, organizational context and career and professional development issues. This up-to-date picture of NBTs will provide useful baselines for the implementation of the National Service Framework, and may be used by the Department of Health, education providers and services. METHOD: A postal survey (using the same template for categories of information as the two earlier surveys) was used and questionnaires were sent to 237 of the 274 trained NBTs whose name appears on the Central NBT Register, maintained at the Institute of Psychiatry/Maudsley Training Centre. RESULTS: One hundred and five of 230 eligible respondents (45.6%) returned questionnaires and additional data were obtained from 27 NBTs who provided information to the Register in the year before the survey. Thus, some data were available for 57% of the sample. As in earlier surveys, it was found that the majority of therapists remain in clinical practice, undertake substantial further education and training and are involved in research and teaching as part of their overall role. The two central developments are an increasing move towards working in primary care and an increased emphasis on cognitive interventions. NBTs complete a substantial number of treatments per year and increasingly treat clients with difficulties not encountered during their basic training. NBTs now receive much more supervision than in previous surveys and continue to use valid and reliable measures of change in practice. However, the number of NBTs remains small and the impact on potential populations who would benefit from effective psychological interventions is minimal. This paper discusses the implications for service delivery. [ABSTRACT FROM AUTHOR]

This paper reports part of an ongoing study on how nursing knowledge develops in practice and influences patient outcomes. The practice focus is post-anaesthesia nursing, an area which has been under-represented in nursing research. A qualitative approach was used to explore narrative data, collected by in-depth interviews, with 32 experienced post-anaesthesia nurses. Data analysis and interpretation were informed by a phenomenological perspective consistent with a research focus on individual experiences. Interpretation of the narratives gave rise to a description of knowledge development which occurred as nurses gained experience, drew on the available knowledge base, and used knowledge in practice. This led to the identification and description of 'referential' and 'effective' types of knowledge. Referential knowledge comprises the variety of external knowledge sources available to inform practice. When referential knowledge was incorporated into the personal knowledge of the individual nurse in everyday practice, it was transformed into effective knowledge which was used by nurses to achieve desired patient outcomes. The study findings indicate that nurses used effective knowledge as evidence for decision making and interventions in everyday practice. The key finding of the study is that effective nursing knowledge requires practice for its development. [ABSTRACT FROM AUTHOR]

In recent years, patient advocacy has been claimed as an integral part of the nurse's role in health care delivery in the United Kingdom (UK). Support from the nursing leadership/elite is seen as important in the promulgation and diffusion of any 'new' role in nursing. This paper explores the perceptions and attitudes of nurse leaders in the UK to the adoption of the patient advocate role as an 'innovation' in nursing. Using a qualitative methodology, semi-structured interviews with six of nursing's 'elite' were conducted over a period of 5 months. Results revealed contradictions and paradoxes within the views of the elite. Although leaders recognized patient advocacy as a role integral to the moral value system in nursing enhanced by the nurse-patient relationship, they objected to the professionalization of the role, seeing an exclusive claim to patient advocacy as intensifying interprofessional conflicts in health care. It is argued that unless professionalized, the individual nurse will continue this potentially risky activity without adequate authority or support systems. The results overall question the role of the nursing leadership in the diffusion of innovations in nursing. [ABSTRACT FROM AUTHOR]

This paper describes a preliminary cross-sectional study which aimed to compare levels of death anxiety and coping responses in palliative care and accident and emergency (A & E) nurses. Forty-three nurses (23 from palliative care and 20 from A & E) were recruited from a district general hospital and nearby hospice. Both sites had the same mean annual death rate of 150 patients. Death anxiety was measured by the Death Attitude Profile-Revised Questionnaire and coping responses were elicited by a semi-structured interview. As hypothesized, hospice nurses had lower death anxiety and they were more likely to recall both good and difficult experiences related to patient care. Unlike the hospice nurses, a subgroup (20%) of A & E nurses reported that they were unable to discuss problems with colleagues. The study has implications for the development of institutional support for staff to enable nurses to provide good quality care for dying patients and bereaved people. [ABSTRACT FROM AUTHOR]

