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

Aim. The aim of this paper is to shed light on how nurses describe situations that reflect achievement and provide confirmation that they have done good work. Background. Nurses’ recognition of good work does not seem to have been the object of direct investigation, but is indirectly reflected in studies focusing on nurses’ perceptions on work environments and the multifaceted nature of nursing. However, acknowledging high-quality performance in professional nurses can facilitate nurses in maintaining and strengthening the goals and values of the profession. This in turn can help nurses shoulder the multifaceted responsibilities they have to patients and next of kin. Design. This paper is part of the Professional Learning in a Changing Society project, Institute of Educational Research, University of Oslo, funded by the Research Council of Norway. The project involves four professional groups. This paper, however, focuses on a group of 10 nurses, nine of whom work in hospitals and one in an outpatient clinic. A qualitative approach was chosen to gain insight into how nurses, as well as the other professional groups in the project, engage in processes of knowledge production and quality assurance work. Methods. Data presented in this paper derive from semi-structured in-depth interviews conducted during spring 2005 and focuses on the recognition of good work. Results. The following themes were identified as essential in confirming that one did good work: securing fundamental needs of patients and next of kin; managing the flow of responsibilities; positive feedback. Conclusions. Good work seems to be related to specific situations and a sense of achievement by the respondents. Relevance to clinical practice. Recognition of good work is not only rewarding and enjoyable; it may also serve as a source of consciousness raising for professional and ethical guidelines in the work place. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cerebrospinal fluid circulation disorders are complex and multifaceted conditions making reliable assessment of progress problematic. AIMS AND OBJECTIVES: It is the aim of this paper to explore how efficient measures of quality of life and hope might be used to assess clinical progress for patients with disorders of cerebrospinal fluid circulation. It will be argued that a single-item 10-point quality of life scale and the Herth Hope Index are as effective at measuring progress as the more widely used, but considerably more complex, Short-Form 36. DESIGN: Patients attending a cerebrospinal fluid clinic were sent a questionnaire containing the three measures of progress. Questionnaires were returned in a stamp-addressed envelope to allow initial analysis before the clinic appointment and to enable discussion of results during the clinic appointment. Patients were also assessed using the Mini-Mental State Examination during the clinic appointment. METHODS: The relationship between the three measures of progress was calculated using Spearman's rank order correlation. Correlations of 0.40-0.70 are considered modest and correlations of 0.70 are considered strong; 5% levels of significance are considered significant and 1% levels are highly significant. Internal consistency of the Short-Form 36 was assessed using Cronbach's alpha coefficient. Reliability was considered acceptable for dimension comparisons when alpha > 0.70. RESULTS: All patients were diagnosed with benign intracranial hypertension (n = 74), congenital hydrocephalus (n = 35) or normal pressure hydrocephalus (n = 171). There was a modest to strong correlation between the quality of life-10 and all eight dimensions of the Short-Form 36 for benign intracranial hypertension and congenital hydrocephalus patients. A slightly weaker correlation was demonstrated in seven of the eight Short-Form 36 dimensions for normal pressure hydrocephalus patients. Normal pressure hydrocephalus patients scored significantly lower on the Mini-Mental State Examination, which may contribute to explaining the weaker correlation between the three measures and the weaker internal consistency between the dimensions with the Short-Form 36. Conclusions. This paper demonstrates that efficient indicators of progress (quality of life-10 and Herth Hope Index) can be as effective at assessing clinical progress as more complex indicators (Short-Form 36) in patients who do not demonstrate cognitive deficit. RELEVANCE TO CLINICAL PRACTICE: For clinical application, the Short-Form 36 is too long, difficult to complete, score and analyse for these patient groups. Quality of life-10 and Herth Hope Index could provide efficient and effective measures of clinical progress but this requires further psychometric examination. [ABSTRACT FROM AUTHOR]

This paper explores the concept of comfort within conceptual frameworks that identify comfort as a key component. The paper focuses on two main issues: firstly, descriptions of comfort and how comfort is defined; secondly, the relationship between comfort and other core concepts and how it is similar to, or differs from these concepts. The descriptions of comfort identify the difficulty of defining comfort and note that historical interpretations of comfort have changed over time. Key authors provide different perspectives of comfort and hence a uniform definition is not evident. The degree to which patients' perspectives are represented varies within the frameworks which suggests that further clarity is needed in this area. The relationship between comfort and other concepts considers the boundaries between comfort and two concepts: nursing as therapy and caring. Comfort tends to be seen as a minor aspect of these concepts focusing on relief of discomfort or actions that demonstrate caring. The paper concludes that there is a lack of clarity around the use of the term comfort which fits with a view of comfort as an emerging concept. Descriptions of comfort are clearly evident in the literature but differ in relation to the authors' views of nursing. The relationship between comfort and nursing as therapy and caring is also complex and highlights the debate in relation to comfort as a part of caring or as the overall focus of care. [ABSTRACT FROM AUTHOR]

