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The main aim of this paper is to explore and discuss the interesting juxtaposition of patient involvement within a standardised Enhanced Recovery After Surgery care programme (ERAS). We address our aim by examining the work and strategies of nursing staff caring for patients during postoperative recovery from surgery, exploring how these two potentially competing priorities might effectively co‐exist within a hospital ward. This was a qualitative exploratory study, with data generated through 42 semi‐structured interviews with patients and nurses who had taken part in an ERAS programme in one of three hospital wards in the United Kingdom, adopting a reflexive thematic approach to data analysis. We shine a light on the work undertaken by patients and nurses during the navigation of postoperative recovery, identifying strategies of collaboration and negotiation during this journey. Furthermore, we also identify and consider patients engaged in peer‐peer support during postoperative recovery. This paper adds to the existing literature and current ways of thinking in relation to the quest for standardised, clinically effective care balanced with the aspirations for individualised, patient‐centred care. This paper also helps inform thinking about the use of care pathways in relation to service delivery, considering how best to initiate and deploy best practice aimed at safe and effective postoperative recovery. [ABSTRACT FROM AUTHOR]

Background: Moral distress is recognized as an international problem that contributes to decreased work productivity, job dissatisfaction and intent to leave for adult Critical Care nurses. Aim: To explore Critical Care nurses moral distress levels using the Moral Distress Scale Revised (MDS‐R) and its relationship with intention to stay. The study reported in this paper was part of a larger study that also investigated Critical Care nurses' work environment in Canada and the Midlands region of the UK. Study design: During January to August 2017 a cross‐sectional survey was distributed to adult Critical Care nurses in the Midlands region of the UK. Methods: Surveys were distributed to adult Critical Care Registered Nurses in the Midlands region of the UK examining moral distress levels and intention to stay in Critical Care, the organization (NHS Trust) and in the nursing profession. Results: Two hundred sixty‐six number of a potential sample of 1066 Critical Care nurses completed the survey (25% response rate). Age and moral distress were significantly positively correlated with intention to stay on their current unit (r = 0.16, P =.05), indicating older nurses were more likely to stay in the critical care unit. Moral distress was negatively correlated with intent to stay scores, showing critical care nurses with higher levels of moral distress were less likely to stay on their unit (r = −0.20, P =.02). Moral distress was also significantly negatively correlated with intention to stay with their current employer (r = −0.28, P <.001). Nurses that stated they had high rates of moral distress were more likely to consider leaving their current employer. Conclusion: Moral distress appears to be an issue among adult Critical Care nurses requiring further exploration and development of effective strategies to reduce this phenomenon and stabilize the workforce by reducing turnover. Relevance to clinical practice: By identifying the top causes of moral distress, tools and strategies can be developed to allow the Critical Care nurse to work within an ethically safe clinical environment and reduce the turnover of experienced adult Critical Care nurses. [ABSTRACT FROM AUTHOR]

Purpose To examine the nature of the interruptions during medication work. Design An exploratory descriptive design was used with 28 nurses during 15 medication rounds in the medical, surgical, and gynecology wards at a 1000‐bed tertiary teaching hospital in Saudi Arabia. Methods: Non‐participant prospective observational and follow‐up interview methods were used to collect data. A standard paper‐based tool and digital stopwatch to count the interruptions were used. Nurses' sources, the secondary tasks undertaken, and the impacts of the interruptions were considered. The data were analyzed via descriptive analysis. Results: A total of 87 medication‐related events occurred. In these, 182 interruptions accounted for 90.0% of the total. Interruptions were more frequent during medication administration and often occurred in the corridors and patients' rooms. Nurses, medical officers, and impediments were frequent sources of interruptions. The secondary tasks attended by the nurses were mostly related with impediment resolutions and patients' needs. System failures appeared to be associated with clinical and procedural errors. Conclusion: The results of this study provide information regarding the course of interruptions during medication work in a Saudi Arabian hospital. Nurses were the main source of interruptions related with the provision of patient care and resolution of impediments. Interruptions tended to be associated with clinical errors and procedural failures due to system failure. Promoting a culture of respect and workplace etiquette in global healthcare settings demands minimizing non‐life‐threatening interruptions during nursing works. Clinical relevance: Strategies used in hospital management systems that affect nursing, pharmacies, human resources, and ancillary service department collaborations should be monitored for effectiveness and to ensure patient safety. Various approaches toward medication management systems, such as the utilization of an Omnicell automatic dispensing machine and cabinets within each patient's room, as well as others, such as wearing a "no‐interruption zone" sign, could be tailored and matched to the context of the practice to reduce interruptions. [ABSTRACT FROM AUTHOR]

Positioning the individual at the centre of care (person‐centred care [PCC]) is essential to improving outcomes for people living with multiple chronic conditions. However, research also suggests that this is structurally challenging because health systems continue to adopt long‐standing, episodic care encounters. One strategy to provide a more cohesive, individualised approach to care is the implementation of the nurse navigator role. Current research shows that although PCC is a focus of navigation, such care may be hindered by the rigid, systematised health services providing siloed specialist care. In this paper, we utilised a case study method to investigate the experiences of a nurse navigator and patient. The nurse navigator and the patient participated in individual interviews, the transcripts of which were analysed using critical discourse analysis. Findings from a larger research project suggest that traditional measures (hospital avoidance, emergency department usage) which work as the service objectives of the nurse navigator service have the potential to stifle the delivery of PCC. The analysis from this case study supports the broader findings and further highlights the need for improved alignment between service objectives and the health and well‐being of the individuals utilising the services. [ABSTRACT FROM AUTHOR]

Abstract: Background: The increase in the incidence of dementia in the aging population and the decrease in the availability of informal caregivers put pressure on continuing care systems to care for a growing number of people with disabilities. Policy changes in the continuing care system need to address this shift in the population structure. One of the most effective tools for assessing policies in complex systems is system dynamics. Nevertheless, this method is underused in continuing care capacity planning. Methods: A system dynamics model of the Alberta Continuing Care System was developed using stylized data. Sensitivity analyses and policy evaluations were conducted to demonstrate the use of system dynamics modelling in this area of public health planning. We focused our policy exploration on introducing staff/resident benchmarks in both supportive living and long‐term care (LTC). Results: The sensitivity analyses presented in this paper help identify leverage points in the system that need to be acknowledged when policy decisions are made. Our policy explorations showed that the deficits of staff increase dramatically when benchmarks are introduced, as expected, but at the end of the simulation period, the difference in deficits of both nurses and health care aids are similar between the 2 scenarios tested. Modifying the benchmarks in LTC only versus in both supportive living and LTC has similar effects on staff deficits in long term, under the assumptions of this particular model. Conclusion: The continuing care system dynamics model can be used to test various policy scenarios, allowing decision makers to visualize the effect of a certain policy choice on different system variables and to compare different policy options. Our exploration illustrates the use of system dynamics models for policy making in complex health care systems. [ABSTRACT FROM AUTHOR]