The professional identity of the nurse: concept analysis and development The aim of this paper is to highlight the concept of professional identity of the nurse in order to promote theoretical clarity and examine implications for nursing practice. A modification of the hybrid model for concept development was followed. Accordingly, the theoretical analysis of conceptualizations and corresponding theoretical frameworks were combined with empirical data gathered from the field, from semi-structured interviews with eight registered nurses. The sampling was strategic and continuous. Personal and interpersonal dimensions and socio-historical aspects of the concept were found in the literature review as well as in the interview data. Attributes, antecedents and consequences of professional identity of the nurse in relation to the identified dimensions were stated. The analysis ends with a comprehensive description of the concept. Further, the relations to the concepts of self-esteem, self-image, professionalism and professional self-image, as well as professional function and roles of the nurse, are outlined. Finally, the importance of the developed concept is discussed, and suggestions for further research are presented. [ABSTRACT FROM AUTHOR]

The development of the extended role in nursing has been seen by some as primarily a means for nurses taking on tasks that have traditionally been the work of junior doctors. Others object to this view and ascribe to the 'new nursing' perspective of Salvage. She sees the extended role as moving towards increasing autonomy and operating in a professional rather than a bureaucratic occupational model. This view militates against the development of nurses as mini-doctors. This paper discusses the controversy surrounding the development of the extended role, focusing particularly on the use of complementary therapies as a legitimate component of the 'new nurses' role. [ABSTRACT FROM AUTHOR]

Over the last decade nursing has progressed from a reliance on empirical theory applied to practice to a recognition that experience develops knowledge that can guide the actions of practitioners. Reflection is a means of surfacing experiental knowledge, and students may begin to use reflection as their experience of nursing accumulates. As Carper was a key figure in widening that knowledge accepted as knowing in nursing beyond the empirical, it is both justified and recommended that her work should be incorporated into reflective practice. Johns has integrated Carper's work in his model of guided reflection and this paper briefly examines this combination. The main focus is on two further patterns of knowing: unknowing and sociopolitical knowing. These patterns are examined and the contribution they could make to reflective practice is discussed. [ABSTRACT FROM AUTHOR]

This paper argues that Heidegger's phenomenology does not have the methodological implications usually ascribed to it in nursing literature. The Heidegger of Being and Time is not in any sense antagonistic to science, nor does he think that everydayness is more authentic, more genuine, than scientific enquiry or theoretical cognition. It is true that social science must rest on interpretive foundations, acknowledging the self-interpreting nature of human beings, but it does not follow from this that hermeneutics exhausts all the possibilities. Positivist approaches to social science are certainly inconsistent with Heidegger's ontology, but realist approaches are not and structuration theory, in particular, can be seen as a sociological translation of his ideas. Social enquiry in nursing is not therefore confined to studies of lived experience. Indeed, lived experience research constitutes not a realization, but rather a betrayal, of Heidegger's phenomenology, being thoroughly Cartesian in spirit. [ABSTRACT FROM AUTHOR]

This paper explores the efficacy of reflective practice within the context of clinical supervision. It examines some potential limitations that reflective practice has within the context of clinical supervision drawing upon the literature and the early stages of the author's empirical work. It concludes that whilst there is considerable congruence in the use of reflective practice within clinical supervision sessions, there are potential disadvantages in making the assumption that reflective practice should be an integral part of all forms of clinical supervision. [ABSTRACT FROM AUTHOR]

In this paper, the consequences were there greater autonomy in nursing practice, are considerd. Autonomous practice implies accountability which entails both personal and professional responsibility: a personal responsibility to endorse ethical conduct consistent with professional practice; and a professional responsibility to exercise discretionary powers to the ultimate benefit of the patient. In this context, discretionary responsibility implies: recognizing a patient's wants may not be consistent with a patient's needs; abstaining from collusion with noncompliant patients; supporting the patient's right to refuse treatment only after full psychological exploration; understanding the psychological ramifications of informed consent from a practitioner and recipient point of view; maintaining appropriate personal and professional boundaries; and fostering collegiate relationships with the medical fraternity grounded on egalitarian principles. The author provides a philosophical and psychological analysis of responsibility in an effort to achieve a deeper understanding of the relationship this has with the concepts of 'freedom' and 'accountability'. [ABSTRACT FROM AUTHOR]

