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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]

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]

This article presents consultation papers of the United Kingdom Central Council for Nursing, Midwifery and Health Visiting. Consultation papers prepared by the working groups are now being given a wide distribution throughout the professions of nursing, midwifery and health visiting. The task of the working groups, in considering comments will be greatly assisted if views on the recommendations and proposals in the consultation paper are channelled back through an appropriate professional organization or trade union. The Council has set up seven working groups. Each working group is looking at a particular aspect of the 1979 Act and the related future responsibilities which the Council will inherit.

This paper explores a night nursing sub-culture which is struggling to survive. The context is the NHS in the UK. This exclusively female group within an organization numerically dominated by women evokes hostile reactions from other cultural groups within the NHS, based on its perceived espousal of 'female' ways of being. Increasingly threatened by the new managerialism of the NHS, the permanent night shift faces extinction as a group. This paper describes the night nurse culture as it exists in a general hospital and offers some insights into the way that gender relations evolve to sustain male power in an organization where women are numerically dominant. [ABSTRACT FROM AUTHOR]

This article presents information related to nursing. At a reception given by Her Majesty Queen Elizabeth the Queen Mother at St James's Palace, London to mark the thirtieth birthday of The British Commonwealth Nurses War Memorial Fund, future plans were announced. The Council of the Royal College of Nursing of Great Britain has decided to create fellows from amongst its members of at least five years' standing who have made exceptional contributions to the advancement of the science and art of nursing. Fellows will be expected to have completed a course in post-basic nursing education where appropriate, and to present a paper or thesis and/or demonstrate innovation or exceptional competence in advancing nursing.

AIM AND OBJECTIVE: The purpose of this study was to explore, describe and develop a greater understanding of the experiences of overseas black and minority ethnic nurses in the National Health Service (NHS) in the south of England. BACKGROUND: For the past five decades, the NHS has been recruiting overseas black and minority ethnic nurses from several former British colonies to alleviate the manpower shortages. More recently there has been a shortage of nurses in the labour force and as a result the NHS has once again recruited overseas nurses. Despite this recruitment drive there are limited studies outlining how overseas black and minority nurses have fared in the NHS. METHODS: This qualitative phenomenological study used four purposeful focus groups and all participants involved were interviewed at a place convenient for them. These all non-white participants originated from Asia, Africa and the Caribbean. Each focus group contained six participants with an overall total of 24 participants involved in the study. RESULTS: Following thematic analysis, the findings revealed six themes such as, the devaluation process, concept of self-blame, discrimination/lack of equal opportunity, concept of invisibility, experiencing fear and benefits of being here. Several overseas nurses felt devalued and indicated that white UK nurses appeared to have placed little trust in them. They stated that both discrimination and lack of equal opportunity were present in the workplace and they also revealed that some white UK nurses were sometimes abusive. As a result they tolerated such behaviour for fear of being thrown out with their families. Despite such negative experiences participants indicated that the experiences gained whilst working in the NHS were useful. CONCLUSIONS: There is a need for overseas nurses to be treated fairly and with respect particularly in the light of an acute labour shortage of nurses in the NHS. The findings suggest that overseas minority ethnic nurses' experiences have been mixed, with some positive as well as negative experiences, within a process that devalues them as workers. RELEVANCE TO CLINICAL PRACTICE: This paper highlights a need for a re-evaluation of equal opportunity policies and proposes more diversity training so as to prepare nurses to cope with an increasingly complex and diverse workforce. [ABSTRACT FROM AUTHOR]

There is widespread discussion at the present time of participation--allowing members of an organization to exert an influence on the processes of decision-making. The National Health Service is not isolated from this debate and already a number of experiments have been carried out at various levels of the service to allow a wider range of opinion to influence decisions than hitherto. This paper reports on a study the author carried out into one such exercise, designed to assist a Health Board reach decisions about the long-term pattern of health care in its area. Nurses, paramedical staff and local authority staff, as well as doctors, were appointed to a series of programme planning committees to advise the Health Board on issues of long-term policy. After 2 years of operation, a study was carried out into the operation of the committees and the lessons drawn from the experience should be relevant to actual and potential members of any consultative or decision-making body. [ABSTRACT FROM AUTHOR]

Nurses in the United Kingdom spend much time attempting to fit British nursing practice into the theoretical framework of American nursing models. This is often a manipulative process in that it seeks to establish positive links with a care delivery system totally unlike our own. In the present paper the authors detail the process of establishing a new nursing model which integrates nursing curricula, education and practice to meet the needs of patients, staff and students within their own health district. An over-emphasis on lower levels of human need is common within nursing practice, which, although often blamed upon lack of human and financial resources, is also due to practitioners' misconceptions. The latter are invariably the result of a lack of an adequate or overt, practice orientated, conceptual framework. The Human Needs Model of Nursing adapts Maslow's concept of human needs to create such a conceptual framework for practice. It places equal emphasis on those patient problems which arise as the result of unmet needs at higher levels as well as those at lower levels, thereby acknowledging the holistic and dynamic nature of man. [ABSTRACT FROM AUTHOR]

This article presents information related to nursing. Members of the nursing profession, not only in Great Britain but throughout the World, lost a great friend earlier this year when Elise Gordon died on February 4, 1977. She possessed a rare mix of scholarship, charm and warmth, and was editor of Nursing Mirror for 25 years from 1937 to 1963 when she retired. Proposals for a radical and new reorientation of WHO's programme budget policy, to enhance its effectiveness in serving the world's neediest people, were endorsed at the 59th session of the WHO Executive Board held in Geneva this year.

