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

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

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

AIMS: 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]

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

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

AIMS: This paper suggested the need to interrogate the notion of 'integration' to facilitate the retention of migrant nurses. BACKGROUND: The growth in internationally recruited nurses in the UK's health system has led to a raft of policies that aim to ensure that such nurses are well 'integrated' into their 'new environment'. It is assumed that integration will improve the quality of internationally recruited nurses' experience in the UK, improve their retention rates and thus improve the quality of health delivery within the UK. However, most of the steps through which integration is sought tend to move between some version of assimilation and 'respect for difference'. CONTRIBUTIONS: This paper aimed to add to existing literature on the integration of internationally recruited nurses in the UK by suggesting three steps towards rethinking 'integration policies'. It suggests the need to recognize migration as only one of the differentiating factors within the nursing sector, to ensure that integration does actually become a two-way process and to be cognizant of the multiple shapes that racism can take. The first two steps will prevent a slip between integration and assimilation while the last will help rethink any anti-racist training that may form part of integration policies. CONCLUSIONS: There are many factors influencing the experiences of internationally recruited nurses and not all of them can be addressed within current integration policies. RELEVANCE TO CLINICAL PRACTICE: Rethinking integration can help improve the experience of internationally recruited nurses. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: This paper shows that overseas nurses (OSN) recruited to UK hospital trusts become deskilled in technical aspects of clinical practice. BACKGROUND: Existing research reports that many newly recruited OSN are prevented from using technical skills acquired in training abroad, to the detriment of the National Health Service (NHS) and the concern of the nurses themselves. DESIGN: The author conducted case study work in three NHS hospital trusts in the northwest of England. The findings reported are part of a wider investigation into the assimilation(1) of OSN from the Philippines, India and Spain into NHS hospitals. Semi-structured interviews were undertaken with members of four groups of actors: managers, OSN, home nurses (HN) and mentors, which were analysed thematically. Results. The research confirms the finding that many OSN are prevented from using technical skills in the UK, but also suggests reasons why this is so. The finding of deskilling emerged strongly in all three cases and is singled out for discussion in this paper. CONCLUSIONS: The experience of OSN highlights ambiguity surrounding the role of the nurse in British hospitals. This arises partly because OSN tend to be recruited to the bottom grades of nursing in the NHS, where their technical skills are underused. RELEVANCE TO CLINICAL PRACTICE: Segmentation within the nursing hierarchy contributes to the conflicting messages and mismatch of expectations experienced by nurses at the ward level, regarding the role of the nurse. [ABSTRACT FROM AUTHOR]

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

Aims. This paper reports on organizational influences on nurse consultant post holders. The influence of individual characteristics has been the subject of another paper. Background. Nurse consultant posts were set up in the United Kingdom from the late 1990s onwards and, therefore, there has been little opportunity to report on evaluations of these innovative initiatives. Design. A cross-sectional design, using a convenience sample, was adopted. Methods. Ten nurse consultants working in a variety of settings and specialties participated in in-depth, tape-recorded interviews. The data were analysed using the Framework approach. Findings. Support systems were important influences on nurse consultants' role achievement levels. These took the form of internal trust networks, nurse consultant forums and links with higher education institutions. Post holders both gave and received support and acted to empower other nurses. Thus, relationships were vital to successful role integration. The culture and structures of the National Health System were also a powerful influence in terms of local and national modernization policies, and participants had to be careful in their choice of strategies to deal with the traditional medically dominated culture. Conclusions. The new nurse consultant role is challenging and innovative, but a major area of contention is how much post holders are expected to take on work previously done by doctors rather than developing their nursing role. Organizational support and commitment are needed if nurse consultants are to maximize the benefits of this innovation. Relevance to clinical practice. The findings show that new nursing roles are not always easily accepted in multidisciplinary settings and that holders of such post need to have the appropriate previous knowledge, skills and personal characteristics, as well as the ability to negotiate their way through organizational influences. [ABSTRACT FROM AUTHOR]

The movement of complementary therapy training and education into higher education in the United Kingdom (UK) and the interest in alternative therapeutic approaches within the health professions presents an ideal opportunity for multidisciplinary teaching and shared learning. The diversity and similarities of complementary therapies and areas of convergence with conventional healthcare practice can be explored. The recent publication of the House of Lords Select Committee on Science and Technology report on complementary and alternative medicine (HL Paper 123) provides a broader context for discussion and makes specific recommendations about regulation, education and research in the UK. This paper considers the appropriateness of integrating complementary therapies into education for conventional healthcare practitioners, what we should integrate, and when might be the most appropriate time in the education of healthcare practitioners to introduce different therapeutic modalities and their respective philosophical languages. Rather than present a range of solutions, the paper raises some fundamental issues that are central to the integration of complementary therapeutic approaches. If these issues are neglected as we hurry to incorporate different 'techniques' into our conventional practice, we may simply be left with additional tools that we are ill equipped to use. [ABSTRACT FROM AUTHOR]