Although codes of practice for those concerned with the health care of others have always been inherent in the structure of societies, they have been institutionalized within the nursing discipline since the end of the last century. Up until the early 1970s they promulgated subservience to the medical discipline. As a result of the processes of emancipation and professionalization, the philosophy of the nurse has come to contain concepts of autonomy, accountability and patient-advocacy, based on a personal and individualized care system. Research in recent years has shown that nurses are making morally sound and ethically acceptable choices based on their own decision-making abilities, whilst having little or no active knowledge of the existing professional codes. Based on the literature, the author discusses ethical codes in relation to their perception by nurses in the clinical situation. The influence of the code in the areas of moral decision-making, administration and management, and education are likewise discussed and the conclusion is reached that codes remain the cornerstone of nursing practice. [ABSTRACT FROM AUTHOR]

The section comments on the article "Is the Professional Code Still the Cornerstone of Clinical Nursing Practice?," by P. Esterhuizen, which appeared in the 1996 issue of the "Journal of Advanced Nursing." It comments on the significance of professional code in clinical nursing practice. It points out the adverse impact of the failure of management to implement the spirit of the codes. It asserts that nurses feel uncomfortable with any prescriptions that might limit professional practice.

Title. Caring for abused women: impact on nurses’ professional and personal life experiences. Aim. This article is a report of a study of the impact of caring for abused women on nurses’ professional and personal life experiences. Background. Encountering abused women can have emotional, cognitive and behavioural influences on nurses, known as vicarious traumatization. They may feel incompetent to deal with such an overwhelming problem and may avoid screening survivors of abuse. Thus, nurses treating these survivors need to be aware of their attitudes, emotions and differential responses during these interactions. Method. A phenomenological study was carried out in 2005 in Israel. The data were collected using in-depth, interviews with 22 female Israeli nurses in hospitals and community healthcare clinics. Findings. Data analysis revealed one main theme, ‘Struggling on work and home fronts’, based on two subthemes: ‘Encounter with domestic violence: a challenge to nurses’ professional role perception’ and ‘Between work and home’. Nurses experience perplexity regarding abused women and their professional care. Encounters with these women challenge nurses’ personal and professional attitudes, as well as influencing their personal lives (intimate relationships, parenthood and gender attitudes). These encounters induce empathy and compassion, but also anger and criticism towards abused women, creating emotional labour for the nurses. Conclusion. The dissonance between personal values, attitudes and emotions and the desirable professional intervention procedures might impede nurses’ performance in caring for abused women. Implementing training programmes for screening and intervening with abused women might reduce the emotional labour required, enhance nurses’ responses to domestic violence, and enable personal growth. [ABSTRACT FROM AUTHOR]

The author contends that with the acceptance of health care as a universal human right has come a variety of national, provincial, state, and local systems for providing health care. An international network of rapid communications makes peoples everywhere aware of the variety of systems and the fact that some systems other than their own show better results, as measured by, for example, the infant mortality rate, or the incidence of venereal disease. Traditional roles for doctors, nurses, health educators, social workers and others are in question. To meet the needs of the people, health educators, physicians, social workers, nurses and all other categories of health personnel must constantly evaluate their roles and be ready to modify them for the common good and modify the programmes that prepare them for their work. While the roles of doctors, nurses and others are, necessarily, in these rapidly changing times, in a fluid state, some health workers must provide a 24-hour service that helps human beings with their essential daily activities when they lack the strength, knowledge, or will, to carry them out unaided and to work towards the development of a healthy independence. This intimite and essential service is, in the author's opinion, the universal element in the concept of nursing. The most successful preparation of nurses will, the author argues, always include whatever gives them the broadest possible understanding of humanity and the world in which they live. It will also provide an opportunity to see expert nursing care given and to have the satisfaction of seeing the care they themselves give, hasten a person's recovery, help a person cope with a handicap, or die in peace when death is inevitable. [ABSTRACT FROM AUTHOR]

