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Reports on the research conducted by the author which analyzes articles and research findings published in the 2001 and 2002 issues of the periodical "Journal of Clinical Nursing." Revelation that Great Britain was the highest contributor to the periodical; Information that not a single paper was published from the U.S.; Methodology adopted by the researcher; Details of three broad categories under which research papers by the journal are published.

The article reports on the range of methods used in the original papers in the "Journal of Clinical Nursing." In this issue of the journal the author included original papers only. He use the content of the abstract to decide what the main methodological feature of the paper was. The author discusses the problems relating to the methodological variety of papers published in nursing journal.

The author reflects on the aims of the making "Journal of Clinical Nursing" (JCN) be known internationally. The journal is an international scientific journal which seeks to promote the development and exchange of knowledge that is directly significant to nursing and midwifery practice. With manuscripts reviewed internationally and international responses from around the world, these realizes the aim to be known. The research published within are of the international standard and relevance.

AIM AND OBJECTIVES: To provide an overview of tinnitus, current management and its psychosocial impact offering strategies for managing acute and chronic tinnitus in practice. BACKGROUND: Tinnitus, characterised by the perception of sound in the absence of external stimuli, is experienced by about 10% of the population at some time in their lives. It may be temporary/longstanding; approximately 5% adults experience severe, persistent tinnitus affecting their lifestyle. Although many adjust successfully, others are disabled by the condition. Though often unrecognised, tinnitus affects many patients regardless of their presenting illness. DESIGN: A literature review including descriptive, theoretical and empirical material. Databases were searched using the keyword 'tinnitus' providing diverse information which was used to address the research questions. RESULTS: Tinnitus represents more than 'simple' ringing in the ears and may be accompanied by many distressing changes. It may be acute or chronic. It is difficult to treat, care may be directed towards management rather than cure. Many patients are, however, told that 'nothing can be done'. Relevance to clinical practice. Despite the high prevalence of tinnitus, there is a paucity of relevant nursing literature suggesting that there is an information deficit amongst nurses. The information provided shows that understanding the full impact of the condition and identification of patients' needs are essential to effective care. Strategies to help affected patients are given. CONCLUSIONS: Tinnitus, a widespread, often intractable condition, affects millions of people; there is considerable debate about its causes. Tinnitus is distressing and may be severe enough to affect lifestyle and quality of life. Affected patients need considerable support and advice on healthcare options, encouragement to try different treatments and recognition that help and hope are available. Though patients may have to learn to live with tinnitus, the most important thing is that they recognise that help is available. [ABSTRACT FROM AUTHOR]

Comments on the articles on the importance of place in older people nursing, published in the September 2, 2005 issue of the "International Journal of Older People Nursing." Contextual information provided by geographical gerontology; Potential of geographical gerontology to provide critical and direct evidence for practice; Role of place in the concepts of gerontological nursing practice.

The front cover of the journal is presented along with the issue's editors and information on membership and subscriptions.

AIMS: The aim of this paper is twofold. Firstly, it describes hospital nurses' general use of the language function in the nursing discharge notes of patients who will require posthospital home health care. Secondly, it addresses the similarities and differences in completeness, structure and content between paper and electronic nursing discharge notes. BACKGROUND: Previous research has identified gaps in the accuracy and relevance of information communicated between nurses working at different organizational levels. DESIGN AND METHODS: A descriptive design with a text analysis framework was used. RESULTS: The study shows that the text in the nursing discharge notes is information-dense and characterized by technical terms, although the nurses contextualized and individualized the content of the terms to clarify the message. Both similarities and differences were found in range and detail of the information nurses exchanged when they used paper or electronic discharge notes. CONCLUSIONS: The use of structured and standardized templates helped nurses improve the completeness, structure and content of the information in the nursing discharge notes. RELEVANCE TO CLINICAL PRACTICE: Whether paper or electronic documentation is used, the findings in this study highlight the challenges nurses encounter in ensuring continuity of care during patients' trajectory through the health system. The findings may help clarify the appropriateness of the content and language nurses use in the nursing discharge note as a communication medium. This study may also be helpful to nurses planning to use EPRs, as it illustrates some of the issues which should be clarified before this is implemented. [ABSTRACT FROM AUTHOR]

The article presents the editorial policy of the journal regarding the subject of authorship.

The article highlights several original articles published in 2005 to reflect the clinical content of the first issue of the "Journal of Clinical Nursing." The article on endometriosis is about women's health and about pain that could also fall within the area of endocrinology. Articles about children are often about a specific disease like asthma and could be classified under respiratory nursing. Papers about stroke are usually based on an older population and could be classified under older people or neurological nursing.

