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Nurses' performance in written examinations often bears little relationship to their level of clinical proficiency in the ward. This paper describes a method of making written exatninations more relevant to the clinical situation. It describes the development of a case history test which confronts students with the kind of information they have to interpret and act upon in the ward, and which requires them to recall the principles of nursing care and apply them in a way similar to real life. Evidence is presented that tests of this type are more closely linked to clinical performance than are conventional written examinations, and guidehnes are given for constructing case history tests. [ABSTRACT FROM AUTHOR]

Aim. This paper explores nurses' experiences 1 year after an organization's commitment to providing a client-centred and client-empowering partnering approach to care. Background. Historically, nurses' approach to providing care in all nursing contexts has been one of doing for clients, and previous studies have focused more on in-hospital care than on home care. However, the isolation inherent in in-home nursing and nurses' limited professional autonomy and power associated with physician control over patients in home care have been reported, as has their difficulty in finding the meaning and satisfaction of human connectedness and mutuality in nurse-client relationships. Overall, research to date does not inform us about how nurses might make a change toward a more client-centred and client-empowering approach to nursing. Methods. An interpretive phenomenological design was used to elicit in-depth understanding about Registered Nurses' experiences of providing care using this innovative empowerment model. A purposefully selected sample of eight Registered Nurses participated in in-depth interviews. Data were generated during 2002. Hermeneutic analysis was used to elicit themes and patterns emerging from the data. Findings. Caring, client-centredness and the context of in-home care were important in implementing the new partnering approach. Barriers encountered at system, organizational and personal levels distracted nurses from fully comprehending and enacting the approach. After a year, they had begun to contemplate potential strategies for partnering with clients, but had not yet explored the power of their professional autonomy. Conclusion. Nurses are inclined to practise within the expert model of service delivery. They need to work through issues of professional autonomy and rise to the challenge of exercising their autonomy within the current healthcare context if they are to attend more consistently to client-centred empowering partnering. The home care setting offers an excellent environment for achieving these aims. [ABSTRACT FROM AUTHOR]

In this paper I explore the possibilities of nursing as safeguarding through a phenomenological description of a small sculpture by the German artist Käthe Kollwitz. My discussion will be grounded in Heidegger's understanding of technicity as a pervasive systematizing and aggressive challenging-out. The method is grounded in Merleau-Ponty's and Heidegger's contention that strong artworks are truth-disclosing and show up our precognitive contact with the world. Bringing nursing concerns to an encounter with single strong artworks can help us cultivate a more receptive openness to our patients. [ABSTRACT FROM AUTHOR]

Nursing is frequently described as a caring practice. What this concept means may be less clear. This paper considers nursing as a caring practice in three steps. First, the concept of practice based on Taylor's and MacIntyre's philosophical definitions of the term is described. Secondly, numerous notions of caring are presented; the call from some nurse researchers for quantification of the concept and why this is problematic is discussed; and an exposition of caring from a phenomenological perspective is provided. Finally, the notions of practice and caring are joined, and the concept of a caring practice is presented. Nursing as a public caring practice is illustrated with examples from an interpretive phenomenological study. In conclusion, it is claimed that a phenomenological view of caring combined with a comprehensive definition of practice is well suited to nursing, and allows for a description of nurses’ caring practices from both a nursing and patient perspective. [ABSTRACT FROM AUTHOR]

PARKER JM.Nursing Inquiry2004;11: 210 –217Nursing on the medical wardThis paper considers some issues confronting contemporary medical nursing and draws upon psychoanalytic theories to investigate some seemingly straightforward and taken-for-granted areas of medical nursing work. I am arguing that the everyday work of medical nurses in caring for patients is concerned with bringing order to and placing boundaries around inherently unsettled and destabilized circumstances. I am also arguing that how nurses manage and organize their work in this regard stems from traditional practices that tend to be taken for granted and not explicitly thought about. It is therefore difficult for nurses to consider changing these practices that often have negative consequences for the nurses.I want to examine the impact upon nurses of the consequences of three taken-for-granted nursing practices: (i) the tendency of nurses to confine their reactions to what is going on so as to present a caring self; (ii) the tendency of nurses in their everyday talk to patients to confine, limit and minimize meaning; and (iii) the tensions and ambiguities that emerge for nurses in the policing function they perform in confining patients to the bed or the ward. Negative consequences on nurses of these practices potentially include stress and confusion regarding their ability to care for patients; an undervaluing of nursing skills; and a deterioration in the nurse–patient relationship. Clinical supervision for medical nurses is proposed as a means of facilitating greater understanding of the nature of nurses’ relationships with patients and the complex dimensions of their medical nursing role. [ABSTRACT FROM AUTHOR]