ramage c. (2004) Journal of Advanced Nursing 45(3), 287–296 Negotiating multiple roles: link teachers in clinical nursing practice The background to this study was a concern about the teacher's role in clinical practice. Experience suggested that teachers believed that their role in practice was important but that there were significant forces which impeded their ability to move with ease between education and practice. A discrepancy between previous research findings and theoretical discussions, and the reality experienced by teachers, led to the adoption of grounded theory as a way of exploring uncertainties in the situation. Data were gathered over a period of 7 years and involved 28 in-depth interviews with nurses with a range of educational roles, employed in educational institutions and practice settings in inner city and provincial areas in the South of England. The data revealed four categories, ‘gaining access’, ‘negotiating credibility’, ‘being effective’ and the core category ‘negotiating multiple roles’. The core category is addressed in this article. Experiences of moving from a position of clinical practitioner to link teacher involved: ‘disassembling the self’ through leaving behind old identities; ‘reconstructing the self’ through clarifying new ways of being; and, finally, ‘realizing the self’ through reciprocal interpersonal activity with students, educational and nursing colleagues. It is inevitable that an individual with a remit for change entering an established social group will experience difficulties in establishing their role. It is also clear that an individual who changes their role within a group to reflect behaviours not congruent with the primary activity in that setting will experience dimensions of social exclusion. Further work needs to address how educational roles can make a significant impact on the everyday lives of students and nurses working in practice. The findings of this study are as relevant for the new roles of practice educator, clinical facilitator and practice placement co-ordinator as they are for link teachers and lecturer practitioners. Several suggestions are made to improve links with practice. [ABSTRACT FROM AUTHOR]

varcoe c., doane g., pauly b., rodney p., storch j.l., mahoney k., mcpherson g., brown h. & starzomski r. (2004) Journal of Advanced Nursing 45(3), 316–325 Ethical practice in nursing: working the in-betweens While contemporary ethical theory is of tremendous value to nursing, the extent to which such theory has been informed by the concerns and practices of nurses has been limited. With a view to complementing extant ethical theory, a study was undertaken to explore, from the perspective of nurses, the meaning of ethics and the enactment of ethical practice in nursing. Located in the interpretive/constructivist paradigm, using an emergent design, this inquiry employed focus groups to collect the data. Eighty-seven nurses from a wide range of practice settings were interviewed in 19 focus groups of three to nine nurses each. The nurses described ethics in their practice as both a way of being and a process of enactment. They described drawing on a wide range of sources of moral knowledge in a dynamic process of developing awareness of themselves as moral agents. Enacting moral agency involved working in a shifting moral context, and working in-between their own values and those of the organizations in which they worked, in-between their own values and those of others, and in-between competing values and interests. Analysis of the experiences and concerns of the nurses offered new understanding of ethics in nursing and direction for the development of ethical theory pertinent to nursing practice. [ABSTRACT FROM AUTHOR]

gibson f., fletcher m. & casey a. (2003) Journal of Advanced Nursing 44(6), 591–602 Classifying general and specialist children's nursing competencies Whilst there is evidence in the literature to support the continuation of a children's nursing qualification, the distinction between generalist and specialist nursing is insufficiently comprehensive to distinguish children's nursing from other branches of nursing. To develop a definition of children's nursing and specialist children's nursing in terms of competencies as the basis for differentiating them from other forms of nursing. A multi-method comparative design incorporating a case study approach was used. This included a nominal group technique, focus groups, Delphi survey and semi-structured interviews. Two arms of data collection were undertaken concurrently (during 1998–2000) with children's nurses ( n = 146) and specialist children's nurses (children's cancer nurses, n = 37) from a number of centres in the United Kingdom (UK). The holistic competencies developed from the data exposed characteristics of knowledge, skills, abilities, values and qualities displayed in the context of professional work for both groups of nurses. A classification of competencies was developed inductively from the data by two independent researchers through the labelling, defining and ordering of competencies. The resulting hierarchy of competencies and sub-competencies illustrates relationships between children's nurses and specialist children's nurses and provides a detailed definition of children's nursing and specialist children's nursing. There is a significant common element in these two areas of nursing practice, and generalist preparation in children's nursing is the foundation of specialist children's nursing practice. Generalist knowledge and skills are expanded in specialist practice and there is also evidence of specialist practice that is beyond the scope of general nursing practice. [ABSTRACT FROM AUTHOR]

