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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]

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]

Aims and objectives. This paper explores the perceptions of career progression in the NHS of a group of midwives and nurses trained in Ghana and working in the UK. It draws on semi-structured interviews with nurses, midwives and managers which were conducted as part of the Researching Equal Opportunities for Overseas trained Health Professionals project (REOH). Background. Research into overseas nurses in the UK has tended to focus on their experiences of discrimination in relationships with colleagues, managers and patients. There is limited statistical evidence indicating that migrant nurses experience slower career progression than their UK-trained counterparts. However, there is little analysis of their experiences and perceptions of the process of career progression or their understandings of the factors that could account for their limited entry into higher grades. Conclusions. This paper argues that many Ghanaian nurses and midwives can experience difficulty in progressing into senior positions because of cultural differences and gaps in knowledge. However, this paper indicates that these problems can become institutionalized and entrenched by practices on the ward, particularly support from managers being dispensed as patronage that is not given equally to all. This creates an informal system of promotion to management which is not transparent, is based on subjective and culturally specific criteria and can undermine egalitarian formal procedures and create spaces where discriminatory practices can operate. Relevance to clinical practice. These processes can lead to sectors of the workforce becoming demoralized, to the wastage of skills and other resources and problems in staff retention. [ABSTRACT FROM AUTHOR]

Aims. To review and reflect on the literature on recognition-primed decision (RPD) making and influences on emergency decisions with particular reference to an ophthalmic critical incident involving the sub-arachnoid spread of local anaesthesia following the peribulbar injection. Background. This paper critics the literature on recognition-primed decision making, with particular reference to emergency situations. It illustrates the findings by focussing on an ophthalmic critical incident. Design. Systematic literature review with critical incident reflection. Methods. Medline, CINAHL and PsychINFO databases were searched for papers on recognition-primed decision making (1996-2004) followed by the 'snowball method'. Studies were selected in accordance with preset criteria. Results. A total of 12 papers were included identifying the recognition-primed decision making as a good theoretical description of acute emergency decisions. In addition, cognitive resources, situational awareness, stress, team support and task complexity were identified as influences on the decision process. Conclusions. Recognition-primed decision-making theory describes the decision processes of experts in time-bound emergency situations and is the foundation for a model of emergency decision making ( Fig. 2 ). Relevance to clinical practice. Decision theory and models, in this case related to emergency situations, inform practice and enhance clinical effectiveness. The critical incident described highlights the need for nurses to have a comprehensive and in-depth understanding of anaesthetic techniques as well as an ability to manage and resuscitate patients autonomously. In addition, it illustrates how the critical incidents should influence the audit cycle with improvements in patient safety. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: This paper aims to explore the critical elements of advanced nursing practice in relation to policy, education and role development in order to highlight an optimal structure for clinical practice. BACKGROUND: The evolution of advanced nursing practice has been influenced by changes in healthcare delivery, financial constraints and consumer demand. However, there has been wide divergence and variations in the emergence of the advanced nurse practitioner role. For the successful development and implementation of the role, policy, educational and regulatory standards are required. CONCLUSION: The paper highlights the value of a policy to guide the development of advanced nursing practice. Educational curricula need to be flexible and visionary to prepare the advanced nurse practitioner for practice. The core concepts for the advanced nursing practice role are: autonomy in clinical practice, pioneering professional and clinical leadership, expert practitioner and researcher. To achieve these core concepts the advanced nurse practitioner must develop advanced theoretical and clinical skills, meet the needs of the client, family and the community. RELEVANCE TO CLINICAL PRACTICE: In a rapidly changing people-centred healthcare environment the advanced nurse practitioner can make an important contribution to healthcare delivery. The challenges ahead are many, as the advanced nurse practitioner requires policy and appropriate educational preparation to practice at advanced level. This will enable the advanced practitioner articulate the role, to provide expert client care and to quantify their contribution to health care in outcomes research. [ABSTRACT FROM AUTHOR]

AIMS OF THE PAPER: The paper describes the creation of, the rationale behind and the external funding of a collaborative research-clinical practice development position. The paper also demonstrates the benefits of nursing's collaboration with external funding bodies and the value of moving from our traditional position of assuming that 'the hospital' will always provide. BACKGROUND: There is a constant refrain that nursing must become more 'research-based' and develop an active research culture. In harsh financial times however, funding for research development is scarce. Nurses can respond to this by bemoaning the lack of money or by taking an entrepreneurial approach, creating innovative project proposals that develop new partnerships and attract external funding. DISCUSSION: Institutional support for clinical research is often more verbal than financial as most health care systems are experiencing extreme financial stringencies. Nurses need to reconsider the notion that every initiative must automatically be funded by the institution. In this paper we show how in a busy major hospital, clinicians and researchers collaborated to create and fund the kind of innovative research and practice development position that may be impossible to fund through existing budgets. CONCLUSION: With creativity and determination, nurses can challenge the orthodoxy that they are solely dependent on institutional funding. If there is a clear project vision, a convincing rationale, a strongly argued 'business case' and a passionate and persistent team, then innovative new projects and positions can be realized. RELEVANCE TO CLINICAL PRACTICE: Developing clinical focused, practice based research is now a worldwide policy and practice imperative for nurses. Unfortunately, current levels of institutional funding are unlikely to support research promotion positions and initiatives. This paper outlines an approach to securing funding for research initiatives that can create exciting new positions and develop productive partnerships between researchers, clinicians and external agencies. [ABSTRACT FROM AUTHOR]

Aim. This paper presents qualitative findings from a study that explored nursing students' experience of belongingness when undertaking clinical placements. The aim is to locate the professional and practical implications of the research within an Ascent to Competence conceptual framework.Background. The need to belong exerts a powerful influence on cognitive processes, emotional patterns, behavioural responses, health and well-being and failure to satisfy this need can have devastating consequences. The literature suggests that diminished belongingness may impede students' motivation for learning and influence the degree to which they are willing to conform rather than adopt a questioning approach to clinical practice.Design. A mixed methods, cross national, multi-site case study approach was adopted with third-year preregistration nursing students from three universities (two in Australia and one in England) participating; 362 in the quantitative phase and 18 in the qualitative phase.Findings. Qualitative findings demonstrated that, although the primary purpose of clinical education is to facilitate students' progress towards the attainment of competence, the realisation of this goal is impacted by a wide range of individual, interpersonal, contextual and organisational factors which can be conceptualised hierarchically. By this structuring it is possible to see how belongingness is a crucial precursor to students' learning and success.Conclusion. The framework demonstrates that students progress to a stage where attainment of competence is possible only after their previous needs for safety and security, belongingness, healthy self-concept and learning have been met.Relevance to clinical practice. The future of the nursing profession depends upon the development of confident, competent professionals with a healthy self-concept and a commitment to patient-centred care and self-directed learning. This paper demonstrates that the realisation of this goal is strongly influenced by the extent to which students' clinical placement experiences promote and enhance their sense of belonging. [ABSTRACT FROM AUTHOR]

AIM: This paper examines the hitherto mostly unrecognised relationship between gender, health and children; its significance for nursing practice and how it has been considered in nursing research. BACKGROUND: Holistic nursing practice with children requires adequate assessment and consideration of all potential influences on children's lives. Socioeconomic disparities have received widespread attention and gender inequalities in adult health have been studied in some depth. The links between gender, health and children, however, have received little consideration. The paper first considers this context in depth; it then applies the context to research in practice. DESIGN: Systematic review. METHODS: A systematic literature search was undertaken on four mainstream nursing research journals over 38 months up to February 2007. A total of 567 articles met the key word searches. Duplicates, opinion pieces and articles not focusing on children were removed. The remaining 23 nursing studies relevant to child health were examined for their gender sensitivity. RESULTS: Full consideration of gender issues was found largely to be absent in nursing research on children. Eight studies gave specific consideration to gender relevance, where boys and girls may have responded differently to care. Only six studies specifically addressed gender sensitivity. Allowing children a voice, however, was a strength in these studies, with 18 reflecting children's views directly. CONCLUSIONS: Major gaps still exist in research and theorisation relating to children, health and gender. These need to be acknowledged and investigated, particularly in relation to how they might impact on nursing care. RELEVANCE TO CLINICAL PRACTICE: Nursing practice and research needs to account for all potential health issues, of which gender may often be important. [ABSTRACT FROM AUTHOR]