ABSTRACT Background The first independent paediatric retrieval nurse practitioners ( RNP) in the UK and Europe were appointed in 2006 in one hospital Trust. Since then, many have been appointed around the UK but the range of responsibility and scope of the role is unknown as well as possible geographical variability. Aim The aim of this paper is to explore the role and scope of paediatric retrieval nurse practitioners in the United Kingdom ( UK). Method A two part questionnaire was sent to all RNPs identified by the regional retrieval/transport centres. Information was sought about the role and scope of RNPs and how the role may have changed since appointment. RNPs were asked to self-assess their own ability in a variety of technical and leadership skills. Conclusion The majority of respondents felt their role had expanded since appointment. RNPs reported that they would now lead the team for any critically ill infant or child where previously they were retrieving stable or high dependency patients. Other expansions of their role included being on a middle grade tier of the medical rota, asked to undertake aeromedical transfers, providing the withdrawal of care at referring centres and non-medical independent prescribing. Relevance to Practice This survey has revealed the changing role and scope of RNPs in the UK but most importantly, the increased responsibility of the roles. Over 80% of RNPs rated their leadership skills between proficient and expert on Benner's Novice to Expert Continuum (Benner, 1984). [ABSTRACT FROM AUTHOR]

AIM: This paper presents the findings of a review and appraisal of the evidence for the effectiveness of nurse case management in improving health outcomes for patients living either with Diabetes, Chronic Obstructive Pulmonary Disease or Coronary Heart Disease. BACKGROUND: Long term chronic health conditions provide some of the greatest challenges to western health care systems. In the UK, three of the most significant chronic conditions are Diabetes, Chronic Obstructive Pulmonary Disease and Coronary Heart Disease. Patients with these long term conditions are high users of health services who often receive unplanned, poorly co-ordinated, ad-hoc care in response to an exacerbation or crisis. To counter this, the nurse case manager is identified as a central aspect of improving care for these patients. However, the evidence for the effectiveness of nurse case management in improving health outcomes for the chronically ill is scarce. DESIGN: A structured review of the literature. METHOD: The review was undertaken focussing on studies that evaluated nurse case management with one or all of the three major long term chronic conditions. A total of 108 papers were initially reviewed and filtered to leave 75 citations that were appraised. About 18 papers were finally included in the review and subject to thematic analysis based on the health outcomes evaluated in the studies. RESULTS: Significantly positive results were reported for nurse case management impact on five health outcomes; 'objective clinical measurements', 'quality of life and functionality', 'patient satisfaction', 'adherence to treatment' and 'self care and service use'. RELEVANCE TO CLINICAL PRACTICE: The evidence generated in this review suggests that nurse case managers have the potential to achieve improved health outcomes for patients with long term conditions. Further research is required to support role development and create a more targeted approach to the intervention. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a concept analysis of forgiveness. Background. Worldwide interest in and funding for forgiveness research has brought about a body of knowledge from many disciplines that could be clinically useful to nursing. At this time, nurse scholars are beginning to challenge one another to focus on this important area of inquiry. To date, however, most scholarship on forgiveness has been conducted in related disciplines, rather than in nursing. Conceptual and theoretical work is needed in nursing to promote knowledge development in this area. Method. The CINAHL, Medline and PsycInfo databases were searched for papers published between 1990 and 2007 using the keywords, forgiveness, forgive, or reconciliation in the title or abstract. The non-linear evolutionary process of concept analysis was used to identify the concept of interest, its origins, realm, attributes and context, characteristics, and implications. Forgiveness was also explored from an international multi-cultural perspective. An exemplar is included to illuminate the concept. A total of 34 scholarly works from a variety of disciplines were included in the analysis. Findings. A definition of forgiveness emerged from the analysis, as well as a multicultural understanding of the concept. Three important attributes of forgiveness are that it is the relinquishing of a negative response, replacing the negative response with a benevolent response, and a process that occurs over time. Multi-cultural attributes centre on group harmony, re-establishing harmonious connections between people, and the morality of considering others as worthy of love and understanding. Conclusion. A multi-cultural understanding of forgiveness may provide the impetus for further theory development and research in nursing, and could be used to educate nurses on beginning interventions in this area. [ABSTRACT FROM AUTHOR]

Mental health triage/duty services play a pivotal role in the current framework for mental health service delivery in Victoria and other states of Australia. Australia is not alone in its increasing reliance on mental health triage as a model of psychiatric service provision; at a global level, there appears to be an emerging trend to utilize mental health triage services staffed by nurses as a cost-effective means of providing mental health care to large populations. At present, nurses comprise the greater proportion of the mental health triage workforce in Victoria and, as such, are performing the majority of point-of-entry mental health assessment across the state. Although mental health triage/duty services have been operational for nearly a decade in some regional healthcare sectors of Victoria, there is little local or international research on the topic, and therefore a paucity of established theory to inform and guide mental health triage practice and professional development. The discussion in this paper draws on the findings and recommendations of PhD research into mental health triage nursing in Victoria, to raise discussion on the need to develop theoretical models to inform and guide nursing practice. The paper concludes by presenting a provisional model for mental health triage nursing practice. [ABSTRACT FROM AUTHOR]

The concrete insertion of nurses into the context of an inquiry contributes to empirical evaluation research of health promotion programs. As interveners and concrete actors in social movements, nurses are in a privileged position to give realism to a local understanding of the political and cultural context of evaluative research. Drawing on the practice of empirical evaluation research, this paper seeks to generate new methodological approaches in a way that broadens nursing inquiries in community health nursing. It explores new ways of thinking about epistemology and knowledge production in nursing practice. For 5 months an evaluative research project adopting a participatory-action research approach was conducted with local community actors in an AIDS prevention project in Amazonas (Brazil) in a prostitution setting. An auto-ethnographic journal was used as a reflective approach for the critical analysis of nursing research activities. This paper calls for a closer relationship between scientific research settings and the sociopolitical and the sociocultural aspects of nursing practice. It increases an incorporation of popular, social and professional experiential learning and skill acquisition in embedded knowledge production. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives The development of rehabilitation and intermediate care services, and roles therein, is part of current UK health policy to meet the demands of the ever-growing older population. One new role is the rehabilitation assistant (RA). This is a generic support worker trained at a basic level in nursing, physiotherapy, occupational therapy and social work who works under the supervision of the referring professionals, to deliver integrated rehabilitation programmes. RAs were introduced in one region in the north-west of England to increase the rehabilitation activity for patients. An empirical qualitative study was recently undertaken to evaluate the impact of the RAs from the perspectives of patients and associated nurses, therapists, managers and the RAs. Methods Fifty-five semi-structured interviews were used to collect data, which was then inductively analysed into categories and then themes. The categories included variations in role, benefits of role, acceptance and integration of role, difficulties with role, training and retention. This paper focuses on the benefits and difficulties of the role. Results It was found that patients, professionals and the RAs expressed great satisfaction with the new role. However, barriers to effective rehabilitation were reported owing to ward routines and organizational systems that interrupted and caused inconsistencies with the rehabilitation care programmes for patients. Conclusions If it is agreed that the majority of patients (unless end stage terminally ill, unwilling or unable) could benefit from some degree of rehabilitation, then there is an issue around how such skills could be widely implemented. This paper discusses the barriers to effective rehabilitation, the benefits and drawbacks of looking at new ways of working and the need for a unified approach by all care workers in rehabilitative care. [ABSTRACT FROM AUTHOR]