The production and implementation of clinical practice guidelines is currently a high political priority and a rapidly developing field within healthcare in the United Kingdom (UK). Their purpose is to provide clinicians with a synthesis of the best available external evidence and operationalize the implementation of evidence-based practice. Despite indications that clinical guidelines can make a difference to the quality of patient care, there is some evidence that practitioners struggle with their application. The aim of this paper is to report one element of a trial undertaken by three collaborating universities in the Northern and Yorkshire Region of the UK health service during 1997-1998. The objective was to understand what makes guidelines acceptable and usable, or otherwise, to health professionals. The findings reported in this paper describe the process of care in those general practices that elected to implement guidelines for the management of patients with venous leg ulcers. We conclude that planning for training, resource and quality improvement processes must be built into a team's guidelines implementation procedures. A preliminary needs analysis of the contextual 'hurdles and levers' within each primary healthcare team is also necessary to identify individual issues that must be addressed if the process is to succeed. These findings provide some lessons for successful implementation of clinical guidelines in general. Recommendations for nursing policy makers, managers, practitioners and researchers are included. [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]

1996 saw the implementation of Clinical Effectiveness Initiatives by the NHS Executive and the Royal College of Nursing to promote the use of evidence-based care. This paper examines whether or not nurses will be encouraged and facilitated by these initiatives to provide evidence-based care for their clients. Both initiatives appear to assume that the use of evidence-based care leads to improved client care, but several issues are raised which still need to be resolved before this assumption can be made. The NHS Executive advocates the use of randomized controlled trials as the method of choice for providing evidence of clinical effectiveness. However, this may not necessarily be the best methodology for some areas of nursing practice. The paper concludes that the Royal College of Nursing's Clinical Effectiveness Initiative has great potential to provide the necessary motivation and facilitation, providing other professional issues are resolved. [ABSTRACT FROM AUTHOR]

Aims. To provide an overview of the literature relating to the principles, policy and practice of extended nursing roles in UK intensive care settings to date; to review and critically assess evidence of impact, outcomes and effect on practice and provide suggestions for future research. Background. It is known that career development opportunities, new technologies, patient needs, as well as the reduction in junior doctors' hours, are driving the development of new roles for nurses. Policy initiatives aim to expand nursing roles to support professional substitution. In adult, neonatal and paediatric intensive care, specialist trained nurses and designated advanced nursing practitioners are increasingly taking on extended practice of clinical tasks previously undertaken by medical staff. As yet there are no statutory regulations on the perceived scope and definition of the role of extended and advanced roles. Design. Systematic review. Methods. Search of electronic databases and selection of policy and peer-reviewed reports and reviews of extended nursing roles or advanced nursing practitioners in UK intensive care settings. Results. Chronological review shows policy development proceeding in a relatively ad hoc way. There is limited information available about how extensively or effectively extended nursing roles are being implemented in intensive care settings in the UK, particularly in adult and paediatric intensive care. To test local initiative findings for reliability and generalisability, a more robust evidence base is required. Conclusions. More data are needed on definition and outcomes of extended nursing roles in intensive care and care process measures should be developed to better inform implementation of nurse role development in the UK. Relevance to clinical practice. The review of policy and research evidence in this paper may better inform clinicians working in adult, neonatal or paediatric intensive care, as they continue to be challenged by expansion and development of their role. It may also help to form a basis and evaluation for future research into extended and advanced nursing roles in intensive care settings. [ABSTRACT FROM AUTHOR]

AIMS: This paper explores the ethical, theoretical and methodological implications of predictive testing in studies of child abuse, neglect and harm. BACKGROUND: The use of screening instruments to make predictions about children who may later be abused, neglected or at risk of exclusion is promoted in research and policy. The recent UK Action Plan on Social Exclusion suggests that health visitors and community midwives should be trained to use these tools in practice. METHOD: Position paper. CONCLUSIONS: The accuracy of screening instruments to identify children who will be abused or neglected has not been established. Even if the theoretical and methodological challenges of predictive instruments could be overcome, the ethical implications of their use are very difficult for nurses and midwives. RELEVANCE TO CLINICAL PRACTICE: Nurses, midwives and health visitors require high levels of awareness of risk factors in working with children and families. We have a responsibility to reach professional judgements about risks of harm for individuals. This is best performed through improving skills in working with parents and carers to identify those factors which may impede their ability to offer safe developmental care to their children. [ABSTRACT FROM AUTHOR]

bash a. (2004) Journal of Clinical Nursing 13, 11–16 Spirituality: the emperor's new clothes? This paper explores the concept of ‘spirituality’ with reference to the Patients’ Charter that stipulates that a person's religious, spiritual and cultural needs should be respected at all times. The aim is to offer a critical analysis of what the word ‘spirituality’ may mean when used in the Patients’ Charter and to explore the implications of this for clinical practice. A critical discussion based on a literature review, examining in particular methodological presuppositions. The meaning of ‘spirituality’ in the Judaeo–Christian biblical traditions is explored. Some of the heuristic assumptions in contemporary research on ‘spirituality’ are examined. Philosophical (i.e. non-scientific) and scientific questions to do with ‘spirituality’ are disentangled. The paper concludes that: (i) ‘Spirituality’ is an elastic term not capable of universal definition as each person's spirituality is an individual matter for them and (ii) tools that are being developed for identifying a person's spirituality run the risk of making wrong presuppositions about what comprises spirituality. It is unlikely that tools can be developed that are widely applicable for identifying and assessing spirituality. [ABSTRACT FROM AUTHOR]

