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Globally the number of older people living alone is increasing. Little is known about the life experience of older people living alone in Mainland China. This study aimed to explore older people's experience regarding different components of their lives. A cross-sectional survey of 387 older people aged 60 years and above and living alone in two communities in Shanghai was conducted from April to July 2015. A structured questionnaire including 15-item Geriatric Depression Scale, Activity of Daily Living Scale, UCLA Loneliness Scale version 3, Social Support Rate Scale and Older People's Quality of Life Questionnaire was used to assess the health status, loneliness, social support, quality of life and demographic information. A total of 15.7% of the participants rated their health as poor with 56.8% reporting chronic diseases and 26.9% reporting being depressed. A total of 71.1% of the participants reported a high level of functional ability. However, 54.3% and 21.7% of the participants reported a moderately and moderately high level of loneliness respectively. The median of SSRS was 30 and the mean of Older People's Quality of Life Questionnaire was 120.2, indicating a lower level of social support and quality of life. There were statistically significant differences in health, loneliness, social support and quality of life across the participants with different characteristics. Interventions to improve the health status, reduce loneliness, increase social support and maintain or improve quality of life of older people living alone in Shanghai could be developed and implemented. Potential interventions include providing frequent home care services, early detection of depression, encouraging more contacts from children and other family members, and providing support from other sources.

Aim To establish an explanatory model of registered nurses' attitudes towards older people and working with older patients. Background Increasing demands for health-care from an ageing population will require a higher proportion of nurses who have positive attitudes towards older people and like working with older patients. Method A convenience sample of registered nurses (n = 579; 79.3% response rate) attending continuing professional education courses within a large university in London was surveyed from October to December 2011. Results Registered nurses expressed positive attitudes towards older people and 89.7% reported positive attitudes towards working with older patients. The variables of self-ageing anxiety, attitudes towards health-care resource allocation, knowledge of ageing, ethnic group, job title, attitudes towards older patients and interaction between ethnic group and attitudes towards working with older patients explained 42.6% of the variance in attitudes towards older people. Factors, including attitudes towards older people, self-ageing anxiety, commitment to nursing, attitudes towards health-care resources allocation among older people and clinical specialty explained 16.7–34.3% of the variance in attitudes towards older patients. Conclusion The models identified several related factors that may help in the selection and management of nurses for caring older people. Implications for Nursing Management Our findings highlight the importance of investing in continuing education related to gerontological nursing and the ageing process so that there is a growing pool of registered nurses who wish to care for older patients.

Aim To explore critical care nurses' views of their job satisfaction and the relationship with job burnout, practice environment, coping style, social support, intention to stay in current employment and other work-related variables. Background Nurse shortage is a global issue, especially in critical care. Job satisfaction is the most frequently cited factor linked to nurses' turnover. Method A convenience sample of cardiac critical care nurses (n = 215; 97.7% response rate) from 12 large general hospitals in Shanghai was surveyed from December 2010 to March 2011. Result Over half of the sample reported satisfaction with their jobs. Nurses with 10–20 years of professional experience and those who had taken all their holiday entitlement reported higher levels of job satisfaction. The independent variables of practice environment, intention to stay, emotional exhaustion, personal accomplishment and positive coping style explained about 55% of the variance in job satisfaction. Conclusion Chinese cardiac critical care nurses' job satisfaction was related to work related variables, which are amenable to managerial action. Implications for nursing management Our findings highlight the imperative of improving intrinsic and extrinsic rewards, together with the flexibility of work schedules to promote job satisfaction and staff retention. A clinical ladder system is needed to provide promotion opportunities for Chinese nurses.

Loneliness is a serious problem for older people, which can be alleviated by social support. The dramatic population ageing together with social and economic change in China increases the likelihood of loneliness and the availability of different sources of social support of older people. The aim of this review was to identify the prevalence of loneliness and its related factors and sources of social support of older people in China. Electronic literature searches were conducted in September 2011 using Web of Science, PsycINFO, MEDLINE, PubMed, CINAHL, China Academic Journal and VIP Database for Chinese Technical Periodicals. Twenty-six papers were identified and reviewed. The prevalence of loneliness varied across the studies, reflecting the different measurements and samples. Marital status, gender, age, educational level, economic level, living arrangements, health status and social support were significant factors related to loneliness. The family was the most important source of social support followed by friends. The receipt of family support improved subjective well-being and mental health, but the effects of support from friends were inconsistent. Chinese older people received relatively little support from neighbours, governmental or other social organisations. Further well-designed studies are needed to identify additional factors related to loneliness and to understand the support from friends, neighbours, formal organisations and other sources.