AIM: This paper reports on an action research study which raised some questions about the processes of developing a sense of shared ownership in action research in a research environment which does not always have the appropriate mechanisms to support and sustain action research. BACKGROUND: Action research has gained popularity in nursing and healthcare research, offering a way of developing practice-based knowledge, which can assist in changing practice and democratizing inquiry. METHODS: There are other organizational constraints on action research which arise at different levels, and which also require discussion. These can be issues about communication and ownership at a practice level and issues of funding and project management procedures. This paper reports on a study in which these issues came to the fore, and offers some thoughts on how they can affect the processes of action research. CONCLUSION: While the principles of action research appear to offer much towards the development of a practice-rooted body of knowledge for nursing, unless some of the issues of ownership are resolved, it is unlikely to move beyond academic rhetoric. RELEVANCE TO CLINICAL PRACTICE: If nursing is to engage in action research, this must be done critically and reflectively and careful attention paid to developing an inclusive and collaborative approach to knowledge and practice development. Furthermore, to develop in nursing and health care research, it must find ways to meet the requirements of funding bodies. [ABSTRACT FROM AUTHOR]

kearney p.m. & pryor j. (2004) Journal of Advanced Nursing 46(2), 162–170 The International Classification of Functioning, Disability and Health (ICF) and nursing Nursing conceptualizes disability from largely medical and individual perspectives that do not consider its social dimensions. Disabled people are critical of this paradigm and its impact on their health care. The aims of this paper are to review the International Classification of Functioning, Disability and Health (ICF), including its history and the theoretical models upon which it is based and to discuss its relevance as a conceptual framework for nursing. The paper presents a critical overview of concepts of disability and their implications for nursing and argues that a broader view is necessary. It examines ICF and its relationship to changing paradigms of disability and presents some applications for nursing. The ICF, with its acknowledgement of the interaction between people and their environments in health and disability, is a useful conceptual framework for nursing education, practice and research. It has the potential to expand nurses’ thinking and practice by increasing awareness of the social, political and cultural dimensions of disability. [ABSTRACT FROM AUTHOR]

The physical health of people diagnosed with a mental illness is significantly poorer in comparison with the general population. Awareness of this health disparity is increasing; however, strategies to address the problem are limited. Carers play an important role in the physical health care of people with mental illness, particularly in facilitating navigation of and advocating in the health care system. A specialist physical health nurse consultant position has been suggested as a way to address the physical health care disparity and limited research available suggests that positive outcomes are possible. In the present study, a qualitative exploratory research project was undertaken, involving in-depth interviews with people identifying as mental health carers. Two focus groups and one individual interview were conducted involving a total of 13 carers. The resulting data were analyzed thematically. Views and opinions about the proposed physical health nurse consultant (PHNC) position were sought during these interviews and are reported in this paper. Two main sub-themes were evident relating to characteristics of this role: reliability and consistency; and communication and support. Essentially carers expressed a need for support for themselves and consumers in addressing physical health concerns. Successful implementation of this position would require a consistent and reliable approach. Carers are significant stakeholders in the physical health of consumers of mental health services and their active involvement in identifying and tailoring services, including development of the physical health nurse consultant must be seen as a priority. [ABSTRACT FROM AUTHOR]

The paper describes the collection, some methodological difficulties and interpretation of some data from a study carried out in the Research Unit 1969-75, with students from three intakes (1969, 1970 and 1971) to six types of experimental and the traditional scheme of nurse training. (Differences between the experimental and traditional course students are described.) It is suggested that the experimental and traditional course students from the study are different in terms of attitudes. It is also proposed that nurse training can be seen as survival of the fittest and that differences in courses result in different obstacles to be overcome. It is emphasized that the traditional courses investigated in the study are not representative of such courses in general. This paper complements an earlier paper on 'Evaluation research: the need for multiple criteria' (House 1977). [ABSTRACT FROM AUTHOR]

The management of consumer-related risk is paramount in a secure forensic mental health facility. However, the consequent risk aversion presents a major barrier to consumers forming sexual relationships in a manner that is open and accepted. Investigation of the views of nurses working in forensic mental health settings on this topic is limited, and even more so for consumers of services. This qualitative exploratory study was undertaken to elicit the views of consumers and nurses about forming sexual relationships within this long-term and secure setting. Individual in-depth interviews were conducted with 12 nurses and 10 consumers. The benefits of, and barriers to, sexual relationships was identified as a major theme, and these findings are the focus of this paper. Nurse responses included the subthemes 'supportive factors' and 'potential dangers', reflecting their qualified support. Consumer responses included the subthemes 'therapeutic', 'feeling normal', 'restrictions and barriers', and 'lack of support and secrecy'. The importance of sexual relationships was clearly articulated, as was the difficulties in forming and maintaining them within the forensic setting. More open discussion about this commonly-avoided issue and the education of nurses and other health professionals is required. [ABSTRACT FROM AUTHOR]