Chronic obstructive pulmonary disease: a phenomenological study of patients’ experiences The purpose of this study is to explore the experience of living with chronic obstructive pulmonary disease by investigating the subjective phenomenon as described by the patient. Chronic obstructive pulmonary disease is now recognized as one of the most common chronic respiratory diseases in the United Kingdom, with a high prevalence of morbidity and mortality. As the disease progresses, symptoms increase which gradually influence all aspects of the lives of those affected by it. A phenomenological approach was identified as the most appropriate method to gain an understanding of living with chronic obstructive pulmonary disease. The data were obtained from 10 participants using unstructured interviews to capture detailed experiences verbatim. Analysis, based on the framework of Diekelmann et al. ( The NLN Criteria for Appraisal of Baccalaureate Programs: A Critical Hermeneutic Analysis, NLN Press, New York, 1989), was employed to interpret the data and determine shared themes that evolved during the course of the research. The data revealed valuable insights, from a patient's perspective, into the impact chronic obstructive pulmonary disease had on their daily lives. The accounts obtained from participants, many of who had severe chronic obstructive pulmonary disease, illustrate the detrimental effects of this debilitating disease. Breathlessness was identified as the most troublesome symptom leading to anxiety, panic and fear. Participants also described feeling frustrated and tired because of their breathlessness, which led to loss of social activity. This also resulted in a loss of their role within the family including loss of intimacy in personal relationships. Despite this, half of the participants felt they had a fairly good quality of life. The use of phenomenology as a research methodology fulfilled the aim of gaining a greater understanding of the experiences of living with chronic obstructive pulmonary disease. It provided valuable insights into how patients view the overall impact and their subsequent degree of coping with chronic obstructive pulmonary disease from day to day. Whilst there is no cure for chronic obstructive pulmonary disease and medical interventions have limited effect, health professionals can do much to improve patient's symptoms and experiences of living with chronic obstructive pulmonary disease by listening to how their symptoms affect them and adapting coping strategies. It is hoped that the themes revealed in this study generate additional understanding and insight for future innovative practice. [ABSTRACT FROM AUTHOR]

Maclaren j. (2004) Journal of Advanced Nursing 45(5), 457–464 A kaleidoscope of understandings: spiritual nursing in a multi-faith society Spirituality is an increasingly discussed topic in nursing. In some parts of the UK there is a policy requirement to establish policies of spiritual health care which are appropriate to a multi-cultural society. In the nursing literature, spirituality is discussed from religious and secular perspectives which seem impossible to reconcile into a coherent philosophy. To discuss the relationship of spirituality to nursing and to suggest how we can think about spirituality as nurses working in a society of many faiths and cultures. Spirituality can be thought of in relation to individual patients and nurses. It also has significance for the profession of nursing and for health care as a whole. The difficulty of defining spirituality is discussed, and it is suggested that a definition of ‘spiritual nursing’ may be more achievable. Different concepts of spirituality are compared, including religious and secular spirituality. The relationship between religion and spirituality is seen as potentially problematic, with some religions denying the existence of secular spirituality. Secular spirituality and New Age movements are non-religious but spiritually influential phenomena. The problem for nursing is how to reconcile the immense variety of approaches to spirituality. The concept of spirituality as a meta-narrative is considered, and a postmodern appreciation of pluralism is employed as a way of embracing different spiritual realities. Spiritual nursing can be an opportunity for nurses to enlarge their understanding of the human condition rather than a narrowly defined concept to be applied within a model of practice. [ABSTRACT FROM AUTHOR]

The article presents an insight to changes taking place in nursing profession. Nurses themselves are embarking on a long and penetrating period of self-examination of their own roles and priorities. As far as nurses are concerned, the present National Health Service Organization of the Great Britain is a valuable tool in this overture to long term change. It is going to enable nurses to take a major step forward, where they are going to be much more in the front line and not just as shock troops but as the leaders and governors of their own profession.

As part of a larger study, female student nurses from overseas and Britain in four training schools for the general nursing register were interviewed to obtain their perceptions of their reception at the hospital. their later welfare, and some of their general reactions to their training. Differences between the British and overseas student nurses were mainly related to experience before training and their reception at the hospital. Many similarities between the two groups were also found with respect to their later experiences and attitudes toward nursing. A proportion of the overseas students had experienced expressions of racial prejudice from patients. [ABSTRACT FROM AUTHOR]