Children with complex healthcare needs typically require technical and/or medical equipment in the home. This growing group of children and families need support that crosses agency and professional boundaries, necessitating effective multi-agency working. There are many examples of multi-agency working around the United Kingdom (UK), some specifically designed to meet the needs of children with complex healthcare needs and their families. Recent legislation and policy statements have highlighted the importance of joint planning and working. Currently no research exists that examines the impact of these initiatives on disabled children with complex healthcare needs and their families. The 'Working Together' project is an ongoing research study based at the Norah Fry Research Centre, University of Bristol, Bristol, UK. The project aims to explore the impact of multi-agency work on children with complex healthcare needs and their families. This paper examines the literature on barriers to disabled children and the need for multi-agency working. It also considers the concept of multi-agency working and how different approaches to working together might be perceived by children and families. [ABSTRACT FROM AUTHOR]

A qualitative study of user perspectives published previously by the author found that children and young people who are dependent on ventilators spend many months and in some cases years in hospital when they no longer had a medical need or wanted to be there. This second paper is drawn from the same qualitative study and reports on the barriers that the children and young people who are dependent on ventilators, and their parents, described as important factors in preventing their discharge from hospital. Six issues were identified as significant barriers that prevented the children and young people from being discharged. These were: the attitudes of professionals; the lack of joint commissioning and accounting responsibility; general poor management both within the health service and in collaborating with other services; complex social issues; housing problems; and a general lack of auditing and outcome measures. The generalizability of the findings is unknown. However, recommendations are made in relation to the need to establish joint commissioning and accounting responsibility for care and services, and to establish outcome measures to monitor the effectiveness and appropriateness of the care and services provided. [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]

• This paper presents a taxonomy of Infant, Child and Adolescent (ICA) nursing diagnoses and clinical outcomes that has been developed with the co-operation of nurses caring for children in the United Kingdom. • Three focus group interviews were conducted in one acute care NHS trust in London (referred to as the host trust in this paper) in 1998/99, in which participants were asked to consider nursing and family factors relevant for identifying and providing care. • A total of 28 ICA diagnoses, including definitions, defining characteristics and outcomes, were identified for clinical testing and included in the ICA taxonomy. • The ICA diagnostic labels and outcomes for care were further tested for their relevance for clinical practice in a Delphi Survey carried out in 1999 and their use in clinical practice began in 1999. • This research augments the findings from an initial Delphi survey carried out in 1993 and case study research in 1996. • The previous research initiated the development of a unified language for children’s nurses, children and their families, to aid communication and decision-making. • Implications of this and future research for clinical practice, nationally and internationally, are also discussed. [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]

This paper highlights issues related to men's health research arising from a small-scale study, carried out by a male researcher, to identify the experience of men following transuretheral resection of prostate (TURP) for benign prostatic hypertrophy (BPH). The intention of this paper is to stimulate methodological debate rather than to be a research report. For the study, an informal interview approach was used within a phenomenological framework, and interview experiences raised issues which have been previously discussed under the rubric of feminist research. The conclusion drawn is that a style of research which attempts to gain a holistic view of patients' experiences is better termed 'humanistic research' because the term 'feminist research' clearly cannot be applied to men studying men's health-related experiences. [ABSTRACT FROM AUTHOR]

• This paper presents an overview of the work of the Royal College of Nursing (RCN) in developing an assessment tool to determine the need for registered nursing by older people in continuing care. • In the past, healthcare has been provided free and social care ‘means-tested’. • The erosion of the NHS’s responsibility for continuing care provision through the development of eligibility criteria has resulted in the majority of older people having their care services means-tested, including their nursing care. • The RCN has argued that older people have inter-related health and social care needs, that nursing care is an integral component of healthcare provision and that therefore older people should not have to pay for nursing care. • This paper describes the work undertaken by the RCN to develop a tool for use in assessing older people’s need for registered nursing – ‘The RCN Nursing Older People Assessment Tool’. • The underpinning theoretical framework is outlined and the process of constructing the tool is described. • In addition, the stages of assessment using the tool are outlined. • A pilot study in seven nursing homes managed by three different companies was undertaken to test the reliability and acceptability of the tool. 178 paired assessments were completed (89% of the intended sample). • The results of the pilot study demonstrated that the tool has a high degree of reliability and acceptability. • Further testing of the tool is recommended using a larger sample of nursing home residents. [ABSTRACT FROM AUTHOR]