The paper explores consequences of applying the view that illness is negative first-person experience in caring practice. The main reason this is an important issue is that it is empirically documented that patients conceive of illness in different ways. Communicating about illness in caring practice can therefore involve difficulties. I argue that many of these difficulties can be avoided if nurses focus directly on the extension of the concept of illness – patients’ experiences like the state of being in pain – and not on how this extension is represented as (the intension) illness. This argument is compatible with different views on the nurse–patient relationship as a communicative process. All it requires is the acceptance of minimal assumptions about concepts and concept possession. The argument has a descriptive and a normative dimension. It is descriptive in the sense that it seeks to use concepts from philosophy of mind to explain how many nurses succeed in talking about illness without applying the concept of illness. It is normative in the sense that it provides a philosophical justification for this practice. [ABSTRACT FROM AUTHOR]

Most definitions, or descriptions of nursing emphasize that it is an interpersonal activity focusing on the understanding of the patient as an individual. In addition, such descriptions highlight not only the caring aspect of the role of nursing but also the health maintenance and rehabilitation aspects. The paper discusses the fact that despite these definitions, nursing is still task orientated, largely based on the medical model and hidebound by tradition. Suggestions are made of ways in which this approach may be altered. The use of the nursing process, the concept of the primary nurse and the developing of empathetic understanding being some of the ways in which individualized care may become a reality. The adherence to tradition highlights that nurses are the greatest hindrance to progress in nursing. [ABSTRACT FROM AUTHOR]

This paper describes the establishment and organization of the Joint Board of Clinical Nursing Studies. It outlines the philosophy which has developed since 1970 and which has formed the basis of the Board's work. The belief that ongoing clinical education should contribute to the quality of patient care, and to the personal and professional development of the nurse and midwife, has been fundamental to the formation of the Board's policies. Factual information is given on various aspects of the work of the Board. The difficulty of assessing the value of the work is recognized, but the importance of this activity is stressed. Formative evaluation is required as an integral part of every course. An attempt is made to assess the value of the Board's work to the patients, the nurses taking the courses, and to the nursing service. [ABSTRACT FROM AUTHOR]

This paper develops an argument that the choice of occupational strategy for nursing in the last century still has implications today. Nurses have retained a hierarchical principle of organization and have, albeit reluctantly, retained an in-service pattern of training. They have been concerned about recurrent shortages of nurses and this has influenced modes of development. These factors contribute to a continuity which is apparent in both 'Salmon' and 'Briggs', the two most influential reports on British nursing in recent decades. Such continuities in nursing development tend to preclude the raising of fundamental questions about the nature of nursing work and the manner in which it might be changed. [ABSTRACT FROM AUTHOR]

This article explores interview data from a study of 50 Norwegian generalist nurses' focus group accounts of caring for dying patients in the hospital and care home. An eclectic discourse analytic approach was applied to nurses' accounts of the patient and three discursive contexts of reference to the patient were identified: the ‘taken as read’ patient, the patient paired with particular characteristics and the patient as psychologically present. Talk about the patient falls mainly into the first two contexts, which position the patient in relation to three closely related discursive processes: individualization, anonymization and objectification. The third context presents the patient as a person with a particular identity. The analysis is discussed in a broader philosophical and sociological context in which we return to some of the theoretical work on death and dying of the 1990s and the topic of sequestration. We suggest that nurses' talk about the patient can be heard to participate in a continuing sequestration of the dying patient in healthcare institutions focused on ‘result-oriented’ care. [ABSTRACT FROM AUTHOR]

Aim. The aim of this critical care sleep assessment pilot study was to evaluate the usefulness of three sleep assessment tools to identify which, if any, provided the closest comparison between the nurses' judgement and the patients' experience of their sleep. The study objectives were to: (i) compare patients' and nurses' assessment of sleep using three different rating tools. (ii) Ascertain patients' preferences with non-interventional, user friendly, practical tools in critical care. (iii) Recommend changes and improvements to the way that sleep is assessed and documented. Background. Sleep is important for promoting critical care recovery and sleep disturbance is known to cause irritability, aggression and increased stress levels. The availability and use of valid critical care sleep assessment tools is limited. Design. A descriptive comparative study using three sleep assessment-rating scales were constructed to provide easy to understand tools for completion by both patients and nurses in critical care. Methods. Structured interviews were undertaken with 82 patients and 82 nurses using a convenience sample from four multispecialty critical care units in one large teaching trust. Patients were included in the study if they met a list of pre-defined criteria to obtain responses from lucid orientated patients. Results. No tool produced a close association between the nurses' assessment of the patients sleep and the patients' assessment of their sleep. Patients found two of the three tools easy to use when rating their sleep. Discussion. Objective invasive measurements of sleep as well as complex subjective tools appear inappropriate to be used as a part of daily critical care practice. The application of simple rating scores has a high degree of error when nurses assess patients' sleep, even though high levels of patient observation and assessment are practiced in critical care. Conclusions. More research is needed to examine the assessment of sleep in critical care, particularly linking rating scales to alternative methods of physiological assessment of sleep. Findings indicate nurses are unable to accurately assess critical care patients' sleep using rating assessment tools. However patients were found to prefer two sleep assessment tools, one banded in hours to assess sleep quantity and one as a comparison against normal sleep to assess sleep quality. Relevance to clinical practice. This study reviews the importance of sleep assessment and the diverse methods available for assessing sleep focussing on the critically ill patient. More noteworthy it highlights how nurses sole judgements of patients sleep is not a reliable method in clinical practice, however it provides some indication on the application of 'easy to use' tools to assist in the patients assessments of their sleep. [ABSTRACT FROM AUTHOR]