Aims and objectives. To review the literature on inflammatory bowel disease in older and younger people and to identify whether they included a nursing or psychosocial perspective, or were informed by theories of ageing. Background. Inflammatory bowel disease, manifested as Crohn's disease and ulcerative colitis, affects younger and older people and is associated with a range of psychosocial factors. Nurses have an important role to play in caring for people with inflammatory bowel disease. Methods. A systematic review of literature related to inflammatory bowel disease and older people was carried out using the MEDLINE, CINAHL EMBASE and Cochrane databases between 1990-2006. Conclusions. Generally speaking, the clinical features of inflammatory bowel disease are similar in younger and older people, as are indications for surgery, survival and the usual wide spectrum of severity of disease. Corticosteroid treatment carries additional risk for older people. The studies used both retrospective and prospective designs, with the former using patient records, and the latter using follow-up of patients with inflammatory bowel disease. Sample sizes were adequate for statistical analyses but there was no reference to reliability or validity of data collection methods. None of the studies considered psychosocial aspects, or the role of nurses in caring for people with inflammatory bowel disease. A specific gerontological perspective was lacking from the papers reviewed. While the clinical features of inflammatory bowel disease are similar in younger and older people, with the bimodal distribution of age of onset of inflammatory bowel disease, the possibility exists that quality of life and adjustment in older people depend on age of onset. This has not been investigated. Future lines of enquiry taking psychosocial aspects of inflammatory bowel disease into account in older people are explored. Relevance to clinical practice. Nurses play an increasingly important role in the assessment and management of inflammatory bowel disease patients. Little is known about factors which could predict poorer psychosocial health and the impact non-intestinal manifestations may have on this in older people with inflammatory bowel disease. [ABSTRACT FROM AUTHOR]

Editorial. Discusses the topics published in the 2003 issue of the 'Journal of Clinical Nursing.' Quality of published manuscripts; Cost-effectiveness of hospital and home care for patients receiving total joint replacement; Importance of evidence for health care interventions.

Focuses on the process of journalism in relation to the contributions submitted to the 2004 publication of the "Journal of Clinical Nursing" (JCN). Guidelines for the authors; Importance of reviewing the contents of "JCN"; Presentation of the manuscripts as requested in the Guidelines for Authors.

The article presents an examination of the international content of the journal. The author reports that the journal published papers from 46 countries covering all continents of the world. He explains that the journal is becoming increasing international, that it has published more papers in 2008 than any other nursing journal, and continues to have a high impact factor.

Focuses on key issues in gerontological nursing that have a direct impact on practice. Definition of practice development; Overview of the philosophy of personhood; Discussion of the concept of person-centered practice in the context of gerontological nursing.

Aims and objectives. The aim of the study was to enable those planning to make submissions to the 2008 Research Assessment Exercise to make informed decisions regarding their research strategies. The objective of the study was to identify the factors that distinguish those units of assessment (Universities and Higher Education Institutions) that were highly rated from those that received a low rating for nursing in the Research Assessment Exercise of 2001. Background. Nursing research differs in kind from other types of biomedical research. There is a tendency for research in nursing to be characterized by an inward-looking focus and dominated by a concern with the profession itself. Design. The examination of the research output of nursing. Methods. Data from the abstracts of journal articles submitted to the 2001 Research Assessment Exercise for nursing were extracted, classified, collated and analysed. Results. The publications submitted by those in the higher-rated units showed a greater tendency than those submitted by those in the lower-rated units to report on a study involving the collection of primary data; to be multi-authored; to use either qualitative methodology or randomized-controlled trials; and to focus upon clinical issues and have patients as the subjects of the research. Conclusion. Nursing research is in a process of change and growth and is still of variable quality. The development of research towards patient care and clinical issues, and away from issues relating to the profession itself, is most evident among those units of assessment rated highly in the 2001 Research Assessment Exercise. Relevance to clinical practice. The study indicates that the best of current nursing research is focused upon clinical issues and patient care. [ABSTRACT FROM AUTHOR]

BACKGROUND: Patients with acute cardiac chest pain receive oxygen as part of their treatment. Oxygen is given in the belief it will help to correct the oxygen demand - supply imbalance of acute myocardial ischaemia. AIMS AND OBJECTIVES: The aim was to review the evidence base for the use of oxygen to treat acute myocardial ischaemia and the objective was to include all evidence of sufficient quality. DESIGN: A systematic review was carried out to provide a thorough, transparent and replicable review process. METHODS: The review included randomized and non-randomized clinical trials; patients with acute coronary syndrome (unstable angina or acute myocardial infarction); and any outcome measurements of myocardial ischaemia. RESULTS: Nine trials were found, of which two were randomized controlled trials and seven non-randomized clinical trials. There were quality assessment concerns over the methodology, size and analysis within the trials. The effectiveness of oxygen in reducing myocardial ischaemia was unclear from the review, as the trials contained data that suggested oxygen reduced myocardial ischaemia, but also data that suggested it increased myocardial ischaemia. CONCLUSIONS: No definite conclusions could be drawn as to whether oxygen reduced, increased or had no effect on acute myocardial ischaemia. The papers were divided as to recommending oxygen use for all patients with acute myocardial ischaemia or not - although all agreed that patients with systemic hypoxaemia should have this corrected by oxygen administration. The key finding of the review was that there was insufficient evidence. RELEVANCE TO CLINICAL PRACTICE: As oxygen is routinely administered to treat acute myocardial ischaemia, the lack of a clear supporting evidence base must be a source of concern. This is especially so as some of the evidence suggested oxygen may increase myocardial ischaemia. There is a need for experimental-design clinical research to test the effectiveness of oxygen in reducing myocardial ischaemia. [ABSTRACT FROM AUTHOR]

