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AIMS AND OBJECTIVES: This paper examines how nurses are prepared to be clinically competent and safe at registration, so that they are fit for practice and purpose. It follows up two papers on competence published in 1997 and 1998 and investigates subsequent developments. BACKGROUND: In 1979, major changes in nursing affected nurse education and preparation for competence. In the following two decades, it became clear that nurses lacked clinical skills. This paper examines subsequent changes and asks the question whether this crucial shortcoming has now been remedied. This paper considers the background and context of change in nursing and nurse education in the 1980s. It looks at the new ideology, to prepare the 'knowledgeable doer' and examines the consequences of the change on nursing competency from the 1990s to the present day. METHODS: This is a position paper. Professional policy documents from the English National Board for Nursing, Midwifery and Health Visiting, United Kingdom Central Council for Nursing, Midwifery and Health Visiting and Nursing and Midwifery Council, government reports and legislation on nursing and relevant nursing literature are examined and critically analysed and conclusions drawn. CONCLUSIONS: From 1923-1977, mandatory nursing syllabuses set by the General Nursing Council of England and Wales required the registered nurse to have acquired certain specific clinical skills. These were rigorously tested to an explicit standard set by the General Nursing Council before a nurse was awarded state registration. Twenty-five years later, the loss of this system for ensuring this competence and the implications of this loss, have been widely recognised. As a result, many nurse training institutions have introduced clinical skills laboratories, simulation of practice and the Objective Structured Clinical Examination. However, to the authors' surprise and contrary to their initial expectations, the Nursing and Midwifery Council has not made these systems uniform or mandatory and so still has no way of ensuring all nurse training is producing safe nurses in the United Kingdom. The authors conclude that the untested educational ideology that brought root and branch change to nurse training in 1983 and which failed to produce nurses 'fit for practice and purpose' may still prevail. RELEVANCE TO CLINICAL PRACTICE: The present paper demonstrates that United Kingdom nurse training still has no uniform and mandatory system in place to ensure, as far as is possible, that all registered nurses are clinically competent and safe to practice. [ABSTRACT FROM AUTHOR]

Aims. The aims of this paper were (1) to raise awareness of the issues in questionnaire development and subsequent psychometric evaluation, and (2) to provide strategies to enable nurse researchers to design and develop their own measure and evaluate the quality of existing nursing measures. Background. The number of questionnaires developed by nurses has increased in recent years. While the rigour applied to the questionnaire development process may be improving, we know that nurses are still not generally adept at the psychometric evaluation of new measures. This paper explores the process by which a reliable and valid questionnaire can be developed. Methods. We critically evaluate the theoretical and methodological issues associated with questionnaire design and development and present a series of heuristic decision-making strategies at each stage of such development. The range of available scales is presented and we discuss strategies to enable item generation and development. The importance of stating a priori the number of factors expected in a prototypic measure is emphasized. Issues of reliability and validity are explored using item analysis and exploratory factor analysis and illustrated using examples from recent nursing research literature. Conclusion. Questionnaire design and development must be supported by a logical, systematic and structured approach. To aid this process we present a framework that supports this and suggest strategies to demonstrate the reliability and validity of the new and developing measure. Relevance to clinical practice. In developing the evidence base of nursing practice using this method of data collection, it is vital that questionnaire design incorporates preplanned methods to establish reliability and validity. Failure to develop a questionnaire sufficiently may lead to difficulty interpreting results, and this may impact upon clinical or educational practice. This paper presents a critical evaluation of the questionnaire design and development process and demonstrates good practice at each stage of this process. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: The aim of this paper is to share reflectively how my empirical studies on spirituality and culture have had an impact upon nurse education. BACKGROUND: Spirituality and cultural dimensions of care are considered to be integral to holistic care. The healing potentials of spiritual and cultural care are well documented. The commitment to the research programme came due to the concern within early literature on nursing that the provision of spiritual care for patients is inadequate. METHODS: The research programme used action research comprising largely qualitative approaches. As the holistic and multiperspective nature of spirituality and culture requires a multidisciplinary approach and flexibility of methodology, various research techniques were used. RESULTS: The findings from the research programme led to the development of theories, models and conceptual literature on spiritual and cultural care. In particular, two models evolved from the studies: the ASSET for spiritual cares education and training and the ACCESS for transcultural care practice. The critical incident studies provide insights into nurses' roles in spiritual care interventions. The phenomenological study highlights that chronically ill patients use spiritual strategies in coping with their illness. CONCLUSION: Overall, the paper offers a body of evidence that has an impact upon curriculum development in nurse education and nursing practice. RELEVANCE TO CLINICAL PRACTICE: The ASSET model offers a framework for spiritual care education. The ACCESS model offers a framework for transcultural care practice. The critical incident studies map out nurses' roles in spiritual and cultural care with scope for development of care intervention models for the future. The coping mechanisms study highlights how patients use spiritual coping strategies such as prayer and other resources to cope with their chronic illnesses. [ABSTRACT FROM AUTHOR]

