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Comments on the articles on the importance of place in older people nursing, published in the September 2, 2005 issue of the "International Journal of Older People Nursing." Contextual information provided by geographical gerontology; Potential of geographical gerontology to provide critical and direct evidence for practice; Role of place in the concepts of gerontological nursing practice.

Focuses on key issues in gerontological nursing that have a direct impact on practice. Definition of practice development; Overview of the philosophy of personhood; Discussion of the concept of person-centered practice in the context of gerontological nursing.

Aims and objectives. This paper provides a context for this special edition. It highlights the scale of the challenge of nursing shortages, but also makes the point that there is a policy agenda that provides workable solutions. Results. An overview of nurse:population ratios in different countries and regions of the world, highlighting considerable variations, with Africa and South East Asia having the lowest average ratios. The paper argues that the 'shortage' of nurses is not necessarily a shortage of individuals with nursing qualifications, it is a shortage of nurses willing to work in the present conditions. The causes of shortages are multi-faceted, and there is no single global measure of their extent and nature, there is growing evidence of the impact of relatively low staffing levels on health care delivery and outcomes. The main causes of nursing shortages are highlighted: inadequate workforce planning and allocation mechanisms, resource constrained undersupply of new staff, poor recruitment, retention and 'return' policies, and ineffective use of available nursing resources through inappropriate skill mix and utilisation, poor incentive structures and inadequate career support. Conclusions. What now faces policy makers in Japan, Europe and other developed countries is a policy agenda with a core of common themes. First, themes related to addressing supply side issues: getting, keeping and keeping in touch with relatively scarce nurses. Second, themes related to dealing with demand side challenges. The paper concludes that the main challenge for policy makers is to develop a co-ordinated package of policies that provide a long term and sustainable solution. Relevance to clinical practice. This paper highlights the impact that nursing shortages has on clinical practice and in health service delivery. It outlines scope for addressing shortage problems and therefore for providing a more positive staffing environment in which clinical practice can be delivered. [ABSTRACT FROM AUTHOR]

Aims and objectives. To consider the validity and reliability of risk assessment scales for pressure ulcers. Background. Pressure ulcers are a major problem worldwide. They cause morbidity and lead to mortality. Risk assessment scales have been available for nearly 50 years, but there is insufficient evidence to state with any certainty that they are useful. Design. A literature review and commentary. Methods. Bibliographic databases were searched for relevant papers, a critical review was completed on relevant papers. Results. There is contradictory evidence concerning the validity of risk assesment scales. The interaction of education, clinical judgement and use of risk assessment sakes has not been fully explored. It is not known which of these is most important, nor whether combining them results in better patient care. Conclusions. There is a need for further work. A study exploring the complex interaction of risk assessment scales, clinical judgement and education and training is introduced. Relevance to clinical practice. Nurses may be wasting their time conducting risk assessment scoring if clinical judgement and/or education are sufficient to assess pressure ulcers risk. [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]

The article presents the author's comments on the article "Dissemination of research in clinical nursing journals," by M.H. Oermann and colleagues. According to the author, the paper by Oermann does not answer the key question about the impact of the research published in any clinical nursing journal on nursing practice.

arbon p. (2004) Journal of Clinical Nursing 13, 150–157 Understanding experience in nursing This paper reviews research that considered the life stories of experienced nurses and the relationships between life experience, the way in which people find meaning in their experience(s), the development of nursing knowledge, and the influence of these events and understandings on the characteristics and clinical practice of experienced nurses. The dominant perspectives in nursing about the place of experience in the development of nurses’ practice are considered and the paper argues for a broader understanding of experience; placing experience within the context of nurses’ lives, connection with others and their individual understandings about nursing care. The place of experience in the development of nurses has not been well understood although the nursing discourse continues to value clinical experience highly. Becoming experienced as a nurse is described as a progressive and continuous interaction between experience, meaning and the lived world resulting in a personal and unique understanding of practice. The culture and discourse of nursing have tended to exclude or dampen individual difference and the paper considers a more expansive understanding of the place of experience and individual difference in nursing and the relevance of this perspective for the education of nurses. [ABSTRACT FROM AUTHOR]

Introduces articles in the second issue 2004 of the periodical "International Journal of Older People Nursing,". Theme of empowerment in papers in the section one of the publication; Papers analyzing barriers to medical care.