The article presents the author's comments on the paper "An Adolescent Ward; 'In Name Only'," by A. Hutton, that was previously published in the journal. According to the author, Hutton's paper shows the application of power in the management of adolescents within a clinical area. He agrees with the situation highlighted by Hutton in which adolescent wards are seduced by the provision of adolescent facilities, manned by clinical staff to regulate and monitor adolescent behaviour.

The article focuses on the integration of the "Journal of Clinical Nursing" to the Blackwell Synergy OnlineEarly Service. The published papers are considered peer reviewed, edited and complete when they are published online. Changes cannot be made after the online publication date. The papers can be cited as references by using their Digital Object Identifier numbers. The implementation of the OnlineEarly service for the journal represents a commitment to get manuscripts available to the academic community as soon as possible, without sacrificing quality or completeness.

Aims and objectives. This paper provides a context for this special edition. It highlights the scale of the challenge of nursing shortages, but also makes the point that there is a policy agenda that provides workable solutions. Results. An overview of nurse:population ratios in different countries and regions of the world, highlighting considerable variations, with Africa and South East Asia having the lowest average ratios. The paper argues that the 'shortage' of nurses is not necessarily a shortage of individuals with nursing qualifications, it is a shortage of nurses willing to work in the present conditions. The causes of shortages are multi-faceted, and there is no single global measure of their extent and nature, there is growing evidence of the impact of relatively low staffing levels on health care delivery and outcomes. The main causes of nursing shortages are highlighted: inadequate workforce planning and allocation mechanisms, resource constrained undersupply of new staff, poor recruitment, retention and 'return' policies, and ineffective use of available nursing resources through inappropriate skill mix and utilisation, poor incentive structures and inadequate career support. Conclusions. What now faces policy makers in Japan, Europe and other developed countries is a policy agenda with a core of common themes. First, themes related to addressing supply side issues: getting, keeping and keeping in touch with relatively scarce nurses. Second, themes related to dealing with demand side challenges. The paper concludes that the main challenge for policy makers is to develop a co-ordinated package of policies that provide a long term and sustainable solution. Relevance to clinical practice. This paper highlights the impact that nursing shortages has on clinical practice and in health service delivery. It outlines scope for addressing shortage problems and therefore for providing a more positive staffing environment in which clinical practice can be delivered. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: The aim of this paper is to reflect on how an acute hospital trust involved a youth council comprising 17 young people aged 11-18 years to improve children's service delivery in one NHS trust in the UK. BACKGROUND: Over the last decade, there has been an increased emphasis on the active involvement and participation of children and young people in the decision-making processes that affect them. However, one challenge in involving users in acute hospital trusts is how their views are used to develop services. For this reason, University Hospitals Coventry and Warwickshire NHS Trust, UK (University Hospitals Coventry and Warwickshire NHS Trust have given permission to have their name cited in the publication of this article) recognising the emerging national patient and public involvement agenda, planned and developed a youth council for the Trust in 2006. PROCESS: The process of setting up the youth council is outlined. An evaluation workshop took place with 15 members of the youth council and their views are incorporated around three specific areas: Evidence that their involvement has improved trust services; Barriers to young people's voices being heard in service delivery; What could promote young people's involvement in healthcare services. CONCLUSION/RELEVANCE TO CLINICAL PRACTICE: This paper describes the setting up of a youth council but also discusses the potential barriers and how to overcome them to promote young people's involvement in hospital trust service planning and development. Whilst the focus of the council was young people, the principles are of use to a wide range of clinical professionals faced with similar challenges. [ABSTRACT FROM AUTHOR]

Aims and objectives. To consider the validity and reliability of risk assessment scales for pressure ulcers. Background. Pressure ulcers are a major problem worldwide. They cause morbidity and lead to mortality. Risk assessment scales have been available for nearly 50 years, but there is insufficient evidence to state with any certainty that they are useful. Design. A literature review and commentary. Methods. Bibliographic databases were searched for relevant papers, a critical review was completed on relevant papers. Results. There is contradictory evidence concerning the validity of risk assesment scales. The interaction of education, clinical judgement and use of risk assessment sakes has not been fully explored. It is not known which of these is most important, nor whether combining them results in better patient care. Conclusions. There is a need for further work. A study exploring the complex interaction of risk assessment scales, clinical judgement and education and training is introduced. Relevance to clinical practice. Nurses may be wasting their time conducting risk assessment scoring if clinical judgement and/or education are sufficient to assess pressure ulcers risk. [ABSTRACT FROM AUTHOR]

The author addresses the use of the h-index to measure a researcher's performance based on their career publications. He explains that the index is founded on lifetime citations received by a researcher's written work. He mentions the disadvantages of using the h-index. He emphasizes the need to determine the applications and limitations of the h-index.