Aims and objectives. To discuss findings relating to role extension and loss of nursing care to auxiliary nurses. Background. There is ongoing discussion in the literature about what nurses’ roles may be and how the extension of role affects patient care. Various models have been devised to measure outcomes and the value of nursing to patients. However, there are limited data on the views of nurses themselves in terms of what they perceive their role to be and what they feel about role change. Design. A qualitative approach was used with the help of the elements of grounded theory. Methods. Data were analysed using a constant comparative method with core categories identified. The study described in this paper was the final of three. The first two studies involved student nurses and through theoretical sampling, the third sample was chosen to expand the data gained from the students. Results. The findings from the student studies indicated concern that the nursing role was being undertaken by auxiliary nurses. The results of the final study, as discussed in this paper, confirmed this. However, one main difference was that qualified nurses were not necessarily unhappy about auxiliary nurses’ role expansion but were concerned that the role of the nurse was moving away from the bedside. Conclusions. The data suggest that nurses’ roles may be hard to define. An abdication of role, as opposed to delegation of role, seems to be occurring. Critical thinking is needed to ensure this is a decision advocated by clinical nurses. Relevance to clinical practice. Nurses need to be explicit about what their clinical roles are. This study provides data expressing the views of clinical nurses about role expansion and role abdication and corresponding feelings about it. [ABSTRACT FROM AUTHOR]

BACKGROUND: This research arose from a concern that the recovery of patients was being hindered by a lack of understanding and emphasis on psychosocial care during hospitalization. AIMS AND OBJECTIVES: This paper describes some of the findings from a study that was undertaken to explore and describe, from the perspective of hospitalized patients in Western Australia, the perceived therapeutic effect of interpersonal interactions that were experienced during hospitalization. DESIGN: Grounded theory method. METHODS: Interviews were conducted with 40 patients who were, or who recently had been, hospitalized. Seventy-eight hours of participant observation were also performed and during that time patients and nurses were observed and informally interviewed. Relevant documentation such as nursing care plans and patient notes were also reviewed. RESULTS: Emotional comfort was identified as a therapeutic state that patients perceived as enhancing their recovery. Personal control was found to be a central feature of emotional comfort and this accounted for the way in which patients interpreted therapeutic and non-therapeutic interpersonal interactions that they encountered during hospitalization. This paper will describe the conditions that patients perceived had either promoted or inhibited their emotional comfort. These were identified as the level of security, level of knowing and level of personal value. These conditions had been affected by the interpersonal interactions that had been experienced. The characteristics of therapeutic and non-therapeutic interpersonal interactions will be described. CONCLUSIONS: The results from this study provide further insight into and understanding of the therapeutic effect of psychosocial aspects of patient care. Specifically, these results emphasize the importance that patients in hospital place on all the interpersonal interactions that they experience during hospitalization. RELEVANCE TO CLINICAL PRACTICE. The identification of the characteristics of interpersonal interactions that facilitated emotional comfort provides directions for enhancing the therapeutic potential of all interpersonal interactions experienced by patients in hospital. Copyright 2004 Blackwell Publishing Ltd [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]

shattell m (2004) Journal of Clinical Nursing 13, 714–722 Nurse–patient interaction: a review of the literature The aims of this paper are to review a theoretical model useful for developing nursing knowledge related to nurse–patient interaction, review the literature on nurse–patient interaction, and discuss areas for further research. Goffman's theory of face work. Nurse–patient interaction is a central element of clinical nursing practice. This paper shows how Goffman's model can be used as a theoretical framework for understanding nurse–patient communication. Issues such as power, the social and cultural context, and interpersonal competence are shown to be important in the quality of nurse–patient interactions and nurses need to take cognizance of these factors in their interactions with patients. [ABSTRACT FROM AUTHOR]

* Although urinary incontinence is common and can have a substantial impact on an individual's quality of life, few people seek help for this symptom.* This paper examines a theoretical framework proposed by Shaw (1999) as a possible explanatory model for help-seeking and the impact of incontinence on a person's quality of life.* Although aetiology and symptom severity are important predictors of behaviour and impact of symptoms, they did not explain all the variation and so other predictors proposed by the model were explored.* Appraisals of illness and coping resources were found to be important moderating factors between the experience of symptoms and subsequent behaviour and outcome in urinary incontinence.* In the appraisal of symptoms, lack of knowledge of the causes and treatments of urinary incontinence can be a barrier to help-seeking and successful outcome. Other factors such as personality, group differences, and social support can contribute to the appraisal process.* Areas for future research and implications for clinical practice are discussed. [ABSTRACT FROM AUTHOR]

The aims of the study were to identify indicators of quality of nursing care from the perceptions of patients and nurses, and to determine the congruence between patients' and nurses' perceptions. The paper is presented in two parts. Part 1 included the background and methods to the study and the findings from the comparison of patients' and nurses' perceptions. Part 2 describes the perceptions of patients and nurses, and draws conclusions drawn from the study as a whole. Patients and nurses in hospital wards were interviewed using the critical incident technique. We grouped 4546 indicators of high and low quality nursing care generated from the interview transcripts into 316 subcategories, 68 categories and 31 themes. The themes were grouped into eight clusters: therapeutic context for care, attitudes and sensitivity, teaching and leadership, motivation to nurse, monitoring and informing, high-dependency care, efficiency and thoroughness, reflection and anticipation. As shown in Part 1 of the paper, congruence between patients' and nurses' perceptions of quality was high and significant, although there was some difference of emphasis. The findings support an emerging theory of interpersonal competence and quality in nursing care. [ABSTRACT FROM AUTHOR]

