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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]

AIMS: This paper is based on a review of the Australian and International literature relating to the nursing-medical division of labour. It also explores how the division of labour affects patient access to emergency care in small rural health services in Victoria, Australia. BACKGROUND: The paper describes the future Australian health workforce and the implications for rural Victoria. The concept of division of labour and how it relates to nursing and medicine is critically reviewed. Two forms of division of labour emerge - traditional and negotiated division of labour. Key themes are drawn from the literature that describes the impact of a traditional form of division of labour in a rural context. METHODS: This paper is based on a review of the Australian and international literature, including grey literature, on the subject of rural emergency services, professional boundaries and roles, division of labour, professional relationships and power and the Australian health workforce. RESULTS: In Australia, the contracting workforce means that traditional divisions of labour between health professionals cannot be sustained without reducing access to emergency care in rural Victoria. A traditional division of labour results in rural health services that are vulnerable to slight shifts in the medical workforce, unsafe services and recruitment and retention problems. A negotiated form of division of labour provides a practical alternative. CONCLUSION: A division of labour that is negotiated between doctors and nurses and supported by a legal and clinical governance framework, is needed to support rural emergency services. The published evidence suggests that this situation currently does not exist in Victoria. Strategies are offered for creating and supporting a negotiated division of labour. RELEVANCE TO CLINICAL PRACTICE: This paper offers some strategies for establishing a negotiated division of labour between doctors and nurses in rural emergency care. [ABSTRACT FROM AUTHOR]

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

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

AIM: To review systematically qualitative studies, which were found during a literature search for a Cochrane systematic review of the use of family centred care in children's hospitals. BACKGROUND: Family centred care has become a cornerstone of paediatric practice, however, its effectiveness is not known. No single definition exists, rather a list of elements that constitute family centred care. However, it is recognized to involve the parents in care planning for a child in health services. A new definition is presented here. METHODS: The papers were found in wide range of databases, by hand searching and by contacting the authors where necessary, using terms given in detail in the protocol in the Cochrane Library, in 2004. Qualitative studies could not be used for statistical analysis, but are still important to the review and so are described separately in this paper. RESULTS: Negotiation between staff and families, perceptions held by both parents and staff roles influenced the delivery of family centred care. A sub-theme of cost of family centred care to families and staffs was discovered and this included both financial and emotional costs. CONCLUSION: Further research is needed to generate evidence about family centred care in situations arising from modern models of care in which family centred care is thought to be an inherent part, but which leave families with the care of sick children with little or no support. RELEVANCE TO CLINICAL PRACTICE: Family centred care is said to be used widely in practice. More research is needed to ensure that is it being implemented correctly. [ABSTRACT FROM AUTHOR]

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

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

AIMS AND OBJECTIVES: This paper aims to provide a critical engagement with the subject of transcultural spirituality and nursing practice in the context of dying and bereavement. BACKGROUND: There has been considerable interest in the subject of spirituality over the past decade, and a particular association between the study of death and the study of spirituality. The nursing literature has been at the forefront of these developments amongst health and social care professionals. Some of this literature has begun to address the issues raised for culturally competent practice and the significance of patients' belief systems in the diverse cultural contexts with which nurses must engage in contemporary health care. However, the author argues that understanding of the range of contemporary spiritualities and transcultural practice is at an early stage. METHODS: Transcultural spirituality is explored through a critical review of the literature, including the author's own published research on spiritual and philosophical issues in death, dying and bereavement. CONCLUSION: The conclusion is drawn that some common themes and approaches can be found which offer a framework to guide nursing practice with the individual patient and family. RELEVANCE TO CLINICAL PRACTICE: In the absence of guidance, nurses struggle with implementing spiritual care in the fluid and complex context of contemporary spiritualities and frequently resort to broad categorizations. This paper opens up a way of connecting with the unique spiritual position of each patient. [ABSTRACT FROM AUTHOR]

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

Aims. 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]

