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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]

AIM: The aim of this paper was to explore the issues surrounding the spirit of the unborn child. BACKGROUND: Pregnancy and birth have been recognised to have a spiritual nature by women and health professionals caring for them. Midwives and nurses are expected to have a holistic approach to care. I suggest that for care to be truly holistic exploration is required of the spiritual nature of the unborn fetus. METHODS: Historical, philosophical and religious views of the spirit of the fetus, are explored as well as those of women. Investigation was made of views of the timing of 'ensoulment'. RESULTS: The review demonstrates the value women place on the sacredness of pregnancy and birth, and that the spiritual nature of the unborn should be recognised. CONCLUSION:This paper shows that the views and values women have of pregnancy and birth and the powerful, spiritual relationship they have with the unborn, indicates that further discussion and research needs to be carried out in this area. RELEVANCE TO CLINICAL PRACTICE: It is recommended that all who work with women who are pregnant should recognise the spiritual nature of the unborn when carrying out care. [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]

Aim. The aim of this paper is to highlight the significance of care planning and to encourage the integration of a consistent and systematic planning process into nursing practice. Background. Many factors contribute to the successful achievement of clinical outcomes, including patient-practitioner rapport, comprehensive client assessment, accurate differential diagnosis, evidence-based care and the objective evaluation of client progress. One element that is of equal importance to these aforementioned factors is the planning of patient care. However, there are concerns that some practitioners may not be adopting a planned approach to client care, possibly because of a lack of understanding, time, skill or interest in care planning. Method. This is a position paper on the planning of patient care. Results. The planning of patient care can be effectively implemented using a two-stage process. In brief, the first step involves the construction of a general goal, which is the overall, desired outcome of care. The expected outcome, or specific goal, forms the second part of the planning process, which clearly directs clinical care by specifically indicating how and when an individual will achieve the general goal of treatment. Conclusion. This paper highlights the importance of care planning and that the use of a clear, systematic planning framework may help to deliver a more transparent and consistent approach to patient care, which may greatly improve patient health and well-being by hastening the achievement of clinical outcomes. Relevance to clinical practice. The knowledge and strategies contained in this paper can be easily adopted by nurses and other clinicians to modify or build upon existing practice. This knowledge may help foster a more client-centred, participative, individualised approach to care, which may lead to improvements in patient outcomes. [ABSTRACT FROM AUTHOR]

Aim. To review the literature on attitudes of health care professionals to termination of pregnancy and draw out underlying themes. Background. The controversy surrounding therapeutic abortion is unremitting with public opinion often polemic and unyielding. Nurses and midwives are at the centre of this turmoil, and as more termination of pregnancies are being performed using pharmacological agents, they are becoming ever more involved in direct care and treatment. Attitudes towards termination of pregnancy have been found to vary depending on the nationality of those asked, the professionals involved, experience in abortion care, as well as personal attributes of those asked such as their obstetric history and religious beliefs. The reasons for women undergoing abortion were also found to influence attitudes to a greater or lesser extent. Conclusion. This paper explores research studies undertaken into attitudes of health care professionals towards termination of pregnancy, to appreciate the complexity of the debate. It is possible that the increased involvement of nurses in termination of pregnancy, that current methods demand, may lead to change in attitudes. Consideration is given to a number of remedies to create an optimum environment for women undergoing termination of pregnancy. Relevance to clinical practice. This paper establishes via a literature review that attitudes in those working in this area of care depend upon a variety of influences. Suggestions are made for measures to be put into place to foster appropriate attitudes in those working in termination of pregnancy services. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: This paper describes the further development of the substantive theory Optimising Personal Control to Facilitate Emotional Comfort. In previous work, emotional comfort was identified as a therapeutic state that was influenced by several factors, one of which was the hospital environment. This paper focuses on aspects within the hospital environment that patients perceive to influence their feelings of personal control. BACKGROUND: A relationship between control and health has been discussed in previous literature. There are indications that aspects of the hospital environment can impact on a patient's perception of control. This project explored personal control in relation to the hospital environment from the perspective of patients. METHOD: Grounded theory method was used. Data were collected from patients' interviews and field observations and analysed using the constant comparative method. Interviews were tape-recorded and transcribed verbatim. A qualitative data computer program was used to manage the data. RESULTS: The results confirmed the findings of the original study where hospitalised patients were found to experience feelings of reduced personal control. The conditions of level of security, level of knowing and level of personal value were described in terms of their contribution to the patient's feelings of personal control. CONCLUSIONS: Specific directions for further research into the development and evaluation of therapeutic hospital environments that promote personal control and the associated emotional comfort are provided. RELEVANCE TO CLINICAL PRACTICE: This research highlights the importance of considering patients' feelings of personal control during their hospital stay. Several directions for establishment of therapeutic environments within hospitals are provided, but more research in this area is recommended. [ABSTRACT FROM AUTHOR]

