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Presents several papers on nursing outcomes. "Nursing-Sensitive Outcome Implementation and Reliability Testing in a Tertiary Care Setting," by Julia G. Behrenbeck; "Nursing Outcomes Classification (NOC) Implementation and Testing in a Cardiac Surgery ICU," by Kathy Demmer; "Validity Surveys: Selected Nursing Outcomes Classification (NOC) Physiologic Outcomes," by Cindy A. Scherb and Sandra L. Bellinger.

Discusses the contents of the December 2003 issue special section of "Health Services Research." Appeal for the submission of research focusing on the management of chronic illness in managed care setting; Selection criteria for papers; Funding for the medical care quality research from the Agency for Healthcare Research and Quality.

When concepts and the `paper and pencil' tests used to measure these concepts are developed in fields other than nursing and subsequently arc used for nursing purposes. the perspective mismatch heralds a validity issue. This paper presents a case for clinical construct validity as one method of evaluating whether the substantive meaning of a test captures the nursing meaning. [ABSTRACT FROM AUTHOR]

Aim. This paper is a critique of the use of critical incident technique in nursing and a demonstration of how its development has resulted in inconsistency and confusion. Background. Critical incident technique is used globally by nurse researchers to explore a plethora of nursing issues. Its main strengths are flexibility and adaptability, but its popularity has resulted in ambiguity and confusion. Data sources. A search of the CINAHL database for the period 1956-2007 was performed using the search terms critical incident technique and nursing. Together with hand searching, this produced a total of 59 papers. The papers were analysed according to country of origin, research topic, sample size, data collection method, inclusion/exclusion criteria, data analysis and terminology. We then categorized the results of this analysis depending on similarities and differences in the papers. Discussion. We focus on two areas: methodology and terminology. From a methodological perspective critical incident technique has become inconsistent and in relation to terminology, the diverse language associated with the technique has created confusion. Moreover, issues of rigour may be compromised as a result of this inconsistency. A great deal of inconsistency has been created by nurse researchers' attempts to advance critical incident technique. This has led to confusion, which is not helpful for advancing nursing knowledge. Conclusion. While embracing the continued development of critical incident technique, we advocate a standardized approach to its use. Unless nurse researchers are alert to the methodological and terminological inconsistencies in use of the critical incident technique, it risks becoming an interminable quagmire through which navigation will be impossible. [ABSTRACT FROM AUTHOR]

The section introduces several papers which deal with issues and innovations in nursing practice.

This paper is a report of a systematic review to identify, critique and synthesize nursing studies of the measurement of empathy in nursing research. Background. The profound impact of empathy on quality nursing care has been recognized. Reported empathy levels among nurses range from low to well-developed and there is clearly debate about what constitutes empathy and how it can be measured and improved. Data sources. Searches were made of the CINAHL, MEDLINE and PsycINFO databases, using the terms 'empathy', 'tool', 'scale', 'measure', 'nurse', and 'nursing', singly or in combination to identify literature published in the English language between 1987 and 2007. Methods. A systematic review was carried out. The included papers were critically reviewed, relevant data were extracted, and a narrative synthesis was conducted. Results. Thirty papers representing 29 studies met the inclusion criteria. Three types of studies were identified: descriptive studies ( n = 12), studies of empathy and patient outcomes ( n = 6), and evaluational studies ( n = 11). Twenty scales were used, with more than one tool being applied in some studies, suggesting the need for a systematic review of empathy measures in nursing research. A range of settings were studied but some, such as genetic healthcare, have been neglected. Conclusion. Despite numerous tools being used in nursing research to assess empathy, there appears to be no consistency, suggesting the need to evaluate the rigour of empathy tools appropriately, either to inform education or for application in clinical settings. [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]

Provides an overview of articles on issues and innovations in nursing practice.

Presents summaries of articles on issues and innovations in the nursing practice worldwide as of May 2004. "Medical Hegemony in Decision-Making - A Barrier to Interdisciplinary Working in Intensive Care?," by M. Coombs and S. J. Ersser; "The Postmodern Heart: War Veterans' Experiences of Invasive Cardiac Technology," by C. C. Anderson; "Rational Suicide: Uncertain Moral Ground," by K. L. Rich and J. B. Butts.