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

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

Aims and objectives. This review aims to explore the research available relating to three commonly used pain rating scales, the Visual Analogue Scale, the Verbal Rating Scale and the Numerical Rating Scale. The review provides information needed to understand the main properties of the scales. Background. Data generated from pain-rating scales can be easily misunderstood. This review can help clinicians to understand the main features of these tools and thus use them effectively. Method. A MedLine review via PubMed was carried out with no restriction of age of papers retrieved. Papers were examined for methodological soundness before being included. The search terms initially included pain rating scales, pain measurement, Visual Analogue Scale, VAS, Verbal Rating Scale, VRS, Numerical/numeric Rating Scale, NRS. The reference lists of retrieved articles were used to generate more papers and search terms. Only English Language papers were examined. Conclusions. All three pain-rating scales are valid, reliable and appropriate for use in clinical practice, although the Visual Analogue Scale has more practical difficulties than the Verbal Rating Scale or the Numerical Rating Scale. For general purposes the Numerical Rating Scale has good sensitivity and generates data that can be statistically analysed for audit purposes. Patients who seek a sensitive pain-rating scale would probably choose this one. For simplicity patients prefer the Verbal Rating Scale, but it lacks sensitivity and the data it produces can be misunderstood. Relevance to clinical practice. In order to use pain-rating scales well clinicians need to appreciate the potential for error within the tools, and the potential they have to provide the required information. Interpretation of the data from a pain-rating scale is not as straightforward as it might first appear. [ABSTRACT FROM AUTHOR]

AIM: This paper reports on an action research study which raised some questions about the processes of developing a sense of shared ownership in action research in a research environment which does not always have the appropriate mechanisms to support and sustain action research. BACKGROUND: Action research has gained popularity in nursing and healthcare research, offering a way of developing practice-based knowledge, which can assist in changing practice and democratizing inquiry. METHODS: There are other organizational constraints on action research which arise at different levels, and which also require discussion. These can be issues about communication and ownership at a practice level and issues of funding and project management procedures. This paper reports on a study in which these issues came to the fore, and offers some thoughts on how they can affect the processes of action research. CONCLUSION: While the principles of action research appear to offer much towards the development of a practice-rooted body of knowledge for nursing, unless some of the issues of ownership are resolved, it is unlikely to move beyond academic rhetoric. RELEVANCE TO CLINICAL PRACTICE: If nursing is to engage in action research, this must be done critically and reflectively and careful attention paid to developing an inclusive and collaborative approach to knowledge and practice development. Furthermore, to develop in nursing and health care research, it must find ways to meet the requirements of funding bodies. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: This paper discusses the process of change that took place in an intervention study of standardized multidisciplinary assessment guidelines implemented in a female ward for older people in a District General Hospital in South London. This study was one of nine implementation projects in the South Thames Evidence-Based Practice Project. BACKGROUND: The relationship between the worlds of research and healthcare practice is uneasy and contested and, as such, is a breeding ground for challenging questions about how evidence can be used to foment change in clinical practice. Recent literature on change highlights the importance of understanding complexity, which informed our approach and analysis. METHODS: A multifaceted approach to change that comprised evidence-based guidelines, leadership (project leader) and change management was evaluated before and after the implementation by telephone interviews with patients, a postal survey of community staff and interviews with ward staff. A diagnostic analysis of current assessment practice informed the change process. The project leader collected data on adherence. RESULTS: This paper draws on descriptive and qualitative data and addresses the links between contextual issues and the processes and pathways of change, informed by theoretical ideas from the change literature. Key themes emerged: working through others and across boundaries, managing uncertainty and unanticipated challenges. Adherence of ward staff to using the multidisciplinary assessment guidelines was high, with evidence of some dissemination to community staff at follow-up. Three years after the project finished the multidisciplinary assessment is still part of routine clinical practice. CONCLUSIONS: The analysis contributes to understanding about the nursing leadership of change within an interprofessional arena of practice. It highlights the importance of understanding the context in relation to the impact and sustainability of change and thus the utility of conducting a diagnostic analysis in the early stages of implementation. This has implications for developing approaches to change in nursing and interprofessional practice in other settings. RELEVANCE TO CLINICAL PRACTICE: Using research to change practice needs clinical leaders who are supported by the organization and have the skills to implement research evidence, manage uncertainty and build trust with a range of other professionals. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: The aim of this study is to explore the introduction of portfolios into the first year of an MSc in Nursing Programme. BACKGROUND: This paper outlines a framework for portfolio development in postgraduate nursing practice. The framework is being piloted, within the Irish context, with students in the first year of a Masters in Nursing programme and has the potential to be developed for other nursing programmes at postgraduate level. DESIGN AND METHOD: An action research approach has been chosen to study the implementation of the portfolio and the development of a framework to guide this initiative. To date the development of the framework is being piloted as part of the 'taking action' phase of a first action research cycle. RESULTS: In its current stage of development the framework is constructed to embrace the core concepts of specialist nursing practice and the nursing management competencies, from current Irish health care documents. In addition the portfolio is anchored around personal development planning and is supported by the use of action learning tutorials and academic and practice facilitators. The first evaluating phase will take place later this year and will involve the collection of data from students, facilitators and lecturers. CONCLUSION: The introduction of the portfolio at postgraduate level has highlighted, to date, issues of confidentiality in committing experiences to paper, issues around its assessment, and issues around sharing this document with other students. RELEVANCE TO CLINICAL PRACTICE: Portfolio development at postgraduate level emphasizes linking theory and practice and stresses the importance of reflection on practice. The portfolio can also be used by nurses to develop their clinical career pathways and encourage personal development planning. [ABSTRACT FROM AUTHOR]