Aims of the paper. In this paper I hope to, at least partially, succeed in demystifying the research process, especially as it may be perceived by clinicians, encourage their involvement and participation in clinical research and propose practical and rewarding strategies that all children’s nurses can adopt to begin to create a vibrant research culture in any clinical area. Background. The professional and organisational expectation that all nurses will, in some way, be involved in research is growing and will not go away. Despite the historic, toxic dualism that has seen research as essentially the prerogative of ‘The Academy’, clinicians are beginning to take more of an interest and role in research, despite the many obstacles that they face. In today’s health care system, children’s nurses cannot afford to abdicate responsibility for research or to postpone their involvement until the ideal conditions for their engagement come along. This paper suggests approaches and strategies that clinicians, educators, managers and researchers can use as a basis for productive and mutually beneficial collaborative research initiatives. Design. Position paper. Conclusions. Developing clinical-focused, collaborative, interdisciplinary research is now a worldwide policy and practice imperative. There is no reason why children’s nurses cannot take a leading role in this movement. Previous models of research where research has been undertaken by academics and then ‘disseminated’ to clinicians who are expected to ‘implement’ it (and who are then subsequently blamed for failure) has been less than successful and small wonder. Relevance to clinical practice. Where clinicians are directly involved as genuine research partners in both the research process and the project from day 1, there is a real prospect that both the benefits of the inquiry process and any research findings will be more readily adopted by the clinical areas concerned. [ABSTRACT FROM AUTHOR]

AIM AND OBJECTIVES: This paper aims to present a theoretical account of professional nursing challenges involved in providing care to patients suffering from chronic obstructive pulmonary disease. The study objectives are patients' and nurses' expectations, goals and approaches to assisted personal body care. BACKGROUND: The provision of help with body care may have therapeutic qualities but there is only limited knowledge about the particularities and variations in specific groups of patients and the nurse-patient interactions required to facilitate patient functioning and well-being. For patients with severe chronic obstructive pulmonary disease, breathlessness represents a particular challenge in the performance of body care sessions. DESIGN: We investigated nurse-patient interactions during assisted personal body care, using grounded theory with a symbolic interaction perspective and a constant comparative method. METHODS: Twelve cases of nurse-patient interactions were analysed. Data were based on participant observation, individual interviews with patients and nurses and a standardized questionnaire on patients' breathlessness. FINDINGS: Nurses and patients seemed to put effort into the interaction and wanted to find an appropriate way of conducting the body care session according to the patients' specific needs. Achieving therapeutic clarity in nurse-patient interactions appeared to be an important concern, mainly depending on interactions characterized by: (i) reaching a common understanding of the patient's current conditions and stage of illness trajectory, (ii) negotiating a common scope and structuring body care sessions and (iii) clarifying roles. CONCLUSION: It cannot be taken for granted that therapeutic qualities are achieved when nurses provide assistance with body care. If body care should have healing strength, the actual body care activities and the achievement of therapeutic clarity in nurses' interaction with patients' appear to be crucial. RELEVANCE TO CLINICAL PRACTICE: The paper proposes that patients' integrity and comfort in the body care session should be given first priority and raises attention to details that nurses should take into account when assisting severely ill patients. [ABSTRACT FROM AUTHOR]

Aim. Within this paper I explore some of the issues related to eliciting, interpreting, choosing and re-telling stories gathered within narrative inquiry. Background. Most of the literature focusing on narrative inquiry and narratives makes little mention of what makes a story intrinsically ‘good’ or ‘bad’ although it is generally acknowledged that stories have moral lessons embedded within them and have a teaching/learning function. However, many of the moral issues associated with gathering, interpreting and re-telling stories are not really addressed. Method. Adopting a reflexive stance, I draw on Cartier-Bresson's notion of decisive moments and link this to narratives as a way of exploring what makes a story ‘good’/compelling as well as potentially ‘bad’/morally problematic. I develop the idea that narrative researchers may act as ‘horror magnets’ attracting ‘bad news’ stories and may be overlooking some of the more ‘neutral’ and ‘good’/‘good news’ stories. Conclusion. Narrative researchers may be adopting a ‘shock and awe’ approach to their stories without fully considering the potential impact. I propose that narrative researchers should engage in a morally proficient manner with participants/stories and conclude that a relational ethical approach can help us to ‘act well’ with people's stories. Relevance to clinical practice. Narrative inquiry and a storied approach to practice has much to offer researchers, practitioners and patients/families. Stories can get to the heart of patients’ experiences. Stories provide practitioners with one means of ‘acting well’ and in a relational way with their patients. [ABSTRACT FROM AUTHOR]

Aims and objectives. This paper considers the correct method for inserting a rectal suppository, both as a medication and also to achieve bowel evacuation. The aim is to find out whether the correct method is blunt end or pointed end foremost. Background. It follows from a question raised by a third year student nurse. In the classroom, she had been taught that the correct method for the administration of a suppository for systemic absorption was to insert it blunt end foremost into the rectum. However, if the suppository was to be used for evacuant purposes, it should be given pointed end foremost. In clinical practice, however, she was told the suppository should always be inserted pointed end foremost in all cases, whatever the purpose. Design. This article seeks to clarify the dilemma by examining the sources of evidence underpinning different methods for inserting a rectal suppository. Hence, the literature on the insertion of rectal suppositories was gathered as systematically as possible from medical journals and textbooks, nursing journals and textbooks and manufacturers' information to patients. Method. Having gathered the literature, this was examined, appraised and critically analysed for rigour, coherence and reliability. Results. The review of the literature appears to show that evidence adduced for inserting the suppository blunt end foremost derives from one study published in the Lancet in 1991, which challenged 'commonsense'. There did not appear to be other, more recent research. On the other hand, manufacturers' information to patients states generally that the suppository should be inserted pointed end foremost. This has direct relevance for the administration of suppositories and also raises questions as to how research may become integrated into healthcare practice without adequate justification. Conclusions. An article published in the Lancet in 1991 has had a fundamental effect on nursing practice, but has not been subject to scrutiny. The advice given in this Lancet article differs from that currently given by most manufacturers of suppositories, which involves the terms of their product licence. Hence, there is a potential for problems with legal liability should an untoward event arise. Relevance to clinical practice. Inserting rectal suppositories, whether as a medication or to achieve bowel evacuation, is a very common healthcare practice. Currently, there is inconsistency and discrepancy in the correct method for this procedure in both nursing education and practice. This paper examines the reliability of existing evidence and shows the need for further work in order to provide a reliable evidence base for this commonplace clinical procedure. [ABSTRACT FROM AUTHOR]

Aim. To explore and analyse the role of the nurse teacher. Background. This paper examines the issue of clinical credibility among nurse teachers which has been ongoing for over a decade. The move of nurse education from colleges of nursing to the Higher Education Institutes was seen in 1992. Since then, nurse teachers have been faced with the need to juggle the roles of teaching, administration, research and clinical support for students. Nursing students within these Higher Education Institutes require more than the traditional theoretical classroom teaching. Nurse teachers have a role beyond this in encouraging students to link theory with practice, and practice with theory. Therein lies a challenge for nurse teachers to ensure they remain credible within the clinical setting and continue to provide education and support, which is firmly grounded in both practice and theory. Method. The authors have critically reviewed the evidence related to the role of the nurse teacher in an attempt to identify key concepts and ideas, assumptions, supporting examples and the implications for their role. Conclusion. The role of the nurse teacher, it would appear, is a dynamic one that needs to engage actively the needs of the student. Nurses therefore need to be dynamic in their approach in order to respond to both local and global demands and ensure that students become competent, professional, knowledgeable and caring in their approach. Relevance to clinical practice. This paper demonstrates the complex and ever changing role of the nurse teacher. This paper attempts to help nurse teachers understand the complex nature of their role. [ABSTRACT FROM AUTHOR]