• With the recent proliferation in nursing degree programmes over the last 10 years and a suggestion that nursing moves towards an all-graduate profession, the profession as well as the consumer needs to be sure that they are getting ‘value added’ with this ‘higher level’ practitioner. • This paper revisits the debate on the meaning of competence in relation to fitness for practice. • In particular it examines the expectations of the profession of newly registered practitioners at both diploma and degree levels of practice. • It questions whether there is a difference in their level of competence at point of registration and whether it is possible to measure it. • The paper presents a reflective approach to promoting ideas already emerging from the literature in relation to this measurement. • It suggests a more effective use of students’ portfolios of evidence against stated learning outcomes as well as their specific achievements in a range of transferable skills. • A partnership approach between student, practitioner/assessor and academic could usefully share responsibilities of the assessment of competence and ultimately empower the individual for their life-long learning. [ABSTRACT FROM AUTHOR]

The article offers the author's comments on the paper "Newly qualified Irish nurses & interpretation of their preparation and experiences of registration" by M. Mooney published in the periodical "Journal of Clinical Nursing" 16 in the year 2007. According to him, the paper highlights that problem of clinical environment that nursing education and practice is facing. He says that functions of nurse practitioner as educational, managerial and care role are important and needs time to fulfil them.

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. The aim of this article is to review the nursing literature on the notion of advanced nursing practice (ANP) and consequently provide clarifications on the concept of advanced nurse practitioner by developing its' generic features. Background. This paper commences by critically reviewing the concept of advanced nursing practice as it is portrayed within the literature. From this review, a series of contradictions emerged in terms of definitions and roles. On further analysis of the literature the core aims and goals of the ANP are revealed. Methods. An informative and narrative systematic literature review was undertaken, using specific inclusion and exclusion criteria. The mass of retrieved material was carefully screened and methods of data saturation were used. Consequently, the material was read, re-read and indexed as to develop seven thematic units that formed the generic features of the ANP. Findings. The generic features that emerged are: (i) the use of knowledge in practice, (ii) critical thinking and analytical skills, (iii) clinical judgement and decision-making skills, (iv) professional leadership and clinical inquiry, (v) coaching and mentoring skills, (vi) research skills and (vii) changing practice. Conclusion. Reviewing the literature on the concept of ANP, a great variety of definitions, conceptualizations and roles emerged. Nonetheless, on a closer reading, a common goal was identified, which was the attainment of practice and professional autonomy via ANP roles for enhanced practice provision. Eventually, from the reviewed literature, seven generic features of the ANP were developed, thus providing clarification to the role and the characteristics of the ANP. Relevance to clinical practice. Clarifying the confusion surrounding advanced nursing practice and gaining an in-depth understanding of its' generic features would facilitate practitioners, practice educators and clinical managers to develop those skills that would allow them or their staff or students to practise at an advanced level. [ABSTRACT FROM AUTHOR]

Aims and objectives. This paper aims to identify how the statutory requirements relating to spirituality in nurse education can be supported in preservice and in-service education, in the context of inter-professional working implied by every child matters (Department for Education and Skills (DfES) Every Child Matters: Change for Children. DfES, Nottingham DfES 2004a; Every Child Matters: Change for Children in Health Services. Department of Health, London 2004). Background. The basis for this paper is an exploration of the current requirements relating to spirituality in nursing and the consequent requirements for training and education clarified in part through a consideration of parallel policies on spirituality in school education. Inter-professional work, for example, across health, social care and education professions, has a long history in nursing and the changes brought about by the every child matters policy initiative have given such inter-professional work a considerable boost. That policy change has encouraged consideration, in this article, of some common issues arising in nursing and school education professions. Method. This paper consists of a critical review of current and in-coming statutory requirements related to spirituality, nursing and nurse education, and a synthetic review of definitions of and approaches to meeting spiritual needs. Conclusion. The emergent relational framework for considering spirituality in nurse education acknowledges the ambiguity of spirituality and treats that ambiguity as in some ways enabling rather than constraining. Relevance to clinical practice. It is not simply that nurse practice will be likely to change with respect to children. Every person will, in the terminology of the policy, 'matter': there is significant urgency to consideration of effective education and training provision. [ABSTRACT FROM AUTHOR]

This paper is based on a documentary analysis and literature review of critical care nursing commissioned by the English National Board for Nursing, Midwifery and Health Visiting. Five critical care programmes were included in the analysis: ENB 100, 124, 199, 176/183, and 415. In total, 105 curricula were reviewed from 30 institutions. Data were extracted and analysed using an adapted grounded theory approach. The documentary analysis was supplemented by two telephone surveys with lecturers (n=84) and clinical managers (n=81). There was great diversity in the programmes in terms of the academic level at which the courses were set, module configuration, approaches to practice assessment and the amount of student effort for the same professional award. Diversity arose because of different university module formulae, different methods to differentiate level 2 and level 3 practice, different views about the purpose of the course, and an attempt to make the programmes increasingly flexible to accommodate a heterogeneous student population. Documentary analysis has its limitations, and although the research team were able to check out issues with lecturers throughout the analysis, they were unable to capture the lived experience of the curriculum. A second study has been commissioned by the ENB to explore how these issues influence practice. [ABSTRACT FROM AUTHOR]