• Nursing practice is based on experience, tradition, intuition, common sense, untested theory and sometimes research. • There are a number of reasons why nurses may see research as irrelevant to their practice. • This paper provides a model identifying possible strategies to help nurses develop research-based practice. [ABSTRACT FROM AUTHOR]

• The current context of community health care is described and the main issues concerning the development of continuity of care for the handicapped and elderly raised. Changes in philosophical and governmental approaches have coincided at a time of demographic changes that is resulting in increased numbers of elderly. • Continence services are used as a vehicle in order to demonstrate the need for protocols, systems and evaluation measures across community care team boundaries. Current government decisions and reports are interwoven within the text with professional considerations and other requirements for decision making. • The proactive approach offered in this paper for continence services, is also seen as important to other specialist services, such as stoma and diabetes care so that standards of patient care arc improved - these being evaluated by approved quality care tools. [ABSTRACT FROM AUTHOR]

The article comments on a paper which examines the perception of patients of the concept of the quality of care in the psychiatric setting. The author stresses that the information presented in the paper is important as it investigates quality of care from service users' perspective. She emphasizes the significant elements in mental health nursing presented in the paper. She asserts that the paper does not elaborate on whether patients encountered stigmatization from nurses.

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.

This article presents an editorial on delirium. Descriptions of delirium from those who have suffered it show that the episodes are not slight distortions of reality or confusion in time and space but that they are hallucinatory experiences much like terrible nightmares.Two papers are published in this issue on delirium in older people.

AIM: The purpose of the study was to explore the issues surrounding chronic hepatitis C, combination therapy and its impact on personal relationships to enhance understanding of the experiences of patients living with hepatitis C. This paper focuses on the experiences of the patients and their partners' experiences will be published separately. BACKGROUND: Patients with chronic hepatitis C who have active inflammatory changes on liver biopsy may undergo combination therapy with interferon and ribavirin. For some patients, the adverse effects of combination therapy are so severe that it can potentially place an enormous stress on personal relationships. DESIGN: The study was informed by Heideggerian phenomenology. METHODS: Purposive sampling and semi-structured interviews of five patients and their partners were conducted between 2004-2006 in Sydney Australia, to obtain a rich description of their experiences. RESULTS: The findings from this study revealed that chronic hepatitis C and combination therapy had an enormous impact on the lives of the patients, their partners and families. The illness and treatment had significant physiological effects that had an impact on quality of life; however, the social and psychological consequences of living with a highly stigmatised disease with an unknown course and outcome cannot be underestimated. CONCLUSION: The results of this study lend support to the effectiveness of providing equitable services to persons diagnosed with chronic hepatitis C. However, additional research is needed to explore gender, socioeconomic, sexual-orientation, transmission, cultural, religious and genotype differences in this group to address their needs better. RELEVANCE TO CLINICAL PRACTICE: Nurses play a significant role in educating patients with chronic hepatitis C, advocating for them and helping them to achieve a reasonable state of well being. Through deeper understanding of their experiences of illness and treatment, nurses can move beyond the medical oriented approach to care. [ABSTRACT FROM AUTHOR]

Aim and objective. The purpose of this paper is to describe the content of patient education as portrayed and evaluated by rheumatoid arthritis (RA) patients. Background. Rheumatology nurses have an important role in educating and supporting RA patients. However, there is a lack of knowledge of the RA patients’ own perspective of patient education. Design. Survey. Method. Data for this study were collected from 173 RA patients from 11 hospitals and 23 health centers using open-ended questions. Fifty-seven percent (57%) of the patients described the content of patient education and eighty-one percent (81%) evaluated it expressing their experience and satisfaction with it. Data were analysed using descriptive and non-parametric statistical tests. Results. Rheumatology nurses mostly gave their RA patients information about how to use the anti-rheumatic drugs prescribed to them (26%). About half (51%) of the patients were satisfied with patient education. However, every fourth patient (24%) was not satisfied, the main reason for the dissatisfaction being that nurses did not focus on the patient’s emotional support. The patients of over 57 years of age and those who had suffered from RA for over five years were more satisfied with their education than the others. Conclusions. It is important that rheumatology nurses, besides passing on medical treatment-related information, concentrate on RA patients’ emotional well-being. Relevance to clinical practice. The results provide a useful insight into RA patient education. Nurses should avoid merely passing on information in a routine workmanlike way. It is important that they take time to discuss their patients’ feelings and worries especially with newly diagnosed patients. RA patient education should balance patients’ information needs with their need for emotional support. [ABSTRACT FROM AUTHOR]