AIM: This paper examines how time is controlled and governed in operating rooms through interpersonal communication between nurses and doctors. BACKGROUND: Time is a valuable commodity in organizations with improvements often directed towards maximizing efficiencies. As a consequence, time can be a source of tension and interpersonal conflict as individuals compete for control of its use. METHODS: The data in this paper emanate from an ethnographic study that explored a range of communication practices in operating room nursing. Participants comprised 11 operating room nurses. Data were collected over two years in three different institutional settings and involved participant observation, interviews and the keeping of a personal diary. A deconstructive analysis of the data was undertaken. RESULTS: Results are discussed in terms of the practices, in which clinicians are engaged in, to govern and control their use of time. The four practices presented in this paper include; questioning judgment and timing, controlling speed, estimating surgeons' use of time and coping with different perceptions of time. CONCLUSIONS: Time and speed were hotly contested by nurses. They used their personal knowledge of individual surgeon's habits of time to govern and control practice. Nurses thought about surgeons in terms of time and developed commonly accepted understandings about the length of surgical procedures. They used this knowledge to manage the scheduling of operations in the departments and to control the workflow in individual operating rooms. Knowledge of individual surgeons was a source of power for operating room nurses. RELEVANCE TO CLINICAL PRACTICE: Nurses have more power in the operating room than might be imagined but they exercise this power in subtle ways. If operating rooms are to work effectively, the operating room team must understand each others' work better. [ABSTRACT FROM AUTHOR]

Aims. The aims of this paper are to present and discuss the findings that emerged from a qualitative study exploring nurses and patients’ views of the acute psychiatric ward (the context) and the type of care received (the intervening conditions). Background. The phenomenon of suicide and the nursing care of people who are suicidal have previously been investigated. However, literature demonstrates that there is a dearth of information exploring the importance of the ward context in the care of suicidal patients and the intervening conditions that are used by professionals in the care of suicidal patients. Method. Qualitative research using the grounded theory approach. Data collection and analysis. Fifteen patients who had either suicidal ideas or had attempted suicide and 15 psychiatric nurses were interviewed and observed. Data were analysed using open, axial and selective coding. Findings. A substantive theory of suicide-nursing care was developed. For the purpose of this paper, the two categories that emerged in the ‘context’ element of the paradigm model are explored. They were: team working and the psychiatric ward environment. In addition, the four categories from the ‘intervening conditions’ are discussed. They were: nurses’ attitudes and beliefs have an effect on caring, barriers to caring, patients’ negative thoughts and feelings about the care provided and support systems. Conclusion. The findings indicated that the context of the ward environment and the intervening conditions used by nurses in the nursing care of suicidal patients helped to define some of the complex dynamics that impacted on the development of a therapeutic relationship within the practice of suicide-nursing care. Relevance to clinical practice. Environmental factors as well as the nurses’ knowledge and skills and the type of support patients receive impact on the care of suicidal patients. These findings could help to enhance and advance suicide-nursing care. [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]

mckenna hp, keeney s&hasson f (2005) Journal of Clinical Nursing14, 426–434Views on the ground: teaching and clinical assessors’ views on vocational training for healthcare assistants in IrelandThis paper reports the views of teaching staff and clinical assessors on their experience of programme delivery and assessment.In 2001, the Irish Department of Health and Children developed a vocational training programme for healthcare assistants. This programme was piloted nationally across 14 hospital and community sites. Teaching staff and clinical assessors at each site delivered the programme.One-to-one semi-structured interviews were undertaken with 16 clinical staff and 26 teaching staff. With consent, all interviews were tape-recorded, from which the transcripts were subject to content analysis.A lack of experience and preparation among teaching staff and clinical assessors was evident. The staff's commitment to their role on the programme while maintaining their normal duties caused frustration and uncertainty. Not withstanding, the value of the programme in terms of increased motivation, satisfaction and knowledge of healthcare assistants and the impact on care delivery, was recognized by respondents.This programme represents the provision of a national standard training programme for healthcare assistants. It provides an insight into the delivery of such a programme and the educational and training needs of healthcare assistants through the views of staff that taught and assessed on it.Findings suggest that the development and implementation of a national training programme for healthcare assistants is achievable. [ABSTRACT FROM AUTHOR]