This paper provides background material about the Department of Health funded Nursing Development Units (NDUs), specifically their biographical and contextual characteristics, their aims and values, and their organization of work and resources acquired. The data were drawn from questionnaires to clinical leaders and from documentation. The findings are summarized under five questions which address the NDUs' values and aims, their organization of work, multiprofessional working, activeness in acquiring resources and support and the effect of the host organization. Taken as a whole, the aims match the vision of the ideal NDU specified by the pioneers of the NDU movement, and most clinical leaders subscribed to primary nursing as their preferred mode of organizing nursing work. Multiprofessional working was a common feature and there was considerable evidence of equality in team membership status. A small number of NDUs had been awarded grants for research and most were successful in generating income from conferences. Nearly all had links with an academic institution. NDUs that had the support of their Trust's management were able to market their services successfully. Our findings indicate that many NDUs have made good progress but their clinical leaders are the first to admit that there is much more to be done. [ABSTRACT FROM AUTHOR]

• The notion of clinical leadership is significant in current nursing practice, particularly since recommendations made by the Department of Health in 'The Strategy for Nursing'. However, while it is a concept that many nurses aspire to implement, in reality the operationalizing of such a concept is fraught with difficulty. • This paper aims to explore the issue of clinical leadership through a collegiate model developed in a particular practice area. • The development of this collegiate relationship is articulated through the mediums of reflective practice and clinical supervision. • A model of collegiality is offered as an approach to the integration of the spheres of clinical leadership. • If reflective practice is to be a reality then it is essential that both clinical leaders and practitioners engage in such processes within a supportive culture. [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]

Aims and objectives. As the basis for the design of career development opportunities for current and aspiring nursing and therapy consultants, we aimed to explore the factors that shape how these roles have embedded in UK stroke services. Background. The non-medical consultant role has been introduced into UK health care services to provide opportunities for experienced practitioners to progress their careers in clinical practice. Whilst there have been evaluations of the impact of the role on service delivery, little attention has been paid to the pathways towards consultantship. Design. An exploratory design, incorporating focus group discussions, was used to address the research questions. Participating consultants, both nurses and allied health professionals, worked in stroke services, although it is anticipated that the results will have wider application. Methods. Two focus groups were held with non-medical consultants in stroke from across the UK. Participants had the opportunity to comment on an interim paper prior to publication of the results. Thirteen consultants took part in the study. Results. A lack of consensus about the nature of clinical expertise and a diverse range of pathways towards consultantship were identified. Health care policy had presented the opportunity for consultants to be entrepreneurial in the development of stroke services, although this had limited the scope for the development of professional knowledge. Inflexible programmes to support aspiring consultants may limit the opportunities to develop these entrepreneurial skills. Conclusions. This study challenges health care organizations and the education and research departments that support them to think creatively in the way that the non-medical consultant role is embedded, and that this should draw on the commitment of existing consultants to support succession planning. Relevance to clinical practice. The identification of those aspects of career pathways that current consultants have found to be helpful will be useful in designing opportunities for aspiring consultants. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: To explore service user and community mental health nurses views on responses to voice hearing experiences. BACKGROUND: People who hear distressing auditory hallucinations (voices) are often in contact with mental health services. Nursing responses to this experience have been limited, although emerging evidence suggests some utilitarian alternative interventions, such as discussing the content and meaning of the voices. DESIGN: Using exploratory interviews, this study investigated the response to voice hearing, with a purposive sample of community mental health nurses (n = 20) and service users (n = 20). This paper reports on a thematic content analysis of transcribed interviews, which highlighted differences in perspectives of voice hearers and the nurses supporting them. RESULTS: Voice hearers reported that interventions from community mental health nurses were limited to reviews of medication, access to the psychiatrist and non-directive counselling. They identified alternative needs, which involved talking more about the content and meaning of their voices. Conversely, community mental health nurses regarded their responses to voice hearing as being considered, titrated and demonstrating an awareness of the personal contexts of service users. These responses were however restricted by their perception of skill limitations. CONCLUSIONS: The contrasting views of nurses and users of services demonstrated in this study, reveal multiple social realities that represent a challenge to accepted professional responses in the provision of mental health care. RELEVANCE TO PRACTICE: People who hear voices express an interest in more helpful responses from community mental health nurses. The findings of this study indicate that nurses must begin to orientate themselves towards a more critical practice stance that encompasses available knowledge on the voice hearing experience. [ABSTRACT FROM AUTHOR]