Aims and objectives. This study sought to explore the nurses’ experience of a day hospital chemotherapy service in an acute general hospital in Northern Ireland and how this compared with their experience of working in an inpatient setting. Background. Despite the many changes taking place in cancer care delivery, little research has been conducted on nurses’ experience of working in more acute cancer treatment settings. Research conducted to date has tended to focus on the role of nurses in wards, hospices and palliative care settings. Design. This Heideggerian hermeneutic phenomenological study explored nurses’ lived experience of day hospital chemotherapy service. Method. Face-to-face focused in-depth interviews were conducted with the total population of nurses who worked in the day hospital at the time of data collection ( n = 10). Data analysis involved a two-staged approach, the analysis of narratives and narrative analysis, based on the work of Polkinghorne (1995) . Conclusions. The nurses’ viewed their experience of the chemotherapy day hospital as having both positive and negative dimensions. The positive dimensions included an increased sense of autonomy and the challenge of developing new skills, while the negative dimension included a perceived decrease in their caring role: (i) The individual characteristics of the nurse were seen to have a key influence on caring experience; (ii) Role changes led to a perceived dichotomy between their actual and aspired role and their caring and clinical role. Relevance to clinical practice. There is a need to achieve a balance between delivering a clinical role (administering chemotherapy) while maintaining the centrality of the nurse–patient relationship. This can be likened to achieving a balance between ‘nursing the clinic’ alongside ‘nursing the patient’. These findings have implications for the discourse on caring within other outpatient type clinics and discourse on cancer nursing as therapy and the culture of the cancer clinic. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of this present study was to explore patients’ experiences of the meaning they attribute to hope and hoping a year after acute spinal cord injury. Background. Nursing literature is pointing towards the importance of having hope for a healthful living. However, the concept of hope has preliminarily been defined in an abstract and general way and is therefore difficult to grasp. Design and methods. This qualitative study has a longitudinal and descriptive–explorative design. Data were collected by personal interviews ( n = 10) one year after acute spinal cord injury. A phenomenological–hermeneutic approach, based on the philosophy of Ricoeur, was used to extract the essences of the patients’ experiences. Results. The findings resulted in one main interpretation: ‘The Power of Hope’, and two sub-themes: ‘Will, Faith and Hope’ and ‘Hoping, Struggling and Growing’. The power of hope was interpreted as the individual having experienced the meaning a year after the injury, mainly expressed through will power. Conclusions. This study shows that experiences of hope were important to all participants, providing energy and power to the process of struggling because hope is necessary for further progress and personal development. Relevance to clinical practice. Nursing interventions should be mainly directed towards emotional and motivational strategies to promote the will power and personal growth through learning experiences. [ABSTRACT FROM AUTHOR]

Purpose:To describe the nursing interventions used most frequently during an acute hospital stay for three patient groups.Methods:Analysis of nursing interventions documented by use of the Nursing Interventions Classification (NIC) contained in an electronic clinical database obtained from 33 general inpatient units in one large health care facility from July 1, 1998, to June 30, 2002. The numbers of hospitalizations for each sample in the analyses were: 1,435 in the heart failure group, 567 in the hip fracture procedures group, and 11,756 in the fall prevention group.Findings:The mean number of interventions done at least once during a single hospitalization ranged from 18 to 22 for the three samples. For the total number of patient hospitalizations for each group, the number of interventions ranged from 94 for the hip fracture procedures sample to 182 for the fall prevention sample. Seven interventions were done twice or more a day in at least 20% of the sample in all three groups. Patterns of interventions during the first 6 days of care differed by intervention and sample, indicating that nursing care was individualized.Conclusions:The results indicate the types of information that can result from analysis of actual clinical nursing data documented with standardized language (Nursing Interventions Classification) in a nursing information system. The knowledge of nursing interventions used in clinical practice has major implications for staff development and nursing education. The information is also useful in making staffing decisions for different types of patient populations.Journal of Nursing Scholarship, 2005; 37:1, 57-66.© 2005Sigma Theta Tau International. [ABSTRACT FROM AUTHOR]