Little research has examined the care older people receive in the acute surgical setting. Although pain assessment and management are judged to be a priority in nursing, often pain, in older people, is undermanaged for a variety of reasons. Factors such as stoicism, communication and ageism can shape both the patients' and nurses' attitude towards the perception of pain which subsequently affects pain management. Through a review of the literature, this paper aims to: (i) identify how healthcare professionals contribute to the assessment and control of postoperative pain in older people and (ii) explore potential barriers to achieving more advantageous pain control in this group. It is suggested that to improve pain management there is a need to individualize pain assessment for older people and to assist clinicians with enhancing their education and decision-making abilities in this field. This may best be achieved by supporting a programme of change to develop the skills of staff and encouraging learning through reflective practice. There is however a need for further research in this area. [ABSTRACT FROM AUTHOR]

The questions 'what is it that you want from nursing?' and 'how would you know when you have got what you want from nursing?' were put to patients, nurses and other health professionals. The patients identified essential qualities of nurses. Problems within the nursing group are identified. The view of each group on the other's work is discussed. Areas of consensus related to respect, communication, competence, co-operation and context. Indicators or measures of the consensus areas are reported. [ABSTRACT FROM AUTHOR]

This paper outlines the first phase of a project to generate and evaluate the role of an advanced nurse practitioner inductively from first principles. The role was developed by interviewing a wide range of health-care professionals, carers and patients. The resulting role is responsive to perceived need at grassroots level rather than to the needs of managers with no clinical experience. Although the role might not be generalizable to other settings, the method can be applied to any role in any clinical area. [ABSTRACT FROM AUTHOR]

The article presents a commentary on the study which reveals a need to enhance the nursing role in improving health outcomes of cardiovascular disease in China. It notes that the authors of the paper did not propose how the obstacles for changes in cardiac nursing will occur in China. Moreover, it asserts that nurses in China should examine the factors that influence nursing philosophy such as role and authority, and researchers should try to investigate in altering some of these factors.

Comments on the publication of the "Journal of Clinical Nursing." Impression of the nurses about the journal; Index of the quality of a journal; Efforts on the editorial team to review the journal.

Comments on issues relevant to nursing care for the aged. Emphasis on patient choice for nurses to fully perform their duties; Challenges to the removal of barriers to effective care; Strategies for patient empowerment.

Comments on Shattell's nurse-patient interaction paper. Theoretical model for developing nursing knowledge related to nurse-patient interaction within an holistic context; Central element of clinical nursing practice; Findings in the literature which acknowledge the ambivalence associated with patient's views toward nurses and nursing.

Aims and objectives. The purpose of this study is to explore the social construction of cultural issues in palliative care amongst oncology nurses. Background. Australia is a nation composed of people from different cultural origins with diverse linguistic, spiritual, religious and social backgrounds. The challenge of working with an increasingly culturally diverse population is a common theme expressed by many healthcare professionals from a variety of countries. Design. Grounded theory was used to investigate the processes by which nurses provide nursing care to cancer patients from diverse cultural backgrounds. Methods. Semi-structured interviews with seven Australian oncology nurses provided the data for the study; the data was analysed using grounded theory data analysis techniques. Results. The core category emerging from the study was that of accommodating cultural needs. This paper focuses on describing the series of subcategories that were identified as factors which could influence the process by which nurses would accommodate cultural needs. These factors included nurses’ views and understandings of culture and cultural mores, their philosophy of cultural care, nurses’ previous experiences with people from other cultures and organisational approaches to culture and cultural care. Conclusions. This study demonstrated that previous experiences with people from other cultures and organisational approaches to culture and cultural care often influenced nurses’ views and understandings of culture and cultural mores and their beliefs, attitudes and behaviours in providing cultural care. Relevance to clinical practice. It is imperative to appreciate how nurses’ experiences with people from other cultures can be recognised and built upon or, if necessary, challenged. Furthermore, nurses’ cultural competence and experiences with people from other cultures need to be further investigated in clinical practice. [ABSTRACT FROM AUTHOR]

Aims and objectives. This paper aims to forecast the total number of non-working nursing staff in Japan both overall and in terms of separate age groups for assistant nurses and fully qualified nurses. This also examines policy implications of those forecasts. Background. Although the existence of around 550,000 of non-working nursing staff has been announced, the actual number of non-working nurses is not so clear that we might make errors in making policy to meet nurse workforce demand and supply in Japan. Design and method. Estimations by integrating various data on the quantitative characteristics of non-working nursing staff were carried out. Considering the length and the type of education or training in referred four nursing positions; registered nurses, assistant nurses, public health nurses and midwives, we first estimated the number of students who completed a full course. And then multiplying by the ratio for gender and age classifications at the time of entry into courses, the number of those who obtained licenses was estimated. Results. The number of non-working nurses was estimated at 100,000 higher than those in 2005 by government. Looking at age group, it is also possible to see a strong reflection of an employment pattern that follows the life cycle of female workers. Further analysis of life cycle effects and cohort effects proved the effect of life cycles even when subtracting the differences between the working behaviours of different generations. Conclusions. Our findings strongly suggest the need to provide an urgent policy that workplace conditions can be created in which a balance between work and family is achievable. Moreover, to empower clinical activity, we also believe there is an urgent need to reexamine the overall career vision for assistant nurses including in terms of compensation. Relevance to clinical practice. Our findings strongly suggests that consideration for work-life balance of nursing staff; particularly, female staff is all the more important to provide a stable quality care. [ABSTRACT FROM AUTHOR]