AIM AND OBJECTIVES: The aim of this paper is to explain the history and use of hormone replacement therapy (HRT) using McKinlay's theory of medical innovation. The paper will examine why a drug, HRT, was prescribed for mainly healthy women. It reflects on the controversies surrounding HRT and examines some of the possible reasons why, despite an almost complete lack of verifiable research, HRT became one of the most widely prescribed drugs of our time. BACKGROUND: Twenty-four years ago McKinlay published From 'Promising Report' to 'Standard Procedure': Seven Stages in the Career of a Medical Innovation. McKinlay argued that many, if not most, innovations in medicine undergo a process of which assessment of effectiveness is only a late stage placing many patients at risk of receiving treatments which are useless or malign. CONCLUSION: This paper argues that HRT was a medical innovation whose 'career' followed the seven stages describes by McKinlay. This suggests that the Nursing and Medical professions continue to accept innovation uncritically. RELEVANCE TO CLINICAL PRACTICE: This paper underlines the importance of critically assessing the research-based evidence for altering practice and introducing new treatments. It suggests that Nurse Prescribers and other clinicians question the assumed scientific basis of new innovations in clinical practice. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: The aim of this literature review, set within an Irish context, is to present a broad overview of former and existing clinical support personnel, explore the concept of facilitation and examine what is known about the role of the clinical education facilitator. BACKGROUND: The importance of providing a supportive clinical environment to enhance clinical teaching and learning is strongly portrayed in the literature. While the past two decades have borne witness to various clinical support personnel, the literature identifies conflicting demands that these personnel face. No suggestions are advanced as to how to overcome these difficulties, which inevitably influence the quality and quantity of their clinical teaching role. An identifiable gap exists over who has prime responsibility for clinical teaching. It is timely that alternative possibilities for organizing clinical teaching are investigated. A new post emerging in practice settings is that of the clinical education facilitator who is meant to be the key linchpin in clinical areas for reducing the theory-practice gap. METHOD: Relevant literature for this review was sourced using the computerized databases CINAHL, Medline and Synergy. Manual searching of relevant nursing journals and sourcing of secondary references extended the search. Government reports and other relevant documents were obtained through pertinent websites. RESULTS: Papers that explicitly examined the concept of facilitation and explored the posts of clinical education facilitators were included; six research papers were accessed and reviewed. In addition seven non-empirical papers were included. CONCLUSIONS: It is clear that considerable lack of role clarity resides over what constitutes clinical facilitation and the role of the clinical facilitator. Thus, it is paramount to strengthen this support role with Irish empirical evidence. RELEVANCE TO CLINICAL PRACTICE: A major advantage in having a ward-based clinical education facilitator is the benefit of having access to someone who can concentrate solely on clinical education and support with attempts to narrow the theory-practice divide. [ABSTRACT FROM AUTHOR]

Aim. This paper seeks to explain how bulimic mothers accommodated infant feeding demands in conjunction with managing their disordered eating practices. Background. Eating disorders are chronic and disabling illnesses primarily affecting women. There are few qualitative studies describing bulimia in the context of motherhood. Design. The study employed an inductive qualitative approach. Methods. A purposive sample of childbearing women ( n = 16), who self-defined as living with an eating disorder, were recruited. Data were generated from one-to-one interviews; a thematic analysis identified key issues. Results. Participants were primarily responsible for ensuring child/ren's socialisation processes, including modelling appropriate dietary behaviours and these demands often conflicted with their personal needs for food restraint. Pressures to participate in social activities with children were widely experienced as stressful especially when these events focused on food. Participants viewed early and repeated exposure to 'healthy' eating as protective against their children acquiring an eating disorder and in this respect commercial child-care facilities provided alternative environments for children to explore food-related activities. Conclusions. Participants employed a variety of strategies to ensure children's exposure to normalising influences and socialising processes. Concerns about personal competencies with respect to food preparation and storage were articulated by all participants. Relevance to clinical practice. Professionals involved with providing care to mothers and their infants are well placed to support bulimic clients and to foster confidence in their mothering skills. Early and appropriate intervention is key to effecting positive changes in bulimic patterns, with potential benefits to women's future health and well-being and that of their children. [ABSTRACT FROM AUTHOR]

Aim. To explore parents’ views of their identities as they learn to manage their child’s chronic kidney disease. Background. Parents are expected to participate in management and usually learn necessary skills from the multidisciplinary team. Research highlights the importance of professionals defining parents’ management roles in chronic disease; but little is known about parents’ views on their own identities as the complex and dynamic process of teaching and learning unfolds around their child’s condition. According to positioning theory, identity development is a dynamic and fluid process that occurs during interaction, with each person positioning themselves while simultaneously positioning the other person, yet this concept has not been considered in relation to parents’ contributions to disease management. Design. A longitudinal, grounded theory study conducted in a UK Children’s Kidney Unit. Method. This paper focuses on one aspect of a larger study exploring family learning in disease management. Six mothers and two fathers of six children with a recently diagnosed chronic kidney disease participated in a total of 21 semi-structured interviews during the 18 months after referral to the unit. Interviews included discussion about the parts they played in relation to professionals during the management process. Findings were interpreted within a framework of positioning theory. Results. Parents participated in teaching/learning/assessment that was both planned (involving allocated clinical lessons and tasks) and spontaneous (in response to current situations), to facilitate their participation. They positioned multidisciplinary team members as teachers as well as professionals, simultaneously positioning themselves as students as well as parents. Conclusion. Parents’ clinical duties and obligations are not an automatic part of parenting but become part of the broader process of sharing disease management, this can lead to them assuming the additional identity of a ‘student’. Relevance to clinical practice. Involving parents in ongoing discussions about their positions in management may help promote their active and informed participation. [ABSTRACT FROM AUTHOR]

Aims. This paper explores the concept of 'zero tolerance' to abuse in the context of the professional responsibilities of all nurses. The workability of zero tolerance will be considered in light of findings of a study into abuse. Background. Registered nurses are led to believe that zero tolerance of abuse of patients is the only philosophy consistent with protecting the public. However, the approach of zero tolerance is not without its difficulties. Staff, particularly registered nurses, who come into contact with people with intellectual disabilities have a professional responsibility to prevent and report all forms of abuse. Design. This study used a multiphase, multimethod approach (literature review, survey and focus groups). Methods. The results reported here relate to the focus group stage of the study. There were 70 participants in the focus group who worked either as direct care staff with people with intellectual disabilities or as investigators of abuse. Results. Analysis of recurrent themes indicated that both individual (e.g. a positive value base) and systemic factors (e.g. environment) seemed to have an impact on how staff will respond to abuse. Conclusions. This study found that a 'hierarchy of abuse' existed among staff who worked with people with intellectual disabilities. Individual staff members seemed to be 'weighing up' what they perceived as serious abuse before reporting areas of concern. This is in contrast to a philosophy of zero tolerance which registered nurses have to adhere to. Relevance to clinical practice. There needs to be a consistent approach to abuse and nurses need to have appropriate training in which to gain confidence in their role in preventing, identifying and responding to abuse of patients or clients. [ABSTRACT FROM AUTHOR]