Purpose To examine the perception of registered nurses and nursing assistants regarding the use of physical restraints with residents of nursing homes located in four of the regions of Spain; and to evaluate the relationship of these perceptions to the staff respondents' level of training. Design Cross-sectional multicenter and correlational study. The research was conducted in 2013 in 19 Spanish nursing homes with 2,940 residential beds. A total of 785 nurses (170 registered nurses and 615 nursing assistants) participated in the study. Methods The Perception of Restraint Use Questionnaire (PRUQ), consisting of 17 of the most cited reasons for using these devices, was used, as was a questionnaire capturing the sociodemographic characteristics and educational or experience level of staff respondents. Findings Nurses reported the most important uses for restraints as prevention of falls and avoidance of medical device interference. As indicated by an average PRUQ score of 3.47, staff respondents supported restraint use, especially nursing assistants (3.59) as compared to registered nurses (3.00). With regard to training: 83.7% had participated in little, if any, training and only 29.2% had read three or more documents related to restraint use; 66.6% believed that their training was inadequate. No correlation was found between the results of the PRUQ and the respondents´ sociodemographic characteristics or participation in training activities. No differences were found among nurses by region. Conclusions In contrast to papers published in other countries, nurses in this study still consider it necessary to apply restraints in everyday practice. The education of nursing staff regarding restraint and knowledge of alternatives is needed; they should at least be aware of international standards of care regarding physical restraint use. Clinical Relevance Most of the staff perceived their training related to the use of these devices as insufficient. Nursing assistants considered the use of restraints more important than did the registered nurses. [ABSTRACT FROM AUTHOR]

In the context of a growing population of people experiencing mental illness worldwide, mental health nurses are a crucial workforce. Their recruitment and retention, however, is in decline. Drawing on qualitative data obtained from interviews with mental health nurses ( MHN) in Victoria, Australia, the paper employs a range of concepts from role theory to explore professional identity within mental health nursing. The data highlight three key issues in relation to the future recruitment and retention of MHN: (i) the ambiguity of the MHN role; (ii) the weak definition and lack of understanding of the scope of the MHN role by nursing students; and (iii) a lack of communication about MHN as a profession to a wider audience. These findings indicate three avenues through which recruitment and retention in mental health nursing could be improved: (i) public communication; (ii) training and educating of the next generation of MHN; and (iii) more accurately defining the role of the MHN. [ABSTRACT FROM AUTHOR]

Background and Purpose This paper presents findings from a study which aimed to explore contextual, personal and professional factors in applying training in the use of a new stroke self-management programme. Methods Practitioners completed in-depth case reflections as part of their two-day training in the Bridges stroke self-management programme (SSMP). The study utilized a qualitative approach to explore the understanding and meaning participants gave to their experiences of using the SSMP. Data from case reflections were analysed using a thematic content analysis. Results Data from 60 case reflections were included in the analysis. Several themes were prominent including: timing, belief in the concept of self-management, congruence with goal setting, balance of power and subtleties and sensitivities of using the SSMP. The use of in-depth case reflections enabled a personal awareness of the complexities of supporting self-management after stroke. Participants reflected on their communication styles and interactions and how they influence the development of self-management skills in individuals post-stroke. Conclusion Case reflections offered an opportunity for participants who had received training in the use of an SSMP to explore their experiences of using the programme with individuals post-stroke. This enabled personal reflection on learning and facilitated a wider discussion on the professional and organizational context concerning integration of a self-management programme into stroke rehabilitation. The paradox between professionals having a role as 'experts' and the subtle changes in practice towards a more collaborative therapeutic relationship to support self-management needs further exploration. Implication for practice Physiotherapists were required to make a change in their practice from traditional, educational, hands on approaches to one which gave more prominence to facilitating an individual's problem solving, collaborative goal setting and decision-making post-stroke. This study highlights a number of issues relevant to professional learning and education in respect of self-management. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Sexual issues are common for consumers of mental health services and have many adverse consequences for quality of life as well as impacting negatively on the mental illness itself. Nurses in mental health settings are well placed to assess for the presence of and provide interventions for sexual concerns. To date, little research has been undertaken to explore nurses' attitudes and whether sexual issues would be accepted as part of their care. This paper presents findings from the third stage of a qualitative, exploratory research study with mental health nurses working in an Australian mental health service. The findings from the first two stages suggested that the participants had tended to avoid discussion of sexual issues, but a brief education intervention had produced a greater willingness to address sexual issues as part of care. The aim of the third stage was to determine the degree to which changes in practice had continued over time. Two main themes that emerged from this data were: (i) holism, from rhetoric to reality; and (ii) part of what I do. Addressing sexual issues became part of practice, a change sustained 2 years following the intervention, because participants recognized its importance for holistic nursing care. [ABSTRACT FROM AUTHOR]

Abduction, deduction and induction describe forms of reasoning. Deduction and induction are discussed in the nursing literature. However, abduction has been largely neglected by nurse scholars. In this paper it is proposed that abduction may play a part in qualitative data analysis - specifically, in the identification of themes, codes, and categories. Abduction is not, in research, restricted to or associated with any particular methodology. Nevertheless, situating abduction in qualitative research facilitates the identification of three interlinked issues. First, it is suggested that abductively derived claims require support from deductive and inductively sourced evidence if they are to 'hold' and, yet, in qualitative research this is clearly problematic. Second, difficulties in choosing between alternative plausible hypotheses (i.e. concerning theme, code, and category description) are explored through an examination of the 'generality problem'. Third, the role of background and auxiliary theories in adjudicating between hypothesis options is discussed. It is argued that if qualitative researchers utilize abductive inference in the manner suggested, then the peculiarly fallible nature of abduction must be acknowledged and, in consequence, the action guiding potential of qualitative research findings is compromised. [ABSTRACT FROM AUTHOR]

ABSTRACT People diagnosed with a mental illness experience poorer physical health than the general population. Nurses have been identified for their potential role in addressing physical health needs of consumers of mental health services. This paper reports on preliminary findings of a qualitative study on health-care services for physical and mental health in a regional area in Australia. A key purpose of the study was to explore the perceptions of nurses working in mental health settings of their physical care with consumers. A qualitative, exploratory approach was undertaken. Semi-structured focus groups were conducted with 38 nurses from one mental health service. Nurse participants described a common co-occurrence of physical problems and mental illness and expressed the importance of health-care services to treatment and prevention. Participants expressed divergent views on nurses' capacity to contribute to better health-care processes. [ABSTRACT FROM AUTHOR]

Almost half the Australian population, aged 16-85 years, are affected by mental illness at some point in their life, and general practice plays a key role in providing effective mental health care. This paper presents the findings from a study that explored how people living with mental illness are supported in Australian general practice. A descriptive, exploratory study was conducted using semistructured interviews to gather data. The role of mental health nurses in the care and support of people with mental illness emerged from the data. This was explored further and resulted in two key themes: dimensions of time and dimensions of space. Findings from this study present key similarities and differences in the role of mental health nurses, as compared to general practitioners, in relation to dimensions of time and space. Dimensions of time and space are important considerations for general practices when planning to introduce a mental health nurse into their interprofessional team. [ABSTRACT FROM AUTHOR]