Aim. The aim of this paper is to examine inactive nurses' job-searching behaviours to return to healthcare workplace at where serious difficulty of meeting demand and supply of nurses exist. Design and methods. To clarify the factors that would make their attempts easy or difficult, successful or not, we employed econometric method to analyse the probability of job finding in terms of both the length of duration and the quality of consequence in job-seeking behaviour by using microdata pooled on Japan Nursing Association Computer System (NCCS), in which inactive nurses' individual attributes (gender, age, academic background, the types of qualifications, the number of preschool aged children, etc) are stated. Results. From the estimations, we found that (i) having preschool children is one of the factors of delaying job finding, and failing to obtain desired workplace and working style; (ii) nurses with higher educational backgrounds tend to spend a longer time in finding jobs and (iii) training programme for the returners may not work well in case of shorter career blank, while may support for those who have longer one. Relevance to clinical practice. To meet the desired demand for qualified nurses in healthcare facilities, we should (i) develop more supportive working environment for nurses with preschool children, such as more flexible working time and shifts; (ii) encourage the employment of higher educated nurses by reforming compensation scheme, as well as reconsidering of the standard of skill-mix; and (iii) redevelop training programme for returners with more practical contents. [ABSTRACT FROM AUTHOR]

AIMS: The study investigated factors empowering women to continue breastfeeding despite experiencing extraordinary difficulties. The study documented the experiences and characteristics of women who continued to breastfeed (continuing cohort) and those who weaned (non-continuing cohort) despite extraordinary difficulties. DESIGN: Retrospective case control. METHODS: The study was undertaken in south-east Queensland, Australia in 2004. Forty women (20 in each cohort) were recruited over six months. Both quantitative (breastfeeding knowledge questionnaire) and qualitative (semi-structured interviews) data were collected. This paper describes the qualitative data. RESULTS: Women from both cohorts expressed idealistic expectations about breastfeeding and experienced psychological distress due to their breastfeeding problems. Those who continued breastfeeding used coping strategies and exhibited personal qualities that assisted them to overcome the difficulties experienced. Women who continued to breastfeed were more likely to report relying on a health professional they could trust for support. This latter cohort were also more likely to report having peers with which they shared their experiences. Non-continuing women expressed feelings of guilt and inadequacy following weaning and were more likely to feel isolated. CONCLUSIONS: This study has highlighted the methods women use to deal with breastfeeding problems. It has also revealed modificable factors that can improve breastfeeding duration. RELEVANCE TO CLINICAL PRACTICE: The findings indicate that clinicians should: *Provide information which accurately reflects the breastfeeding experience; *Ensure systems are in place so that effective postnatal support for breastfeeding difficulties is available; *Consider screening to ascertain levels of psychological distress, sadness and disillusionment among breastfeeding women; *Design educational interventions with elements of cognitive skills, problem-solving and self-efficacy training to equip women with the skills to overcome any experienced difficulties. [ABSTRACT FROM AUTHOR]

Purpose. This paper presents and discusses the findings from a phenomenological study which illuminated the lived experiences of experienced critical care nurses caring within a technological environment. Background. While nursing practice is interwoven with technology, much of the literature in this area is speculative. Moreover, there is a debate as to whether and how ‘high tech’ and ‘high touch’ are reconcilable; this orientation is referred to as the optimism vs. pessimism debate. On a personal level, the motivation for this study came from the author's 13 years’ experience in the critical care area. Method. Following ethical approval, 10 experienced nurses from two cardiothoracic critical care units in Ireland participated in the study. A Heideggerian phenomenological methodology was used. Data collection consisted of unstructured interviews. A method of data analysis described by Walters was used. Findings. The findings provide research-based evidence to illuminate further the optimistic/pessimistic debate on technology in nursing. While the study demonstrates that the debate is far from resolved, it reveals a new finding: life-saving technology that supports the lives of critically ill patients can bring experienced nurses very close to their patients/families. The three main themes that emerged: ‘alien environment’, ‘pulling together’ and ‘sharing the journey’ were linked by a common thread of caring. Conclusion. Experienced critical care nurses are able to transcend the obtrusive nature of technology to deliver expert caring to their patients. However, the journey to proficiency in technology is very demanding and novice nurses have difficulty in caring with technology. Relevance to clinical practice. It is recommended that more emphasis be placed on supporting, assisting and educating inexperienced nurses in the critical care area and that the use of technology in nursing be given serious consideration. [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]

The author comments on the research paper of F.K. Sun and others that discusses the attitudes of nurses and patients underpinning the complex dynamics of a therapeutic relationship in the management of suicidal patients. Information on the paper and the role of psychiatric nursing are presented. The author concludes that the research does not include the views of the patients and all other professionals in patient management and takes only one-sided opinions of the nurses and hence is biased.