AIM: This paper considers the challenges of delivering effective palliative care to older people with dementia and the possible strategies to overcome barriers to end-of-life care in these patients. BACKGROUND: In UK alone, approximately 100,000 people with dementia die each year and as the number of older people increases, dementia is set to become even more prevalent. Dementia is a progressive terminal illness for which there is currently no cure. Patients dying with dementia have significant health-care needs and in recent years it has been recognised that palliative care should be made available to everyone regardless of diagnosis, as this improves comfort and quality of life. Despite this, patients dying with dementia are often still not given access to palliative care services. METHOD: A review of English language literature published after 1996 to the present day relating to older people with dementia during the terminal phase of their illness. RESULTS: Twenty-nine articles met inclusion criteria for the review. Most originated from North America and UK and were mostly quantitative in nature. Four key themes were identified: difficulties associated with diagnosing the terminal phase of the illness (prognostication); issues relating to communication; medical interventions; and the appropriateness of palliative care intervention. CONCLUSIONS: This review reinforces the importance of providing appropriate palliative care to individuals suffering from end-stage dementia and identifies some of the barriers to extending such specialist palliative care provision. RELEVANCE TO PRACTICE: There is an urgent need to improve palliative care provision for older people with end-stage dementia and, in addition, more research is required on the needs of patients entering the terminal phase of dementia to assist the allocation of appropriate resources and training to ensure quality and equality in the provision of end-of-life care. [ABSTRACT FROM AUTHOR]

AIM AND OBJECTIVE: The purpose of this study was to explore, describe and develop a greater understanding of the experiences of overseas black and minority ethnic nurses in the National Health Service (NHS) in the south of England. BACKGROUND: For the past five decades, the NHS has been recruiting overseas black and minority ethnic nurses from several former British colonies to alleviate the manpower shortages. More recently there has been a shortage of nurses in the labour force and as a result the NHS has once again recruited overseas nurses. Despite this recruitment drive there are limited studies outlining how overseas black and minority nurses have fared in the NHS. METHODS: This qualitative phenomenological study used four purposeful focus groups and all participants involved were interviewed at a place convenient for them. These all non-white participants originated from Asia, Africa and the Caribbean. Each focus group contained six participants with an overall total of 24 participants involved in the study. RESULTS: Following thematic analysis, the findings revealed six themes such as, the devaluation process, concept of self-blame, discrimination/lack of equal opportunity, concept of invisibility, experiencing fear and benefits of being here. Several overseas nurses felt devalued and indicated that white UK nurses appeared to have placed little trust in them. They stated that both discrimination and lack of equal opportunity were present in the workplace and they also revealed that some white UK nurses were sometimes abusive. As a result they tolerated such behaviour for fear of being thrown out with their families. Despite such negative experiences participants indicated that the experiences gained whilst working in the NHS were useful. CONCLUSIONS: There is a need for overseas nurses to be treated fairly and with respect particularly in the light of an acute labour shortage of nurses in the NHS. The findings suggest that overseas minority ethnic nurses' experiences have been mixed, with some positive as well as negative experiences, within a process that devalues them as workers. RELEVANCE TO CLINICAL PRACTICE: This paper highlights a need for a re-evaluation of equal opportunity policies and proposes more diversity training so as to prepare nurses to cope with an increasingly complex and diverse workforce. [ABSTRACT FROM AUTHOR]