The article offers the author's comments on the paper "Nurse and Knowledge of pain" by B. Wilson published in the periodical "Journal of Clinical Nursing" 16 in the year 2007. According to him, the paper established that the factors including education, pre- and postregistration and clinical experience influence nurses' knowledge of pain. He says that the study will help in the further development of nursing education, especially the postregistration education.

The article comments on a paper which explores the facilitation of learning in the practice of nursing. The author stresses that the researchers provide limited information regarding the search results. She emphasizes that it would have been helpful to include a table summarizing the key findings from each of the papers included in the review. She asserts that the researchers have identified on who is responsible for this facilitation of learning.

The article comments on the paper "Clinical education facilitators: a literature review," by V. Lambert and colleagues. The paper highlights the lack of role clarity concerning the job title, clinical education facilitators. The author suggests that a renewed focus is required on the purpose of student support roles and the micro and macro-political contexts in which they are enacted. He stresses that the support of nursing students' learning must be a team effort.

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]

Aims and objectives. This element of the larger Scottish evaluation aimed to explore differences between access routes, cohorts and higher education institutes (HEI) (universities and colleges) in levels of self-efficacy, student support and self-reported competence in a nationally representative sample of student nurses and midwives. Background. This paper reports findings from the National Review of Pre-Registration Nursing and Midwifery Programmes in Scotland. Fitness for practice curricula have been the heart of many recent developments in nurse and midwifery education. Fitness for practice set out to map out the future direction of preregistration nursing and midwifery education with the aim of ensuring fitness for practice based on healthcare need. There have been no national evaluations of the effectiveness of this strategic objective. Previous major evaluations in the 1990s suggested that students may not have had the skills needed to be fit for practice. Design. The study design was a cross-sectional survey of a stratified random sample of student nurses and midwives ( n = 777). Data collected included demographic information, generalised perceived self-efficacy, student support and self-reported competency. Results. Students reported high levels of self-reported competency. There were no significant differences between two cohorts or between students with different access routes. Students rated support from family and friends highest and support from HEI lowest. There was a significant difference in support levels between HEI. Self-efficacy scores were similar to other population means and showed small-moderate correlations with self-report competence. Similarly, self-reported competency appears to be at the higher end of the spectrum, although older students may have a more realistic perception of their competence. However, support from HEI was seen as less satisfactory and varied from one institution to another. Conclusions. This study portrays a relatively positive picture of preregistration fitness for practice curricula. Questions are raised about the relative value students place on support from educationalists and mentors and whether support from family and friends and from peers needs to feature more prominently in curricula. The study provides modest support for social cognitive theory. Relevance to clinical practice. The major drivers for changes in preregistration curricula stemmed from fears about the competence of students. This study did not provide support for this viewpoint, and students' self-reports suggest that curricula are, in this respect, meeting their objectives. Nevertheless support from mentors and from educational institutes may need to be improved. [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. The aim of this paper was to illuminate how recently graduated nurses experience their first year as a nurse. Background. Graduate nurses are expected to identify themselves as members of an interdisciplinary team, to feel comfortable in chaos and to make and defend decisions. By graduation nurses expect to have the necessary competence to perform nursing. Recently graduated nurses lack competence, especially relating to leadership. Design. A qualitative design was chosen and 12 nurses working in hospitals and home care were individually interviewed. Method. The interviews were transcribed verbatim and the texts were analysed using manifest and latent content analysis. Results. The nurses gave descriptions covering numerous experiences, interpreted and categorised in the following eight subcategories: uncertainty and chaos; need for induction; need for a supportive environment; need for recognition; awareness of responsibility; need for positive experiences; becoming experienced; and managing challenges. These subcategories gave reason for the three categories: experience of being new; gaining nurse experience; and gaining competence. The nurses described a tough start as a nurse, but they most of all gave descriptions interpreted as an experience of growth and development, which constituted the theme in this study. Conclusions. Recently graduated nurses have a positive attitude to the challenges of being a new nurse. Although the initial period as a nurse was tough, the nurses appreciated their experiences because they learnt from them. Relevance to clinical practice. Recently graduated nurses should be spared from being the only nurse on duty. Employers both in hospital and home care should facilitate induction programmes for new graduate nurses. [ABSTRACT FROM AUTHOR]

The article discusses the gap between nursing education and practice and the author argues that the quality of undergraduate nursing programs and clinical learning experiences directly impact the quality of care provided by nursing graduates. The author notes the importance of adapting classroom content to the clinical environment, and writes that the journal aims to publish papers that explore nursing education as it relates to practice in order to prepare future generations of nurses.