Aims. This paper reports findings from a large-scale quasi-experimental study that used a measure of caring as a means of evaluating person-centred nursing and aims to illustrate the synergy between the concepts of caring and person-centredness. Background. Evidence would suggest that effective person-centred nursing requires the formation of therapeutic relationships between professionals, patients and others significant to them in their lives and that these relationships are built on mutual trust, understanding and a sharing of collective knowledge. This correlates with the conceptualisation of caring that is underpinned by humanistic nursing theories. Design. A pretest post-test design was used in this study to evaluate the effect of person-centred nursing on a range of outcomes, one of which was nurses' and patients' perception of caring. Methods. The Person-Centred Nursing Index was the main data collection tool. The Caring Dimension Inventory and Nursing Dimensions Inventory, were component parts of the Person-Centred Nursing Index and were used to measure nurses' and patients' perceptions of caring. The Person-Centred Nursing Index was administered at five points in time over a two-year intervention period. Results. Nurses had a clear idea of what constituted caring in nursing, identifying statements that were reflective of person-centredness, which was consistent over time. This was in contrast to patients, whose perceptions were more variable, highlighting incongruencies that have important implications for developing person-centred practice. Conclusion. The findings confirm the Caring Dimension Inventory/Nursing Dimensions Inventory as an instrument that can be used as an indicator of person-centred practice. Furthermore, the findings highlight the potential of such instruments to generate data on aspects of nursing practice that are traditionally hard to measure. Relevance to clinical practice. The findings would suggest that nurses need to be aware of patients' perceptions of caring and use this to influence changes in practice, where the prime goal is to promote person-centredness. [ABSTRACT FROM AUTHOR]

Aim. To find that changes in models of service delivery together with the dynamic nature of the contemporary health care context have changed the direction and focus of nurses' work. The aim of this paper is to explore some of the drivers for change and their impact and recommend a way forward to optimising nurses' work in the hospital environment. Background. The healthcare workplace has been transformed over the past 20 years in response to economic and service pressures. However, some of these reforms have had undesirable consequences for nurses' work in hospitals and the use of their time and skills. Results. As the pace and complexity of hospital care increases, nursing work is expanding at both ends of the complexity continuum. Nurses often undertake tasks which less qualified staff could do while at the other end of the continuum, are unable to use their high level skills and expertise. This inefficiency in the use of nursing time may also impact negatively on patient outcomes. Conclusions. Nurses' work that does not directly contribute to patient care, engage higher order cognitive skills or provide opportunity for role expansion may decrease retention of well-qualified and highly skilled nurses in the health workforce. Relevance to clinical practice. In this climate of nursing shortages, we need to use nurses in a cost-effective but also, intellectually satisfying manner, to achieve a sustainable nursing workforce. [ABSTRACT FROM AUTHOR]

AIM AND OBJECTIVES: The aim of this paper is to reveal the main nursing competencies for spiritual care, which emerged from data collecting from qualified nurses in Malta. BACKGROUND: For nurses to deliver spiritual care, they must be competent to provide care on a physical, mental, social and spiritual level. As spiritual care may be influenced by culture, this study explored the competencies for spiritual care from the Maltese nurses' perspective. METHODS: A descriptive exploratory study investigated nurses' competencies in the delivery of spiritual care to patients with myocardial infarction. Data were collected by means of an open-ended questionnaire on qualified nurses (n=77) followed by an in-depth interview on a stratified random sample (n=14) of nurses from the same respondents. RESULTS: The four main nursing competencies identified were associated with the role of the nurse as a professional and as an individual person; delivery of spiritual care by the nursing process; nurses' communication with patients, inter-disciplinary team and clinical/educational organizations and safeguarding ethical issues in care. CONCLUSION: This study demonstrated the complexity of spiritual care, which requires nurses to increase their awareness of the uniqueness of each individual patient with regard to the connection between mind, body and spirit; the assessment of the spiritual status of patients during illness and the implementation of holistic care as recommended by the Nursing Code of Ethics. RELEVANCE TO CLINICAL PRACTICE: These findings will enable nurses to consider the importance of spiritual care, which may allow them to help empower patients find meaning and purpose during times of illness. More emphasis should be put on spiritual care in the pre- and postregistration education. Further research to translate these main competencies into specific competencies will guide spiritual care. [ABSTRACT FROM AUTHOR]

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

wadensten b. (2005) International Journal of Older People Nursing in association with Journal of Clinical Nursing 14, 8b, 84–89 The content of morning time conversations between nursing home staff and residents The aim of this paper was to investigate what nursing home staff and residents converse about when they first meet each other in the morning and to investigate who starts the conversation. It is a pilot project about communication in a nursing home in Sweden and a basis for a practice development programme. Studies in Sweden have shown that nurse assistants working in care of the older people felt they had too little training in how to communicate. Communicative behaviour influences patients, but little is known about the content of morning time communication in nursing homes. Non-participant observation of 18 staff was carried out using an observation schema. Content analysis was performed. The findings were that it was the staff who initiated conversation and chose the content of conversation. The most common topic in morning time conversation was residents’ health and sickness. Staff in nursing homes, both nurses and nurse assistants need to reflect on their interaction with residents and be conscious of their important role because they create the climate on the ward through conversation. Further studies are needed in order to explore residents’ opinions of what the content of a good communication could be and also to find out how nurses and other staff members’ communication with residents could be improved. Staff need more training and knowledge about how to communicate with older people. [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]