The article presents a commentary on the paper "Being an intensive care nurse related to questions of withholding or withdrawing curative treatment," by R. Hov, B. Hedelin and E. Athlin. According to the author, the paper focuses on the distinction between the perceptions of physician and nurse. He notes that it provides further confirmatory evidence around issues tied up with the withdrawal or withholding of treatment on ICU wards.

Comments on the article "Violence in the Care of Adult Persons With Intellectual Disabilities," previously published in the "Journal of Clinical Nursing." Failure of the study to offer any new understanding of abuse towards people with intellectual disabilities; Poor operationalization of the term violence; Opinion that the research paper deals superficially with both the validity and reliability of the questionnaire.

Aim. The purpose of this paper is to critically explore the sequential explanatory mixed method research design and how it can enhance our understanding of pain management. Background. The general prevalence of pain after surgery has not changed significantly over several decades despite the widespread introduction of new pain relieving technologies. The majority of postoperative pain studies use quantitative methods which offer little understanding of the underlying processes of care. Understanding can be illuminated by using an explanatory mixed method research design. Design. Discursive paper. Method. This paper focuses on the methodological considerations when using a mixed method design. Two previously published mixed methods studies illustrate how findings can inform practice. In the first, 85 women undergoing surgery completed questionnaires to measure pain, anxiety and depression. Telephone interviews explored their pain experiences. The second study considered frequency and patterns of anxiety in the immediate pre and postoperative period. Semi-structured telephone interviews, identified contributing events/situations amenable to nursing intervention. Discussion. Reasons for growing popularity, criticisms, paradigmatic considerations and epistemological roots of pragmatism are explored. The two explanatory mixed method studies provide examples of these studies and how 'inferences' from quantitative and qualitative data can inform practice. Conclusion. This paper connects quantitative and qualitative data, drawing on two research studies, to give greater understanding to the management of pain. Knowledge of the processes responsible for inadequate pain management can be illuminated by using explanatory mixed methods research designs. Relevance to clinical practice. Nursing requires knowledge which reflects the complexity of human health. The explanatory mixed method study can elucidate the problem under scrutiny, e.g. prevalence of pain or anxiety. The qualitative phase can generates an understanding of contributing factors and insights for care delivery. The implicit desire to change and influence practice makes it relevant for those closely aligned to practice. [ABSTRACT FROM AUTHOR]

AIMS: The aim of this paper is to share our experiences of dealing with chaos and complexity in interview situations in the home with children and young people. We highlight dilemmas relevant to dealing with multiple interruptions, building a rapport, consent and confidentiality. Furthermore, we discuss issues regarding the locus of power and control and offer some solutions based on our experiences. BACKGROUND: Creating a safe environment is essential for qualitative research. Participants are more likely to open up and communicate if they feel safe, comfortable and relaxed. We conclude that interviewing parents and their children with cystic fibrosis in their own homes, is chaotic and appears to threaten the rigour of data collection processes. Limited attention or print space is paid to this issue, with published articles frequently sanitising the messiness of real world qualitative research. DESIGN: Position paper. METHODS: In this position paper, we use two case studies to illustrate ethical and pragmatic challenges of interviewing out in the field. These case studies, typical of families we encountered, help emphasise the concerns we had in balancing researcher-participant rapport with the quality of the research process. CONCLUSIONS: Dealing with perceived chaos is hard in reality, but capturing it is part of the complexity of qualitative enquiry. The context is interdependent with children's perceived reality, because they communicate with others through their environment. RELEVANCE TO PRACTICE: This paper gives researchers an insight into the tensions of operating out in the field and helps raise the importance of the environmental 'chaos' in revealing significant issues relevant to peoples daily lives. Knowing that unexpected chaos is part and parcel of qualitative research, will equip researchers with skills fundamental for balancing the well being of all those involved with the quality of the research process. [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]