AIMS: This discussion paper offers an introductory text for nurses and explores the psychoanalytic ideas of transference, counter-transference and repetition compulsion. Disguised case vignettes provide illustrations of the ideas as they might apply to nursing, including professional practice and occupational choice. BACKGROUND: The literature suggests that transference can be a source of creativity as well as destructiveness and influence important communications with oneself and others including the choice of nursing and other health professions as an occupation. Recognizing possibilities of transference, counter-transference along with repetitive patterns of behaviours, can help nurses of all specialities to address situations constructively by responding thoughtfully and appropriately. CONCLUSION: This discussion concludes with the suggestions that we know little about the motivational factors underlying nursing as an occupational preference; moreover, nursing does not have a culture of personal therapy. As such nurses are denied opportunities to understand the possible reasons underlying their occupational choice or gain experiential knowledge of interpersonal dynamics occurring between patients and colleagues. RELEVANCE TO CLINICAL PRACTICE: Transference and counter-transference are thought to have some bearing on all relationships. Forming a natural part of the way human beings relate to each other, transference and counter-transference can bring about sincere human interest, caring and concern. However, there is also potential for disagreements. Recognizing the possible origins of relational difficulties can offer opportunities for professional development to nurses along with the benefits for health service users. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: The aim of this paper is to explore older people's experiences in prehospital emergency care, and identify benefits and difficulties associated with developing a nurse-led ambulance service. Data were collected at sites in Sweden and Norway. Focus group interviews were conducted to enable the collection of data from paramedics, ambulance nurses and nursing students, while individual interviews were utilized to gather data from older people. BACKGROUND: There is little research on the quality of care older people over 65 years old receive in prehospital emergency care. Older people often present with multiple pathology and diverse needs that nurses are well equipped to deal with, but presently there is no clearly defined role for nurses in prehospital emergency care in the United Kingdom, although other countries such as Sweden and Norway are developing an ambulance nurse role. CONCLUSIONS: If the multiple needs of older people were addressed in the prehospital field, a reduction in readmissions and increased functional ability might be achieved. Comprehensive training is required for ambulance staff to enable them to meet such needs. While nurses have a great foundation for this care, additional specialist ambulance training is required alongside a need for education on older people's needs and attitudes to older people. RELEVANCE TO CLINICAL PRACTICE: The introduction of ambulance nurses will result in role differentiation between paramedics and ambulance nurses, which has the potential for creating role conflict. To ensure a smooth transition appropriate training and education for nurses and paramedics should be provided. The end result is a potentially greatly enhanced ambulance care provision, enabling high quality care to all patients. [ABSTRACT FROM AUTHOR]