PURPOSE. This review aims to identify factors associated with parental discharge readiness following pediatric hospitalization, with focus applicability to solid organ transplant patients. DESIGN AND METHODS. Thirty-eight publications, including research and clinical practice papers, were identified using Cooper's methodology for conducting integrative research reviews (1982). RESULTS. Four concepts emerged influencing discharge readiness: support, identification of unique and individual needs, education, and communication and coordination. Synthesis of themes resulted in two overarching concepts: meaningful interactions and confidence building. PRACTICE IMPLICATIONS. Nurses have a singular opportunity to enhance meaningful interactions and confidence building, ultimately promoting a successful transition home. [ABSTRACT FROM AUTHOR]

Occupational stress in nursing has attracted considerable attention as a focus for research and as a consequence multiple objects of nurses' stress, or ‘stressors’, have been identified. This paper puts into question the dominant conceptual and methodological approach to occupational stress in nursing research by both foregrounding the notion of anxiety and juxtaposing it with the notion of ‘stress’. It is argued that the notion of ‘stress’ and the domination of the questionnaire have produced a narrow reading of the topic. Some of the literature on occupational stress/anxiety in nursing is reviewed and our analysis illustrates how the identified objects of stress have a tendency to multiply contingent on the number of studies undertaken. Thus definitive objects of nurses' stress remain elusive. We argue that a return to the notion of ‘anxiety’ and methodological approaches other than empirical ones can bring both depth and breadth to the consideration of occupational distress in nursing. Further, we argue that the object of ‘anxiety’ is unconscious, thus unknown, and given this, a more informative approach is to map nurses' response to anxiety, the discursive formations arising out of anxiety, rather than attempt to define those objects of anxiety. [ABSTRACT FROM AUTHOR]

Aim. Within this paper I explore some of the issues related to eliciting, interpreting, choosing and re-telling stories gathered within narrative inquiry. Background. Most of the literature focusing on narrative inquiry and narratives makes little mention of what makes a story intrinsically ‘good’ or ‘bad’ although it is generally acknowledged that stories have moral lessons embedded within them and have a teaching/learning function. However, many of the moral issues associated with gathering, interpreting and re-telling stories are not really addressed. Method. Adopting a reflexive stance, I draw on Cartier-Bresson's notion of decisive moments and link this to narratives as a way of exploring what makes a story ‘good’/compelling as well as potentially ‘bad’/morally problematic. I develop the idea that narrative researchers may act as ‘horror magnets’ attracting ‘bad news’ stories and may be overlooking some of the more ‘neutral’ and ‘good’/‘good news’ stories. Conclusion. Narrative researchers may be adopting a ‘shock and awe’ approach to their stories without fully considering the potential impact. I propose that narrative researchers should engage in a morally proficient manner with participants/stories and conclude that a relational ethical approach can help us to ‘act well’ with people's stories. Relevance to clinical practice. Narrative inquiry and a storied approach to practice has much to offer researchers, practitioners and patients/families. Stories can get to the heart of patients’ experiences. Stories provide practitioners with one means of ‘acting well’ and in a relational way with their patients. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of this paper was to review the current literature clinical decision-making models and the educational application of models to clinical practice. This was achieved by exploring the function and related research of the three available models of clinical decision making: information-processing model, the intuitive-humanist model and the clinical decision-making model. Background. Clinical decision making is a unique process that involves the interplay between knowledge of pre-existing pathological conditions, explicit patient information, nursing care and experiential learning. Historically, two models of clinical decision making are recognized from the literature; the information-processing model and the intuitive-humanist model. The usefulness and application of both models has been examined in relation the provision of nursing care and care related outcomes. More recently a third model of clinical decision making has been proposed. This new multidimensional model contains elements of the information-processing model but also examines patient specific elements that are necessary for cue and pattern recognition. Design. Literature review. Methods. Evaluation of the literature generated from MEDLINE, CINAHL, OVID, PUBMED and EBESCO systems and the Internet from 1980 to November 2005. Results. The characteristics of the three models of decision making were identified and the related research discussed. Conclusions. Three approaches to clinical decision making were identified, each having its own attributes and uses. The most recent addition to the clinical decision making is a theoretical, multidimensional model which was developed through an evaluation of current literature and the assessment of a limited number of research studies that focused on the clinical decision-making skills of inexperienced nurses in pseudoclinical settings. The components of this model and the relative merits to clinical practice are discussed. Relevance to clinical practice. It is proposed that clinical decision making improves as the nurse gains experience of nursing patients within a specific speciality and with experience, nurses gain a sense of saliency in relation to decision making. Experienced nurses may use all three forms of clinical decision making both independently and concurrently to solve nursing-related problems. It is suggested that O'Neill's clinical decision-making model could be tested by educators and experienced nurses to assess the efficacy of this hybrid approach to decision making. [ABSTRACT FROM AUTHOR]

Title. Clinical decision-making skills on the developmental journey from student to Registered Nurse: a longitudinal inquiry Aim. This paper is a report of a study to explore, from the perspective of nursing students, how they acquire clinical decision-making skills and how well-prepared they feel in this respect regarding their responsibilities as Registered Nurses. Background. Previous research has focused mainly on exploring experienced nurses’ judgement and decision-making. Some studies have elicited senior nursing students’ understanding of the process, but none has explored the development of clinical decision-making skills throughout the educational programme and in the first year as a Registered Nurse. Method. A volunteer sample of 20 respondents, broadly representative of the student cohort regarding qualifications, age, gender and nursing specialty, was recruited. A longitudinal hermeneutic phenomenological study was carried out from 2000 to 2004, using interviews, reflective journals, care studies, critical incident analyses and document analysis. Findings. Ten conceptions of nursing and 10 perceptions of clinical decision-making were identified and a growing pattern of inter-relationships between them became apparent. A ‘matrix model’ was developed by cross-referencing the two thematic categories within the timeline of respondents’ developmental journey through significant milestones and changing contexts. As Registered Nurses they found having to ‘think on your feet’ without the ‘comfort blanket’ of student status both a stressful and formative learning experience. Conclusion. Further collaboration between education and health service partners is recommended to integrate clinical decision-making throughout the nursing curriculum, enhance the development of such vital skills, and facilitate the transition from student to Registered Nurse. [ABSTRACT FROM AUTHOR]

This paper describes the development of a haematology practice development unit. A recurring dichotomy in the literature reviewed is whether such practice development units should be aimed at nurses or at nursing practice. The processes of ensuring the robustness of a series of action research projects are described. All of these projects aim to explore patient perspectives of their illnesses and identify how to improve their care. National Health Service Trust and university partnership arrangements are identified as being of central importance to accreditation processes and to verification of the appropriateness of research outcomes. Staff development initiatives discussed include offering work-based learning opportunities. It is concluded that to disassociate patients, and how best to improve their care, from the development of practitioners is unhelpful. Copyright © 2007 John Wiley & Sons, Ltd. [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]