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 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]

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 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]

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]

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]

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]

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]

Aims. This paper reviews the role of cardiac nursing in China and the potential of this professional group to take an important role in secondary and tertiary prevention initiatives. Background. China is undergoing unprecedented economic growth, yet globalisation of Chinese society has caused an increase in the prevalence of chronic conditions, particularly cardiovascular disease. Studies recognise that health providers and members of the public are not fully aware of the risks associated with cardiovascular disease and consequently are not equipped to deal with this looming epidemic. Design. Position paper. Method. This position paper summarises and discusses the burden of cardiovascular disease in China within the context of evidence for nurse-coordinated interventions. Barriers and facilitators to developing the nursing role in contemporary China are discussed. Conclusions. A key strategy for promoting the role of nurse-led programmes in China is increasing research skills among Chinese nurses to promote independent, collaborative interdisciplinary research. Promoting doctoral education in China, increasing the status of nursing in interdisciplinary teams, collaborating with cardiovascular nurses internationally and increasing the public's awareness of cardiovascular disease are critical steps in promoting nurse-led programmes to improve the health and well-being of the community. Relevance to clinical practice. Given the positive relationship between knowledge and skill levels of nurses and clinical outcomes, China's investment in the education and training of its nursing workforce is critical in improving practice and outcomes in cardiovascular disease. [ABSTRACT FROM AUTHOR]

Aims and objectives. To examine and critique various models guiding the care and education of people with diabetes, to develop more helpful and effective approaches to care. The focus is on relationships and communication between patients and healthcare providers. Background. Many patients are not adhering to the recommended treatments, hence it seems that effective diabetes care is difficult to achieve, particularly for patients of lower socio-economic status, who are disproportionately afflicted. The results are usually devastating, and lead to serious health complications that incisively diminish quality of life for patients with diabetes, frustrate healthcare providers and increase healthcare costs. Design. Critical review. Method. This paper represents a critical review of various approaches to diabetes care and education. A CINAHL search with relevant key words was carried out and selected exemplary research studies and articles describing and/or evaluating the various approaches to diabetes care and management were examined. Particular attention was paid to how the paradigmatic underpinnings of these approaches construct patient - healthcare provider relationships. Conclusion. The literature revealed that the traditional top-down approaches to care were largely ineffective, while collaborative approaches, based in respect and taking the whole persons and their unique situations into account, were found to be central to good care. Further, an integration of the different kinds of knowledge contained in the various approaches can complement and extend one another. Relevance to clinical practice. Avoiding devastating complications by improving the management of diabetes and overall quality of life of patients is a worthwhile goal. Therefore expanding diabetes care beyond the traditional bio-medical model to develop more effective approaches to care is of interest to all healthcare professionals working in this area. [ABSTRACT FROM AUTHOR]