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

Aims and objectives. To outline the development and content of a 'top-up' neuropharmacology module for mental health nurse prescribers and consider how much pharmacology training is required to ensure effective mental health prescribing practice. Background. Debate about the content of prescribing training courses has persisted within the United Kingdom since the mid-1980s. In early 2003 supplementary prescribing was introduced and gave mental health nurses the opportunity to become prescribers. The challenge of the nurse prescribing curriculum for universities is that they have only a short time to provide nurses from a range of backgrounds with enough knowledge to ensure that they meet agreed levels of competency for safe prescribing. There is growing concern within mental health care that the prescribing of medication in mental health services falls short of what would be deemed good practice. Over the past two decades, nurse training has increasingly adopted a psychosocial approach to nursing care raising concerns that, although nurses attending prescribing training may be able to communicate effectively with service users, they may lack the basic knowledge of biology and pharmacology to make effective decisions about medication. Methods. Following the completion of a general nurse prescribing course, mental health nurses who attended were asked to identify their specific needs during the evaluation phase. Although they had covered basic pharmacological principles in their training, they stated that they needed more specific information about drugs used in mental health; particularly how to select appropriate drug treatments for mental health conditions. This paper describes how the nurses were involved in the design of a specific module which would enable them to transfer their theoretical leaning to practice and in so doing increase their confidence in their new roles. Results. The findings of this study suggest that the understanding and confidence of mental health nurse prescribers about the drugs they prescribe coupled with the information they provide to service users can be improved as a result of specific educational support. It would appear that adopting a prescribing dimension to one's role requires nurses to revisit a number of skills that are integral to the work of the mental health nurse, e.g. good communication, establishing empathy, listening to what clients say, responding to what is required and involving clients in their own care. Conclusion. Mental health nurses from one particular Trust in the West Midlands were provided with a 'top-up' course in neuropharmacology and, although they found this challenging, ultimately they found this to be helpful. As nurse prescribing is 'rolled out' to other nursing specialities it is important that local Trusts and Workforce Development Directorates maintain a dialogue about nurse prescriber training to ensure that nurse prescribers receive the appropriate time and support for their ongoing Continued Professional Development. Relevance to clinical practice. As increasing numbers of nurses from different specialities qualify as nurse prescribers it is vital that they are supported by their employing organizations and given the opportunity to maintain their competency and confidence in their prescribing practice. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: This article aimed to explore the factors relating to nurses themselves that influence the delivery of preoperative patient education in everyday surgical clinical contexts at one large general adult teaching hospital in Ireland. BACKGROUND: As landmark studies of preoperative education undertaken in the UK in the 1970s identified the superiority of structured programmes of patient education over and above 'regular' preoperative care, there have been many intervention/outcome experimental studies carried out in this area. However, there has been little interpretative work conducted that explores the regular, or 'usual' preoperative education given to patients in everyday surgical units. Methods. A sample of 12 experienced surgical nurses was selected and each participant was interviewed in depth. Data were analysed using a qualitative strategy resembling grounded theory. RESULTS: Findings indicate that preoperative education was variously interpreted by participants, and participants' accounts suggested that different understandings and practices by nurses resulted in patients receiving different levels of care. In addition, diverse levels of knowledge and experience of individual nurses resulted in unevenness in the type of preoperative education that patients received. A number of participants advocated a more formal method of preparation for nurses in the area of preoperative education. Finally, in some surgical areas, specialist nurses worked side-by-side with regular ward nurses and their input in preoperative education was largely seen by participants in a positive way, particularly in view of the structural constraints that ward nurses faced. CONCLUSIONS: We conclude that nurse-related factors in preoperative education do not arise in a vaccum, but rather are related to the wider organizational practices and culture. The difficulties with preoperative education identified in data may be addressed through organizational investment in preoperative education. RELEVANCE TO CLINICAL PRACTICE: This paper produces evidence for nurses and clinical nurse managers about how nurse-related factors impede preoperative education, and may provide a starting point for how to begin to address obstacles to better preoperative care. [ABSTRACT FROM AUTHOR]

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

AIMS AND OBJECTIVES: The research outlined in this paper aimed to establish a consensus view amongst primary healthcare professionals about the competencies that district nurses need in order to fulfil an effective role in health promotion. BACKGROUND: In recent years there has been a growing emphasis on health promotion in primary care in the United Kingdom and health promotion is becoming increasingly important to nurses who work in the community. However, consideration of the role of the district nurse in health promotion is rather restricted and consequently district nurses have limited access to empirical evidence, from which they can develop their work in health promotion. DESIGN AND METHODS: The Delphi technique was used for this study. Seventy-two primary healthcare professionals were mailed a series of three questionnaires, which achieved response rates of 86, 87.5 and 78.9%. RESULTS: There was a consensus amongst the panellists that district nurses require a range of competencies to engage effectively in health promotion. These were categorized to produce a definitive list of eight knowledge-, seven attitude- and eight skill-related competencies. CONCLUSIONS: For the first time, this study achieves a consensus on the competencies needed by district nurses to engage in health promotion. RELEVANCE TO CLINICAL PRACTICE: District nurses should feel encouraged to develop their health promotion role in light of the fact that many of the competencies that they require for this activity have been identified as essential for their day-to-day nursing practice. The research highlights the fact that new paradigm health promotion is a concept that has moved beyond the academic arena and is recognized as significant by practising health professionals. [ABSTRACT FROM AUTHOR]

Aims and objectives. Observational methods as part of a qualitative approach have been specifically employed in the study of drug error and have undeniable strengths. This position paper will examine some recent research raising a number of ethical, and tangentially, methodological issues concerning the qualitative study of drug errors within United Kingdom National Health Service hospitals. Reflections on the views and ethical conduct of other qualitative researchers are provided to contextualize the discussion. Background. The impact of a drug error, and any resultant adverse event can be significant. The human and financial costs are considerable. Establishing an accurate estimation of the frequency of adverse event and reporting rates has been difficult; additionally, methodological weaknesses in medical error research have sometimes caused further difficulties. Unsurprisingly, observational studies and for that matter, a whole range of other methods are now being considered in the quest to establish both understanding and predictability in relation to medical error. Relevance to clinical practice. It is argued here that any participants in medical error research should be treated in a way that takes account of the prevailing culture of health care and, in the United Kingdom, the current ethos of government policy on medical error. This requires gaining informed consent, promoting transparency in method, and providing the opportunity for participants to learn. Effective error researchers can clearly increase the available knowledge in this critical area but ethical considerations and their chosen methods should show an appropriate level of respect for their participants. Carefully implemented qualitative approaches can help realize such respect. [ABSTRACT FROM AUTHOR]