AIMS AND OBJECTIVES: The aim of this paper is to explore self-care in diabetes and to present a model of factors that affect self-care according to reviewed literature. BACKGROUND: Self-care in diabetes is crucial to keep the disease under control. Self-care consists at least four aspects: (i) self-monitoring of blood glucose, (ii) variation of nutrition to daily needs, (iii) insulin dose adjustments to actual needs and (iv) taking exercise regularly. It is known that diverse factors influence self-care such as knowledge, physical skills and emotional aspects and self-efficacy which have been listed as being of high importance. METHODS: The searched databases were ProQuest, PsycINFO and Medline from 1995 to 2002. The search terms were 'self-care' or 'self-management' coexisting with diabetes and 'self-efficacy'. The search was limited to English and adults with type 1 diabetes. RESULTS: The main components of the model clarify how knowledge, physical skills and emotional factors as well as self-efficacy influence self-care which again affects metabolic control. Flexible self-care indicates high level of self-care when patients are able to care for and manage the disease in a responsible and flexible way that does not affect their life extensively, resulting in adequate glycosylated haemoglobin value. Self-efficacy is a strong predictor of flexible self-care and affects metabolic control through increased perceived ability to conduct self-care. CONCLUSIONS: The review illuminated that benefits of self-care should be emphasized and knowledge of the Diabetes Complication and Control Trial results can contribute to better self-care. However, factors affecting flexible self-care still require better identification. RELEVANCE TO CLINICAL PRACTICE: The review emphasizes and adds to the topic, that in daily practice health care practitioners must assess diabetes-related knowledge, physical skills and emotional factors in combination with self-efficacy and the four self-care areas. The effects of self-monitoring of blood glucose needs better clarifications as it is now regarded the cornerstone of flexible self-care. [ABSTRACT FROM AUTHOR]

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

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]

badger f & mullan b (2004) Journal of Clinical Nursing 13, 526–533 Aggressive and violent incidents: perceptions of training and support among staff caring for older people and people with head injury Reported rates of workplace violence are increasing and studies of violence and aggression to health service staff in the United Kingdom have largely focused upon mental health and accident and emergency units. The study of violence and aggression in other specialties has been neglected. This paper reports the findings from a survey of staff perceptions of training and support in an elderly care and head injury unit. Staff in a care of older people and head injury unit, half of whom were nurses, were surveyed to identify their experiences of violence and aggression in the workplace, their receipt of training, the relevance of training and knowledge of support services. An anonymous semi-structured questionnaire was sent to all nursing, therapy and psychology staff in the unit. Quantitative data were analysed by SPSS and content analysis was adopted for the qualitative data. Just over half the participants had experienced an incident of violence or aggression in the past 12 months. Training was judged to be relevant by almost 90% of respondents but was not always delivered in line with trust guidance. Staff who had been involved in incidents were more likely to identify training needs. A higher percentage of nurses than other professions were involved in incidents, but they were not as aware of the staff support department as other professional groups. The findings indicate that care of older people and head injury units should examine more closely the delivery of staff training on violence and aggression, and invite staff to identify their training needs. A national survey of approaches to staff support may be worthwhile. Staff who had received training judged it to be relevant to their working situations, but outstanding training needs should be identified and addressed. Confidential staff support facilities should be well publicized. [ABSTRACT FROM AUTHOR]

Recent policy statements have stressed the need for fundamental changes to the NHS, especially to the hospital care of older people. Person-centred care underpins such changes. If practitioners are to deliver person-centred care, then they need to learn more about the patient as an individual. One way that this might be achieved is through biographical approaches. This paper describes the findings of a developmental study undertaken over a 6-month period to investigate the introduction of a biographical approach to care on a unit in a NHS hospital. It concentrates on the views of the practitioners who used the approach. The study aimed to explore whether a biographical approach - in the form of storytelling - might be used to encourage person-centred practice. Using a practice development approach, the study explored the views of older people, their family carers and practitioners regarding their participation in life story work. Initial data were collected by focus groups with staff from a nursing home who regularly used life stories as a basis for care planning. Further data were collected through focus groups, semistructured interviews and observation - undertaken before and after the introduction of life story work - with older people, family carers and practitioners. Findings revealed that life stories helped practitioners to see patients as people, to understand individuals more fully and to form closer relationships with their families. Support workers also said how much they enjoyed using the approach to inform their care. Further longitudinal research is required to investigate biographical approaches more fully and to work more closely with practitioners to explore how biographical approaches can be undertaken as part of standard practice and be integrated into the culture and management of care. [ABSTRACT FROM AUTHOR]