Re-reading nursing and re-writing practice: towards an empirically-based reformulation of the nursing mandate This article examines field studies of nursing work published in the English language between 1993 and 2003 as the first step towards an empirically based reformulation of the nursing mandate. A decade of ethnographic research reveals that, contrary to contemporary theories which promote an image of nursing work centred on individualised unmediated caring relationships, in real-life practice the core nursing contribution is that of the healthcare mediator. Eight bundles of activity that comprise this intermediary role are described utilising evidence from the literature. The mismatch between nursing's culture and ideals and the structure and constraints of the work setting is a chronic source of practitioner dissatisfaction. It is argued that the profession has little to gain by pursuing an agenda of holistic patient care centred on emotional intimacy and that an alternative occupational mandate focused on the healthcare mediator function might make for more humane health services and a more viable professional future. [ABSTRACT FROM AUTHOR]

BACKGROUND: Teamwork is regarded as the cornerstone of rehabilitation. It is recognized that the skills of a multiprofessional team are required to provide the care and interventions necessary to maximize the patient's potential to recover from his/her stroke. LITERATURE REVIEW: Critical evaluation of team working is lacking in the literature. Indeed, there is no consensus on a precise definition of teamwork or on the best way of implementing it, beyond a general exhortation to members to work to the same therapeutic plan in a cohesive manner. The literature has highlighted many problems in team working, including petty jealousies, ignorance and a perceived loss of autonomy and threat to professional status. AIM: To determine if the use of team co-ordinated approaches to stroke care and rehabilitation would improve staff attitudes to team working. METHOD: A pre-post design was adopted using 'The Team Climate Inventory' to explore attitudes to team working before and after introducing the interventions. Local Research Ethics Committee approval was obtained. RESULTS: Improvements in attitudes towards team working suggest that the introduction of team co-ordinated approaches (integrated care pathways and team notes) did not result in greater team working. LIMITATIONS: The introduction of an integrated care pathway and team notes is based on an assumption that they would enhance team working. CONCLUSIONS: The results suggest that the introduction of team co-ordinated approaches (team notes and care pathways) do not improve attitudes to team working, teams appear to take a long time to establish cohesion and develop shared values. [ABSTRACT FROM AUTHOR]

Behavioral techniques are increasingly being applied in the geriatric field as part of a broader emphasis on psychological and social treatments in the care of the elderly. The nurse is in the best position to analyze a patient's performance and manage an intervention program; however, some nurses have had little experience of autonomously diagnosing problems and setting performance goals. The authors argue that it is important to set such goals and give examples of how performance may be objectively specified, prerequisites made explicit, criteria for success defined and the con-sequences of goal attainment or non-attainment discussed with those most concerned. A complex situation drawn from the geriatric setting which was used as part of a teaching workshop to help nurses define suitable targets for intervention is described in the Appendix. [ABSTRACT FROM AUTHOR]

In that nursing and sociology arc both concerned with people and the way they interact, it is likely that theories developed in either discipline will provide insights for the other. The theory of social-exchange is therefore viewed in the light of the nurse and patient seeking to meet their own needs and goals and a model is suggested which may indicate levels of satisfaction. Organization theories and patterns of power and compliance are considered in the context of their effect on goal achievement and tentative explanations are offered for behaviour by nurses and patients that might be considered deviant. [ABSTRACT FROM AUTHOR]

Explores the implications of the automation of the health care system for nursing in the U.S. Categorization of automation in a system; Loss of the interaction framework within which the nurse-client relationship occurs; Impact of automation on the primary focus of the nursing profession.

Presents a study that reviews one method implemented in an acute medical/surgical ward and discusses the use of a quality assurance project to ensure a consistent approach to the handover. Need for communicating high-quality patient information accurately, completely and in the most timely and effective way; Analysis of change of shift handovers between nurses; Problems encountered during handovers; Improvement in the communication between staff with less time wasted in accessing information as a result of the audit on the nursing handover.

Reports on the completion of a study of nurses' judgment of patient distress derived from different cultures. Cooperation of the American Nurses Foundation, health professionals from the various countries studied; Confirmation of the difference of the judgment of patient distress by licensed practical nurses; Use of the standard Measure of Inference questionnaire in the study.