dewar b.j. (2005) International Journal of Older People Nursingin association withJournal of Clinical Nursing14, 3a, 48–53Beyond tokenistic involvement of older people in research– a framework for future development and understandingResearch and development work in health and social care are increasingly required to involve users at all stages of the research process yet there is scant empirical evidence to support the justification of this laudable aim. Evidence does suggest that at present efforts to achieve this are primarily tokenistic and that more work is needed, both to examine what user involvement in research activity actually means, and how this can best be supported. This paper sets out to describe developments to support involvement of older people through work at the Royal Bank of Scotland Centre for the Older Person's Agenda and to identify a number of challenges that this has raised for researchers. These challenges have arisen out of a number of assumptions that underpin the process of user involvement. The paper discusses some of the benefits of working in partnership with older people and identifies strategic issues for consideration in order to promote future partnership working. [ABSTRACT FROM AUTHOR]

Background. A systematic review of the research literature published between 19992003 was carried out to review how primary care trust groups and primary care organisations were monitoring the implementation of clinical governance and the effects this may have on nursing.Method. Studies were limited to research papers with explicit methodology applicable to primary care trusts. The selection criteria, search procedures and methods of data extraction and analysis were formed at the outset.Data collection. A data extraction tool developed by Cormack was adapted as a guide to include nine areas of methodological appraisal in summary forms.Results. Initially 87 articles were identified from the search. When papers were omitted on the exclusion criteria seven studies remained.Conclusion. Clinical governance is a notable example of co-ordinated policy development and the entire concept can be difficult to translate into the integrated and systematic approach to improving quality of care. Clinical governance requires changes at three levels: the individual health care professional, primary care teams need to become multidisciplinary with clear understanding, primary care organisations need to put in place systems and local arrangements to support such teams.Relevance to clinical practice. Clinical governance is about changing the way people work; demonstrating that leadership, teamwork and communication is as important to high quality care as risk management and clinical effectiveness. Whilst the sharing of information between practices is seen to be increasing with multi-professional study days occurring in some areas this in turn needs commitment for time and funding. The organisational and cultural environment within the trust as well as resource issues needs continuous attention if high quality governance is to become the norm. [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]