AIM: The aim of this paper is to report a study exploring, from the perspective of key stakeholders (mentors of nurses, managers of nurses, and modern matrons) in one English acute sector hospital, how decisions are made on how many learner nurses can be supported in clinical practice. The objective was to identify what factors are taken into consideration in making these decisions. BACKGROUND: Supporting increasing numbers of students is a demand of current service provision in the English National Health Service, as part of an expansion in the numbers of all healthcare professionals. This is particularly the case in nursing, where the government announced a required increase in numbers of qualified nurses of 20 000. This expansion of numbers has implications for the quality of placement learning in clinical placements. METHODS: Data were collected using three focus group interviews with a total of 12 participants in 2003/04. Recruitment was on a purposive basis. Subsequent analysis identified themes, which were compared across groups. A short questionnaire was also used to establish participants' biographical details prior to the focus groups. FINDINGS: Three key themes were identified: 'capacity issues', 'enhancing support in practice' and 'issues impacting on learning in practice'. 'Capacity issues' identified factors that impact on the capacity of placements to support learners. 'Enhancing support in practice' identified necessary roles and strategies to enhance learning in practice. Finally, 'issues impacting on learning in practice' identified learner groups where support could be enhanced through structured management of the placement experience. CONCLUSIONS: Decisions on learner numbers to be supported at any one time are complex, with a multitude of dimensions. These include identification of types of learners and numbers of mentors available to support them and other operational issues. 'Educational staff' are needed at operational and strategic levels to support learning in practice. Timely and appropriate audit information to support allocation decisions and identify strategies to enhance the quality and support of learning in practice, are also required. RELEVANCE TO CLINICAL PRACTICE: Increases in learner numbers and National Health Service modernization have had an impact on clinical placements' capacity to support learning, and potentially, on learners' achievements in practice. Findings from this study are thus important in evaluating the impact of these policy initiatives. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: To determine the feasibility of a screening tool to identify carers in a general practice. BACKGROUND: The need to support informal carers is well established in policy and practice, but many carers continue to lack the support they need. Identifying carers is a fundamental precondition to providing them with support. Studies often recruit carers who are members of carers' organizations or via the care recipient in receipt of services. However, as nearly 60% of carers receive no support from the statutory services, this group of carers may not be representative of the majority of carers. This paper describes the results of a study undertaken to identify a broader group of carers in a general practice in a large Scottish city. DESIGN AND METHODS: A quantitative research design was employed using a mailed screening survey to identify carers within a general practice. Carers were systematically identified, independent of the care recipient, using a screening tool developed by the researcher which was sent to all adult patients registered with the practice. RESULTS: The response rate was 69%. Overall, 11% of the surgery population identified themselves as carers with a mean age of 55 years. The carers were involved in a range of caring activities of varying levels and duration. CONCLUSION: The screening exercise was time consuming and costly. However, it would be feasible and useful to identify carers in smaller groups. RELEVANCE TO PRACTICE: This study tackles issues that are pertinent to health policy and practice. Carers were systematically identified from a general practice population and included those at an early stage of the caring role, prior to being involved with service providers, as well as those established in their role. If carers are identified early in their caring career the primary health care team is more able to support them proactively. [ABSTRACT FROM AUTHOR]

The Internet is promising to play a prominent role in health care in the future, but there is an imbalance in its use between the East and the West, between genders, the rich and poor, the educated and uneducated and the urban and rural. This paper looks at the use of the Internet from the perspective of these subgroups across the world, and outlines some of the problems facing disadvantaged groups in particular older people and their caregivers in China. Older people and their predominantly family caregivers have limited access to computers which is compounded by lack of access to good health care. However, it is suggested that this will become a growth area as older people and their caregivers may well bypass traditional care for tele-health care and Internet information-based systems. [ABSTRACT FROM AUTHOR]

lymer u-b, richt b & isaksson b (2004) Journal of Clinical Nursing 13, 547–554 Blood exposure: factors promoting health care workers’ compliance with guidelines in connection with risk Health care workers compliance with guidelines, universal precautions, in connection with tasks that could involve contact with patient's blood is unsatisfactory. In a previous paper, we identified different forces that undermine compliance. Socialization into infection control, routinization, stereotyping, perceptions of patients’ wishes and the presence of competing values and norms are examples of such forces. The aim of this article is to describe and analyse different forces that promote adherence to universal precautions. Behavioural variations are seen as a consequence of differences between wards with regard to the safety culture. Safety culture is conceptualized as the outcome of a constant interplay between deactivating and reactivating forces. In this article the focus is on the latter. The grounded theory approach. Data were collected through interviews with nurses and assistant nurses. The charge nurse, informal leaders, students, infection control nurses, type of work, availability of equipment, blood-exposure incidents and media-coverage of infectious diseases are described as potentially important for compliance. The properties these agents must possess in order to be influential are also described. The outcome of an occupationally acquired infection can be fatal. Hence it is important that health care workers take protective measures. The results imply that mere information about safe practices alone is insufficient to achieve that goal. All factors of importance for compliance must be taken in to consideration in clinical work and in education. [ABSTRACT FROM AUTHOR]

* Change in nursing practice has been dogged by factors which have been perceived to be outside the autonomy of nurses. Consequently, projects have been initiated which have then faltered or even ceased altogether.* This paper reports on an action research study that was carried out in Newcastle from 1997 to 1999 and used the process within a focus group setting to rekindle and sustain an innovative change.* The aim of the study was to look at staff perceptions surrounding development of the practice of self-administration of medication for patients.* The findings support the view that all disciplines need to be involved in health service change.* Health service employees should have a knowledge of the theory associated with the change process and be open about their views of proposed alterations in practice.* They also need to have a sense of dissatisfaction with the present, a clear outline of what the problem is and the direction which they intend to take.* Change involves many complex issues. It should be worked through from a bottom-up approach and consist of repeated evaluation exercises which are akin to a cyclical strategy and include a reflective process. [ABSTRACT FROM AUTHOR]

A relative's right to witness resuscitation is the subject of considerable discussion and debate. This paper explores the presence of relatives in the resuscitation room from a moral and ethical perspective. The focus of discussion is essentially upon the principle of respect for autonomy vs. what appears to be the counter-argument, benevolent paternalism. It is concluded that recognition of a relative's right to witness resuscitation is dependent upon health care professionals' willingness to promote the principle of respect for autonomy. [ABSTRACT FROM AUTHOR]