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

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

Aims. This paper draws together the personal thoughts and critical reflections of key people involved in the establishment of a ‘virtual’ practice development unit of clinical nurse specialists in the south of England. Background. This practice development unit is ‘virtual’ in that it is not constrained by physical or specialty boundaries. It became the first group of Trust-wide clinical nurse specialists to be accredited in the UK as a practice development unit in 2004. Design and methods. The local university was asked to facilitate the accreditation process via 11 two-hour audio-recorded learning sessions. Critical reflections from practice development unit members, leaders and university staff were written 12 months after successful accreditation, and the framework of their content analysed. Findings and discussion. Practice development was seen as a way for the clinical nurse specialists to realize their potential for improving patient care by transforming care practice in a collaborative, interprofessional and evolutionary manner. The practice development unit provided a means for these nurses to analyse their role and function within the Trust. Roberts’ identity development model for nursing serves as a useful theoretical underpinning for the reflections contained in this paper. Conclusions. These narratives provide another example of nurses making the effort to shape and contribute to patient care through organizational redesign. This group of nurses began to realize that the structure of the practice development unit process provided them with the means to analyse their role and function within the organization and, as they reflected on this structure, their behaviour began to change. Relevance to clinical practice. Evidence from these reflections supports the view that practice development unit participants have secured a positive and professional identity and are, therefore, better able to improve the patient experience. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim was to describe the process of role transition by an individual who has assumed the position of a consultant nurse in cardiovascular health care. The objective was to explain the ‘gestalt’ of being a consultant nurse and how the ‘gestalt’ has evolved. Background. The development of the consultant nurse role is new, research has described the value and potential contribution of the role. The literature suggests that the role still requires further evaluation and description to be understood better. Design. A free-association narrative interview method was chosen as the research design. Method. An in depth interview, tape-recorded and analysed along with field note analysis was the method for eliciting the narrative. Results. The analysis of the narrative reveals an emerging ‘gestalt’ for being a consultant nurse. Various concepts and phenomena attributable to the role are identified from the experience described. The gestalt explains the journey of the individual through an ‘apprenticeship’ to role attainment, whereby a new sense of professional self or ‘Me’ is realized. Conclusion. The significance of the paper lies in the analysis of the narrative and the insights it gives to help other aspirant consultant nurses. It is through the understanding of these insights that individuals could plan their own learning and development to be achieved in the role of consultant nurse. Relevance to clinical practice. To be effective and provide effective patient care, one can argue that appropriate learning needs to take place. Those that have been appointed to the role have battled to find achievement and acceptance. These battles may be made easier to win if the role is better understood and appropriate preparation provided. Only then will the real potential of the role be realized in improved patient care outcomes. [ABSTRACT FROM AUTHOR]

Aims and objectives. This paper considers the correct method for inserting a rectal suppository, both as a medication and also to achieve bowel evacuation. The aim is to find out whether the correct method is blunt end or pointed end foremost. Background. It follows from a question raised by a third year student nurse. In the classroom, she had been taught that the correct method for the administration of a suppository for systemic absorption was to insert it blunt end foremost into the rectum. However, if the suppository was to be used for evacuant purposes, it should be given pointed end foremost. In clinical practice, however, she was told the suppository should always be inserted pointed end foremost in all cases, whatever the purpose. Design. This article seeks to clarify the dilemma by examining the sources of evidence underpinning different methods for inserting a rectal suppository. Hence, the literature on the insertion of rectal suppositories was gathered as systematically as possible from medical journals and textbooks, nursing journals and textbooks and manufacturers' information to patients. Method. Having gathered the literature, this was examined, appraised and critically analysed for rigour, coherence and reliability. Results. The review of the literature appears to show that evidence adduced for inserting the suppository blunt end foremost derives from one study published in the Lancet in 1991, which challenged 'commonsense'. There did not appear to be other, more recent research. On the other hand, manufacturers' information to patients states generally that the suppository should be inserted pointed end foremost. This has direct relevance for the administration of suppositories and also raises questions as to how research may become integrated into healthcare practice without adequate justification. Conclusions. An article published in the Lancet in 1991 has had a fundamental effect on nursing practice, but has not been subject to scrutiny. The advice given in this Lancet article differs from that currently given by most manufacturers of suppositories, which involves the terms of their product licence. Hence, there is a potential for problems with legal liability should an untoward event arise. Relevance to clinical practice. Inserting rectal suppositories, whether as a medication or to achieve bowel evacuation, is a very common healthcare practice. Currently, there is inconsistency and discrepancy in the correct method for this procedure in both nursing education and practice. This paper examines the reliability of existing evidence and shows the need for further work in order to provide a reliable evidence base for this commonplace clinical procedure. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: The paper discusses the application of the Eastern body-mind-spirit approach in healthcare practice. BACKGROUND: Traumas, sufferings and losses may induce immense distress in patients and their families, as well as apathy and exhaustion in healthcare workers. Over-specialization and compartmentalization of services may provide a convenient shelter for healthcare workers to be detached and to simply focus on a narrowly defined scope of intervention. However, the existential problems are still there. Based upon eastern philosophies and holistic health practices, we propose the body-mind-spirit approach in healthcare settings. METHODS: This is a review paper summarizing the application of the approach on various clinical populations. RESULTS: The approach has been trialled with promising results in a number of health conditions and psychosocial predicaments. Spirituality is not restricted to any religious practices, nor is it narrowed to the pursuit of knowledge at a high level of abstraction. The interconnectedness of the body, mind and spirit presupposes that the practice of spirituality is multidimensional and multi-levelled. CONCLUSIONS: Using the body-mind-spirit framework flexibly we can engage more clients while facilitating the important process of exploration and change. The key components include getting in touch with the inner self, coming back to our senses, connecting our body and mind and rebalancing our relationship with the natural and social environment. The ultimate goal is to move out of meaninglessness and to reach a state of mature spirituality of tranquillity and transcendence. RELEVANCE TO CLINICAL PRACTICE: The practice of spirituality can be easily applied to daily life. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of this paper is to provide an overview of the theoretical basis and application of psychological interventions used in the management of chronic pain. In doing this, psychological factors mediating pain and disability will also be reviewed. Background. A biopsychosocial model of chronic pain is widely purported and pain management is often based upon cognitive-behavioural principles as psychological factors meditating pain and disability have been found to include emotional, cognitive and behavioural components. Conclusions. This paper provides support for a biopsychosocial model of and for the effectiveness and efficacy of psychological interventions for the management of chronic pain conditions. Relevance to clinical practice. The application of psychological approaches to chronic pain management is reviewed and discussed. The way in which psychological approaches may be integrated specifically into nursing management of chronic pain is discussed in a later paper. [ABSTRACT FROM AUTHOR]