Aim. In this paper we present a theory-based taxonomy of the methods used to implement change in practice. Background. Implementation research is characterized by inconsistent terminology for the methods employed and inattention to differences in the relevance of methods across different disciplines. Studies of the effectiveness of implementation have yielded mixed results. Positive effects shown have been small. The limited success of many efforts to implement change in practice may be due, in part, to the absence of a framework to guide the use of implementation methods. Method. A provisional taxonomy of implementation methods, derived from theory and existing taxonomies, was used to content analyse a convenience sample of 43 reports of empirical studies of the implementation of one or more research-based practice changes involving nurses that had been published between 1995 and 2005. This taxonomy was revised throughout the course of analysis to capture more completely the information in each report. Findings. Following the analysis, nine of the 11 methods in the provisional taxonomy were retained, two were removed and five new methods were identified. The final taxonomy includes 14 implementation methods organized into five categories: (a) increasing coordination; (b) raising awareness; (c) persuasion via interpersonal channels; (d) persuasion via reinforcing belief that behaviour will lead to desirable results and (e) increasing behavioural control. Conclusions. The taxonomy presented here differs from prior taxonomies by focusing on nursing and by providing a clear and mutually exclusive guide to implementation methods. By deriving the initial coding strategy from theory, the taxonomy links the methods to theoretical constructs that may inform the selection of methods across different practice changes and settings. [ABSTRACT FROM AUTHOR]

This paper develops a framework for establishing rigour for a discourse analysis of professional transition in midwifery, theorised as a 'female professional project'. Discourse analysis has gained recognition as a useful approach in nursing and midwifery research. It provides an alternative to those qualitative approaches that propose to reveal a 'reality' from the perspective of the individual experience, and that this lived experience can be directly represented in language. There are multiple discourse analytic approaches, and often researchers are not explicit about what type they are employing. Furthermore, to date there are few clear guidelines for what constitutes rigour in a discourse analytic study. Rigour in qualitative research broadly falls into two categories: the replication perspective that argues for the maintenance of criteria of validity and reliability, usually with an underpinning assumption (often unquestioned) that a 'truth' can be revealed. The second is the parallel perspective that questions the ontological and epistemological assumptions of the replication perspective and argues for the development of criteria that reflect the assumed questionable nature of truth and reality. Transferring these criteria to a discourse analytic study revealed some problems. A common challenge identified in achieving rigour in discourse analysis is the maintenance of congruity between the epistemological and ontological basis of a piece of research and the actual analysis conducted or reported. A framework is proposed to address these incongruities and includes six elements. As nurses and midwives increasingly employ discourse analysis in their research, attempts to clarify how rigour will be determined are important if the outcomes of such research are to be seriously considered for their implications for theory, policy and practice. [ABSTRACT FROM AUTHOR]

AIM: The paper reports a study to develop and test a tool for assessing a range of factors influencing the development of evidence-based practice among clinical nurses. BACKGROUND: Achieving evidence-based practice is a goal in nursing frequently cited by the profession and in government health policy directives. Assessing factors influencing the achievement of this goal, however, is complex. Consideration needs to be given to a range of factors, including different types of evidence used to inform practice, barriers to achieving evidence-based practice, and the skills required by nurses to implement evidence-based care. METHODS: Measurement scales currently available to investigate the use of evidence in nursing practice focus on nurses' sources of knowledge and on barriers to the use of research evidence. A new, wider ranging Developing Evidence-Based Practice questionnaire was developed and tested for its measurement properties in two studies. In study 1, a sample of 598 nurses working at two hospitals in one strategic health authority in northern England was surveyed. In study 2, a slightly expanded version of the questionnaire was employed in a survey of 689 community nurses in 12 primary care organizations in two strategic health authorities, one in northern England and the other in southern England. FINDINGS: The measurement characteristics of the new questionnaire were shown to be acceptable. Ten significant, and readily interpretable, factors were seen to underlie nurses' relation to evidence-based practice. CONCLUSION: Strategies to promote evidence-based practice need to take account of the differing needs of nurses and focus on a range of sources of evidence. The Developing Evidence-Based Practice questionnaire can assist in assessing the specific 'evidencing' tendencies of any given group of nurses. [ABSTRACT FROM AUTHOR]

Background Clinical nurse educators and other linking agents such as clinical nurse specialists, advanced nurse practitioners, and nurses working in research leadership positions are an important link in the facilitation of evidence-based practice in health care organizations. Aim The purpose of this paper is to report the findings of a systematic review of the literature regarding clinical nurse educators and research utilization, using the Promoting Action on Research Implementation in Health Services framework as a backdrop for the analysis. Findings There is a positive relationship between research utilization and attitude toward research, higher levels of education, and reading professional nursing journals among clinical nurse educators. The authors suggest that not all clinical nurse educators have the necessary critical appraisal skills and research knowledge to use research effectively in practice. Conclusions Few studies have examined clinical nurse educators and the determinants of their research utilization behaviour in clinical practice. Future research on clinical nurse educators needs to focus on the outcomes of research utilization, including the effectiveness of their role as facilitators and the contexts in which they practice. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a study examining the barriers associated with research knowledge transfer amongst primary care nurses in the context of clinical decision-making. Background. The research literature on barriers to nurses’ use of research knowledge is characterized by studies that rely primarily on self-report data, making them prone to reporting biases. Studies of the barriers to evidence-based practice often fail to examine information use and behaviour in the context of clinical decision-making. Methods. A multi-site, mixed method, case study was carried out in 2001. Data were collected in three primary care organizations by means of interviews with 82 primary care nurses, 270 hours of non-participant observation and 122 Q-sorts. Nurses were selected using a published theoretical sampling frame. Between-methods triangulation was employed and data analysed according to the principles of constant comparison. Multiple linear regression was used to explore relationships between a number of independent demographic variables (such as length of clinical experience) and the dependent variable of nurses’ perspectives on the barriers to their use of research knowledge. Results. Three perspectives on barriers to research information use emerged: the need to bridge the skills and knowledge gap for successful knowledge transfer; information formats need to maximize limited opportunities for consumption; and limited access in the context of limited time for decision-making and information consumption. Demographic variables largely failed to predict allegiance to any of the perspectives identified. Conclusions. Researchers should consider using decision-making as a contextual backdrop for exploring information use and behaviour, avoid relying solely on self-reported behaviour as data, and use a variety of research methods to provide a richer picture of information-related behaviour. Practice developers need to recognize that understanding the decisions to which research knowledge is to be applied should be a characteristic of any strategy to increase research uptake by nurses. [ABSTRACT FROM AUTHOR]