Background The role of the ward manager is integral to service delivery, however, they may lack the necessary authority and autonomy to achieve the organisation and delivery of patient care. Aim To identify initiatives that have strengthened the ward manager role. Methods A review of published literature was undertaken. Data included were drawn from a variety of sources, including policy, professional literature and research studies. Findings Three policy initiatives were identified along with two innovations from ward managers and two recent professional organisation campaigns. One innovation was identified that could improve the process of care delivery thus empowering ward managers' decision making. The literature identified the need for a review of the role, and adequate administrative support and training for the role. Conclusion The literature reviewed provided little evidence of initiatives to strengthen the role of the ward manager, highlighting the imperative to develop an evidence base. There was consensus on the importance of education and training before and during appointment to the position. Implications for nursing management The role of the ward manager remains pivotal in care delivery. The focus should be on how best to support ward managers in achieving their role within health-care systems.

while a.e. & clark l.l. (2009) Journal of Nursing Management 18, 166–172 Overcoming ignorance and stigma relating to intellectual disability in healthcare: a potential solution Aim To propose a strategy for overcoming stigma and discrimination against people with intellectual disabilities within healthcare. Background Evidence of poor healthcare for those with intellectual disabilities resulted in an independent inquiry. The subsequent report has charged healthcare organizations to address current organizational failings. Evaluation The origins of discriminatory practices in health services and the evidence of persisting poor care and stigmatization of this patient group despite UK Government policy are set out. Key issue The stigmatization and resulting discrimination of people with intellectual disabilities persists. Conclusion In addition to investment in core training, organizational change is needed to bring about change and a reduction in health inequality. Implications for nursing management The development of a new framework for nursing is recommended with leadership at all levels of healthcare so that people with intellectual disabilities and their families can expect to receive high quality care in all healthcare settings.

Aim(s) To examine the role of nurses within integrated health care. Background Healthcare planners are overly concerned with the treatment of diseases and insufficiently focused on social cohesion ‐ vertical rather than horizontal integration of healthcare effort. These domains need to be better connected, to avoid medicalization of social problems and socialisation of medical problems. Evaluation Published literature, related to theories of whole system integration. Key issue(s) •When conceptualizing whole system integration it helps to consider research insights to be snapshots of more complex stories-in-evolution, and change to be the result of ongoing community dance where multiple players adapt their steps to each other. •One image that helps to conceptualize integration is that of a railway network. Railway tracks and multiple journeys are equally needed; each requiring a different approach for success. •Traditional nursing values make nurses more attuned to the issues of combined vertical and horizontal integration than medical colleagues. Conclusion(s) Nurses should lead integration at the interface between horizontal and vertical activities. Implications for nursing managementNursing managers and universities should support the development of nurses as leaders of whole system integration, in partnership with local healthcare organizations.

The present paper examines the mechanisms by which health and social care policies put forward by the Government may be translated into community nursing practice. Data from a research project on community nurse case managers were re-examined in the light of two classic theories often cited by policy analysts (i.e. implementation theory and 'street-level bureaucracy'). It was found that the extent to which nurses adopted the case management role, and the model of choice, depended on four major interrelated variables, namely: (1) the clarity of policy guidance; (2) the extent to which it coincided with professional (nursing) values; (3) local practices and policies; and (4) the personal vision of the community nurse. It is argued that this framework may have wider relevance, and this was tested out in two ways. First, major change in one of these variables (Government policy) over time was analysed for its effect on case management practice via the remaining variables. Secondly, an unrelated, but policy-initiated, nursing issue (nurse prescribing) was briefly examined in the light of the framework. It is suggested that this framework may be of some use when considering the likely practice response to policy-related changes in community nursing.

The aim of this paper is to critically consider the role of the support worker in the nursing home sector and with particular reference to the United Kingdom situation. With the expansion of the nursing home sector, there is an increasing population of support workers in this field. Literature in this paper covers the period between 1989 and 2002, beginning with the build up to the introduction of the National Health Service and Community Care Act (available at: http://www.hmso.gov.uk), which necessitated a major shift between public and private sector employment. The findings of this paper indicate limited research, investigating the role of support workers in general and specifically those working in the nursing home sector. The literature suggests that the majority of the role focuses on direct patient care, however, a lack of role clarification was evident and differences emerged between the views of support workers and Registered Nurses regarding the place of support workers in the care process. In particular, support workers saw their role as similar to that of the Registered Nurse, although Registered Nurse regarded 'basic nursing care' as the key remit of the support worker role. The paper also indicated inadequate preparation and subsequent supervision of support workers. These key findings indicate that role clarification, appropriate preparation and a process of continuing development require careful consideration by managers if the positive contribution of this group of care workers is to be fully realized. Furthermore, while there exists no central source of funding to finance the role preparation and mentorship of support workers, training provision will remain ad hoc. Obtaining core funding would allow for the training and education of support workers to become standard practice, which, in turn, is more likely to lead to improvements in the planning and resourcing of care provision. Equally, further research is needed if the support worker role is to be used effectively and efficiently within the expanding nursing home sector.

Aim The study sought to explore (1) reasons for choosing nursing as a career; (2) expectations, if any, of nursing; (3) whether those expectations had been realized; (4) how such expectations had been met or could be met. Background Nursing recruitment and retention are of central concern to health care. The Audit Commission have highlighted the costs of ‘preventable’ staff attrition and suggested that staff turnover may be minimized if staff policies reflected an understanding of the views and aspirations of staff. Method A semi-structured interview survey was conducted with a quota sample of undergraduates attending one university (n=40). Different course groups were represented. Findings Satisfaction of caring for people together with long-term desire to nurse emerged as important factors influencing career choice. Expectations included working in a caring team and having a satisfying career. Conflict experienced in the clinical setting, disappointment over the treatment of nurses and changes within the NHS and nursing were considered among the factors detracting from nursing as a career. Conclusion Health care management must recognize issues of concern to nurses and develop policies which make nurses feel valued.