AIMS AND BACKGROUND: Admiral Nurses are specialist dementia care nurses working in the community with carers of those who have a dementia. The aim of the competency project (2000-2003) was threefold. Firstly to work collaboratively with these specialist nurses to facilitate the development a competency framework that reflects the needs of the Admiral Nursing Service. Secondly, to provide a way to structure evidence demonstrating evolving competency. Thirdly, to specifically enable the nurses to demonstrate evidence of achieving the UK Nursing and Midwifery Council's Higher Level Practice standard. DESIGN AND METHODS: The two complementary approaches of emancipatory action research and systematic practice development were adopted. Methods were taken from action research and systematic practice development approaches with an emphasis on promoting and enabling enlightenment, critical reflection, ownership and creating the best conditions for long-term commitment to the competency framework. RESULTS: The main outcome from this project was the development of a specialist nursing competency framework. The Admiral Nurses' Competency Framework is made up of a set of eight core competencies with three levels of competency statements, loosely structured around the Higher Level Practice standard, and guidance documentation to illustrate how work-based evidence can be generated to demonstrate competence. There were also process-derived outcomes associated with combining systematic practice development with emancipatory action research that had an impact on the culture. The main outcomes here were that practitioners engaged in and experienced learning about how to research their own practice and the consequences of doing this. They also learnt about specialist nursing practice more widely than Admiral Nursing. Finally, there was some increase in awareness about the culture within their teams and organizations. The final competency framework reflects the needs of the service, is owned by the majority of practitioners and project commissioners and this has had a positive impact on implementation. CONCLUSION: In this paper, we report on combining systematic practice development with action research to achieve immediate project aims. In addition we show how a project of this nature can contribute to developing skills in practitioners necessary for cultural changes in practice and contributes to wider issues of modernization within nursing and health care. RELEVANCE TO CLINICAL PRACTICE: This competency framework will enable Admiral Nurses to demonstrate their level of specialist practice, as individuals and collectively as a service and it also promotes the principles of nurses as life long learners. This may have relevance to other groups of specialist nurses. The project has widespread relevance for two reasons. Firstly, it shows that nurses can be involved in designing and testing a competency framework as collaborators. Secondly, that to achieve this within the spirit of approaches, such as systematic practice development and action research, can be testing for all collaborators even were there is a shared or espoused aim. [ABSTRACT FROM AUTHOR]

BACKGROUND: Lecturer practitioner roles have been widely established in the UK, and are seen as having the ability to overcome the theory-practice gap in nursing, as well as offering other benefits including functioning as a link between education and practice. AIMS AND OBJECTIVES: This article systematically reviews the research literature on UK lecturer practitioner roles in nursing and midwifery, in order to construct a picture of the themes that emerge from their national implementation. CONCLUSIONS: Only eight published research studies meeting the inclusion criteria were identified in journals, and five more included from the 'grey literature', totalling 13 suitable research reports. Of these 13 papers, six involved nurses and midwives. Key themes from the literature are outlined and discussed. There is an overwhelming preference for qualitative methodologies, although there is a strong argument for quantitative work in mixed-methods studies. RELEVANCE TO CLINICAL PRACTICE: Lecturer practitioner roles can make an important contribution to nursing and midwifery education, but this is problematic. It is essential that managers clarify the purpose, responsibilities, support and review of lecturer practitioner roles if they are to be successful. Copyright 2004 Blackwell Publishing Ltd [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]

Whilst nurses in the UK have been working in out-patient settings in the speciality of child, adolescent and family psychiatry for nearly 20 years, they are frequently unclear about what is their nursing contribution to the multidisciplinary team. This paper reports a qualitative study of perceptions of the nursing role in child and adolescent mental health teams of 11 clinicians from six different clinics. Whilst other disciplines were each able to define what was unique about their role, there was found to be no consensus as to what nurses brought by virtue of their nursing background. There is a risk that if nurses cannot develop a clearer rationale for their role, or be better able to articulate what they do in these teams, that role might be lost. [ABSTRACT FROM AUTHOR]

This paper reviews the policy developments impacting on professional roles and boundaries in health and social care. A macro-political analysis is used to offer a challenging critique to many of the assumptions associated with cross-boundary working. It explores issues such as: whether or not new nursing roles are truly being developed to meet need; the myths and realities of interprofessional working; how competence can be assured; the need for new forms of professional regulation; the implications for professional education of initiatives such as national occupational standards and shared learning; planning the future health care workforce; and the need for rigorous and robust evaluation of service and role developments. Through this exploration the likely consequences of political and professional initiatives for both cross-boundary working and the profession of nursing itself are illuminated. [ABSTRACT FROM AUTHOR]

Stroke is one of the major causes of disability in the United Kingdom and considerable numbers of stroke survivors need help and support from family carers. The sudden and unexpected nature of stroke means that there is very little time for family members to prepare for a caring role. This paper draws on data from 37 interviews with 14 new carers of stroke survivors and highlights the uncertainty and lack of confidence that family members experience in adopting a caring role. During the initial period following the stroke carers engage in a number of different 'seeking' activities in order to try and ensure that they feel competent, confident and safe to provide care and that they understand the likely future demands they may face. Rather than being facilitated by staff, carers' efforts often go unnoticed or are overlooked, resulting in carers feeling that they are 'going it alone'. Staff need to be more aware of carers' 'seeking' behaviour and actively encourage the formation of partnerships with family members. [ABSTRACT FROM AUTHOR]