ALLEN D and CLOYES K. Nursing Inquiry 2005; 12: 98 –105 The language of‘experience’ in nursing research This paper is an analysis of how the signifier‘experience’ is used in nursing research. We identify a set of issues we believe accompany the use of experience but are rarely addressed. These issues are embedded in a spectrum that includes ontological commitments, visions of the person/self and its relation to‘society’, understandings of research methodology and the politics of nursing. We argue that a poststructuralist understanding of the language of experience in research opens up additional ways to analyze the relationship between the conduct of nursing research and cultural/political commitments. [ABSTRACT FROM AUTHOR]

Nurses should address the concerns of service users in research and engage in collaborative work with them. Doing this presents ethical dilemmas, not least around the issues of assessing capacity and informed consent to participation in research. The view that judgement regarding the capacity to consent is solely the responsibility of a consultant psychiatrist is challenged as inadequate. The concept of 'moral discourse' (Pike 1991) is used to understand the process by which the assessment of capacity may be carried out. This is illustrated by the application of the concept in a qualitative research study carried out to explore what makes mental health services accessible to women with children. The role of the mental health nurse entails surveillance and the development of expertise in negotiating compliance with treatment programmes. The paper outlines the measures taken to ensure that service users felt empowered, rather than coerced, to participate in this study. While Community Mental Health Team workers were engaged in 'moral discourse' in respect of participation by service users in the study, there were difficulties in engaging General Practitioners. However, there was evidence that women themselves felt empowered both to express interest in participating and to withdraw if they so wished. [ABSTRACT FROM AUTHOR]

BACKGROUND: Critical realism is a relatively new philosophical perspective that combines a realist ontology with a relativist epistemology in subscribing to a form of 'robust' relativism. The potential benefits of adopting a critical realist approach are considered in two areas of evaluation research: theory-driven programme evaluation and policy evaluation. AIM: The aim of the paper is to identify the main features of critical realism and explore its potential as a philosophical framework in the field of evaluation research. CONCLUSION: We argue that critical realism provides a coherent framework for evaluation research that is based on the understanding of causal mechanisms. This is particularly important for frontline services seeking to use evidence-based interventions, as interventions need to be properly understood if they are to be used effectively in the context of clinical practice. Critical realism can also add depth to policy analysis. However, there is a potential for critical realists to drift beyond the boundary that separates scientific knowledge from speculative theory when making recommendations about the best course of action to follow. [ABSTRACT FROM AUTHOR]

Research information in nurses’ clinical decision-making: what is useful? Aim. To examine those sources of information which nurses find useful for reducing the uncertainty associated with their clinical decisions. Background. Nursing research has concentrated almost exclusively on the concept of research implementation. Few, if any, papers examine the use of research knowledge in the context of clinical decision-making. There is a need to establish how useful nurses perceive information sources are, for reducing the uncertainties they face when making clinical decisions. Design. Cross-case analysis involving qualitative interviews, observation, documentary audit and Q methodological modelling of shared subjectivities amongst nurses. The case sites were three large acute hospitals in the north of England, United Kingdom. One hundred and eight nurses were interviewed, 61 of whom were also observed for a total of 180 hours and 122 nurses were involved in the Q modelling exercise. Results. Text-based and electronic sources of research-based information yielded only small amounts of utility for practising clinicians. Despite isolating four significantly different perspectives on what sources were useful for clinical decision-making, it was human sources of information for practice that were overwhelmingly perceived as the most useful in reducing the clinical uncertainties of nurse decision-makers. Conclusions. It is not research knowledge per se that carries little weight in the clinical decisions of nurses, but rather the medium through which it is delivered. Specifically, text-based and electronic resources are not viewed as useful by nurses engaged in making decisions in real time, in real practice, but those individuals who represent a trusted and clinically credible source are. More research needs to be carried out on the qualities of people regarded as clinically important information agents (specifically, those in clinical nurse specialist and... [ABSTRACT FROM AUTHOR]

OBJECTIVE: The primary aim of the study was to evaluate the effectiveness of two approaches to increase research awareness among midwives and nurses. DESIGN: Quasi-experimental with the attitudes of staff in the two groups being measured at two points (January and October 1997). SAMPLE: All midwives and nurses working in four clinical areas in an acute NHS Trust. The intervention arm of the study involved all midwives and nurses in the Clinical Directorate of Obstetrics and Gynaecology, while the control arm involved all nurses working in a specialist oncology and haematology unit and in the children's directorate. ETHICS: The Joint Ethics Committee considered approval unnecessary because the study involved staff and not patients. DATA COLLECTION: Data were collected by self-complete questionnaires. INTERVENTIONS: A programme of education with policy and practice interventions targeted at ward sisters. OUTCOME MEASURES: Staff attitudes to, knowledge of, and level of involvement in, research. RESULTS: The study demonstrated a significant increase in both knowledge and use of research resources. Following the programme of education, staff in the intervention group were significantly more likely to use resources associated with research utilization and to report that they had read a research paper within the last month. STUDY LIMITATIONS: The time scale of the intervention was restricted by the funding available; a significant Hawthorne effect was evident with both groups showing an increase in knowledge; the pragmatic nature of the study meant that it was not possible to randomize the study groups; the scale of the study did not permit an economic evaluation. CONCLUSIONS: The introduction of clinical governance challenges healthcare providers to improve the care they deliver. There are huge opportunities for Trusts to invest in developing staff knowledge and use of research. However, staff will only seize these opportunities if there is an appropriate, enabling environment--an environment that delivers intensive interventions and is sensitive to the wider structural factors in the NHS affecting staff morale and commitment. In the absence of this environment, what may be seen as opportunities to managers may be regarded as just another burden by staff. [ABSTRACT FROM AUTHOR]

The recent emphasis on community care for those with mental illness has changed working patterns and modified inter-professional role boundaries within multi-disciplinary teams. Clients with serious mental illness are usually prescribed medications, which have a wide range of side effects. However, it is uncertain who is responsible for monitoring clients for the side effects of their medications, ensuring clients' and carers' understandings of their prescribed medications and optimizing compliance with medication. This paper discusses the findings of the first phase of an ongoing study designed to assess the role of community mental health nurses (CMHNs) in managing clients' medication and the provision of appropriate continuing professional education. Our respondents were 14 CMHNs, seven of whom were preparing to undertake a pharmacology module as part of a higher education diploma, and seven who were to act as comparators. Data from questionnaires, interviews and clinical observations were triangulated. All respondents felt that issues surrounding clients' medication were not accorded a sufficiently high profile and that it was, in part, their responsibility to expand their roles to meet these unmet needs of clients. Administering and managing clients' medications were considered to be the main area of 'occupational territory' which distinguished CMHNs from social workers. However, the nurses felt that their practice was limited by lack of appropriate educational preparation. [ABSTRACT FROM AUTHOR]