This paper aims to conceptualize the issues that surround the notion of existential health. It also seeks to establish the impact that existential issues have upon the health of the individual client and how these might explicitly be applied in clinical practice settings. The ability of clients to draw upon their own existential resources as a fundamental part of their health care experience often goes unrecognized in nursing. Whilst existential mechanisms may be theoretically recognized, as a valid aspect of an individual's unique and personal identity, they are not an established part of the health care activity of nurses. Entrenched biomedical frameworks of care delivery and the interchangeable use of metaphysical health states with existential health states in the established literature present particular dilemmas for the acknowledgement of existential health in clients. A review of the literature has been conducted. This account argues that the failure to recognize and assess a client's existential health status represents a major omission on the part of the clinical nurse. These nurses are, in effect, denying their clients the right to exercise and mobilize an important and valuable health resource. [ABSTRACT FROM AUTHOR]

Recent health care policies have resulted in patients having access to an integrated system of care that is quick and reliable. In concert with these changes, opportunities for professional development in nursing have increased, together with a reduction in the numbers of doctors. Advanced Nurse Practitioners (ANPs) have, therefore, developed to meet the complex demands of health care systems. This paper reports on a study that aimed to explore the current role of ANPs in primary care in the West Midlands region of the UK and how ANPs within three different nursing disciplines in primary care developed their roles over time. The study utilized a qualitative exploratory design incorporating a longitudinal element. Twenty-one ANPs were interviewed during phase one, 15 of whom were interviewed again during phase two, approximately 15 months later. Their managers (where appropriate) were also interviewed during phase one. The findings reveal that the nature and focus of practice varies between disciplines. At the extreme practice end of the practice-strategic continuum, Practice Nurse ANPs' expertise lies in their advanced practical assessment and diagnosis of individual patients, with little opportunity for strategic development. Health Visitor and District Nurse ANPs operate at the strategic end of the practice-strategic continuum, but operate differently at this level. Health Visitors, being community and public health focused are involved in multi-agency work, practice development and policy formulation. District Nurses work with individual patients/carers and the nursing team, thus their involvement in strategic developments tends to focus at the patient care level, such as protocol and practice developments, although their work also involves work in all three other domains. Overall, the findings reveal a unique role for all three with a potential career pathway for ANPs to become Nurse Consultants in the future. [ABSTRACT FROM AUTHOR]

• Transfer to the ward following a period in intensive care may cause stress for patients. • A review of the literature reveals that this phenomenon has been described in a number of different ways, such as transfer stress, transfer anxiety, translocation syndrome and, more recently, relocation stress. • This paper reviews the various concepts before arriving at a more operational definition of the phenomenon. • It attempts to reveal what causes this phenomenon and to what extent it exists. • Patients' responses to transfer are identified and the physical and psychological problems that have been associated with discharge from intensive care are discussed. • Lists of interventions that the literature suggests may reduce or prevent this phenomenon from occurring are reviewed. • Recommendations for practice development and further research are made. [ABSTRACT FROM AUTHOR]

Compliance has been evaluated from a wide range of scientific perspectives since 1950. The fact that there are many concepts referring to 'compliance' (such as 'adherence' and 'commitment') and that there is no agreement on a commonly accepted definition of the concept complicates evaluation. This paper aims to describe the ways in which the compliance of hypertensive patients has been defined and evaluated in earlier studies. The material was collected from the MEDLINE and CINAHL databases and analysed using content analysis. The review indicates that the concepts used in evaluating compliance of hypertensive patients vary considerably and that the most commonly used is 'compliance'. Regardless of the concept used, the methods of measurement and results of the studies indicate that compliance is conceived as observance of health-related advice given by healthcare personnel. This knowledge can be used in the evaluation of hypertensive patients' compliance in general and in developing the measurement of compliance. [ABSTRACT FROM AUTHOR]

The Leicestershire Medical Research Council (MRC) Incontinence Study is a series of interrelated studies exploring the epidemiology of urinary symptoms, including incontinence, and evaluating service provision and treatment options for these symptoms. This paper describes one aspect of the Leicestershire MRC Incontinence Study, namely the development, implementation and evaluation of a new nurse-led continence service. When developing a new service it is important to determine its acceptability and suitability to the target population. The new mode of service delivery was dependent on specially trained Continence Nurse Practitioners (CNP) delivering predefined evidence-based treatment interventions. Objective and subjective outcome measures were used to evaluate the service. The service was shown to be effective in reducing urinary symptoms and led to high levels of patient satisfaction. This service is currently being evaluated in a randomized controlled trial. [ABSTRACT FROM AUTHOR]

Carers working in psychiatric care are sometimes exposed to insane, unpredictable and violent actions. In rare cases a patient appears to be resistant to all forms of pharmacological treatment. Fifteen carers (four registered nurses, 11 enrolled nurses) on a psychiatric ward in Sweden were interviewed about their experiences when caring for a person who acted in a disturbing manner. Narrative interviews were conducted and interpreted using a method inspired by Ricoeur. Four themes were formulated which describe the carers' uncertainty about the future, their inability to interpret the patient's disturbing behaviour and their own overall feeling of meaninglessness. The carers were of the opinion that the patient had the power and ruled the ward, which led to them feeling they were subjugated victims. The interviews also revealed the carers' recognition of forbidden feelings and actions and unknown negative sides. These results were interpreted and reflected on in the light of an ethical framework in order to achieve a deeper understanding of the text. This paper shows that an ethical perspective is important when searching for the meaning of caring for patients acting in a disturbing manner. The study raises the question: 'Is it possible to establish good when evil has dominion?'. [ABSTRACT FROM AUTHOR]