* This paper provides a review of current literature which focuses on issues relating to the care of cancer patients in the 21st century and the evolving role of the advanced practitioner in nurse-led clinics in cancer care.* The review, in particular, identifies more specifically the skills used and the patient needs which can be met by innovative nurses working in nurse-led clinics.* An in-depth discussion of a specific nurse practitioner's experience allows some of the skills of advanced nursing practice to appear more visible, for example, the assessment and investigation of patients experiencing symptoms associated with colorectal cancer.* The implications for clinicians and educationalists in cancer care is highlighted within the conclusions. [ABSTRACT FROM AUTHOR]

* This paper presents the findings of an evaluation of a local clinical supervision scheme for practice nurses in Leicestershire, UK.* A baseline and a follow-up postal questionnaire were sent to all practice nurses (including supervisors) and general practice senior partners to find out how far the objectives of the local scheme had been met during the first year of implementation. Two focus groups gathered qualitative data about the process of implementation.* Twelve months after implementation 12% of practice nurses and over two thirds of GPs reported that they were unaware of the scheme. Forty-three percent of practice nurses did not know who their local supervisor was; most reported that they would like to have known.* Eighteen percent of practice nurses reported uptake of supervision through the local scheme. The benefits of involvement were professional development tailored to individual learning needs and regular opportunities to share work-related problems with peers; about a third reported benefits for the practice as well.* The existing availability of peer support and time needed to undertake clinical supervision were common reasons given for non-involvement in the scheme. Misconceptions about the purpose of clinical supervision presented further obstacles.* At follow-up over half of the practice nurses remained undecided about their future involvement in the scheme.* If the benefits associated with clinical supervision are to be realized, the obstacles that currently hinder practice nurses' involvement need addressing. [ABSTRACT FROM AUTHOR]

• Nursing/practice development units (N/PDU) are perceived as centres for pioneering, evaluating and disseminating innovative practice development and facilitating the professional development of practitioners. • This paper reports on a pluralistic evaluation research study of the nursing/practice development unit accreditation programme provided by the University of Leeds, UK. Individual and focus group interviews were undertaken with key stakeholders involved in six nursing/practice development units. These included: clinical leaders, team members, executive nurses, trust board members, general medical practitioners, nursing/practice development unit steering group members, and accreditation panel members. Stakeholder perceptions of what constituted a successful nursing/practice development unit were elicited and then used to judge the success of the programme. • Seven criteria for judging the success of nursing/practice development units were identified. These were: achieving optimum practice; providing a patient-orientated service; disseminating innovative practice; team working; enabling practitioners to develop their full potential; adopting a strategic approach to change and autonomous functioning. • The findings highlighted differences between the rhetoric of a successful nursing/practice development unit and the reality in which they function. Whereas all the units were actively involved in innovative practice development, evaluation, dissemination and networking activities, several factors influenced the success of the units, in particular, the role of the clinical leader, the motivation and commitment of nursing/practice development unit members, financial resources, and the nature of support from managers, medical staff and education institutions. • Although the nursing/practice development units had made significant progress in developing both healthcare practice and practitioners, there is still a need to consider how the claim that nursing/practice development units benefit patients can be substantiated. [ABSTRACT FROM AUTHOR]

* This paper considers methodological and philosophical issues that arose during a multi-centre, randomized controlled trial of a new nursing intervention to manage breathlessness with patients with primary lung cancer.* Despite including a diverse range of instruments to measure the effects of the intervention, the uniqueness of individuals' experiences of breathlessness were often hidden by a requirement to frame the study within a reductionist research approach.* Evidence from the study suggests that breathlessness is only partly defined when understood and explored within a bio-medical framework, and that effective therapy can only be achieved once the nature and impact of breathlessness have been understood from the perspective of the individual experiencing it.* We conclude that to work therapeutically we need to know how patients interpret their illness and its resultant problems and that this demands methodological creativity. [ABSTRACT FROM AUTHOR]

* Greater emphasis is being placed on reducing clinical variation in managing patient groups in the reformed National Health Service (NHS) in the United Kingdom (UK).* The use of a care pathway to enable greater control over the process and quality of care will be explored for patients suffering from schizophrenia.* The paper addresses three main factors for the development of care pathways for people suffering from schizophrenia: predictability of the illness; nature of standardized care; and role autonomy.* It is argued that the diagnosis of schizophrenia does not lend itself easily to predicting care and treatment within a care pathway framework. However, a care pathway may bring other benefits, such as standardized care and a greater control over the delivery of care.* Development and implementation of hospital care pathways require extensive research. Qualitative research directions are advocated due to the possible difficulties of conducting an experimental study. [ABSTRACT FROM AUTHOR]

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

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]