Aim. This paper reports one aspect of a larger study of nursing research strategies in one English region, focusing particularly on nurse consultants' characteristics and achievements in the role. Background. Nurse consultant posts have only been established in the United Kingdom since 1999 and, although much comment has appeared in the professional literature, there is very little research-based evidence of how the roles are developing. The role is intended to integrate four domains: expert practice; professional leadership and consultancy; education, training and development; and practice and service development. 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. Results. Four themes were identified from the data: characteristics of the postholder, role achievement, support systems and National Health Service influences. The first two themes are discussed in this paper and the data show that the nurse consultants varied in terms of their academic background and previous experience. Not all had the recommended minimum of Master's degree level preparation and some had limited research experience. These background characteristics seemed to influence the degree to which they were able to achieve the four domains of the role, with those with lower qualifications and from a mental health background appearing to struggle most. Conclusions. New appointments to these roles should only be made when candidates possess the recommended levels of educational preparation and professional experience of change management. It is also important that there is clarity about the scope of the role, which should not include management responsibilities. On-going research is essential to evaluate how the roles develop for postholders, the extent to which they fulfil policymakers' expectations and what difference they make to patient care from a patient perspective. Relevance to clinical practice. The findings show that holders of such posts need to have appropriate previous knowledge, skills and personal characteristics, as these seem to influence their ability to integrate the four domains of the role and thus achieve the requirements of the post. [ABSTRACT FROM AUTHOR]

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

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

In the context of increasing interest in how rurality affects health services and nursing practice in the UK, this paper reports and discusses data from a survey of older people living in three English villages. The survey found that village populations differed widely, that there were changes in the proportions of older people in the villages over time, and that close social networks existed for some but not all. The paper concludes that health care practitioners should avoid stereotypes of village life. In their increasing emphasis on health promotion and active ageing among older people, nurses may find data collected by the voluntary sector to be a useful resource. Working in partnership with groups to achieve a deep under- standing of local contexts may assist nursing practitioners when building up pictures of older patients' health-related needs and views. [ABSTRACT FROM AUTHOR]