Aim. To explore district nurses’ workload management, job satisfaction and the challenges they face. Background. This paper reports qualitative findings from a qualitative and quantitative study to identify a district nursing perspective on use of time, challenges and work satisfaction. District nursing is under increasing pressure because of the increasing shift to care in the community, early hospital discharge and changes in demography with an ageing population and more people with chronic illnesses. Design. Qualitive. Method. The study took place in one Scottish Health Board and data were collected in February and March 2005. The qualitative approach involved a total of 31 district nurses and senior managers in focus group discussions or individual interviews. Results. Three main themes were identified: (1) the priorities of district nurses and their views on work unrelated to ‘hands on’ clinical care, (2) aspects of district nursing considered stressful and (3) district nurses’ job satisfaction. Conclusion. District nurses and managers agree that caring work with patients is the priority for the service and provides job satisfaction. Many nurses feel overwhelmed by their workload and have little control over the admission of patients to their caseload; they are mainly demand led and therefore reactive care providers. A culture of long hours has developed as district nurses struggle to meet the needs of patients. Feeling devalued lowers satisfaction and Agenda for Change is perceived as de-valuing the skills of community nurses. Relevance to clinical practice. More clerical support is required so district nurses can deliver care to patients. District nurses can better represent their workload and how it is managed through expressing the nature of assessing risk and caring for patients as opposed to defining patients care needs by medical diagnoses. Extending the hours of the full district nursing service would benefit patients and staff. [ABSTRACT FROM AUTHOR]

Aims and objectives. This paper reports on non-mature general nursing students' perceptions of nursing as a career prior to their first clinical placement. Background. It is widely recognised that the first clinical practice experience serves a dual role, that of validating students' choice of career and shaping their perceptions of nursing. This study sought to explore 23 first year non-mature (<23 years) nursing students' perceptions of nursing as a career prior to their first clinical exposure. The students accessed the programme via two different modes of recruitment. Method. This qualitative descriptive study used focus group interviews as a means of data collection. Interviews were held within 10 weeks of entry into nursing. Data were analysed using the five stages of framework analysis. Ethical approval was obtained. Results. Mode of recruitment did not influence students' perceptions of nursing. The students unanimously identified caring as the essence of nursing. They also acknowledged the role of the media in shaping theirs and society's perception of nursing. Male students expressed concern regarding the negative connotations associated with their career choice. Student participants could not appreciate the totality of the curriculum content at this stage of their course. Conclusions. Caring remains the essence of nursing. Educators need to take cognisance of first year students' abilities to appreciate the link between theory and practice. This may be enhanced by the employment of teaching strategies that role-model this link for students. Recruiters must be proactive in addressing the challenges facing males in choosing nursing as a career. Relevance to clinical practice. An insight into how nursing students perceive nursing prior to their first clinical placement is important for clinicians. This information is valuable in terms of providing registered nurses with an understanding of the students' perspective and the associated supports required by nursing students on first clinical placements. [ABSTRACT FROM AUTHOR]

Aim. This paper explores the role of the mentor in contemporary nursing practice in the UK. It presents findings from a recent study which investigated the impact of a locality-based nursing education initiative on students, practice mentors and academic staff and draws on another study, conducted in the same setting and two Australian sites, to examine the perceptions of nursing students and mentors. Background. Within nursing, mentorship is integral to students' clinical placement experiences and has attracted increasing interest among researchers. Despite a plethora of studies focussing on mentoring and its nature and application within the practice setting, limited attention has been paid to the extent to which guidelines provided by regulatory bodies for nursing inform and influence the practice of mentoring in contemporary health-care settings. Design. The study used a two-phased design with data on mentorship being focussed on the second phase. Method. Data were collected using an online survey questionnaire of pre-qualifying students and a postal questionnaire for practice mentors. Findings. The findings highlight the importance of mentorship for prequalifying students and emphasise the need to provide mentors with adequate preparation and support. They confirm previous research, but also highlight improvements in bridging the gap between rhetoric and reality for mentorship. Results are further strengthened when compared with those of the second study. Conclusions. Findings provide new evidence of a narrowing of the gap between the theory and practice of mentoring and for the continuing implementation of national standards to clarify the roles and responsibilities of the mentor. They also suggest the benefits of developing such standards in countries with similar systems of support for nursing students. Relevance to clinical practice. Mentorship is pivotal to students' clinical experiences and is instrumental in preparing them for their role as confident and competent practitioners. [ABSTRACT FROM AUTHOR]

Aim and objectives. To examine empirically and in-depth how discriminatory attitudes and practices are experienced by overseas nurses and how the discrimination may affect their well-being and career progression and, furthermore, to apply the theoretical perspective of embodiment in understanding these processes. Background. The UK healthcare sector has, in recent years, relied on overseas-trained professionals to fill up vacancies in nursing and other professions. Research shows that overseas nurses claim that their UK colleagues, managers and patients express discriminatory, racist and xenophobic attitudes. Design and method. The paper provides an existential phenomenological analysis of in-depth interviews with two overseas nurses. The data are drawn from a study of overseas-trained healthcare workers’ experiences working and living in the UK. The two cases have been purposively selected to provide an illumination and discussion of personal experiences with discrimination, how individuals may respond to these and how their professional career is affected. Findings. Discrimination towards migrant workers may, at times, be experienced as ‘blatant racism’ or, in more subtle forms, as ‘aversive racism’. It is demonstrated how such discrimination may impact on the afflicted person's sense of self, suggesting a theoretical model of the embodiment of discrimination. Discrimination not only works at an interpersonal and institutional level, but is a form of ‘symbolic violence’ that may be internalized to affect the person's ‘habitus’; it can be resisted through meaning-making activity that explains and hence objectifies and embodies the experience in a way that allows individuals to positively influence their situation through agency. Conclusion. This article details how social and institutionalized discrimination in the UK healthcare sector may be internalized by overseas workers and affects their professional careers. Relevance to clinical practice. The study allows a theoretical reflection on the damage inflicted by discrimination, and it may contribute to the eradication of discriminatory practices and the development of necessary support and monitoring mechanisms. [ABSTRACT FROM AUTHOR]

Aim. The aim of this case study was to acquire understanding concerning the first-line nurse manager's goal-profile, i.e. prioritization of goals in her work as a first-line nurse manager, through use of an action-theoretic and confirmatory theory. Background. The first-line nurse manager's pivotal role regarding quality of care and development in relation to on-going changes in the health care sector is stressed by many researchers and the transition from nurse to manager is described as a demanding challenge for the first-line nurse manager. Methods. The case study described in this paper concerns a first-line nurse manager in an actual working environment in care of older people. Data collection comprised interviews, observations, a job description and policy documents. A hermeneutic interpretation was used for data analysis. Results. The results showed that the first-line nurse manager had three goals in her goal-profile, in the following order of priority: (i) a nurse goal that she had strongly accepted and in which she had excellent control, (ii) an administrator goal that she had accepted and in which she had control, (iii) a leadership goal that she had not accepted and in which she did not have control. Both the administrator and leadership goals were based on her job description, but the nurse goal was a personally chosen goal based on her own self-relation/goal-fulfilment. Conclusion. The first-line nurse manager's prioritized self-identity, based on successful realization of goals in her goal-profile, was decisive in the manifestation of her work. Relevance to clinical practice. This study contributes to a new understanding of the first-line nurse manager's self-identity related to work in terms of goal acceptance and goal control of prioritized goals. This action-theoretic approach could be a valuable 'key' for understanding leadership (or lack of leadership) in clinical practice. [ABSTRACT FROM AUTHOR]