AIMS AND OBJECTIVES: I will argue that overseas nurse recruitment is the consequence of a care gap, which arose from several policy shifts in the 1990s and in part from the rhetoric of a normative moral discourse in the UK which claims that caring is the moral essence of nursing. I will suggest that this discourse has masked the uncoupling of caring from nursing practice and that this uncoupling places the overseas nurses in a contradictory position. BACKGROUND: In an increasingly competitive global labour market, the UK is faced with a nursing shortage and has been recruiting trained nurses from abroad (NMC 1993-2002). DESIGN AND METHODS: This paper is based on two related, qualitative studies using semi-structured focus groups and individual interviews. The first explored the experiences of overseas nurses in the UK and the second investigated the equal opportunities and career progression of overseas nurses in the UK. RESULTS: The data from these studies challenge the normative UK value that caring is at the heart of nursing. These data are the lens through which we see this contradiction explicitly played out. Overseas nurses observe that caring (as undertaken by health care assistants in care homes) is not nursing yet caring is being passed down the line as a process that marginalizes the overseas nurses and at the same time devalues their skills. I do not argue that overseas nurses care at a higher standard (although this may be the case) just that they care differently, that they expected UK nurses to deliver basic care and, instead, experience UK nursing practice as less autonomous and of a lower standard than they expected. CONCLUSIONS: I argue that the overseas nurses' views help us understand the processes by which the uncoupling of caring from nursing has come about. RELEVANCE TO CLINICAL PRACTICE: This paper discusses a workforce issue which is directly relevant to clinical practice because it focuses on the meaning of care; what is caring, what are caring activities and how are these represented in the discourse on caring in the literature? This paper also reveals significant worries among nursing managers about how to staff the nursing workforce and what nurses should be doing in the clinical areas. [ABSTRACT FROM AUTHOR]

The article presents the author's comments on the article "Dissemination of research in clinical nursing journals," by M.H. Oermann and colleagues. According to the author, the paper by Oermann does not answer the key question about the impact of the research published in any clinical nursing journal on nursing practice.

The article introduces papers published within the issue, including one about the importance of nursing in chronic renal disease, and another that demonstrates an effective and economical intervention to improve quality of life in patients having hemodialysis.

AIMS: The paper gives an overview of nursing research papers published on spiritual care between 1983 and October 2005. It also provides pointers for the future direction of research in this emerging field. BACKGROUND: Spiritual care of patients/clients is expected of nurses and is reflected in nursing codes of ethics, nurse education guidelines, policy documents and nursing guidance. Recent years have seen a proliferation in nursing research in this area, particularly in the UK and North America, and now in other European countries. It seemed timely, therefore, to review this published research. METHOD: Included in the review were 47 original published nursing research papers identified from a CINAHL search and from a collection held by the author since 1983. Papers were sorted into five categories, a template to aid reviewing was produced and a short summary and critique of each paper was written. CONCLUSIONS: Research on spirituality and health needs to move forward in a systematic and co-ordinated way. RELEVANCE TO CLINICAL PRACTICE: Hopefully, the research summarized in this paper will be useful to clinicians and nurse educators as they strive to incorporate spiritual care within their practice. In turn patients/clients and their families should benefit from care which is more holistic and addresses their deepest concerns and needs. [ABSTRACT FROM AUTHOR]

BACKGROUND: This paper reviews research that considered the life stories of experienced nurses and the relationships between life experience, the way in which people find meaning in their experience(s), the development of nursing knowledge, and the influence of these events and understandings on the characteristics and clinical practice of experienced nurses. AIMS AND OBJECTIVES: The dominant perspectives in nursing about the place of experience in the development of nurses' practice are considered and the paper argues for a broader understanding of experience; placing experience within the context of nurses' lives, connection with others and their individual understandings about nursing care. RELEVANCE TO CLINICAL PRACTICE: The place of experience in the development of nurses has not been well understood although the nursing discourse continues to value clinical experience highly. Becoming experienced as a nurse is described as a progressive and continuous interaction between experience, meaning and the lived world resulting in a personal and unique understanding of practice. The culture and discourse of nursing have tended to exclude or dampen individual difference and the paper considers a more expansive understanding of the place of experience and individual difference in nursing and the relevance of this perspective for the education of nurses. [ABSTRACT FROM AUTHOR]

arbon p. (2004) Journal of Clinical Nursing 13, 150–157 Understanding experience in nursing This paper reviews research that considered the life stories of experienced nurses and the relationships between life experience, the way in which people find meaning in their experience(s), the development of nursing knowledge, and the influence of these events and understandings on the characteristics and clinical practice of experienced nurses. The dominant perspectives in nursing about the place of experience in the development of nurses’ practice are considered and the paper argues for a broader understanding of experience; placing experience within the context of nurses’ lives, connection with others and their individual understandings about nursing care. The place of experience in the development of nurses has not been well understood although the nursing discourse continues to value clinical experience highly. Becoming experienced as a nurse is described as a progressive and continuous interaction between experience, meaning and the lived world resulting in a personal and unique understanding of practice. The culture and discourse of nursing have tended to exclude or dampen individual difference and the paper considers a more expansive understanding of the place of experience and individual difference in nursing and the relevance of this perspective for the education of nurses. [ABSTRACT FROM AUTHOR]