robinson a & street a (2004) Journal of Clinical Nursing 13, 486–496 Improving networks between acute care nurses and an aged care assessment team Acute care nurses have an important role in the discharge planning of older people from hospital to home. However, few nurses understand the changing aged care system or the consequences of poor referral on the lives of older people postdischarge. This paper reports the findings of a research project, which aimed to investigate the possibilities for facilitating the transition of older people from hospital to home through improving the working relationship between nurses and members of a multidisciplinary aged care assessment team (ACAT). The paper reports one action research cycle from a larger project. Action research was chosen because its focus on knowledge development and action leads to practical solutions to clinical problems. The research approach included interactive forums designed to facilitate effective collaboration between the nurses and ACAT in the discharge planning of older people. Data collection strategies included audiotapes of ACAT research discussions, field notes, policy documents, referral forms and an evaluation tool. The findings illustrate that ward nurses have, at best, a limited knowledge and understanding of the aged care system, its function, or how to access services. They need assistance to develop their knowledge of services available to support older people following discharge. The conduct of interactive forums, which utilize a case study approach, facilitated such knowledge development and empowered the nurses to become more involved in discharge planning. Participation in the forums also facilitated new collaborative partnerships between the nurses and ACAT, which enhanced effective discharge planning. The paper outlines practical strategies to support collaboration between ward nurses and community providers and/or multi disciplinary assessment services. It provides a list of key considerations for the development of effective ward/community networks to facilitate the discharge of older people. [ABSTRACT FROM AUTHOR]

reed j., weiner r. & cook g. (2004) International Journal of Older People Nursing in association with Journal of Clinical Nursing 13, 3a, 3–10 Partnership research with older people – moving towards making the rhetoric a reality As nursing develops closer partnerships with older people in delivering care, it also needs to develop partnerships in order to create the knowledge base for practice in a way that challenges professional hegemony and empowers older people. However, the process of developing partnerships in research takes place against a background of academic research traditions and norms, which can present obstacles to collaboration. This paper is a reflection on the issues that have arisen in three projects where older people were involved in research at different levels, from sources of data to independent researchers. It points to some of the areas that need further exploration and development. [ABSTRACT FROM AUTHOR]

monaghan c. & begley a. (2004) International Journal of Older People Nursing in association with Journal of Clinical Nursing 13, 3a, 22–29 Dementia diagnosis and disclosure: a dilemma in practice Providing the individual with the correct information about their diagnosis can help maximize the patient's autonomy, however empirical evidence identifies inconsistencies in the practice of diagnosis disclosure in dementia. Within health care, ethical problems arise frequently and these present a challenge for health care professionals. This challenge can also give rise to conflict when professionals are torn between respecting autonomy, doing good and avoiding paternalism. The aim of this paper is to highlight the need for interprofessional collaboration when faced with ethical dilemmas such as diagnosis disclosure in the care of adults with dementia. The use of a dialogue and supplementary notes are used to explore crucial ethical points raised by health care professionals. The increasing rate of dementia and the need for patients to have access to timely and appropriate information about their diagnosis has prompted much debate about disclosing the diagnosis with the individual who has dementia. This paper may also be useful for educational purposes when used as a framework for discussion/debate in student nurse education. Ethical theories are of benefit in assisting the members of the multidisciplinary team to reach a morally defensible decision. Making ethical decisions in practice can cause the nurse concern. While there is no complete set of ‘rules’ that can provide an answer to each ethical dilemma, it is of immense value to nurses working within the multidisciplinary team to possess a sound knowledge of ethical positions in order to analyse the many complex situations that nurses encounter. The pivotal role of the health care professional is to work in collaboration and engage in sharing the diagnosis with the patient. It is hoped that this paper will stimulate and encourage further debate and study regarding the individual with dementia and diagnosis disclosure. Recommendations for practice, education, policy and research will also be highlighted. [ABSTRACT FROM AUTHOR]

mccormack B. (2004) International Journal of Older People Nursing in association with Journal of Clinical Nursing 13, 3a, 31–38 Person-centredness in gerontological nursing: an overview of the literature Person-centred practice is a recurring theme in gerontological nursing literature. While there are many descriptive accounts of attempts at developing person-centred practice, in reality, there are few studies that identify the benefits of this way of working. Thus far, systematic research into person-centred nursing practice is poorly developed. This paper aims to explore the concept of person-centredness and person-centred practice in order to add clarity to discussions about the term in the context of gerontological nursing. This literature-based exploration discusses the meaning of the word ‘person’ and the way this word is translated into person-centred practice. It is argued that there are four concepts underpinning person-centred nursing: (i) being in relation; (ii) being in a social world; (iii) being in place and (iv) being with self. The articulation of these concepts through existing models of person-centred practice in nursing raises the recurring themes of knowing the person, the centrality of values, biography, relationships, seeing beyond the immediate needs and authenticity. There is a need for further research and development work in gerontological nursing to distinguish between person-centred practice and good quality care for older people. [ABSTRACT FROM AUTHOR]