Pain of moderate to severe intensity continues to be an important problem for many hospitalized patients. Nurses spend more time with patients than any other health professional group and have a key role to play in the management of patients' pain. This paper reports the findings from a series of focus group interviews which were undertaken to explore nurses' perceptions regarding pain and the administration of narcotic analgesia. Themes identified from participants' comments related to (1) the pivotal role of nurses in pain management; (2) nursing assessment and pain management decisions; (3) individual factors influencing nurses' pain management decisions; and (4) the influence of others on nurses' pain management decisions. [ABSTRACT FROM AUTHOR]

• The Government, in Health of the Nation (DoH, 1992), set targets for health authorities to introduce specific interventions intended to reduce the rates of suicide in the districts for which they are responsible. • Those who deliberately harm themselves are an important group for interventions aimed at suicide prevention. • Self-harming individuals are known to seek help from a range of care providers, not just those specifically intended to meet their needs. • Individuals with problems of self-poisoning and self-injury have placed increasing pressure on general hospital staff involved in their care. There should therefore be adequate services for suicide attempters in every general hospital. • Policies and protocols must be introduced and evaluated, to ensure that the self-harmer's experience during crisis is not a catalogue of unhelpful encounters. • This paper is an account of an action research project concerned with the assessment and management of self-harming patients in one accident and emergency department. • The project aimed to enhance departmental policies and procedures for managing this group of patients. • Practical problems can inhibit the introduction of even the most desirable of innovations. Action research provides a way of overcoming these problems whilst doing research at the same time. [ABSTRACT FROM AUTHOR]

This paper presents the hospital experience of a group of coronary artery bypass graft surgery patients. A description of the qualitative methodology is given. The participants' experience was identified as facing uncertainty and possible death. Excerpts from interviews are given. The participants coped with the situation by praying or having others pray on their behalf. Their uncertainty and possible death was affected by the conditions of: available support; environment; credible authority; information; belief; and their psychophysiological status at the time. [ABSTRACT FROM AUTHOR]

This paper describes a preliminary investigation into the efficacy of dressings in preventing catheter exit site infections in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). It has been carried out in the form of a pilot study. The background to the study is described and the literature is reviewed. This revealed that it is an important field of research. Exit site infections are the main cause of morbidity and treatment failure in CAPD patients. The rationale for carrying the study out, the findings and the implications for further study are reported and discussed. There is little guidance in current literature for clinicians on the prevention of catheter exit site infection. Patients are difficult to recruit to research studies. Practising nurses need training and careful management as data collectors. [ABSTRACT FROM AUTHOR]

* The aim of this 2-year study funded by the English National Board for Nursing, Midwifery and Health Visiting was to examine the relationship between teaching, support, supervision and role modeling in student clinical learning within the context of Project 2000 courses. * The research, using a two-stage case-study design, employing predominantly qualitative methods of data collection, investigated the perceptions of students, tutors and practitioners of their experiences of these processes in the clinical setting. * This paper focuses on the findings obtained from the practitioner data, highlighting not only the significant role played by practitioners in facilitating student learning, but also the implications for practitioners in undertaking this role. * The preparation required for supervising clinical learning, the integration of theory and practice and the organization of patient care have been identified as particularly important to the development of effective clinical learning environment. [ABSTRACT FROM AUTHOR]

The increasing demand for cost-effective and efficient health care may create a demand for more demonstrably effective hospital-based rehabilitation services, with the explicit goal of enabling patients to return home after short admissions; thus rehabilitation is centre stage. This paper reports the findings from a study of the rehabilitation of elderly people in hospital; in particular it focuses on an aspect of the process of care: namely staff perceptions of rehabilitation work, with particular emphasis on the role of the nurse. A conversational style of interviewing was used with 56 staff respondents from two rehabilitation wards for elderly people. Findings suggest that therapists are often seen as experts, and nursing is viewed as separate from rehabilitation, and hence nurses are an under-utilized resource in this field. It is suggested that there is a need to examine further the reality of multidisciplinary teamwork in rehabilitation, particularly with respect to maximizing the potential contribution of nurses, with the end goal of improving patient outcomes. [ABSTRACT FROM AUTHOR]

• In recent times, nursing has witnessed a growing support for the notion of theory as being instrumental in enhancing nursing practice and ultimately patient care (Marriner, 1986). Whether generated from nursing practice, or `borrowed' from other fields, the use of theory is viewed by some as the key to the ultimate recognition of nursing as a scientific, professional discipline in its own right (Stevens, 1984). Parallel to this view, there is a research perspective that questions the ultimate contribution of certain theories to health-care practice, particularly those emanating from other disciplines, urging caution in their practical utility. This paper enlarges upon this theme, focusing specifically upon the psychological theory of bonding, attempting to explore critically the degree to which it can be used in nursing practice, and to which it contributes towards our understanding of the attachment behaviour between a mother and her infant. • A brief outline is given of the theory and its impact on health-care practice, and possible limitations discussed with reference to the conceptual origins of bonding theory, the validity of its research methodology, and its use within the wider health-care setting. • A feminist sociological perspective is used in a brief attempt to explore the wider implications of the bonding theory in relation to the position of women. [ABSTRACT FROM AUTHOR]