A comparison of pre-Project 2000 and Project 2000 nurses’ perceptions of their research training, research needs and of their use of research in clinical areas ¶Most of the literature on the research training and education of nurses has focused on teaching strategies. Only a few authors have assessed systematically the impact of research modules or courses on the knowledge and attitudes of nurses. There is a lack of research on nurses’ use of research following their preparation. This paper reports on some of the data from a large-scale survey of the utilization of research among nurses in Northern Ireland. In particular, a comparison is made of the perceptions of pre-Project 2000 and Project 2000 qualified nurses of their research training, research needs, and use of research in clinical areas. A questionnaire was distributed to a convenience sample of 2600 nurses from 23 hospitals in 14 Trusts in Northern Ireland. The response rate was 52·6% (n = 1368). The findings show, among others, a shortfall in research preparation of pre-Project 2000 nurses in important aspects of research. While Project 2000 nurses reported receiving more training, they did not report higher rates of research utilization than pre-Project 2000 nurses. Registered mental nurses (RMNs) and registered nurses mental handicap (RNMHs) also reported lower rates of research utilization than registered general nurses (RGNs), despite reporting the same amount of research preparation as RGNs. The implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Nurses currently construct careers in a climate of continuing occupational and organizational change. A longitudinal project is in progress which is documenting the post-qualification histories of a cohort of registered general nurses, and studying the extent to which their careers represent occupational choice, a response to organizational constraints, or a combination of both. Three elements comprise the core of the research: questions which provide information on the cohort's career plans, charts which document their career histories and questions which explore the relationship between the two. The basis of the design is the first element, and this paper focuses on the problems encountered in designing the questions and routeing structures which enabled all cohort members to describe their plans for the future. The importance of extensive pilot work is demonstrated in the development of options tailored for each potential career pathway and to allow expressions of uncertainty to emerge at points when appropriate to respondents. Of the 1164 members of the cohort, 1015 returned the questionnaire; a response rate of 87%. Findings are presented on the cohort's plans at qualification. The majority of respondents (86%) saw themselves as remaining in nursing and in clinical practice in the early post-qualification period. Eighteen per cent said they intended to practise abroad at some point, 30% foresaw a likelihood of working in the private sector, 59% wanted to take one or more English National Board courses and 42% expressed interest in obtaining an undergraduate or postgraduate degree. [ABSTRACT FROM AUTHOR]

Moral certainty and uncertainty have a profound impact on nurses' ethical choices. In order to describe these concepts, the author examined long-term care nurses' convictions about the issue of withholding or withdrawing artificial nutrition and hydration from elders. A convenience sample of 25 BSN and MSN-prepared long-term care nurses were interviewed and asked to describe their experiences with this issue. A qualitative analysis utilizing Colaizzi's (1978) methodology was performed. Five categories of conviction emerged from the data. These five categories included absolute moral conviction, strong moral conviction, moderate moral conviction, moral uncertainty with conviction and moral uncertainty. Eighty-four per cent of the sample was convinced that tube feeding was not always in the resident's best interest. Sixteen per cent of the sample were uncertain, but were convinced that the resident should not suffer. A pattern emerged from the interview results and the answers to three additional questions. The pattern suggests that the more experience a nurse has with nontreatment the more likely she or he is to agree with it. In this paper. the five categories of conviction are compared and contrasted, the pattern of conviction described, and the implications of the findings for nursing discussed. [ABSTRACT FROM AUTHOR]

Telephone interviews were employed by nurse researchers as a means of collecting data from elderly people following their discharge from hospital. The paper reviews the literature concerning interviews with elderly patients by telephone and recounts first-hand experience of the method on the basis of over 500 telephone interviews. Although some difficulties were encountered in conducting interviews with the hearing-impaired and the unwell, the method was found to be a cost-effective and useful means of obtaining follow-up data for research purposes. The prime factor in ensuring successful use of the method was the recruitment of subjects via personal interview prior to telephone contact. [ABSTRACT FROM AUTHOR]

Increasingly, qualitative research methods are being embraced by nurse researchers because these approaches allow exploration of human experience. Failure to explicate qualitative methodologies is resulting in a body of nursing research that is either mislabelled or is classified broadly as qualitative and subject to charges that qualitative research lacks rigour. In this paper, the authors discuss the importance of specificity in methodology and distinguish between phenomenology and grounded theory, two frequently misused terms in the description of qualitative methodology. [ABSTRACT FROM AUTHOR]

There has been increasing interest in the attitudes that the general public and health care professionals hold towards cancer, the effect these have on an individual's likelihood to present early with symptoms, and the quality of care patients with the disease receive from carers. The research appears to indicate that the attitudes of both groups are largely negative and stereotyped, and cancer is seen as being more devastating than other life threatening diseases. These attitudes have been associated with patterns of poor communication and care for cancer patients. This paper looks critically at the research into the attitudes of nurses towards cancer and calls for more innovative methods than have been used to date. There is a need to increase our understanding of this complex problem before indications for education and practice can be made. [ABSTRACT FROM AUTHOR]

Since sleep and healing appear to be associated, achieving the optimum quality of sleep among hospital patients should be a priority for both clinical nurses and researchers. This paper discusses various methods of sleep assessment which may be used by those intending to conduct research in this field. [ABSTRACT FROM AUTHOR]

This paper makes the point that for psychiatric patients the nursing process based on a systems approach may be more useful than that based on problem-solving or activities of daily living. Some of the key concepts used in this approach are (i) listing component parts of a system, (2) defining the inside and outside of systems, the outside being described as environment, (3) changing the boundaries or the interface of various systems, as appropriate, (4) observing the impact of the environment and especially of the nurse herself as a part of the system or the environment, (5) tracing input, output and throughput, and (6) drawing distinctions between open and closed systems and accounting for a steady state in the system. [ABSTRACT FROM AUTHOR]

The effect of the use of nursing auxiliaries (NA) compared with qualified staff on patient care is likely to come under increasing scrutiny as a result of recent management changes arising from the implementation of the 1989 White Paper Working for Patients and is emphasis on meeting quality criteria at minimum cost . However, despite the large-scale utilization of NA within the health service there is a paucity of research evaluating their effectiveness on any parameter. This article describes findings of a 3-year study designed to investigate the contribution of NA in an area where they form a substantial part of the workforce, namely, elderly care.