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Objective: The aim of this study was to report clinical treatment recommendations for low back pain (LBP) based on 5 international guidelines and best evidence from the Cochrane database of systematic reviews. Methods: Five LBP guidelines available in English language were appraised, including 4 studies published since the seminal work by Koes et al (Spine 2001;26:2504–5213). The guidelines were examined for treatment recommendations concerning nonspecific LBP and guideline quality with application of the Appraisal of Guidelines for Research and Evaluation instrument. Secondly, a systematic literature search for reviews and randomized controlled trials was conducted using a modified version of the search strategy recommended by the Cochrane Back Review Group. Two systematic reviews were identified. Results: According to best evidence from review of the Cochrane database of systematic reviews, there remains a lack of consensus regarding reported efficacy of spinal manipulative therapy for the treatment of nonspecific LBE Furthermore, the guidelines reviewed in the present study have not changed significantly with respect to treatment recommendations for nonspecific LBP since the original review, and there is inconsistency between the guidelines regarding optimal time to introduce spinal manipulation to treat nonspecific LBP. Conclusion: Treatment recommendations for nonspecific LBP, particularly spinal manipulation, remain inconclusive. Guideline developers need to consider guidelines in neighboring countries and reach consensus on how evidence is graded and incorporated into guidelines. Guidelines should continue to be regularly updated to incorporate new evidence and methods of grading the evidence. [ABSTRACT FROM AUTHOR]

Summary Background The European Union Bologna Process has laid the foundation for a common European competence-based educational framework. In many countries, nursing education is in transition from vocational to higher education, with many diverse systems. The competence-based approach provided by the project Tuning Educational Structures offers a common and coherent framework able to facilitate the implementation of the principles underpinning the Bologna Process reform. Objectives This study aimed to ascertain the relevance that Italian nursing university lecturers attributed to the 40 competences of the Italian version of the nursing Bachelor's and Master's Degrees. These competences were developed through adoption of the Tuning Methodology in the nursing context. Setting The study was conducted in the 4 universities of one region of Italy which offer nursing Bachelor's and Master's Degrees. Participants A total of 164 Italian university nursing lecturers. Methods Using a four point scale, a cross sectional survey was conducted from March 2011 to April 2012. Participants evaluated each competence according to its relevance for Bachelor's or Master's Education. Frequency analysis was conducted. Results The significance for each competence of Tuning was rated very high by Italian lecturers and appeared to overlap partially with the original European study. In Italy, the most relevant competences for Bachelor's Degree were the skills associated with the use of appropriate interventions, activities and skills in nursing and the skills associated with nursing practice and clinical decision-making. For Master's Degree, leadership, management and team competences were the most important. Conclusions The Tuning Nursing Project was accepted by the Italian lecturers. The competence-based approach was considered by Italian lectures as a support enabling to reflect on the current Italian nursing education cycles of study and to ensure shared visions and common approaches between Italian and European lecturers. [ABSTRACT FROM AUTHOR]

Summary: Background and Aim: This study sought to increase the understanding of the concept of reflection within nursing. The research focused on the social construction of reflection through a post-registration, palliative care programme in the United Kingdom (UK). Design and Participants: An interpretive ethnographic approach was used to study reflection from the perspective of students and teachers, whilst paying attention to local organisational, contextual and cultural issues. Methods: Data collection included: observations of teaching and learning interactions, interviews, extracts from programme documentation and student reflective learning contracts (RLCs). Findings: Findings identified a learning culture committed to reflection as a valuable way of helping nurses make sense of their practice. Similar to Barnett''s (1997) concept of ‘critical being’, students and teachers described reflection as a way of ‘being’ rather than simply ‘thinking’ or ‘doing’, since reflection intertwined propositional, affective and active elements. This process of reflective ‘being’ was connected with a humanistic approach to nursing, which emphasises the importance of actively using and expressing oneself in order to care for people. Conclusion: This paper contributes empirical knowledge on the meaning of reflection in nursing regarding: teachers'' and students'' perspectives, reflection as a way to make sense of practice, and reflection as a way of ‘being’ and its association with humanistic nursing. [Copyright &y& Elsevier]

Background Nursing involves caring for the ‘whole person’ and it is considered inappropriate for nurses to think or talk about patients in objectifying or dehumanising ways. Objectifying discourses can dominate within the arena of critical care, and critical care nurses can experience moral distress as they struggle to think about patients as persons. No previous study has examined the role played by ‘impersonal’ talk in the delivery of nursing care. This paper reports a study which examined the relationship between nursing practice and the way(s) in which critical care nurses think and talk about patients. Objectives The study objectives were to (1) identify and characterise the ways in which critical care nurses think and talk about patients; and (2) describe patterns of nursing practice associated with these different ways of thinking. Study design An ethnographic study was undertaken within one critical care unit in the United Kingdom. Data were collected over 8 months through 92 h of participant observation and 13 interviews. Seven critical care nurses participated in the study. Data analysis adopted the perspective of linguistic ethnography. Findings Analysis of these data led to the identification of seven Discourses, each of which was characterised by a particular way of talking about patients, a particular way of thinking about patients, and a particular pattern of practice . Four of these seven Discourses were of particular significance because participants characterised it as ‘impersonal’ to think and talk about patients as ‘routine work’, as a ‘body’, as ‘(un)stable’ or as a ‘medical case’. Although participants frequently offered apologies or excuses for doing so, these ‘impersonal’ ways of thinking and talking were associated with practice that was essential to delivering safe effective care. Conclusions Critical care practice requires nurses to think and talk about patients in many different ways, yet nurses are socialised to an ideal that they should always think and talk about patients as whole persons. This means that nurses can struggle to articulate and reflect upon aspects of their practice which require them to think and talk about patients in impersonal ways. This may be an important source of distress to critical care nurses and emotional exhaustion and burnout can arise from such dissonance between ideals and the reality of practice. Nursing leaders, scholars and policy makers need to recognise and legitimise the fact that nurses must think about patients in many ways, some of which may be considered impersonal . [ABSTRACT FROM AUTHOR]