• This paper describes the findings of a literature review of the effectiveness of nursing. Three journals were selected in which this type of study was most likely to be published. A diversity, of attempts to measure nursing effectiveness with various types of patient was found. Generally, however, there was a lack of rigour in study design and sample sizes were too small to be able to draw conclusions. No studies were found which undertook a cost-effectiveness analysis of nursing interventions. • Suggestions for the way forward in measuring nursing effectiveness are given, together with questions to be addressed by nursing research. [ABSTRACT FROM AUTHOR]

• A research-based project was conducted to introduce structured pain assessment on a surgical ward at a general hospital in Kenya, East Africa. The aim was to improve pain control, and subsequently patients' recovery and satisfaction with care. • It was agreed that the ultimate aim was to develop and use a common tool for pain assessment throughout the hospital, thereby reducing disparity in various clinical areas, and raising standards of patient care. • The project was seen as a pilot, and planned introduction of the pain assessment took place over 1 month. • This paper describes the findings in relation to the patient sample, and perceptions of nurses taking part. It also contains reflections about action research, and how it may enter the scene as a way of understanding the whole picture retrospectively. [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]

Registered nurses in Australia are the primary users of medical equipment in the direct care of patients. The cross-sectional survey reported in this paper explores how and what registered nurses working in a large hospital in a South Australian city initially learn about the medical equipment they use in direct patient care, as well as the consequences of equipment use for both patients and staff. Equipment use had positive and negative aspects both for registered nurses and patients, the central issue of which was quality patient care. Inherent in this issue was knowledgeagle and proficient device use, which, it is argued, hinges on equipment education. The two most frequently identified methods of initial learning were reading the user/instruction manual and consulting the policy and procedure manual. At least 90% of respondents indicated they initially learned how to operate equipment and its purpose and function. Medical equipment use caused nearly half the nurses to feel stressed, but only 9.4% had used medical equipment that had harmed a patient. [ABSTRACT FROM AUTHOR]

• Spirituality is often equated or used synonymously with the word religion but it appears this concept can be defined in broader terms. • Nurses do not appear to consider spirituality adequately in clinical practice but if holistic care is to be given to patients it is essential that the spiritual component of individuals is addressed. • This paper explores the concepts of spirituality and clinical practice. Clarification of the term spirituality is given followed by a critical review of the literature in order to establish its relevance to nursing practice and to what extent patients' spiritual needs are met. Aspects of spiritual assessment and spiritual care are also outlined. • It is suggested that nurse education may help nurses incorporate spirituality into clinical practice by increasing their knowledge and understanding of such a concept. [ABSTRACT FROM AUTHOR]

Problems surrounding the discharge of patients from hospital have been well-documented in the research literature and highlighted in recent Audit Commission reports. The need for effective discharge planning and post-discharge support is increasing as lengths of stay in hospital continue to fall. Elderly patients are in particular need of well-planned discharge. This paper reports the findings of an exploratory study in which elderly patients were interviewed before and after discharge from hospital. Three main problem areas which were identified are discussed: lack of preparation for discharge; difficulties in managing at home after discharge; limited provision of health and social services in the post-discharge period. It is suggested that nurses are in a key position to improve discharge planning and procedures for patients (particularly the elderly) returning home from hospital. [ABSTRACT FROM AUTHOR]

•Despite the efforts of nursing theorists, educationalists and practitioners, the theory-practice gap continues to defy resolution. This paper argues that only by reconsidering the relation between theory and practice can the gap be closed. •Drawing upon ideas from teaching and other practice-based disciplines, including nursing, the article suggests that the current model of viewing theory as informing and controlling practice should give way to a mutually enhancing model in which theory is derived from practice, and I turn influences future practice. •This coming together of theory and practice is referred to as nursing praxis, and suggests that informal theory should be unique to each individual encounter with each patient. •The clinical nurse is thus not only a practitioner, but a theorist and researcher, who responds to patients not according to some grand, inflexible theory, but by the process of reflection-in-action, drawing upon their expertise and a repertoire of past experiences and encounters. [ABSTRACT FROM AUTHOR]

Elderly people are more often subject to coronary diseases than young people, and the rapid growth of the number of elderly people in society has implications for care. An interesting alternative or complement to traditional rehabilitative care is self-help groups where 'natural' care can bring a new perspective to practice. The aim of this paper is to describe a nurse intervention in connection with self-help groups for elderly persons post-coronary. This intervention embraces health advice for the group members in the form of a guidebook, comprising physical, psychological and social health aspects to be used in group meetings. From a publich health perspective such an intervention is one way to show how nurses can work in rehabilitative care, as well as in promotive and preventive care, outside the health care and medical services. [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.