The subject of clinical supervision for nurses and health visitors in the UK is considered in this paper. The paper highlights recent debates in thinking and rapid developments in practice. The original concept of clinical supervision, its theoretical propositions and development, recent policy influences and current strategies for evaluation are debated. [ABSTRACT FROM AUTHOR]

Proponents of intravenous filters claim that they remove bacterial contaminants, particulate matter, air emboli and reduce the incidence of phlebitis. From unstructured observation by the author at a large general hospital not using filters it was concluded that the incidence of complications was no greater than at a hospital having a policy for using these filters. Despite the introduction of a filter that claims to retain endotoxin for up to 96 h, filters are still misused, over used or unused in different departments of the same hospital. This paper examines the literature that supports and criticizes the advantages and disadvantages of using such filters. The research is reviewed to ascertain whether the widespread use of filters is justified and whether they effectively reduce or prevent the complications of intravenous therapy. The paper reviews the causes and incidence of complications of intravenous therapy and alternative methods used for reducing these complications. The evidence shows conflicting results and argues that complications are inevitable despite the use of filters or careful medical action. The manufacturer's claims are supported by a plethora of literature but discrepancies are evident and the author remains unconvinced of their widespread use in today's fragile economic climate when the cost of treating the adverse effects of intravenous therapy is considered. [ABSTRACT FROM AUTHOR]

This paper outlines the role of quality audit within the framework of quality assurance, presenting the concurrent and retrospective approaches available. The literature survey provides a review of the limited audit tools available and their application to continence services and care delivery, as well as attempts to produce tools from national and local standard setting. Audit is part of a process; it can involve staff, patients and their relatives and the team of professionals providing care, as well as focusing on organizational and management levels. In an era of market delivery of services there is a need to justify why audit is important to continence advisors and managers. Effectiveness, efficiency and economics may drive the National Health Service, but quality assurance, which includes standards and audit tools, offers the means to ensure the quality of continence services and care to patients and auditing is also required in the purchaser/provider contracts for patient services. An overview and progress to date of published and other projects in auditing continence care and service is presented. By outlining and highlighting the audit of continence service delivery and care as a basis on which to build quality assurance programmes, it is hoped that this knowledge will be shared through the setting up of a central auditing clearing project. [ABSTRACT FROM AUTHOR]

• This paper outlines the role of quality audit within the framework of quality assurance, presenting the concurrent and retrospective approaches available. • The literature survey provides a review of the limited audit tools available and their application to continence services and care delivery, as well as attempts to produce tools from national and local standard setting. Audit is part of a process; it can involve staff, patients and their relatives and the team of professionals providing care, as well as focusing on organizational and management levels. • In an era of market delivery of services there is a need to justify why audit is important to continence advisors and managers. Effectiveness, efficiency and economics may drive the National Health Service, but quality assurance, which includes standards and audit tools, offers the means to ensure the quality of continence services and care to patients and auditing is also required in the purchaser/provider contracts for patient services. • An overview and progress to date of published and other a projects in auditing continence care and service is presented. By outlining and highlighting the audit of continence service delivery and care as a basis on which to build quality assurance programmes, it is hoped that this knowledge will be shared through the setting up of a central auditing clearing project. [ABSTRACT FROM AUTHOR]

Introduces articles in the second issue 2004 of the periodical "International Journal of Older People Nursing,". Theme of empowerment in papers in the section one of the publication; Papers analyzing barriers to medical care.

The article presents a commentary on the paper "Being an intensive care nurse related to questions of withholding or withdrawing curative treatment," by R. Hov, B. Hedelin and E. Athlin. According to the author, the paper focuses on the distinction between the perceptions of physician and nurse. He notes that it provides further confirmatory evidence around issues tied up with the withdrawal or withholding of treatment on ICU wards.

Comments on the article "Violence in the Care of Adult Persons With Intellectual Disabilities," previously published in the "Journal of Clinical Nursing." Failure of the study to offer any new understanding of abuse towards people with intellectual disabilities; Poor operationalization of the term violence; Opinion that the research paper deals superficially with both the validity and reliability of the questionnaire.