Aims and objectives. The aim of this paper is to report on the insights of newly qualified Irish nurses into their preparation for registration as general nurses and to develop insights into the postregistration experience. Background. Nurse education in Ireland has undergone much reform over the past decade. These changes include the introduction of supernumerary status for nursing students and the formation of links with institutes of higher education. No Irish literature was found on this subject. Method. Individual semi-structured, in-depth interviews were held with 12 newly registered nurses, from two cohorts, within 10 months of qualification. A grounded theory approach was adopted and content analysis employed to analyse the data. Results. Two categories, entitled Learning the Ropes and The Metamorphosis emerged from the analysis of data. Within each of these categories there were two subcategories. All respondents reported that since qualification, they had become increasingly conscious of their isolation and unmet needs as nursing students. Postregistration, they enjoyed their increased status and widespread recognition by others. Conclusions. This study details how improvements can be made at clinical level to assist the preparation of nursing students for registration. The positive aspects of registration are revealed through descriptions of comparisons of pre- and postregistration experiences, while the shortcomings of the journey to registration are described. Relevance to clinical practice. Pre-registration nurses have unmet clinical needs which, if fulfilled, would benefit them post-registration. Good ward morale is elementary for student learning and enhances the post-registration experience. Registered nurses are highly conscious of their altered status. These findings are pertinent to clinicians and educationalists as they prepare nursing students for practice. [ABSTRACT FROM AUTHOR]

AIM: This paper explores the development of a low-cost, involving methodology for constructing nursing-focused evidence-based national care guidance, known as Best Practice Statements, the intended users of which are gerontological nurses practising throughout Scotland. DESIGN: The Best Practice Statement construction methodology forms one cycle in a five-year longitudinal action research study that aims to achieve evidence-based nursing, facilitate professional networking to support practice development and promote the principles and practice of gerontological nursing. Achieving these aims involved designing a virtual Practice Development College. METHODS: A Community of Practice comprising practising gerontological nurses, expert advisors, academic teaching and research nurses collaborated in face-to-face meetings and in the virtual Practice Development College to delineate and refine the procedural model for Best Practice Statement construction. Focus groups, telephone interviews, analysis of on-line archives and documentary outputs formed the analytic dataset. RESULTS: Qualitative analysis indicated that, from the perspective of the community of practice, the emerging methodology facilitated the melding of knowledge sources reflecting the dominant evidence hierarchy with other forms of evidence valued by gerontological nurses, in the Best Practice Statement. RELEVANCE TO CLINICAL PRACTICE: Current methods of care guidance construction rarely address the concerns of nurses and the evidence from which guidelines are developed is narrowly defined with regard to inclusion and acceptability. In contrast this model focuses on nursing issues, embraces a wider definition of evidence and ensures that the published Best Practice Statements are credible and achievable in gerontological practice, where they are tested and refined as an inherent aspect of the development process. [ABSTRACT FROM AUTHOR]

coffey a. (2005) Journal of Older People Nursing in association with Journal of Clinical Nursing 14, 8b, 75–83 The clinical learning portfolio: a practice development experience in gerontological nursing Assessment of clinical practice in post registration programmes can require a different focus to capture the essence of learning at a higher level. There are differences of opinion in the literature on the potential use of the portfolio as an assessment method. The aims of this paper are to describe the use of a portfolio of evidence-based practice and reflection to assess clinical learning in a Higher Diploma in Gerontological Nursing Programme and to present the findings of a pilot evaluation of this assessment. The evaluation was conducted by postal questionnaire distributed to the first cohort of students following graduation from the programme in 2002. Arising from this exploration of the student experience, it appears that the use of a portfolio in addition to formative assessment, can promote a link between theory and the advancement of gerontological nursing practice. [ABSTRACT FROM AUTHOR]

grandell-niemi h, hupli m, leino-kilpi h&puukka p (2005) Journal of Clinical Nursing14, 685–694Finnish nurses’ and nursing students’ pharmacological skillsThe purposes of this study were to investigate the pharmacological skills of Finnish nurses and graduating nursing students, to determine how pharmacological skills are related to background factors and to identify differences between nurses and students and, finally, to examine how the instrument used, the Medication Calculation Skills Test, works.Pharmacology is a relevant and topical subject. In several studies, however, pharmacological skills of nurses and nursing students have been found insufficient. In addition, pharmacology as a subject is found to be difficult for both nursing students and nurses.The study was evaluative in nature; the data were collected using the Medication Calculation Skills Test, developed for the purposes of this study. The instrument was used to gather information on background factors and self-rated pharmacological and mathematical skills and to test actual skills in these areas.Results concerning pharmacological skills are reported in this paper. The maximum Medication Calculation Skills Test score was 24 points. The mean score for nurses was 18.6 and that for students 16.3. Half of (50%) the students attained a score of 67% and 57% of nurses attained a score of 79%.Nurses and students had some deficiencies in their pharmacological skills. Nurses had better pharmacological skills than students according to both self-ratings and actual performance on the test.It is vitally important that nurses have adequate pharmacological skills to administer medicines correctly. This study showed that the Medication Calculation Skills Test seems to work well in measuring pharmacological skills, even though it needs further evaluation. Findings from this study can be used when planning the nursing curriculum and further education for Registered Nurses. [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]