Aims and objectives. This paper examines issues of contention regarding current practices and suggests the application of the experiential theory of learning (incorporating reflective practice) to advanced cardiac life support (ACLS) training. Background. The need for formalized training in cardiopulmonary resuscitation (CPR) and ACLS is well documented. However, the effectiveness of traditional training programmes has not been firmly established. The question still remains - how to best ensure transfer of learning enabling learners to apply classroom knowledge successfully in the clinical setting. It is argued that educators can no longer rely on traditional teaching methods and more effective learner-centred education techniques are required. Method. A review of available literature regarding ACLS training has been conducted for this discussion. Data sources and selection: MEDLINE, CINAHL, OVID, Expanded Academic and Proquest were searched using textwords. English-language articles related to CPR and ACLS practices and also experiential learning were reviewed. Additional references were also reviewed from the bibliographies and from citation searches on key articles. Articles related to CPR/ACLS and experiential learning practices published within the last 10 years were reviewed. Results. There is evidence that past ACLS training programmes have proven inconsistent and inadequate, with numerous studies reporting trainees have poor retention; and, therefore, ineffective ACLS skills as a result. Conclusions. The reviewed literature demonstrates that the need for effective ACLS training is clear. Increasing numbers of critically ill patients in hospitals means that it has never been more important to ensure the competence of healthcare professionals. Training must give learners a chance to pull together all aspects of ACLS and the use of experiential learning has the potential to achieve this aim. Relevance to clinical practice. It is argued that providing training designed and implemented using experimental learning enhances learning through critical thinking and reflection, and subsequently should improve ACLS outcomes. [ABSTRACT FROM AUTHOR]

This paper presents an argument for the use of Bayesian reasoning in considering the value of evidence in making nursing judgements. Background. Nursing has taken on board the drive towards evidence-based practice. There has been little discussion, however, of how evidence should be interpreted. There is a growing interest in health care in the use of Bayesian reasoning for evidence interpretation, both in research and in clinical practice; as yet, there is a limited discussion in the literature of relevance to nursing. Objectives. To provide a short tutorial in the application of Bayes rule to a clinical judgement. To discuss the implications for practice of adopting a Bayesian perspective. Discussion. The relationship between evidence and clinical judgement is outlined. The need to accept uncertainty, and be equipped to deal adequately with this, is discussed: some basic ideas of probability are rehearsed. An outline of Bayesian reasoning is offered and a demonstration of the application of Bayes rule to a nursing judgement is presented. Relevance to practice. A rationale for adopting a Bayesian perspective on evidence interpretation is offered: namely the changing context of practice, with the blurring of professional boundaries and the need to articulate judgements, the avoidance of error and the opportunity to identify the appropriate areas for investigation in nursing. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of this study was to consider the impact that an eating disorder had on the family, particularly the parents. The objective was to give a voice to parents in order to develop new understandings of their experience leading to more appropriate clinical decision-making. Background. The impact of an eating disorder on family life has not been well-documented in the published literature. There are numerous articles from the sufferer's perspective and treatment modalities. The following paper describes a component of a larger study that explored the parent's perspective of having a child with an eating disorder. Design. Nineteen mothers and three fathers from Sydney, Australia, volunteered to be interviewed as the result of advertizements placed in parent support organization newsletters and by using the snowballing technique. Methods. A qualitative approach using semi-structured interviews was used to explore parents’ experiences of having a child/adult child with an eating disorder. Themes were identified through in depth analysis. Results. Themes that were extrapolated from this research included, family unification or disintegration, parent's inability to cope, inconsiderate comments from significant others, social isolation and financial impacts. Conclusions. This study reports five overarching effects on family life. The authors conclude that one way in which the life of parents and families could be improved would be increased involvement and integration into the treatment process. For this to happen, health professionals would need to acknowledge the family as a resource. Relevance to clinical practice. This research documents the family struggle and highlights the current omissions concerning the family's role. The need for changes to clinical practice is substantiated. It requires health professionals to scrutinize their own clinical practice and consider modification of the treatment process. [ABSTRACT FROM AUTHOR]

Aims. This paper reports a study to identify patient's perceptions of quality of care at an emergency department and areas for quality improvement. Background. Patients are not always satisfied with the care received at emergency departments. More attention needs to be paid to the specific needs and expectations of the non-urgent group of patients, who make up the majority of attenders at many emergency departments. Nurses’ and physicians’ perceptions about good quality of care do not always agree with patients’ perceptions. Instruments measuring patient satisfaction have often been focused on inpatient treatment. Method. A prospective, descriptive survey design was adopted and the study took place in one emergency department at a Swedish university hospital in 2002. The participants were 99 women and 101 men, with an average age of 51 years. The emergency department version of the questionnaire Quality from the Patient's Perspective was used for data collection. Results. Patients estimated quality of care at the emergency department as fairly good, but there were areas in need of improvement. A high percent of inadequate quality was related to the environment in the emergency department. About 20% of patients reported that they did not receive effective pain relief. More than 20% estimated that nurses did not show an interest in their life situation and patients did not receive useful information on self-care and about which physician was responsible for their medical care. Conclusions. The use of a research-based instrument gave valuable information for quality improvement in clinical practice. Many of the identified areas for quality improvement are related to nursing care. Therefore, the importance of nursing care in the emergency department should be highlighted to nurses and physicians and they also need to be more attentive to the need of the individual patient. Relevance to clinical practice. Identifying areas for quality improvements are important, to know where to take action. These findings may facilitate the work with changing attitudes and working routines, which are needed to deliver effective care and to improve patients’ perceptions of quality of care at emergency departments. [ABSTRACT FROM AUTHOR]

Aim. The aim of this paper is to explore the operation of two different types of knowledge in health care and the position of the nurse to assist in the confluence of knowledge to develop the well-informed patient. Background. If patients are to be active participants in their care they require useful information. Interactions in contemporary health care mostly involve ‘medico-scientific’ knowledge, that refers to the ‘science’ of patients’ conditions, as opposed to ‘everyday’ knowledge, which refers to information that can assist patients in lifestyle matters relating to their condition. Theoretical perspective. This paper draws on the work of the ‘well-informed citizen’ as proposed by Schutz in the analysis of two patient case studies of practices in the acute care setting of the hospital. Method. Data collection was undertaken through fieldwork, incorporating participant observation and discussions with patients in general medical/surgical areas. Results. Two patient case studies representative of the findings are analysed. Analysis identifies the predominant use of ‘medico-scientific’ knowledge to the detriment of ‘everyday’ knowledge during interactions between patients and all health professionals. Conclusions. There is predisposition in the acute context to interact in ‘medico-scientific’ knowledge as opposed to ‘everyday’ knowledge that does not facilitate a comprehensive understanding by patients of how they can best manage their lifestyle. Relevance to clinical practice. Using the notion of Schutz's ‘well-informed’ citizen this study identifies strategies for nursing staff to capture and explore the development of ‘everyday’ knowledge that can assist patients to become more informed and improve their health management. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: This paper reviews study findings of preferred music on agitated behaviours for older people with dementia and provides implications for future research and practice. BACKGROUND: Music has been suggested as a feasible and less costly intervention to manage agitated behaviours in older people with dementia. However, no review of the literature focusing on study findings of preferred music on agitated behaviours in older people with dementia had been reported. METHODS: A review was undertaken using electronic databases with specified search terms for the period of 1993-2005. The references listed in the publications selected were also searched for additional studies. RESULTS: Eight research-based articles met the inclusion criteria and were included in the review. The preferred music intervention demonstrated positive outcomes in reducing the occurrence of some types of agitated behaviours in older people with dementia. The findings from these studies were relatively consistent in finding improvement in agitated behaviours although the findings in one study did not reach statistical significance. The small sample sizes and some variations in the application of the preferred music intervention mean that caution is needed in drawing conclusions from these studies. CONCLUSIONS: This review highlights that preferred music has positive effects on decreasing agitated behaviours in older people with dementia; however, the methodological limitations indicate the need for further research. RELEVANCE TO CLINICAL PRACTICE: Findings from the review highlight the beneficial outcomes of preferred music in reducing agitated behaviours for older people with dementia. The incorporation of preferred music has the potential to provide a therapeutic approach to the care of older people with dementia. [ABSTRACT FROM AUTHOR]