This paper reports the results of a small qualitative study of nurses and midwives who had undertaken a course in aromatherapy, one of the most popular complementary therapies in the UK. In particular, it examines barriers to putting their knowledge into practice. Participants had completed the aromatherapy course between 9 months and 2 years previously, and worked in a variety of settings. All were approached via their employing NHS trust. The interviews which took place in the clinical area were tape recorded and generally lasted for about 40 minutes. Data were analysed using the procedure outlined by Colaizzi (1978) Significant statements were clustered into themes, guided by whether they had a 'look alike/feel alike' quality, and were subsequently validated with the informants. The main themes discussed in this paper are the personal and professional benefits that respondents reported from undertaking the course, organizational issues and the frustrations they experienced because of delays in implementing changes in practice. [ABSTRACT FROM AUTHOR]

The Diana Children's Community Teams (DCCTs), a new nurse-led service funded by the Department of Health, were established to provide care in the community as an alternative to hospital for children with life-threatening/life-limiting illnesses and their families. This paper presents selected findings highlighting the professionals' experiences which formed part of the evaluation of the Diana, Princess of Wales Children's Community Service in Leicester, Leicestershire and Rutland. The Diana Service in Leicestershire attempts to encompass both parental empowerment and interagency collaboration. By working in partnership with the children and their families, the team provides an integrated and multiprofessional community-based service. This paper particularly concentrates on the perceptions and recommendations from the Diana team itself. Three independently managed Community Nursing Services existed in Leicestershire prior to the Diana teams; a Paediatric Macmillan Service, a Children's Community Nursing Service and a Respite Service. The Leicestershire DCCT integrated the three nursing services into a single team. This team has moved away from a traditional uniprofessional service structure by encompassing a wider team of multiprofessionals, including a cultural link worker, an occupational therapist, a physiotherapist, a play specialist and a team of trained counsellors, working in partnership to provide a quality service for families. * The evaluation, which used a longitudinal multimethod process analysis based on an action research framework, suggests that children with complex and life-limiting illnesses and their families benefit greatly from an effective seamless service. This paper recommends a framework of care that may be relevant to other teams of children's community services across the country. This service has been judged by the impact it has had on the families who use it and the professionals employed within it. [ABSTRACT FROM AUTHOR]

An economic analysis was conducted as an integral part of a comparison of the effectiveness and suitability of Hospital at Home (HaH) and in-patient interventions. The sample comprised 109 adult primary total joint replacement patients and 21 of their co-resident informal carers. Part 2 is principally a methodology paper and describes how nurses may use a variety of methods to compare cost between treatment modalities. A Cost-Effectiveness Analysis framework uses the data from Paper 1 to calculate the economic feasibility of HaH compared with traditional in-patient interventions as a worked example of how the principles of economic analysis can be used within health care research. The basic information for calculating cost of both interventions was obtained by multiplying the mean length of total treatment days by the cost per treatment day. However calculating and comparing cost for in-patient and HaH modalities was multifaceted and included costs incurred by patients and families as well as any shift in cost from tertiary to community and outpatient services. Application of the cost-effectiveness analysis framework demonstrated that not only was HaH more effective than in-patient care in several aspects, but also it was less costly because of a mean reduction in length of stay of 0.9 days per patient and a significant reduction in cost per treatment day because of removal of hospital overhead costs and reduced special duty payments even when offset against additional transport, community and outpatient costs. [ABSTRACT FROM AUTHOR]

This paper describes an action research study in a community setting. A group of residents from a local housing estate and a number of local workers used participative methods to explore local child care issues with the aim of developing initiatives for improved child care. The paper describes the study processes and reflects on lessons learnt. A discussion of implications for interprofessional working concludes the paper and includes emphasis of the need to focus on shared objectives, and develop appropriate organizational structures and educational provision. [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]

The article provides information on how the "Journal of Clinical Nursing" is reviewed. Accordingly, the people behind the journal have considered to operate double blind peer reviewing as the best way to maintain neutrality of both the authors and reviewers. It explores on the reviewing process of the journal through citing the procedures and approaches of the reviewers as well as the authors to provide an acceptable publication.

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

The author talks on the developments of the Journal of Clinical Nursing (JCN). The publication of each issue of JCN will be published in two parts, one will focus on clinical practice and the other will highlight papers on issues that have an impact on clinical practice. It aims to provide relevant information to practice directed mainly to nurse educators, managers and policy makers. It also features the two new section edited by two new editors.