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]

In this paper the constructs `stress' and `coping' as defined in an earlier paper (Clarke 1984) are used as a perspective for the interpretation of disease processes. The second half of the paper is devoted to an examination of the nurse's role which is seen as concerned with helping patients in the reduction or avoidance of stress and the strengthening of coping. General hospital nursing and district nursing is analyzed in greater depth than other types of nursing. [ABSTRACT FROM AUTHOR]

This paper is concerned with the evaluation of a workshop for teachers of nursing devoted to an individualized teaching and learning strategy. The paper gives a brief account of the history of such workshops and continues by defining individualized teaching. Following this the characteristics of the Keller Plan strategy are outlined. This is followed by details of the course organization; its aims and objectives, and the characteristics of the course members. Finally, the method of evaluation is described and results are discussed. [ABSTRACT FROM AUTHOR]

Presents information on the "Journal of Advance Nursing." International relevance of the journal; Overview of its establishment; Subscribers and readers of the journal.

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.

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.

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 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]

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]

Presents an introduction to a series of articles about issues and innovations in nursing practice.

Introduces a series of articles focusing on nursing.

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]

Objective: To review the definition of ‘primary care’ and ‘inappropriate’ patients in ED and develop a generally acceptable working definition of a ‘primary care’ presentation in ED. Method: A Medline review of articles on primary care in ED and the definitions used. Results: A total of 34 reviewed papers contained a proposed definition or comment on the definition for potential ‘primary care’, ‘general practice’, or ‘inappropriate’ patients in ED. A representative definition was developed premised on the common factors in these papers: • Low urgency/acuity – triage categories four or five in the Australasian Triage Scale • Self-referred – by definition, patients referred by general practitioner/community primary medical services are not primary care cases because a primary care service has referred them on • Presenting for a new episode of care (i.e. not a planned return because planned returns are not self-referred) • Unlikely to be admitted (in the opinion of Emergency Nurse interviewers) or ultimately not admitted Discussion: This definition can be applied either prospectively or retrospectively, depending on the purpose. Appropriateness must be considered in light of a legitimate role for ED in primary care and the balance of resources between primary care and emergency medicine in local settings. [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]

Presents a list of articles on nursing and health care management issues, published in January 2003.

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.

Introduces a series of articles on advanced nursing.

The article presents a call for papers for the annual history issue of the periodical "Nursing Inquiry." It invites submissions from historians of nursing or health-care on any topic of historical concern. Individual or themed submissions welcome. Interested parties are advised to contact Sioban Nelson for discussion on themed issues. Other contact information relative to the matter is presented.

This paper challenges the notion of “care”, arguing that people who need support in their daily lives have been constructed as “dependent people”. Instead, the author argues, if we want to empower people we must learn from the Independent Living Movement, from the people who struggled against segregation and insisted that access to personal assistance over which they have control is a civil rights issue. The paper takes issue with Clare Ungerson's perspective on the new direct payments legislation. This legislation is an important stage in the achievements of a civil rights movement and social researchers have a moral responsibility to collaborate with this movement in any work which they develop on issues which are not of mere academic interest but which concern people's rights to choice and control in their lives. [ABSTRACT FROM AUTHOR]

GAVIN J.N. (1997) Journal of Advanced Nursing 26, 692-697 Nursing ideology and the 'generic carer' A review of the concept of ideology in a nursing context is presented. The meaning of a nursing ideology is explored and that meaning compared to the proposals for the future of nursing contained in the 1996 report on The Future Healthcare Workforce published by the University of Manchester, England. The paper suggests a number of core beliefs and values that are generally supported in nursing and their implications for the future development of the profession. These include a commitment to the role of science in nursing, the concept of caring in nursing practice and the continued pursuit of the professional project. The paper will demonstrate the extent to which the proposals contained within the report for a 'generic carer' compliment or conflict with the suggested ideology of nursing. It concludes with a reference to the policy-making process at local and national levels and the opportunities available to nurses to influence the direction of change. The paper reflects the volatility of the current political climate in health care and the extent to which nurses operating in that climate feel empowered or disenfranchised. [ABSTRACT FROM AUTHOR]

This paper discusses the way in which quality of care has been measured and in particular draws attention to the vagueness of concepts such as autonomy, individuality and dignity. In our research we have put forward a number of indicators for the quality of care received by patients and, in addition, we have constructed a method by which they can be measured, through the use of standardized observation schedules. This paper therefore describes our indicators and the data collection process followed. This aspect of our work is part of a larger study into work satisfaction and quality of care in psychogeriatric wards in Scotland. Ultimately, the data will allow us to identify factors affecting high and low levels of job satisfaction as well as factors influencing good and bad quality of care. Further, we will be able to examine any association between work satisfaction and the quality of care delivered to patients. The results of this research are due to be published shortly. [ABSTRACT FROM AUTHOR]