Aim. This paper reports phase II of a pilot study that aimed to determine whether self-insertion of a speculum by women undergoing a pap smear would be more comfortable and lead to an improvement in satisfaction and a decrease in anxiety associated with this procedure. Background. Research demonstrates that pelvic examinations are considered by most women to be unpleasant and are routinely associated with embarrassment, apprehension, fear and often some level of discomfort and/or pain. Design. The study used quantitative and qualitative data collection techniques. Phase I (described elsewhere) tested the newly developed Speculum Self-Insertion Satisfaction Questionnaire for content validity, internal consistency and clarity. Phase II pilot study tested the technique of speculum self-insertion. Women's general level of anxiety was measured using the State Trait Anxiety Inventory, both before and after they performed the self-insertion procedure. Women's satisfaction and acceptance of the procedure was measured using the Speculum Self-Insertion Satisfaction Questionnaire and explored through the use of qualitative research techniques. Participants. A total of 198 women attending family planning clinics in Perth, Western Australia, between September and December 2003 were invited to participate in the study. One hundred and thirty-three women agreed to self-insert their own speculum. Results. The study demonstrated that speculum self-insertion was acceptable to most women, especially younger women. Nearly 91% of women either agreed or strongly agreed that they were satisfied with the experience of self-insertion and would choose to self-insert the speculum again. This included the women who had not previously had a speculum examination. The quality of specimen collected was not detrimentally affected by speculum self-insertion. Conclusions. The results of this pilot research, while needing to be replicated in a larger study, demonstrate that offering women the opportunity to self-insert a speculum during a routine pelvic examination is an acceptable, innovative, simple and cost-neutral change in clinical practice that increases women's comfort and satisfaction and potentially makes sexual health screening less threatening to women of all ages. Relevance to clinical practice. Speculum self-insertion may encourage women's attendance at clinics for regular screening. Early diagnosis and treatment will result in better health outcomes for women, families and the community at large. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: The aim is to devise a decision-making model to help nurses and allied professionals treat the symptoms of infectious diseases in a logical way that maximizes the benefits of symptoms and minimizes any harm that they might do. BACKGROUND: This paper considers the symptoms of infectious diseases from an evolutionary perspective, applying theories from ecology and evolution to nursing. Building upon evolutionary theories that suggest symptoms occur as the result of host defences, pathogen manipulations or as pure side-effects, it is suggested that those symptoms that have evolved as host defences should not always be treated because of their beneficial effects. However, clinical decision-making is more complex because of the rapid changes in environment and behaviour, which may impact upon the usefulness of symptoms to the host. CONCLUSIONS: Although some symptoms can be identified as being beneficial adaptations, this alone is not sufficient indication to decide which symptoms should or should not be treated. Other considerations include any negative outcomes and behavioural and environmental changes that may affect the significance of any adaptation. RELEVANCE TO CLINICAL PRACTICE: Nurses should aim to maximize the host defences of the patients they are caring for in order to speed recovery and to reduce transmission and the need for antibiotics. This model helps nurses to identify factors that should be considered when these decisions are made and suggests some principles that might be followed in other situations. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: This paper undertakes a critical appraisal of the methodological issues associated with studies that have investigated the extent to which music decreased the anxiety experienced by patients in short-term waiting periods such as day surgery. BACKGROUND: Investigations and surgery undertaken on a day basis have significantly increased in number over the last decade. Music has been evaluated as an appropriate nursing intervention in relation to pain, discomfort and anxiety in a number of clinical settings but its usefulness for decreasing anxiety in short-term waiting periods such as day surgery is only beginning to be understood. CONCLUSION: A number of methodological limitations are identified by this critical review, particularly in relation to the design of research studies. Recommendations to strengthen research in this area are suggested and include (i) describing methods clearly and with detail to allow assessment of the validity and rigour of study results; (ii) using permuted block randomization; (iii) recruiting from a variety of surgical procedures and cultural groups; and (iv) standardizing the health care provided during waiting period. RELEVANCE TO CLINICAL PRACTICE: Music as a simple and cost-effective intervention to reduce the anxiety experienced in limited time periods will have enormous impact on clinical practice where patients wait and undergo invasive investigations, procedures or surgery. However, the evidence of its utility in these unique environments is only beginning to emerge and this critical review provides a basis for considerations for future research. [ABSTRACT FROM AUTHOR]

thompson d.r., lopez v., lee d. & twinn s. (2004) Journal of Clinical Nursing 13, 131–135 SARS – a perspective from a school of nursing in Hong Kong Severe acute respiratory syndrome (SARS) is a new infectious disease with significant morbidity and mortality that has had a major impact on health and health care services worldwide. Hong Kong has had a significant number of cases and deaths. Nurses, at the vanguard of the clinical health care team, have been particularly affected by it. The outbreak prompted the health authorities to implement a series of public health measures and hospital policies, including a guideline for the diagnosis and management of patients with SARS. This paper aims at providing an overview of what is known about SARS and the impact it has had in Hong Kong and to highlight from the perspective of a school of nursing the major clinical, educational and public health implications. The lack of understanding and uncertainty about the disease led to significant variation in the provision of information, contributing to the confusion and anxiety in the community. Therefore, there is a need to revise the nursing curriculum, to provide continuing education to all health care professionals, particularly with regard to infection control measures, and to revisit the range of public health policies to ensure the health of the community is protected by these policies. There also has been a reaffirmation of the importance of health promotion that highlights the importance of the partnership between nurses, health policy makers and public health personnel. It is evident that the organization and delivery of clinical practice, teaching and health promotion have to be flexible and responsive to a changing health scenario. Nurses must play a crucial role in the prevention, detection and containment of SARS. They will need to implement and ensure strict adherence to infection control measures and, in some circumstances, isolation and quarantine may be warranted. Attention to the psychological state of patients and family members should not be overlooked. Paramount is education of patients, families and members of the public at large. [ABSTRACT FROM AUTHOR]

Little emphasis has been placed by clinicians on the need for routine evaluation of outcomes of community mental health nursing interventions. Although numerous descriptive studies exist, there is little systematic evaluation of the work of community mental health nurses, and this problem is particularly acute in the field of preventative work. This paper presents the results of a small initiative to incorporate outcome evaluation into the clinical work of a community mental health team. Ninety-nine participants in a series of stress management workshops completed stress questionnaires before a series of 2-day workshops and were followed up at between 3 and 6 months afterwards. At follow-up, participants reported greater gains in terms of stress management than did no-treatment controls. The study offers tentative evidence for the effectiveness of community mental health nurses in offering effective preventative interventions and also indicates that such interventions are amenable to outcome evaluation within the context of routine clinical practice. [ABSTRACT FROM AUTHOR]

Much has been written concerning the use of complementary and alternative therapies in health care. It is the author's belief that much of the current debate exists within a context of little knowledge of the research concerning these therapies. Because of this lack of knowledge, nursing practice may not be informed and/or directed by research. Despite guidance from the UKCC (1992) nurses need to ensure that their position regarding these therapies is based upon a judicious review of the literature and carefully crafted and reasoned actions. [ABSTRACT FROM AUTHOR]

The author comments on the article "The Ascent to Competence Conceptual Framework: An Outcome of a Study of Belongingness" by T. Levett-Jones and J. Lathlean. He admits that the article is interesting because it views competence in a different approac. He considers the inadequacy of competence as the objective for studying nursing. He addresses the sufficiency of competence as a concept in nursing education for clinical medicine.

The author reflects on a study which makes contribution to the debate about the use of different methods of clinical thermometry. The study has led to a very general statement on the use of tympanic thermometers, which is not supported by data and is not generalized to other clinical settings. He pointed that the problems with the conclusion are twofold, which include the relationship between different thermometry sites and the ability of various techniques to inform clinical decision making.