The article presents a commentary on the paper "Being asked not to tell: nurses' experiences of caring for cancer patients not told their diagnosis," by S. Kendall. According to the author, the paper presents an under researched area in which culture, Chinese medicine, modernity and western-based ethics collide. He stresses that it begs the question of the complexity of communications in respect to the decision to tell or not the truth regarding the diagnosis of cancer for Chinese patients.

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]

Atopic eczema is a relatively common disease which frequently occurs during childhood. This paper reports the findings of a research study which explored the effects upon family life of caring for a child with severe atopic eczema. Seventy-seven accounts written by mothers of preschool children with this disease were analysed using qualitative latent content analysis. The focus of this paper is on the implications of the disease for the mothers' role and the additional work generated by the disease. The implications of these findings for nursing practice, in particular the work of health visitors and paediatric community nurses, is discussed. Throughout this paper the term 'nurse' is used to describe both nurses and health visitors. [ABSTRACT FROM AUTHOR]

This paper is based on work undertaken by the National Institute for Nursing to establish mechanisms to enable purchasers to be more explicit about purchasing health visiting services by the commissioning health authority. The paper describes work undertaken to identify current issues, through selected reviews of the literature, the use of questionnaires, interviews with key stakeholders and, as a result, the development of an 'ideal model for practice' for health visitors. The development of possible outcome measures for health visiting practice is also considered in the context of changing health-care demand and delivery which is both a feature and the future of community care. [ABSTRACT FROM AUTHOR]

This paper is primarily concerned with the use of readability formulas to determine the reading ease of printed education materials (PEMs) given to ostomy patients. Whilst the particular clinical focus is stoma care nursing, the content is relevant to all nurses who use printed text to inform their patients. PEMs have significant advantages in conveying information compared with verbal presentations alone. Methods to calculate readability using the Flesch, FOG and SMOG readability formulas are described. Presentation factors that affect readability are briefly reviewed, including use of 'white space', font size and paper colour. The problem of functional illiteracy and the need for indirect assessment of patient literacy are discussed. PEMs in use are often found to be difficult to read. Stress is identified as a potential factor in further reducing a patient's ability to deal with information. Three commercially available PEMs are evaluated for ease of reading and their score on the FOG index indicates that only about 40% of the UK population would understand them. Nurses are advised to evaluate the readability of their PEMs and to assess indirectly the literacy of their patients, so that they can more sensitively match PEMs to patient ability and need. [ABSTRACT FROM AUTHOR]

This paper explores the early experience of dementia when the veil of uncertainty that surrounds the diagnosis of this condition is lifted. Consideration will also be given to the impact of dementia on carers and the service demands that are created. In the UK alone there are estimated to be 636 000 people living with dementia, with this figure rising to just under 900 000 by the year 2021. In the USA the projected number of people with Alzheimer's disease is expected to be 9 000 000 by the year 2040. Despite a wealth of social and gerontological research on the impact of dementia upon family carers, service responses and policy initiatives are fragmented because dementia is excluded from some important recent initiatives, such as the Mental Health Task Force. Current services and interventions focus predominantly on the later stages of dementia, when a meaningful perspective of the person with dementia is difficult to obtain. Nursing has a relatively long history of caring for people with dementia and their family carers. The paper will also consider the contribution of nursing and nursing research to the field and explore additional avenues for service intervention and education. [ABSTRACT FROM AUTHOR]

This paper gives a brief review of existing research studies concerning patient information. The paper outlines two relevant perspectives on information giving and on the meaning of information to the individual patient: ideological and practical. From these two perspectives the knowledge structures of four patient groups: surgical patients, cancer patients, dialysis patients and psychiatric patients are looked at more closely. [ABSTRACT FROM AUTHOR]

Editorial. Discusses the achievements and the future of the "Journal of Clinical Nursing." Increase in publication; Changes in the cover; Inclusion of structured abstracts in the articles; Provision of comments from experts in the relevant fields; Analysis of international content of high ranking nursing journals.