This paper reports the findings of a study that sought to gain insight into the experiences of third year nursing students who participated in a 4-week clinical placement in an international setting. This study is different from many studies describing international placements for undergraduate nursing students as it concentrates on clinical experiences on placement. Students' reflective journals and face-to-face discussions were used to collect data, which were analysed by thematic content analysis. Categories were identified describing a focus on micro clinical-based issues that expanded over time to a focus on broader issues reflecting the 'nursing culture' of the placement. Students described both positive and negative aspects of being placed in an international clinical setting, with the concept of 'being different' emerging. Whilst the findings cannot be generalized beyond the sample, the study highlights the importance of adequate preparation and support for students on international clinical placements, with emphasis on attention to clinical detail. [ABSTRACT FROM AUTHOR]

• This paper outlines the qualitative findings of a study exploring the transition from student to Registered Nurse and the catalytic effect of the way in which newly registered nurses are prepared for this role change. • The study explored the experiences of one cohort of students undertaking the pre-registration Advanced Diploma in Nursing Studies at the University of Sheffield. • Data were collected pre-qualification and post-qualification in order to compare the expectations and reality of the transition period. Two key aspects emerged, one relating to the experience of students undertaking the final module of the course and the other to preceptorship once qualified. These two areas of practice have been the focus of development following dissemination of the research findings in the local NHS Hospitals. • The study suggests that the transition period remains very stressful for some nurses, because of both pre-registration educational issues and the level of support received once qualified. Careful planning of the student experience in the final year and addressing inconsistencies within the preceptorship programmes of newly qualified nurses are needed. The study is stimulating change in the local NHS hospitals, with the aim of enhancing the overall experience of student nurses and newly qualified staff alike. [ABSTRACT FROM AUTHOR]

This paper reviews the literature on nursing competence measurement and reports the results of a comparative quantitative study of the competencies of Project 2000 diplomates and BA (Hons) Adult Nursing graduates from two UK nursing programmes. The findings reveal that graduates appear to overcome any initial limitations and become more competent than the diplomates in certain areas. Attention to social awareness and participation is necessary in both pre-registration programmes, whilst greater attention could be given to graduates' leadership and management development. Diplomates need support in their professional development if they are to achieve the same level of competence as graduates during the first post-qualifying year. There are implications for the level of support afforded to qualifying nurses in their first staff positions; preceptorship programmes could be an important means of assisting newly qualified staff to gain confidence. More research on nurse competencies with larger samples drawn from programmes across the UK is needed. [ABSTRACT FROM AUTHOR]

Work-Based Learning is the bringing together of self-knowledge, expertise at work and formal knowledge. It takes a structured and learner-managed approach to maximizing opportunities for learning and professional development in the workplace. The development and assessment of nursing competence can be facilitated through Work-Based Learning, although this may require pedagogic and structural changes within nurse education. There are a number of conditions which must accompany effective participative learning, and these are discussed in the paper in relation to examples of nursing programmes. This method of learning and assessment has potential to bridge the gap between theory and practice, and as such it can only be achieved through commitment and partnership between the individual practitioner, clinical services and universities. [ABSTRACT FROM AUTHOR]

In the light of current political and professional debate in the United Kingdom concerning preparing nurses for competence, this paper takes an historical perspective, and considers how nursing competence was defined historically through an analysis of statutory syllabuses and nursing textbooks 1874-1977. Competence was perceived by nursing textbook writers to have four facets. Firstly, it involved the moral character of the nurse; secondly, it required technical knowledge, practical skill and procedure; thirdly, it depended on the role of the ward sister; and fourthly, it relied on the professional etiquette of right relationships. The analysis shows that the traditional system of nursing competence presumed a clearly defined purpose: the production of the bedside nurse, whose function was to care for the sick person. This raises a fundamental question for nursing today: what is the purpose of the modern nurse? [ABSTRACT FROM AUTHOR]

Changes in the delivery of health care and changes in population characteristics and health care requirements mandate changing requirements in nursing education. This is necessary to meet patient and family needs and to deliver quality health care. This paper describes the background to nursing education in the Nordic countries and gives an account of an initiative in Norway to prepare advanced practice nurses for clinical practice in this dynamic environment. [ABSTRACT FROM AUTHOR]