Commentary on the article "Protocol-based Care: The Standardisation of Decision-making?" by J. Rycroft-Malone, M. Fontenla, K. Seers, and D. Bick is presented. Protocol-based care and clinical decision-making are discussed. Hospital protocols and their utilization by nurses are examined. The need for the nursing profession to examine the correlation between clinical decision-making and the implementation of evidence-based practice is also discussed.

The article reflects on the value of nursing practices in clinical research. Nursing work makes a significant contribution in assisting the further explanation of medical practices. It provides an opportunity for nurses to contribute in the clinical practice knowledge through research reports that contain information about their practices.

The article comments on the relevance of the placebo effect to nursing and midwifery research. The placebo effect accounts for the evolution of therapeutics which have been designed on the basis of research. The use of credible placebos is considered impractical in clinical nursing research. The application of specific treatments is analyzed to determine whether a specified treatment is a placebo.

Aims. To test the reliability and validity of the Chinese version of the Nursing Practice Environment Scale (C-NPES) translated from the Lake’s Practice Environment Scale of the Nursing Work Index and to explore nurses’ perceptions of the nursing work environments in Taiwan Background. Magnet hospitals are characterised by professional autonomy, control over nursing practice, adequacy of staffing, supportive management and effective interdisciplinary relationships, which are successful in attracting and retaining nurses. In Taiwan, this concept has gained importance since the SARS crisis of 2003. However, there have been limited Chinese instruments based on magnet hospital traits to explore Taiwan’s nursing work environment. Design. This study was designed as a cross-sectional survey. Purposive convenience samples of 842 nurses were recruited from five acute hospitals in Taiwan. Internal consistency reliability, content validity using expert review, construct validity using factor analysis and criterion-related validity were examined. Results. The Cronbach’s alphas were 0·90 for the total scale and 0·87–0·65 for the subscales. The validity was obtained using a content validity index and principal component analysis of five-factor structure (variance explained 47·89%). The criterion-related validity was supportive of the turnover rate ( t = 7·84, p < 0·001). The participants disagreed on staffing and resource adequacy and participation in hospital affairs but agreed on professional development. Conclusion. The preliminary psychometric properties of C-NPES have been established. Considering cultural appropriateness, the subscales of staffing and participation in hospital affairs need advanced modification. Relevance to clinical practice. The C-NPES will provide hospital administrators with an overview of magnet hospital settings for nursing practice. It is beneficial for the stabilisation of the nursing workforce as well as for the optimisation of nursing work environments. Additionally, the use of professional development programs to enhance nurses’ knowledge of SARS prevention is favorable. [ABSTRACT FROM AUTHOR]

Aim. To test changes in adherence to nurses' falls prevention work resulting from improving attitudes and ownership of practice. Background . Workforce surveys indicate that nurses leave nursing because they cannot deliver the care they value. When challenged why, nurses claim no power of decision-making or authority to change their work with dissatisfaction and disengagement with work ensuing. Nurses espouse 'caring' but are observed taking risks with patients' safety reflecting poor congruence between values and behaviours. Attitudes and decision-making involvement are factors that influence work behaviours. Hence, increased adherence should be achieved by improving nurses' attitudes through active decision-making surrounding practice. Design. Mixed methods study. Methods. Mixed methods were employed during 2004 by surveying attitudes (self-esteem, professional values and work satisfaction) before and after re-engineering nurses' work using practice development (PD) to gain time to spend in prevention work. Practice behaviour was observed and measured at intervals during the study. Results . Initially, nurses had good self-esteem and professional values but were not satisfied with their work. Following the PD, self-esteem and professional values were unaffected; however, nurses expressed increased sense of ownership and greater satisfaction. Nurses were observed to engage in more prevention work. More effective ways of assessing and communicating risk and monitoring nurses' performance of prevention work were created and evaluated. Patients' environments were made safer and more patient-centred. Conclusion. Manipulation of attitudes and values is not warranted if attitudes and values are good. However, participation in work-related decision-making engages practitioners and leads to greater congruence between values and behaviour. Recommendations include promoting reflection and action to achieve cultural change and person-centred care. Relevance to clinical practice. This study is relevant to international readership as adds to what is known about nurses' practice behaviours related to falls prevention and will assist others when designing and implementing programs that address patient safety and optimise nurses' adherence. [ABSTRACT FROM AUTHOR]

Aim. The purpose of this study was to explore the effect of oral secretion on aspiration and reducing ventilator-associated pneumonia. Background. Ventilator-associated pneumonia is a serious hospital-acquired infection with reported incidence rate of 12·2% and mortality rate of 29·3%. Oral secretion is purported as a media which brings the oropharyngeal pathogens down to the respiratory track. Methods. Two-group comparison study design was adopted. Subjects were recruited from an adult general intensive care unit of a medical centre in Taipei city. Patients in the study group received suction of oral secretion before each positional care, in contrast with patients in the control group who received routine care. Results. Ventilator-associated pneumonia was found in 24 of 159 (15·1%) patients in the control group and in five of 102 (4·9%) patients in the study group with a reduction of risk ratio of 0·32 (95% CI 0·11-0·92). Eight of the 24 ventilator-associated pneumonia patients died in the control group; however, none of those ventilator-associated pneumonia patients died in the study group. The increased chance of survival was 1·50 (95% CI 1·13-1·99). The length of stay in ICU and duration of mechanical ventilation were reduced in the study group. In consideration of cost, the cost of tubes used to remove oral secretion is much less than the one used to do continuous subglottal suction. Conclusion. Removal of oral secretion is effective in reducing the incidence of ventilator-associated pneumonia with minimum cost intervention. Relevance to Clinical Practice. This study provides evidence that removal of oral secretion prior to position change is cost effective to reduce the incidence of ventilator-associated pneumonia. As such intervention is an easy task, routine removal of oral secretion is recommended as the standard of daily nursing care of patients on ventilator. [ABSTRACT FROM AUTHOR]

AIMS: To identify and critique literature on the adolescent lived experience of chronic illness; describe the lived experience; and to make recommendations for clinical practice. BACKGROUND: Young people with chronic illness have the same developmental issues as those who are healthy. However, development can be disrupted by treatment and repeated hospitalisation. While the physical consequences of chronic illness on development have been established, the subjective personal experience is less known. DESIGN: Literature review. METHODS: Electronic databases and hand searches were made of the literature published between January 1990-September 2007. Literature was eligible for inclusion if it involved adolescents between 10-19 years, and published in English and used qualitative methods of data collection. Methodological quality was assessed using the criteria described by Cesario et al. [Journal of Obstetrics, Gynaecology and Neonatal Nursing 31 (2002) 31]. CONCLUSIONS: Twenty studies were identified involving young people with a wide variety of chronic illnesses. The study quality was variable, however, generally the majority was assessed as being good or fair. Seven common themes were found between the identified studies: developing and maintaining friendships; being normal/getting on with life; the importance of family; attitude to treatment; experiences of school; relationship with the healthcare professionals; and the future. RELEVANCE TO PRACTICE: As there was commonality in themes between studies strategies to lessen the burden of chronic illness during adolescence do not necessarily need to be disease specific. Nurses need to focus on treating the young person rather than their illness. [ABSTRACT FROM AUTHOR]