AIM: This paper presents the findings of a review and appraisal of the evidence for the effectiveness of nurse case management in improving health outcomes for patients living either with Diabetes, Chronic Obstructive Pulmonary Disease or Coronary Heart Disease. BACKGROUND: Long term chronic health conditions provide some of the greatest challenges to western health care systems. In the UK, three of the most significant chronic conditions are Diabetes, Chronic Obstructive Pulmonary Disease and Coronary Heart Disease. Patients with these long term conditions are high users of health services who often receive unplanned, poorly co-ordinated, ad-hoc care in response to an exacerbation or crisis. To counter this, the nurse case manager is identified as a central aspect of improving care for these patients. However, the evidence for the effectiveness of nurse case management in improving health outcomes for the chronically ill is scarce. DESIGN: A structured review of the literature. METHOD: The review was undertaken focussing on studies that evaluated nurse case management with one or all of the three major long term chronic conditions. A total of 108 papers were initially reviewed and filtered to leave 75 citations that were appraised. About 18 papers were finally included in the review and subject to thematic analysis based on the health outcomes evaluated in the studies. RESULTS: Significantly positive results were reported for nurse case management impact on five health outcomes; 'objective clinical measurements', 'quality of life and functionality', 'patient satisfaction', 'adherence to treatment' and 'self care and service use'. RELEVANCE TO CLINICAL PRACTICE: The evidence generated in this review suggests that nurse case managers have the potential to achieve improved health outcomes for patients with long term conditions. Further research is required to support role development and create a more targeted approach to the intervention. [ABSTRACT FROM AUTHOR]

Aim. To explore the impact of renal cancer treatment on patients' quality of life.Background. Renal cancer accounts for 95,000 deaths worldwide and its incidence rate is rising. At present there are several therapeutic approaches to the treatment of renal cancer, ranging through surgery, immunological therapies and vaccine treatment. Each of these therapies may have a substantial effect upon patients' quality of life. However, a systematic appraisal of the empirical evidence about treatment impact is lacking.Design. Literature review.Methods. A structured review of the empirical literature on the impact of renal cancer treatment upon quality of life was undertaken. Literature was appraised and themed according to the treatment modalities included in the study.Results. From 873 papers initially identified 52 were retrieved for detailed scrutiny resulting in a final 16 papers being included in the review.Conclusions. This review discusses the complex effect of renal cancer upon a patient's quality of life as treatment modalities change. The need for nursing education and awareness of these issues is therefore highlighted to maximise patient care.Relevance to clinical practice. Understanding the impact of treatment for renal cancer enables nurses to empathise more significantly with patients and also act as mediators in regard to treatment choice and treatment cessation. It also enables nurses to inform and educate renal cancer patients prior to making treatment choices. [ABSTRACT FROM AUTHOR]

Aims. The aim of this paper is to provide an account of the early development of what was originally known as 'mental deficiency' nursing in the UK and Ireland.Background. After a brief review of research literature, it analyses key issues behind the development of a workforce positioned on the margins of nursing in the two jurisdictions through a comparative discussion of similarities and differences.Design. The paper draws on two doctoral studies that examined the development of intellectual disability nursing using an historiographical design.Methods. Primary sources consulted included records of nursing regulatory bodies, national archives, Royal College of Psychiatrists, archives, nursing journals, individual institutional records in both jurisdictions.Results. In both countries, psychiatrists established early training programmes for nurses, although a nursing model was adopted to meet service needs in the 1950s.Conclusions. However, the way in which this branch of nursing developed laid the foundation for tensions as to whether it is appropriately located within the discipline of nursing. Ireland's colonial past and postcolonial position, the role of the church, welfare systems and diverse socio-political drivers for change represent key differences between the two jurisdictions.Implications. What eventually became known as learning or intellectual disability nursing poses a continued challenge for the profession as a whole in regard to its breadth, role and focus in working with marginalised groups in society. The paper considers the risks for UK and Irish intellectual disability nurses for marginalisation in nursing should they forge closer links to other disciplines concerned with common threads of disability, education or social care. [ABSTRACT FROM AUTHOR]

Aims. To offer a detailed discussion of the issue of 'lack of critique' in the literature on spirituality in nursing. The discussion will include the limited use of sources from theology and religious studies and the demand to separate spirituality and religion and will go on to examine the consequences of the resulting approach. The drive for unique knowledge to further professionalisation and the demands of inclusiveness are suggested as possible reasons for the development of the current model. The dangers and pitfalls of definition are explored. The paper suggests that theology could provide insights into explaining spirituality. Background. The last four decades have seen a proliferation of definitions of spirituality in the nursing literature. Recently, in response to their own concerns and prompts from outside the 'spirituality' community authors have suggested that we revisit this literature with a more critical stance. This paper is in response to that suggestion. During the course of a PhD supervised from a department of practical theology I have critically analysed the literature from several perspectives and this paper is one result of that review. Design. Literature review. Methods. Critical reflection on how spirituality has been defined. Conclusion. The lack of critique has produced a bias in the literature towards broad, generic, existential definitions which, together with the intentional divorce from religion and theology have led to definitions which have the tendency to result in a type of spiritual care which is indistinguishable from psychosocial care, hard to explain to patients and difficult to put into practice. Relevance to clinical practice. The acceptance of a diverse range of understandings of spirituality and a greater focus on practical ways of using it in nursing care are the direction the profession should be moving into. [ABSTRACT FROM AUTHOR]