BACKGROUND: The nature of modern government and needs of policy-makers demand accurate information that is delivered quickly. This study was part of a larger project for the Department of Health relating to nurse practitioner (NP) education and practice in UK. AIMS: The aim of the study was to identify the principal factors that help or hinder the development of NP roles in the National Health Service. METHODS: In order to facilitate a rapid response, a Delphi study was undertaken using electronic mail (e-mail) and was completed within 4 weeks. Key stakeholders in NP practice, education and research and (non-governmental) policy-making were invited to participate. Key themes relating to the deployment and practice of NPs were generated. These were refined and collated by the research team and then rated by the respondents. RESULTS: This approach generated valuable expert consensus data around NP deployment and practice. Nurse practitioners' practice is recognized as an integral part of health care that needs to be recognized by regulatory bodies to promote understanding of their potential at local levels. Nurse practitioners need freedom to innovate, adequate support and appropriate education to allow true autonomy. Limited prescribing and local restrictions on requesting investigations hinder practice. LIMITATIONS: Although this was a small-scale study, the expert panel was wide-ranging and achieved substantial consensus. CONCLUSION: The organisational and cultural changes that are required to foster the development of practice and deployment of NPs have yet to be instigated, according to the comments of the key stakeholders in this study. There appears to be a clear message that the government needs to take a more interventionist role in supporting nursing developments, rather than leaving this to local arrangements. [ABSTRACT FROM AUTHOR]

Background. Two approaches dominate current thinking in health and welfare: evidence-based practice and reflective practice. Whilst there is debate about the merits of evidence-based practice, reflective practice is generally accepted with critical debate as an important educational tool. Where critique does exist it tends to adopt a Foucauldian approach, focusing on the surveillance and self-regulatory aspects of reflective practice. Aim. This article acknowledges the critical purchase on the concept of reflective practice offered by Foucauldian approaches but argues that microsociological and discourse analytic approaches can further illuminate the subject and thus serve as a complement to them. Methods. The claims of proponents of reflective practice are explored, in opposition to the technical-rational approach of evidence-based practice. Findings. Reflective practice tends to adopt a naive or romantic realist position and fails to acknowledge the ways in which reflective accounts construct the world of practice. Conclusions. Microsociological approaches can help us to understand reflective accounts as examples of case-talk, constructed in a narrative form in the same way as case records and presentations. [ABSTRACT FROM AUTHOR]

Background. Interpersonal conflict among nurses (traditionally called ‘horizontal violence’ or ‘bullying’) is a significant issue confronting the nursing profession. However, there is a dearth of research focusing on horizontal violence experienced by new graduate nurses. Aims. In order to assess the priority for preventive intervention programmes, the aims of this study were to determine the prevalence of horizontal violence experienced by nurses in their first year of practice; to describe the characteristics of the most distressing incidents experienced; to determine the consequences, and measure the psychological impact, of such events; and to determine the adequacy of training received to manage horizontal violence. Method. An anonymous survey was mailed to nurses in New Zealand who had registered in the year prior to November 2000 (n = 1169) and 551 completed questionnaires were returned (response rate 47%). Information was requested on the type and frequency of interpersonal conflict; a description of the most distressing event experienced; the consequences of the behaviour; and training to manage such events. The Impact of Event Scale was used to measure the level of distress experienced. Results. Many new graduates experienced horizontal violence across all clinical settings. Absenteeism from work, the high number of respondents who considered leaving nursing, and scores on the Impact of Event Scale all indicated the serious impact of interpersonal conflict. Nearly half of the events described were not reported, only 12% of those who described a distressing incident received formal debriefing, and the majority of respondents had no training to manage the behaviour. Conclusions. First year of practice is an important confidence-building phase for nurses and yet many new graduates are exposed to horizontal violence, which may negatively impact on this process. The findings underscore a priority for the development of effective... [ABSTRACT FROM AUTHOR]

Aims. To investigate the place and validity of effective process in evaluating health promotion practice in nursing and, in doing so, develop a specific model for this purpose. Background/rationale. The failure of many nurses to provide successful health promotional programmes is underpinned by a distinct lack of evaluation research activity. Without this type of activity, health-related nursing practice remains limited in its scope and nature. This article seeks to redress this situation by proposing a specific evaluation model that assists the nurse in their attempts to include evaluative research activity in future health promotion practice. Method. This article draws on existing literature to develop an evolving theoretical perspective for health promotion practice in nursing. The proposed model was developed from this perspective. Conclusion. Evaluation is an essential activity for any health promotion programme. Failure to include it in practice ensures that attempts to conduct health promotion are usually rendered ineffective and unsuccessful. Evaluation models are valuable tools that nurses can incorporate routinely into existing frameworks of practice, alongside other models of health education/health promotion, such as planning models. The development of this model is intended to enable nurses to review their current practice and offer a further framework for those who wish to extend their current health promotion repertoire. [ABSTRACT FROM AUTHOR]