dewing j. (2004) International Journal of Older People Nursing in association with Journal of Clinical Nursing 13, 3a, 39–44 Concerns relating to the application of frameworks to promote person-centredness in nursing with older people There is an increasing need to develop a multi-dimensional discussion and critique around the concept of ‘person-centred’ in the context of the delivery of nursing care for older people. As the context of nursing being considered here, it is primarily nurses who should be leading with this discourse, although drawing on a broad range of ideas from outside of nursing. The person-centred movement, commonly believed to originate in the care of those with dementia in the UK, is growing, especially in the UK and Australia, with signs of it moving across parts of Western Europe and North America. Person-centredness has a big emotional appeal to many nurses working with older people, perhaps because it ‘has the right feel’ for them and nurses believe it ‘feels right’ for older people. It has grabbed the attention of many practising nurses in the UK in a way that humanistic nursing theory and the various associated nursing models from previous decades, seemed to have missed. This paper contributes to the discussion by suggesting that there are conceptual frameworks that nurses can draw on to help them understand and enhance their practice. However, it is suggested that these frameworks are either in their infancy or incomplete and they still need to convince nurses of their utility for day to day practice. It is also pointed out that the underpinning concept of ‘personhood’ has not yet been fully clarified by nursing. [ABSTRACT FROM AUTHOR]

bonner a. & walker a. (2004) Journal of Clinical Nursing 13, 210–218 Nephrology nursing: blurring the boundaries: the reality of expert practice Expertise in nursing has been widely studied; there have been no previous studies into what constitute expertise in nephrology (renal) nursing. This paper describes a ‘real-world’ characteristic of expert nephrology nursing practice. This paper, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, aims to explore the concept blurring the boundaries. The study utilized grounded theory methodology and symbolic interactionism. The study took place in one renal unit in New South Wales. Sampling was purposive then theoretical; the sample consisting of six non-expert and eleven expert nurses. Simultaneous data collection and analysis using participant observation, review of nursing documentation and semi-structured interviews was undertaken. The study revealed that only expert nephrology nurses ‘blurred the boundaries’ of professional nursing practice. They did this by moving intermittently and purposefully, for the benefit of particular patients, into medical domains in the areas of prescribing, dispensing and ordering of pathology tests. Non-expert nurses did not cross these professional boundaries. Blurring the boundaries was a significant feature of expert nursing practice, and this study was the first to describe explicitly nursing boundaries as two distinct entities; that is, formal and informal. There are some nephrology nurses who have sufficient knowledge and experience to prescribe some medications and to order certain investigations. [ABSTRACT FROM AUTHOR]

This paper examines the usefulness of an integrated approach to needs assessment using an empowerment framework, within a health visitor/client interaction, in the home setting. It is intended to demonstrate the existence of a flexible approach to assessing need that is based on research about necessary processes for carrying out health visiting. The design of the tool described in this paper allows the use of professional judgement as well as fulfilling commissioning requirements to address health outcomes. Health promotion and empowerment are central to health visiting practice and should be reflected in the way needs are assessed. Many NHS trusts have introduced a system of targeting and prioritizing health visiting through a system of questioning to assess needs. This may reveal the work that health visitors do, but may also inhibit the open, listening approach required for client empowerment. Different methods of assessing need can be used that do not compromise the commissioning requirements, the health visitor's duty of care or professional accountability. The empowerment approach is key to the philosophy of health visiting. There are ways of approaching needs assessment that do not compromise the ethos of partnership-working in a health promoting way. [ABSTRACT FROM AUTHOR]