This paper looks critically at the nature of nursing theory from three perspectives. Firstly, it examines the current state of nursing theory with a particular focus on Patricia Benner's work. This examination concludes that nursing theory is currently beset by the problems of scientific and moral relativism and philosophical incoherence because it has abandoned a traditional realist approach to the care of patients. Secondly, the roots of this contemporary nursing position are analysed and the conclusion is reached that nursing theorists are implicitly presuming this traditional 'common sense' view of nursing, although their own philosophical assumptions do not support it and indeed are removing the ground from beneath it. The traditional theory underpinning the quality of the nurse's care, and hence the ethos of nursing, is rearticulated. In conclusion it is suggested that nursing needs to debate the modernist views that are now holding sway in nursing and rediscover a theory for the care of patients that holds together the personal, the pastoral, the scientific and the technological aspects of patient care. [ABSTRACT FROM AUTHOR]

This paper aims to examine the promotion of advanced clinical practice. It addresses questions such as: • what is advanced clinical practice? • what is the relevance of knowledge to clinical practice? • what is the relevance of research to clinical practice? • what is the relevance of the culture to clinical practice? • what is the role of the clinical nurse? It does not present ready answers. Rather, it attempts to highlight difficulties and ambiguities originating from the contradictory goals and requirements of nursing education, research and practice. [ABSTRACT FROM AUTHOR]

The author reflects on the availability of the 'Journal of Clinical Nursing" abstracts in Chinese texts. The author stated that the purpose of the translation was to have an open communication, and mutual encouragement in nursing education. It explores the plans on the publication of relevant papers on-line. The author inferred that the translation was a historic event for the journal.

The article comments on the paper "Student nurses' knowledge, skills and attitudes towards the use of portfolios in a school of nursing," by S. Nairn and colleagues, published in the "Journal of Clinical Nursing." The author has doubts about the reliability and validity of portfolios, not as a method of learning, but as a means of assessing student learning. He thinks that the portfolio is more positively viewed by first year students than by third year students.

The author evaluates the role of the advanced neonatal nurse practitioner (ANNP) in neonatal nursing. The author, commenting on the paper by P. Nicolson and others, highlights ANNP's accountability in planning and directing care. The author points out the limitations of Nicolson's study and emphasizes on education and training from the ANNPs. The need for systematic training of ANNPs to improve patient care is also underlined.

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 article focuses on the need for undergraduate nursing students to be familiar with complementary and alternative medicine (CAM). It considers how, with rising popularity, CAM is on the curricula of several medical schools. It also discusses the increased interest in the use of CAM in clinical nursing practice.

The authors present their response to a comment made on their article about the importance of maintaining the clinical credibility of nurse teachers. They clarify the meaning of anti-academic culture within the nursing context and reiterate the need for nurse lecturers to balance teaching, clinical placement support, research and administration. According to the authors, continued collaboration between practice and universities is needed to ensure quality learning for future nurses.

The author comments on the previously published article "Nurse education: the role of the nurse teacher," by Mark Gillespie and Brian McFetridge. He asserts the failure of the authors to relate their claim on the importance of maintaining the clinical credibility of nurse lecturers in the context of Great Britain. He further refutes the declared antiacademic culture in the clinical setting.

The author reflects on qualitative research trends in nursing practice and expresses opinion on the papers and posters presented at the International Council of Nurses (ICN) Conference held in 2005, Taiwan. An overview on the popularity of Phenomenology, descriptive and/or exploratory research and grounded Theory among nurse researchers is offered. The author also advises qualitative methodologists to master broad criteria, which in turn would enhance quality study in nursing practice.

Evaluates clinical competence of student nurses in Great Britain. Preregistration nursing programs; Example of a nursing competencies questionnaire; Conclusion that self-assessment of clinical competence should form an important element in the overall assessment of student nurses.

The article presents the author's comment on the article "From competence to capability: a study of nurse practitioners in clinical practice," by A. Gardner, and colleagues. According to the author, capability draws a line between training and education. Gardner and others apply the capability framework to nurse practitioners. The author hopes that others in nurse education at pre-registration and post-registration levels will consider this framework for their activities.

The article presents an opinion on the use of action research and other methodologies in the development of nursing knowledge in response to the commentary of T. Williamson. The author expressed their disappointment and confusion because the ideals of their study in developing an inclusive form of action research had not been met.