The article presents the author's views on paper by Luck L, Jackson D., and Usker K. on individual acts of violence encountered by nurses in emergency department. The author argues that the paper's ethnographic approach on nurses' experience of being assaulted was valuable. It discusses the zero tolerance policy in Great Britain. It is inferred that the study provides insight on why some people are aggressive towards hospital staff.

The article comments on "Nurses as providers of support for mothers of premature infants," a paper by E. Mok and S.F. Leung which was published in the 2006 issue. The study explored the supportive behavior of nurses as experienced by mothers of premature infants in Hong Kong, China. The findings on parents' perceived and received support needs in a neonatal unit are discussed.

The article comments on the effect of age on quality of life in implantable cardioverter defibrillator recipients. Given the ubiquity of quality of life measures in health research it may seem nonsensical to claim that it was invented in 1966, but analysis of one of the author gives this as the date on which the very first paper to address the quality of life was published in the medical literature. Researchers describe the SF-36 as measuring important health concepts such as physical and mental health and health transition.

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

Aims and objectives. To describe and analyse the nurses' role in responding to the influenza epidemic in New York City in 1918.Background. Today the world is facing the threat of pandemic avian influenza and there is renewed interest in lessons learned from the influenza pandemic of 1918, one of the deadliest disease outbreaks recorded in history. Much of the published history has been written from a medical or military perspective. No comprehensive account of nursing's role has been written.Design. A social history framework was used.Methods. Traditional historical methods were used for data collection, data immersion, the development of a chronology and themes. Critical analysis of social, political and economic context was also done. Primary sources included the Lillian D. Wald papers at the New York Public Library, newspapers, journal articles and other archival data.Results. In 1918, New York City nurses provided care to thousands of patients. They did so with minimal federal support, relying on local community agencies to establish makeshift hospitals and provide soup kitchens. The Henry Street Visiting Nurses, assisted by numerous social agencies and Red Cross volunteers, visited patients in their homes and provided them with the only treatment there was: nursing care.Conclusions. In 1918, immediate cooperation among a previously established network of nursing and other social organisations and prompt cooperation with the American Red Cross and the United States Public Health Service was essential to New York City's response to the crisis.Relevance to clinical practice. Should an influenza pandemic occur today, as many as a billion people could fall ill. Shortages of antiviral drugs, the speed with which the pandemic could occur and its widespread effects are such that nursing, public health and medical professionals will need to rely on local personnel and supplies. Immediate cooperation and collaboration among federal, state and local organizations will be essential to the response. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: This paper explores the range of models of involvement which are drawn upon in an empirical study and which are invoked in the literature and policy. The results and discussion of the study help to excavate and explore the muddle of conceptualisations of involvement and how this leads to difficulties for practitioners, patients and managers in implementing the relevant policy. BACKGROUND: Patient and public involvement has developed an important profile internationally within health and social care policy. However, its importance as a rhetorical device has not been accompanied by adequate developments in how it is operationalised. DESIGN: Cross-sectional study, with an intervention conducted at three sites, and non-intervention measures taken at two control sites. METHODS: This paper draws on an empirical study of involvement. Focus groups were conducted with a lung cancer team and people affected by cancer at five health boards across Scotland. Chief executives of each of these five health boards also took part in individual interviews. Participants were asked to describe their ideas of what involvement is and their application of it. RESULTS: A range of ways of conceptualising involvement were apparent. Few of these moved beyond the use of patient satisfaction questionnaires. At times, troubling understandings were articulated, for example, using public meetings to communicate decisions about service closures to the public. CONCLUSION: The slow escalation of involvement is in part because of the myriad ways in which it is conceptualised and discussed. Thus, we conclude that one of the greatest barriers to truly integrating patient involvement into health services, policy and research is the conceptual muddle with which involvement is articulated, understood and actioned. RELEVANCE TO CLINICAL PRACTICE. Clinicians need to be supported to seek clarity in the use and operationalisation of involvement if the agenda is to be truly adopted and strengthened. [ABSTRACT FROM AUTHOR]