This paper describes changes that have taken place, over a period of 10 years, in the way physicians and nursing staff in Finland give initial information and advice to the parents about their child's disability. It also discusses the association between quality of information given and parents' feelings of insecurity or helplessness. In the study, we compared the experiences of parents of older (aged 12-17) disabled children with those of parents with younger (aged 7-9 years) disabled children. There were 85 children, whose disabilities were either learning or physical, or, in a few cases, both. Parents completed a questionnaire and were interviewed by a social worker. According to these reports, the initial information and advice received by the parents with younger children about their child's disability and its treatment, and on coping with the child at home, was better than that received by the parents of the older children. The parents of the younger children also reported feeling better prepared to take care of their child. Those parents who reported having received little information and practical advice on coping with their child at home experienced feelings of insecurity and helplessness five times as often as those who were satisfied with the information and advice. [ABSTRACT FROM AUTHOR]

Presents the author's response to Watson's commentary on her paper "Nurse-patient interaction: A review of the literature". Insights on caring relationships; Discussion of Goffman's theoretical perspective of nurse-patient interaction.

The article comments on a paper which examines the factors which constrain nurses from research participation. The author stresses that this paper is refreshing as it focuses on the role of nurses as knowledge producers. He asserts that the finding of the study shows that there is still more work to be done to help nurses appreciate the potential contribution of research to practice. He emphasizes the need to invite more participants in the study.

Discusses the report "The global shortage of registered nurses: An overview of issues and actions," by Jim Buchan and Lynn Calman, and published by the International Council of Nurses. Factors contributing to the problem of nursing shortages in less developed countries; Effects of inadequate nursing staff levels; Variation in the ratio of nurses between developed and under developed countries.

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 article presents a response to the commentary made by Paul Ramcharan on the authors' article "Being an intensive care nurse related to questions of withholding or withdrawing curative treatment" According to the author, they agree with Ramcharan's conclusion that the study substantiates nurses' need to be supported emotionally. They also underscore the necessity of improving organizational systems concerning team working and the decision-making process.

The article presents a commentary on the study "A Review of Clinical Decision Making: Models and Current Research," by M. Banning. It is suggested that educators should assist student nurses to develop skills in decision making and managing complex information. The two models of clinical decision making were also discussed including the information processing model and the intuitive humanist model.

The article focuses on current nursing practice models that often speak of the need for nurses to provide spiritual care to patients as part of holistic nursing practice. There is an assumption by the authors that because the spiritual dimension is beyond scientific quantification, it cannot be accurately described, let alone defined. The spirit makes the person feel alive in a qualitative sense rather than a mechanical sense. The spiritual dimension gives shape to a person's life, providing hope and helping the person to ascribe meaning and purpose to their life. This in turn shapes how they invest their deepest love.

This article illustrates the quality and relevance that the "Journal of Clinical Nursing" has achieved. The first issued of the journal was published in January 1992 with the primary aim that as a result of regularly reading the journal practitioners will be enabled to demonstrate an understanding and application of up-to-date knowledge relating to nursing/midwifery and health visiting. With an evergrowing number of personal and library subscribers world-wide, there is increasing evidence that this aim is being achieved. The journal has established an international reputation with subscribers throughout North America and Europe and a growing number of new subscribers in the Middle East, the Far East and Australasia.

The article presents the author's comments on the article "Literature Review: Decision-Making Regarding Slow Resuscitation," by J. Kelly. It reflects that the article covers a wide range of information. It states that there are many factors in decision-making regarding resuscitation that influences the attitude of medical professionals. It informs that health professionals in countries with Christianity as the religious background have the attitude to do everything possible to save human life.

The article presents a commentary on an article about mealtimes in hospitals in Great Britain. It highlights concerns about the quality of food and drink in hospital settings for older people with dementia. The sociology of food is a ground sounding term, while in the sociology of the body, the commonplace is as girded by rules and power as other social systems. The study further found that nurses were using their skills to record fluid intake but could not record food intake.

The article reports, in brief, on a study that surveyed general practice patients and practice nurses about using the telephone or email as alternatives to face-to-face consultations with the nurse. The goal of this study was to investigate ways of improving access for patients to practice nurse appointments. Telehealth, the provision of health services via telecommunication technologies, has been initiated in many countries, in a variety of settings, and by a range of providers. In the U.S. there are many commercial telephone call centres and most hospitals have some form of telephone triage system.

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.