Background. Diabetes constitutes a global public health problem. Today about 135 million people are affected and it is estimated that the number in 2025 will be 300 million. Aims. By reviewing existing literature the aim is to raise awareness among nurses, nurse educators and nursing students of the global epidemic of diabetes mellitus, its multiple underlying causes, especially social ones, and how to fight it. A further aim is to discuss the implications for future curriculum content in nurse education programmes. Findings. The main underlying causes of the disease are genetic and environmental factors, such as urbanization and industrialization, as well as increased longevity and changes in lifestyle from a traditional healthy and active life to a modern, sedentary, stressful life and over-consumption of energy-dense foods. This process, labelled 'coca-colonization', is evident all over the world, although more so in developing countries. The prevalence of diabetes mellitus varies among populations due to differences in genetic susceptibility and social risk factors such as change in diet, obesity, physical inactivity and, possibly, factors relating to intrauterine development. Migrants are especially affected. Diabetes mellitus needs to be treated by a holistic approach through dietary adjustment, exercise, medication (if needed), education and self-care measures. Type 2 diabetes mellitus is a preventable disease. The main implication for nurses and nursing curricula is to change the focus from the individual with diabetes mellitus and management to prevent deterioration of health (secondary prevention), to population-based community-intervention programmes. These need to focus on health promoting activities to raise awareness among healthy people of the risk factors for diabetes mellitus. Conclusion. Nurses all over the world have an important role in fighting the diabetic pandemic by health promotion aimed to keep people healthy as long as possible. [ABSTRACT FROM AUTHOR]

AIMS OF THE STUDY: To determine: (1) the types of clinical events nurses perceived as 'critical'; and (2) whether nurses' experiences of critical incidents were associated with any demographic variables such as qualifications and current area of work. BACKGROUND: A review of the literature revealed little research has investigated in detail which clinical events nurses perceived as 'critical', apart from two North American studies. Exploratory research of Australian nurses was undertaken to confirm and contrast their understandings and views with those of other work specialties and North American findings. DESIGN/METHODS: Two hundred and twenty-seven full-time registered nurses at a metropolitan medical centre responded to a survey questionnaire designed for the study based on findings of earlier studies regarding critical incidents. RESULTS: Respondents viewed the sexual abuse of a child and death of a child as the most critical of events listed on the questionnaire and an emergency situation as the most frequent and stressful incident in the previous year. Factor analysis indicated the existence of three types of critical incident represented by Grief, Emergency, and Risk Scales. Events on the Grief scale were most stressful for respondents. Although several significant relationships were found for demographics with the Grief and Risk Scales, findings were considered tentative because of disproportionate representation on many of the demographics. CONCLUSION: Further research is necessary to substantiate the findings of the study. However, the identification of the scales provided a concise way of conceptualizing the essential elements of critical incidents. [ABSTRACT FROM AUTHOR]

Aim. The aim of this study was to explore family caregivers' experiences of in-hospital respite care for people with dementia and the factors that influenced their perceptions of the service. Background. The provision of respite care is based on the assumption that temporary relief from caregiving will relieve caregiver stress and may possibly extend the duration of home care. Research evidence suggests that this is a simplistic perspective which fails to account for families' concerns about the quality of institutional care and the impact of relocation on the person being cared for. Design. Nine family caregivers, using four different hospitals sites were interviewed during a period of 3 years from 1994 to 1997. The research texts were analysed using a critical discourse analysis approach drawing on the work of Foucault. Findings. Family caregiver texts were distinguished by difference rather than by homogeneity. Caregivers occupied a range of positions in terms of their ability to take advantage of the respite time intermittent care offered. My reading of these texts has highlighted the aspects of nurse-family relationships that ameliorated, or alternately exacerbated, the tensions felt by caregivers, as they were torn between the necessity to have a break and their anxieties about the impact of in-hospital respite care on the person with dementia. Conclusion. Nurses' practices in this study were a critical element in facilitating, or alternately constraining, family caregivers' ability to relinquish care and to take full advantage of the respite time. The research findings highlight the need for nurses and other formal caregivers to locate themselves in a secondary and supporting caregiving role, to acknowledge the family caregivers as the primary caregiver, and use family caregivers in-depth and intimate knowledge of the needs of their relative to inform care within the institutional setting. [ABSTRACT FROM AUTHOR]