The development of community care policy and the inadequacies of professional responses to the needs of informal carers were described in an earlier paper. A qualitative analysis of carers' replies to a questionnaire survey demonstrated that the most potent stressors, contrary to what has previously been assumed, were linked more to subjective perceptions of events or circumstances than to the objective features of the events and circumstances themselves. This paper presents a quantitative analysis of data from the same survey which confirm the impressions gained from the analysis of the qualitative data. These findings prompt a reconceptualization of carer burden within a transactional model of stress, which is then considered as a basis for understanding how carers adapt to stress in their lives. Practice implications are assessed. [ABSTRACT FROM AUTHOR]

This paper is concerned with the phenomenon of human suffering and is an attempt to justify and begin theoretical development of this phenomenon for nursing science. The paper is divided into three sections. The first section describes the interest of nursing science in the phenomenon and critically examines relevant literature in order to further conceptualize development and clarification. This section concludes with a theoretical definition of suffering derived from this critique. Suffering is defined as an individual's experience of threat to self and is a meaning given to events such as pain or loss. The second section elaborates on this definition and examines how it can inform theoretical discussion in two areas with import for nursing -- the patient's experience of suffering and the nurse's experience of patient suffering. The final section briefly considers some implications for clinical research. [ABSTRACT FROM AUTHOR]

Course evaluation is defined 'as the collection and use of information in order to make decisions about an educational programme' (Cronbach 1963). The study described in this paper was undertaken by members of the professional and research staff of the Joint Board of Clinical Nursing Studies, Londoa The paper describes how the need for work on course evaluation arose and how a package was developed and piloted in 15 course centres with a total of 205 students. The ways in which the package is being used by schools of nursing and colleges of higher and further education is also described The philosophy that evaluation has an important part to play in developing dynamic and sound educational systems is emphasized Evaluation should be an integral part of every course and planned at the outset with other parts of the detailed course programme, involving both students and teachers in measuring the effectiveness of the course. [ABSTRACT FROM AUTHOR]

This paper addresses the place, position and potential of what is characterized as the `Learning Resources Movement' in nurse education. It is based on experiences drawn from 10 years viewing resource use in general and nursing education, and, more recently, on observations arising from a research project looking at the growth within the school of nursing, of organizational structures for their development. It dims that the true potential of the movement has nowhere been fully realized It sees the present position as indeterminate and misconceived It claims that further development of such resources as are and will be available is intricately tied up with the professional development of nursing in a `chicken-and-egg' situation. It argues that the stage has now been reached where the successful development of the one cannot proceed without the successful development of the other. Drawing on a fairy-tale analogy the paper views the Learning Resources Movement as a powerful tool for seeing through the shining surfaces of what to many are new curricular clothes and dealing with the basic truths of the situation underneath. [ABSTRACT FROM AUTHOR]

Focuses on the development of practice with respect to end-of-life issues in long-term care. Papers published in the 2006 issue of the "International Journal of Older People's Nursing"; Call for addressing the lack of definitive evidence to support the development of particular interventions in the area of geriatric nursing.

PURPOSE. This paper aims to provide insight into nursing classifications and to report the effects of nursing diagnostics implementation. This paper summarizes the results of six studies. METHODS. Two systematic reviews, instrument development and testing, a pre–post intervention study, and a cluster-randomized trial were performed. FINDINGS. The NANDA International classification met most of the literature-based classification criteria, and results showed the Quality of Nursing Diagnoses, Interventions and Outcomes (Q-DIO) to be a reliable instrument to measure the documented quality of nursing diagnoses, interventions, and outcomes. Implementation of standardized nursing language significantly improved the quality of documented nursing diagnoses, related interventions, and patient outcomes. As a follow-up measure, Guided Clinical Reasoning (GCR) was effective in supporting nurses’ clinical reasoning skills. CONCLUSIONS. Carefully implementing classifications led to enhanced, accurately stated nursing diagnoses, more effective nursing interventions, and better patient outcomes. IMPLICATIONS. Rethinking implementation methods for standardized language and using GCR is recommended. Based on the results of this study, the inclusion of NANDA International diagnoses with related interventions and outcomes in electronic health records is suggested. [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]

Title. The essence of nursing care: Polish nurses’ perspectives Aim. This paper is a report of a study to identify Polish nurses’ definition of the concept of nursing care. Background. Polish nursing currently is in a period of scientific research focusing on development of precise definitions of concepts. Definitions of nursing are influenced by culture, social expectations and healthcare systems. Accepted scientific definitions of concepts should be based on empirical verification that takes theoretical and practical perspectives into account. Methods. A survey questionnaire was constructed from analysis of a random sample of 27 essays about nursing care that had been completed by 300 Polish nurses. The survey questionnaire, which was designed to measure the essence of nursing care, was completed by 324 Polish nurses during 2004 and 2005. Findings. Analysis of survey questionnaire responses revealed that the essence of nursing care encompasses providing care, communicating, supporting, helping, assisting, accompanying and managing. Participants indicated that nursing care recipients include healthy persons, ill persons and persons at risk for disease. Conclusion. The concept of nursing care encompasses several traits or characteristics that can be applied to both well and ill people. [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]