Aims and objectives. This paper draws upon an evaluation of the first group of nurse consultants in Scotland. The evaluation aimed to identify the extent to which they fulfilled the remit of their posts which comprised four core functions. One of these functions was to provide professional leadership and this paper focuses on this element of the role and aims to explore it in relation to the attributes of transformational leadership. Background. Nurse consultants were introduced in the UK in 2000. Their purpose was to achieve better outcomes for patients and strengthen leadership. Nursing research identifies leadership as a key element of the role, with postholders adopting transformational leadership approaches. Research from the fields of sociology and psychology identifies difficulties in formulating a coherent theory of leadership, arguing for better understanding of leadership processes. Design. Qualitative. Methods. This paper draws on 31 semi-structured interviews with four nurse consultants who were interviewed twice over six to nine months and 23 other 'stakeholders' who worked with them. Results. Varied leadership activity at ward, NHS Trust and strategic levels was identified. Postholders used approaches that resonated with the attributes of transformational leadership. Leadership processes included developing a vision for the service, acting as mediator and champion, and exerting control over complex change initiatives. Techniques of leadership included taking a 'softly softly' approach, pacing change initiatives and arguing assertively with those in senior positions. Interview findings also identified the level of preparation that was required to meet the remit of the posts, highlighting the importance of interpersonal skills and intellectual effort in achieving outcomes. Conclusions. Nurse consultants require considerable technical expertise, cognitive and interpersonal skills, and the ability to take risks. The data suggest that the leadership attributes required are transformational in nature but that they also exceed those identified in much of the literature. These posts require appropriate support if they are to be sustainable. Relevance to clinical practice. This paper adds to our understanding of the complexity of the nurse consultant role and highlights the challenge of providing appropriate professional development for postholders. [ABSTRACT FROM AUTHOR]

Aim. The purpose of this paper is to critically explore the sequential explanatory mixed method research design and how it can enhance our understanding of pain management. Background. The general prevalence of pain after surgery has not changed significantly over several decades despite the widespread introduction of new pain relieving technologies. The majority of postoperative pain studies use quantitative methods which offer little understanding of the underlying processes of care. Understanding can be illuminated by using an explanatory mixed method research design. Design. Discursive paper. Method. This paper focuses on the methodological considerations when using a mixed method design. Two previously published mixed methods studies illustrate how findings can inform practice. In the first, 85 women undergoing surgery completed questionnaires to measure pain, anxiety and depression. Telephone interviews explored their pain experiences. The second study considered frequency and patterns of anxiety in the immediate pre and postoperative period. Semi-structured telephone interviews, identified contributing events/situations amenable to nursing intervention. Discussion. Reasons for growing popularity, criticisms, paradigmatic considerations and epistemological roots of pragmatism are explored. The two explanatory mixed method studies provide examples of these studies and how 'inferences' from quantitative and qualitative data can inform practice. Conclusion. This paper connects quantitative and qualitative data, drawing on two research studies, to give greater understanding to the management of pain. Knowledge of the processes responsible for inadequate pain management can be illuminated by using explanatory mixed methods research designs. Relevance to clinical practice. Nursing requires knowledge which reflects the complexity of human health. The explanatory mixed method study can elucidate the problem under scrutiny, e.g. prevalence of pain or anxiety. The qualitative phase can generates an understanding of contributing factors and insights for care delivery. The implicit desire to change and influence practice makes it relevant for those closely aligned to practice. [ABSTRACT FROM AUTHOR]

AIMS: The aim of this paper is to share our experiences of dealing with chaos and complexity in interview situations in the home with children and young people. We highlight dilemmas relevant to dealing with multiple interruptions, building a rapport, consent and confidentiality. Furthermore, we discuss issues regarding the locus of power and control and offer some solutions based on our experiences. BACKGROUND: Creating a safe environment is essential for qualitative research. Participants are more likely to open up and communicate if they feel safe, comfortable and relaxed. We conclude that interviewing parents and their children with cystic fibrosis in their own homes, is chaotic and appears to threaten the rigour of data collection processes. Limited attention or print space is paid to this issue, with published articles frequently sanitising the messiness of real world qualitative research. DESIGN: Position paper. METHODS: In this position paper, we use two case studies to illustrate ethical and pragmatic challenges of interviewing out in the field. These case studies, typical of families we encountered, help emphasise the concerns we had in balancing researcher-participant rapport with the quality of the research process. CONCLUSIONS: Dealing with perceived chaos is hard in reality, but capturing it is part of the complexity of qualitative enquiry. The context is interdependent with children's perceived reality, because they communicate with others through their environment. RELEVANCE TO PRACTICE: This paper gives researchers an insight into the tensions of operating out in the field and helps raise the importance of the environmental 'chaos' in revealing significant issues relevant to peoples daily lives. Knowing that unexpected chaos is part and parcel of qualitative research, will equip researchers with skills fundamental for balancing the well being of all those involved with the quality of the research process. [ABSTRACT FROM AUTHOR]