AIMS AND OBJECTIVES: To explore influences on decision-making concerning placement capacity planning for supporting nursing students in clinical placements. The research questions were: * How are decisions relating to capacity planning and management of the learning environment made within the practice areas? * What factors were or are perceived as important to take into consideration when making these decisions? BACKGROUND: It is already known that clinical placements are pivotal to pre-registration nurse education. The recent large expansion of nurse education places means that more students require clinical placements than previously. This study explored decision-making about placement capacity amongst mentors in one central English county. DESIGN: A qualitative design using focus groups. STUDY AND METHODS: Collecting data allowed researchers to engage mentors in discussions concerning their decisions about how many students they could support in practice and the learning environment they could provide. Twenty-nine active nursing student mentors participated, representing three branches (Adult, Mental Health and Child Health Nursing) from various acute and community settings and professional roles. RESULTS: Three themes emerged relating to capacity management issues in clinical placements: * Capacity issues: how decisions are made in relation to capacity planning, by whom they are made and what influences them? * Supporting learners and enhancing support in practice. * Issues impacting on learning in practice. CONCLUSIONS: This study adds further understanding of the need for robust information to support allocation decisions, coupled with greater clinical staff and mentors' involvement in decisions about student support. The forthcoming Skills for Health Ensuring Quality in Partnership requirements may add authority and structure to student support activities. RELEVANCE TO CLINICAL PRACTICE: Strategic practice and placement development links and joint appointments between UK NHS trusts and higher education institutions should be considered if placement capacity issues are to be addressed successfully and the quality of students' placements are to be safeguarded. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of this review was to explore the literature to determine what is known about adolescent sleep, the causes and consequences of disturbed sleep in adolescence and the implications this has for nursing practice. Background. Sleep disorders are relatively common in young people. Disturbed sleep can be both a cause and a result of ill health and if recognised can indicate psychosocial, psychological or physical difficulties. Design. Literature review. Methods. Searching of key electronic databases. Results. Disturbed sleep in adolescents has several potential consequences, including daytime sleepiness, reduced academic performance and substance use/abuse. However, despite its significance and frequency, sleep disturbance is an area of adolescent health that is almost entirely unaddressed within the nursing literature. Conclusion. Nursing has a role to play in assisting adolescents and their families to recognise the importance of sleep to the general health and well-being of young people. Relevance to clinical practice. There is a need for nursing to develop tools to assess sleep in adolescent clients and non-pharmaceutical interventions to assist adolescents achieve optimum sleep and rest. Nurses may also contribute to educating adolescents and their families regarding the importance of good sleep hygiene. [ABSTRACT FROM AUTHOR]

Aim. This study reports on nursing students’ current capacity to handle standard and additional infection-control precautions in terms of their knowledge, application skills and confidence. Background. These precautions are recommended as the guidelines for preventing infections and ensuring occupational safety. As nursing students undertake patient care during clinical practice, their knowledge of and ability to apply these precautions with confidence should be examined before they enter the clinical field. Method. A specific tool, the Infection Control Evaluation, was developed and distributed. Design. A cross-sectional survey involving a sample of preservice nursing students was conducted in southern Taiwan. Results. The results were based on an 88% response rate and indicated that the level of knowledge concerning standard and additional precautions was low among Taiwanese nursing students. Their ability in applying these precautions in clinical practice also appeared to be inadequate. Conclusions. Such findings indicate that Taiwanese preservice nursing students require a comprehensive foundation course in infection-control precautions before they enter the clinical environment. This will help to ensure their protection and that of their patients. Relevance to clinical practice. As the findings highlight the importance of providing such education for students before they undertake any clinical work, the information provided here can help nursing educators and academics to develop a specific program. [ABSTRACT FROM AUTHOR]

Aims. This study was aimed at comparing perceptions of portfolios between student nurses at the early and latter stages of their training and how they compare with their lecturers’ perceptions. Background. Portfolios are used widely in nurse education. There has been research into how portfolios are perceived and understood, but there is little evidence into how student nurses and lecturers compare quantitatively in perceptions of portfolio use. Design. Survey. Method. Forty-eight nursing lecturers and 413 nursing students, from a multi-centred School of Nursing in the UK, completed a questionnaire. Data were analysed with exploratory factor analysis, varimax rotation of the factor solution, internal consistency analysis, and analysis of variance. Results. Five factors were extracted, which were labelled: (1) portfolios as a means of skills acquisition, (2) other means of teaching and learning beyond using portfolios, (3) processes of showing the portfolio to others, (4) having favourable attitudes towards portfolios and (5) lecturers’ ability to share knowledge about portfolios. Scales developed from these five factors had high levels of internal consistency. Lecturers were the most positive of the three respondent groups in their views of portfolios, whereas third- and fourth-year students were the least positive. There were significant differences between student nurses and their lecturers, concerning how information on portfolios is communicated by the lecturer. Conclusion. There were significant discrepancies between lecturers and student nurses in their views on how portfolios are used. The value of portfolios becomes less salient to student nurses towards the end of their training. Relevance to clinical practice. Lecturers and clinical mentors need to look at students’ perceptions and why some nursing students’ views on portfolios deteriorate. There could be regular discussions with students to see how and why the students begin to see portfolios as less useful for their education and continual professional development. [ABSTRACT FROM AUTHOR]