GOBBI M. Nursing Inquiry 2005; 12: 117 –125 Nursing practice as bricoleur activity: a concept explored The debates concerning the nature of nursing practice are often rooted in tensions between artistic, scientific and magical/mythical practice. It is within this context that the case is argued for considering that nursing practice involves bricoleur activity. This stance, which is derived from the work of Levi-Strauss, conceives elements of nursing practice as an embodied, bricoleur practice where practitioners draw on the‘shards and fragments’ of the situation-at-hand to resolve the needs of the individual patient for whom they care. This conceptualisation of nursing practice will be analysed with a particular emphasis on its implication for nursing epistemology, pedagogy and praxis. The evidence to support this argument is drawn from empirical work that investigated nurses’ use of intuition, the work of Levi-Strauss, and issues in nursing epistemology and ontology. The paper itself is written from the perspective of a bricoleur who uses‘bits and pieces’ from the domains of nursing, philosophy, psychology, education, sociology and anthropology. [ABSTRACT FROM AUTHOR]

Aim. The aim of this paper is to discuss six issues influencing the introduction of advanced practice nursing (APN) roles: confusion about APN terminology, failure to define clearly the roles and goals, role emphasis on physician replacement/support, underutilization of all APN role domains, failure to address environmental factors that undermine the roles, and limited use of evidence-based approaches to guide their development, implementation and evaluation.Background. Health care restructuring in many countries has led to substantial increases in the different types and number of APN roles. The extent to which these roles truly reflect advanced nursing practice is often unclear. The misuse of APN terminology, inconsistent titling and educational preparation, and misguided interpretations regarding the purpose of these roles pose barriers to realizing their full potential and impact on health. Role conflict, role overload, and variable stakeholder acceptance are frequently reported problems associated with the introduction of APN roles.Discussion. Challenges associated with the introduction of APN roles suggests that greater attention to and consistent use of the terms of the terms advanced nursing practice, advancement and advanced practice nursing is required. Advanced nursing practice refers to the work or what nurses do in the role and is important for defining the specific nature and goals for introducing new APN roles. The concept of advancement further defines the multi-dimensional scope and mandate of advanced nursing practice and distinguishes differences from other types of nursing roles. Advanced practice nursing refers to the whole field, involving a variety of such roles and the environments in which they exist. Many barriers to realizing the full potential of these roles could be avoided through better planning and efforts to address environmental factors, structures, and resources that are necessary for advanced nursing practice to take place.Conclusions. Recommendations for the future introduction of APN roles can be drawn from this paper. These include the need for a collaborative, systematic and evidence-based process designed to provide data to support the need and goals for a clearly defined APN role, support a nursing orientation to advanced practice, promote full utilization of all the role domains, create environments that support role development, and provide ongoing evaluation of these roles related to predetermined goals. [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 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 paper presents a sociocultural and historical literature review of gender related issues associated with family-centered caregiving for frail, elderly relatives in modern Japan. Issues addressed from a Japanese perspective are (a) women and social norms of caregiving, (b) feminine identity and caregiving, (c) women in the workforce, and (d) women and caregiving. Implications for research are also discussed. [ABSTRACT FROM AUTHOR]

How can we achieve evidence-based practice if we have a theory–practice gap in nursing today? ¶The purpose of this paper is to discuss how nursing can achieve evidence-based practice when a theory–practice gap exists in nursing today. The paper commences with an introduction to the concept of evidence-based practice and a discussion of the relationships between theory, practice and the theory–practice gap. An analysis of the two concepts will then be presented from within the four pillars of nursing, namely management, practice, research and education. The paper will conclude with a discussion of whether evidence-based practice can be achieved in view of the theory–practice gap. [ABSTRACT FROM AUTHOR]

Special issue Nursing science: knowledge development for the good of persons and society Guest editors: Pamela J Grace and Danny G Willis [ABSTRACT FROM AUTHOR]

The paper gives a brief account of the development of individualized nursing care, from the introduction of the nursing process to the more recent interest in primary nursing. Individualized care would appear to have been adopted as an ideal by the nursing profession, with little debate about some of the possible implications of such an approach. The paper outlines some other perspectives on patient care, and discusses the limitations of an individualistic framework which fails to acknowledge the communal and societal aspects of patient care. [ABSTRACT FROM AUTHOR]