Aim. In this position paper, the self-efficacy model of medication adherence in chronic mental illness is presented, and its application to antipsychotic medication adherence is considered. Background. Poor adherence to antipsychotic medications is common in chronic mental illness. Major implications of this are relapse and re-hospitalisation. Several conceptual frameworks have been developed about adherence and, in some instances, have been incorporated in medication taking studies, but have resulted in inconsistent outcomes. Method. This paper draws on a review of literature from databases to inform the development of the self-efficacy model of medication adherence. Inclusion and exclusion criteria were developed from primary and secondary research questions. Results. The model places the person with chronic mental illness as an active participant central to the process of medication taking. It has three components: core factors, contextual influences and a continuum. The factors comprise a central factor, self-efficacy and four interrelated supporting influences: perceived medication efficacy; access to, and relationships with, health professionals; significant other support and supported living circumstances. The factors are affected by three broad contextual influences - personal issues, medication side-effects and complexity, and social stigma - which affect the way individuals take their medications. A continuum exists between adherence and non-adherence. Conclusion. The model positions service users at the heart of adherence by giving prominence to self-efficacy, medication efficacy and to immediate social, psychological and environmental supports. Further work is needed to validate, refine and extend the model. Relevance to clinical practice. For practitioners involved in prescribing and medication management in people with chronic mental illness, the model provides a theoretical framework to strengthen adherence. It highlights the need to consider broader influences on medication taking. Moreover, it places the person with chronic mental illness as an active participant at the centre of strategies to enhance adherence. [ABSTRACT FROM AUTHOR]

Aims and objectives. This paper reviews and summarises the literature on assessment, diagnosis and management of personality disorder in people with intellectual disability. It will proceed to argue the implications of a mental health nurse practitioner in clinical practice. Background. Personality disorder is a potentially severe and disabling condition causing significant distress as well as presenting considerable challenges for service providers. Diagnosis in people with intellectual disability is controversial. However, it is considered that this population is at greater risk of these disorders. There is, however, little research on which to base clinical interventions or service planning. Design. Systematic review. Methods. A literature search of electronic data was undertaken in April 2007 using CINAHL, AMED, Medline, PsycINFO, EMBASE and Cochrane Library. Other sources included Google Scholar, hand searching of reference lists and texts and search of relevant websites. Results. The literature on personality disorder in intellectual disability is notable for its paucity. The limited evidence available suggests that this population is at greater risk of personality disorder and that assessment and diagnosis is complex and often overshadowed by the intellectual disability. Few papers address treatment, there are no trial-based studies and it has not been established whether results can be extrapolated from research in the general population. Conclusions. The issue of personality disorder in people with intellectual disability is shrouded in controversy with a dearth of robust evidence to inform assessment or therapeutic care. Personality disorder does, however, provide a basis for decisions on type and intensity of support required for this population who have significant levels of unmet need. Relevance to clinical practice. Some people with an intellectual disability and personality disorder can live in the community with specialist support. The mental health nurse practitioner has the potential to provide people with dual diagnostic support needed to enhance the capacity of the service system to meet the needs of this complex and difficult population. [ABSTRACT FROM AUTHOR]

AIM: This paper aims to describe caring needs associated with existential aspects of living with addiction. BACKGROUND: Spirituality is considered a driving force within and the concept relates to self, others and God and the relationships between them. The spiritual dimension is of great importance in both the addiction itself as well as in recovery and addressing caring needs relating to spirituality is important in nursing. DESIGN: Hermeneutic inquiry was used to explore caring needs related to peoples experiences of living with addiction. METHOD: This paper is a hermeneutic expansion of findings presented in Part I. Existential themes in the form of spiritual challenges and caring needs are reflected upon as a process between figure and background. RESULTS: The themes presented are: meaning - meaninglessness, connectedness - loneliness, life - death, freedom - adjustment, responsibility - guilt, control - chaos. Caring needs associated with them are identified as; the need to create a new frame of reference for interpreting of life, the need to experience coherence in life, a restored dignity as well as the need for a sense of community and attachment, confirmation and acceptance. The caring need for forgiveness and reconciliation is also identified as well as the need for continuity, comprehensibility and manageability. CONCLUSIONS: When caring for patients suffering from addiction nurses should address patients' spirituality. The caring communion is vital, as it is the foundation for meeting the patients' needs. Intervention by nurses should focus on aspects that will help patients feel alive and in communion with others. RELEVANCE TO CLINICAL PRACTICE: Understanding and being able to identify patients' caring needs associated with existential aspects of living with addiction will enable nurses to provide professional care and promote patient's recovery. [ABSTRACT FROM AUTHOR]