Aims. To explore the expectations of final year nursing students before they start employment and to describe the experiences of newly graduated nurses during their first six months of employment as registered nurses. Background. Nursing shortages are at crisis point world wide with registered nurses leaving the profession at a high rate and changing occupations. Thus, there is a need to reflect on new graduate nurses experiences in relation to retention and support. Design. Husserl’s phenomenological approach was used to gain insight and understanding into the lived experiences of new graduate nurses. Methods. Students enrolled in a Bachelor of Nursing programme at an Australian University were interviewed in their final semester and during employment in the hospital setting. Semi-structured interviews were used to gather data from 13 participants. Data were collected at three intervals: prior to commencing employment, one month and six months postemployment and the results were analysed thematically. Results. As students, the participants held positive perceptions surrounding their impending role as a registered nurse and what it would encompass. However, after one month of employment, it became apparent that nursing comprised of a culture that embraced cliques which excluded them. The graduates were unprepared for ‘bitchiness’ and the limited amount of assistance with unfamiliar tasks they received from registered nurses. Participants also found rotating to different wards recreated the feelings they experienced on commencing employment. Conclusions. Nursing curricula should prepare new graduates for foreseeable stressors and oppressive practices so that graduates can become proactive in preventing and responding to factors such as silence and aggression. Moreover, nursing courses need to ensure that socialisation issues are addressed to assist in the eradication of oppressive practices. Finally, organisations need to address socialisation issues such as hostility within the workplace to address the attrition of new graduates from the profession. Relevance to clinical practice. Individuals in clinical practice settings need to be cognisant of the significant role that experienced registered nurses and nurse unit managers occupy in the socialisation of new graduate nurses. Additionally, there needs to be increased awareness that nursing culture can influence recruitment and retention of new graduates. Further, health care organisations need to evaluate the benefits of new graduates rotating through clinical areas in the first 12 months of employment. [ABSTRACT FROM AUTHOR]

Aim. To determine the effects of a course for nursing students on developing competence in spiritual care and the factors that might influence the effects. Background. Studies suggest that role preparation in nursing for spiritual care is poor. For the assessment of competence, few or no explicit competency framework or assessment tools seemed to be used. Design. Quasi-experimental crossover design (pre-post-test). Method. The subjects were students from Christian nursing schools in the Netherlands (n = 97). The intervention consisted of a course in spiritual care. Competencies were measured with an assessment tool, the Spiritual Care Competence Scale. Data were analysed by t-test procedures (paired-samples t-test). At T(1) vignettes were added to assess the quality of the students' own analyses. These data were analysed by a Mann-Whitney test. Regression analyses were performed on the influence of student characteristics on the subscales of the assessment tool. Results. Ninety-seven students participated in this study. Analysis showed statistically significant changes in scores on three subscales of the Spiritual Care Competence Scale between groups (T(1)) and over time for the whole cohort of students on all subscales (T(2)). Clinical placement showed as a negative predictor for three subscales of the Spiritual Care Competence Scale. Experience in spiritual care and a holistic vision of nursing both showed as positive predictors on certain competencies. A statistically significant difference was observed between groups in the student analysis of a vignette with explicit spiritual content. Conclusions. The outcomes raise questions about the content of education in spiritual care, the measurement of competencies and the factors that influence competency development. Relevance to clinical practice. The results provide nurse educators with insight into the effects of education in spiritual care on students' competencies and help them consider a systematic place for spiritual care within the nursing curriculum. [ABSTRACT FROM AUTHOR]

Aims and objectives. To understand the variation of ways that students understand the informal or buddy registered nurse role during facilitated clinical experience, and to identify the relationship between student learning and student understanding and experience of the registered nurse role during clinical experience. Background. Student clinical experience is an essential aspect of all undergraduate nursing programs. Students expect registered nurses to supervise and support them and to provide learning experiences during clinical placement. Both positive and negative experiences have been reported in the research literature. The quality of the relationship between the registered nurse and the student directly affects the learning outcome for students. Design. Qualitative research using a phenomenographic approach. Methods. Semi-structured individual interviews with 24 students from all three years of an undergraduate nursing program at a metropolitan university in Brisbane, Queensland, Australia, who voluntarily participated in this study. Interviews were conducted at the completion of a recent clinical experience. Results. While adequate monitoring and supervision is an expectation of students, there is a wide variation in the way registered nurses appear to understand this aspect of student learning. In the category of description, 'registered nurse as gatekeeper: gatekeeping as monitoring and supervision', student conceptions were identified as: registered nurse awareness, registered nurse vigilance, promoting learning/developing learning and growing (as) students. Students identified their experiences and the strategies they used when monitoring and supervision were lacking or limited. Conclusions. The findings of this study illuminate the need for recognition of the complexity of the informal registered nurse role with students and highlight the areas that should be addressed to promote quality student learning experiences. Relevance to clinical practice. Registered nurses need adequate preparation for their informal role to support and supervise undergraduate students in clinical placement to ensure the safe development of student competence and confidence for their graduate registered nurse role. [ABSTRACT FROM AUTHOR]