AIM: To understand staff acceptance of a remote video monitoring system for operating room (OR) coordination. BACKGROUND: Improved real-time remote visual access to OR may enhance situational awareness but also raises privacy concerns for patients and staff. DESIGN: Survey. METHODS: A system was implemented in a six-room surgical suite to display OR monitoring video at an access restricted control desk area. Image quality was manipulated to improve staff acceptance. Two months after installation, interviews and a survey were conducted on staff acceptance of video monitoring. RESULTS: About half of all OR personnel responded (n = 63). Overall levels of concerns were low, with 53% rated no concerns and 42% little concern. Top two reported uses of the video were to see if cases are finished and to see if a room is ready. Viewing the video monitoring system as useful did not reduce levels of concern. Staff in supervisory positions perceived less concern about the system's impact on privacy than did those supervised (p < 0.03). Concerns for patient privacy correlated with concerns for staff privacy and performance monitoring. Technical means such as manipulating image quality helped staff acceptance. CONCLUSIONS: Manipulation of image quality resulted overall acceptance of monitoring video, with residual levels of concerns. OR nurses may express staff privacy concern in the form of concerns over patient privacy. RELEVANCE TO CLINICAL PRACTICE: This study provided suggestions for technological and implementation strategies of video monitoring for coordination use in OR. Deployment of communication technology and integration of clinical information will likely raise concerns over staff privacy and performance monitoring. The potential gain of increased information access may be offset by negative impact of a sense of loss of autonomy. [ABSTRACT FROM AUTHOR]

Aim. This article presents the core concept of ‘visible-ness’ that emerged from an ethnographic study, which explored the nature of communication, for children (for ease of reading children refers to children and young people), admitted to a children’s hospital in the Republic of Ireland. Background. The importance of engaging with both child and family has been espoused as fundamental in promoting ‘family’-centred care. To date, studies have almost exclusively explored parents’ and nurses’ perspectives of the nature of parent participation and nurse–parent interactions and relationships. Although there is evidence of an emerging body of knowledge, which explores children’s perspectives of their information, and communication needs, little is known empirically about the communication process between children and members of the health care team in inpatient hospital settings. Design. The principles of ethnography underpinned the study design. Method. Fieldwork took place over four months in one 35-bedded children’s ward. Forty-nine children, ranging in ages from 6 to 16 years with a variety of medical and surgical conditions, participated. Various modes of data collection were employed, namely semi-participant observations, unstructured interviews, draw and write technique and a child-friendly ‘stick a star’ quiz. Results. The core concept to emerge was that of ‘visible-ness’. ‘Visible-ness’ existed along a continuum consisting of two polar ends, ‘being overshadowed’ and ‘being at the forefront’. These polar ends illuminated the degree to which children were, or wanted to be, included in the communication process and the extent to which children’s agenda was addressed. Conclusion. This study provides empirical insight into children’s experiences of communication in an inpatient hospital setting. A key recommendation calls for the development of communication assessment strategies to determine the ‘ideal’ position children would like to occupy, at any given point in time, along the ‘ visible-ness’ continuum. Relevance to practice. This study emphasises the need for all health professionals to embrace the individualism of each child patient with regard to their specific communication needs. [ABSTRACT FROM AUTHOR]

Aim. This systematic review examines how specific coping strategies are associated with psychological and physical outcomes in rheumatoid arthritis. Background and methods. Rheumatoid arthritis is a long-term condition that people cope with but it is unclear whether specific coping strategies have an effect on mood and function. Therefore a systematic review was undertaken of the coping with arthritis literature and 174 studies were initially included. Further examination determined that 31 studies (11 longitudinal and 20 cross sectional) were finally included in the review. The 31 studies were clinically and methodologically diverse; therefore the analysis of results was a qualitative synthesis. Coping strategies that contributed to the prediction of outcomes were allocated to a new structure for the classification of coping. Results. The results demonstrated there was not sufficient, consistent evidence to support the overall view that individual coping strategies contributed to longitudinal outcomes in rheumatoid arthritis. However, major differences in the design of included studies may have hindered the comparison of results. There was some evidence from longitudinal studies that patients who used resting, inactivity, etc. (helplessness category) experienced negative outcomes. Avoidance (escape) was the most common overall category associated with predominantly negative outcomes in both cross-sectional and longitudinal studies. Conclusions. There was generally limited evidence to suggest an association between coping strategies and outcomes but the design of studies and the lack of clarity about coping strategies were identified as problems. This study used a new framework for the conceptualisation of coping strategies, thus contributing to further examining the utility of coping strategies and contributing to their redefinition. Relevance to clinical practice. The use of helplessness (inactivity and passive coping) and escape/avoidant coping strategies, including denial and wishful thinking, could be identified and addressed by nurses and other health professionals to reduce the associated negative outcomes. [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]