Aim. The aim of this study was to initiate an exploration of parents’ understanding and experiences of their child’s reconstructive genital surgeries for ambiguous genitalia. Background. The determination of gender for a child born with ambiguous genitalia is a complex medical and social process influenced by biological, psychological, social and cultural factors. Two main approaches exist; one promotes interventions (optimal gender policy) while the other suggests delaying interventions (informed consent policy) until the child can contribute to the decision. Methods. An exploratory narrative inquiry design was chosen. Data were collected through narrative interviews with a purposive non-random sample of 10 parents of eight children (aged 0–11 years) who had ambiguous genitalia. Results. Parents’ stories reflected strong protective instincts towards their children along with feelings of shock and disbelief. Parents’ social construction of gender influenced their attitudes and beliefs about their child’s ambiguous genitalia and the need for surgery. Parents’ desired to be ‘good parents’ and do what they perceived as ‘right’ for their child. They considered genital surgery as a necessity primarily relying on medical advice to guide them at times of uncertainty and confusion. Parents rarely shared stories about their child’s surgeries/genitalia outside of the couple relationship and these stories were often referred to as ‘secrets’. Conclusion. Having a child with ambiguous genitalia was perceived as problematic and brought about changes in roles, responsibilities, goals and social status as a parent beyond those usually associated with parenthood. Relevance to clinical practice. These early findings help increase awareness of parents’ experiences and of the problems and emotional challenges that parents face when their child is born with genital ambiguity. [ABSTRACT FROM AUTHOR]

Aim and objective. To describe the experiences of families, whose children have life-limiting and life-threatening conditions and who have complex healthcare needs, of receiving respite care at home or in a hospice. Background. Respite provision is an extremely important service in assisting families to cope with the extra stresses and problems of coping with children with complex healthcare needs. There are different issues when the venue is home or a hospice. Design. Semi-structured interviews were carried out with families of children with complex healthcare needs, receiving respite care at home or in a hospice. Methods. A convenience sample of 11 families was interviewed using an interview schedule, exploring their experiences of the service and their views on the service. Results. The areas of concern identified as significant to all the families were referral to respite service, service organisation, communication, relinquishing control to respite carers and satisfaction with service. Conclusion. Within the provision of respite care, there needs to be more overt referral systems and criteria, negotiation of appropriate roles, continuity of care, regular assessment of need and acknowledgement of the difficulty, which parents have in relinquishing control to respite carers. Relevance to clinical practice. High-quality respite care for families involves more than just organising a respite session. Healthcare professionals organising and providing care could manage a service more effectively, if taking the above issues into consideration. [ABSTRACT FROM AUTHOR]

Aim. To ascertain whether there is a relationship between the perceived importance of pain management tasks and the quality of an individual nurse’s practice. Background. The evidence to guide nurses’ pain management practices is readily available. However, children’s nurses’ pain management practices often fall short of the ideal. The (lack of) priority attributed to pain management has been suggested as one reason for this. However, this supposition has not previously been explored. Design. Participant observation. Method. Data were collected about children’s nurses’ ( n = 13) post-operative pain management practices on one children’s surgical ward in the English Midlands. Nurses ( n = 12) also completed a questionnaire to provide a measure of the importance attributed to pain management tasks. Results. The questionnaire responses of individual participants ( n = 12) were compared to the observational data. The perceived importance of a pain management task did not affect the likelihood of it being undertaken. Conclusion. Several explanations for these results have been put forward. It is apparent that the hypothesis, put forward in other studies that increasing the priority attributed to pain management will improve pain management practices may be overly simplistic. Relevance to clinical practice. The evidence to guide nurses’ pain management practices is readily available. However, children’s nurses’ pain management practices seem to fall short of the ideal. Possible reasons for this need to be explored so that practice can be improved. [ABSTRACT FROM AUTHOR]

Aim. This study explored the experience of long-term renal illness, including issues concerning compliance with treatment, from the perspectives of children and young people. Background. Children and young people have difficulty complying with renal treatment; research in this area usually focuses on their compliance with a narrow range of behaviours: compliance with dialysis, tablet taking and dietary and fluid restrictions. Renal compliance studies are usually premised on the assumption that children will automatically comply with treatment and/or that blame for non-compliance rests with the child and family. Design. The study, underpinned by a view of children as competent social agents, used ethnography to explore and describe the everyday experience of long-term renal illness. Method. Ethnographic fieldwork – involving participant observation, informal interviews and the use of children’s drawings – took place over 16 months in a hospital renal unit comprising an inpatient ward, a haemodialysis unit and an outpatient clinic. The primary participants were 13 children; 14 carers and 36 staff members also participated. Data were interrogated through descriptive and thematic forms of analysis. Results. This study reveals participants’ perspectives on the physical and social impact of renal treatment. It also provides a conceptualisation of life with long-term renal illness that highlights children’s management of ‘illness labour’, their inhabitation ‘renal geographical space’, ‘a renal body’ and a ‘renal social world’. Conclusions. These findings show how compliance with renal treatment involves particular embodied experiences that are hard for children to manage. Traditional views of compliance/non-compliance render children’s embodied experience and their labour in managing dialysis, thirst and their difficulties with tablet taking irrelevant, whilst this study shows these as highly relevant to children. Relevance to clinical practice. The conceptualisation of children’s experience arising in this study provides a new way of considering the embodied experience of children with long-term renal illness. [ABSTRACT FROM AUTHOR]

Aim. The aim of the present study was to investigate nurses’ opinions about using standardised care plans in electronic health record and quality standards for clinical practice. Background. Following introduction of an electronic health record, use of standardised care plans and quality standards has increased among nurses at two hospitals in Sweden. Understanding nurses’ opinions is important to continued development in this area. There are few previous studies on nurses’ opinions about standardised care plans. Design. Survey. Method. The study was quantitative, descriptive and based on a questionnaire. The questionnaire included items on nurses’ knowledge of and opinions about standardised care plans and quality standards. Results. The majority of the nurses were of the opinion that standardised care plans increase their ability to provide the same high-quality basic care for all patients. They also thought that a common standardised care plan across several professions would improve conditions for provision of high-quality care. The majority of the nurses also felt that the quality standards are a prerequisite of maintaining standardised care plans of high quality. There was no consensus on whether standardised care plans increase the risk of failing to notice patients’ individual problems. Most agreed that standardised care plans decrease documentation time as well as redundant documentation. The study showed that training is needed to teach nurses how to use standardised care plans in care provision. Conclusions. The nurses in the study had positive attitudes towards use of standardised care plans and felt that they could facilitate nursing practice. Relevance to clinical practice. Use of standardised care plans can improve nursing documentation and facilitate work for nurses. Moreover, it can support nurses in their use of evidence-based nursing methods. The present study shows that nurses have positive attitudes, which could facilitate continued use of standardised care plans. [ABSTRACT FROM AUTHOR]

Aim. This observational study sought to investigate the process of evidence use by health professionals during development of evidence-based clinical management tools. Background. Studies conducted to explore the process of research use are scarce and knowledge of this process is essential for our understanding of the influences on research use in practice. Design. A qualitative, non-participant, observational design. Methods. Behaviour and actions of two separate multidisciplinary teams were observed and audio-recorded during a combined total of seven meetings for the development of clinical management tools. Semi-structured, one-to-one interviews were conducted approximately half-way through the development process and following completion of the clinical management tools. Results. Three major themes emerged from this research. First, the process of clinical management tool development and evidence use. Nurses assumed responsibility for coordination of development which focused on describing current practice. Second, the forms of evidence employed during the development process included the use of experiential knowledge, opinions and knowledge of the context, in addition to research evidence. However, reference to research evidence was limited and its incorporation into the instrument was infrequently observed. Third, the use of research evidence emerged with respect to how such evidence was employed. Conclusion. This study focused on real-life discussion and decision-making that occurred between health professionals when developing evidence-based clinical management tools. Health professionals may have a tendency to rely on their professional experience and current practice in preference to seeking and applying relevant research evidence. Relevance to clinical practice. Nurses have an important role to play in the development of multidisciplinary evidence-based clinical management tools, but to actively participate in this process they need to be familiar with the relevant research evidence and have the skills and confidence to integrate the evidence into practice. [ABSTRACT FROM AUTHOR]