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Nurse‐led clinics are known to positively impact and benefit patients; however, there is little understanding of the role of the nurse in a nurse‐led male Lower Urinary Tract Symptoms (LUTS) clinic. LUTS affect up to 30% of males over 65 in the United Kingdom and can significantly impact the quality of life of the person experiencing them. LUTS can be managed with conservative changes, as well as with medication and surgical intervention. The aim of this scoping review is to map what is known about the role of the nurse in a nurse‐led male LUTS clinic and what research tells us regarding, the barriers and enablers in nurses leading a male LUTS clinic. This scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐SCR) checklist and the methodological guidelines set out by the Joanna Briggs institute. A literature search was carried out over three databases (CINAHL, Medline Ovid, ProQuest health and medical collection) and systematically searched from 2000 to 2021. Grey literature was also searched, and citation chaining was undertaken. Following a systematic review of the literature, four papers met the inclusion criteria for this scoping review. The emergent themes across the four papers consisted of structure, assessment and resources, and effectiveness of the nurse‐led male LUTS clinic. There was clear agreement across the literature regarding the investigations and assessment the nurse should carry out. Ongoing practical, theoretical, and observational training and education is required to ensure the nurse is competent in running a male LUTS clinic. The papers reviewed showed the nurse provided a supportive role to the consultant. However, there is evidence indicating there is a move towards autonomous practice. There is a dearth of the current research relating to the role of the nurse in nurse‐led male LUTS clinics and the enablers and barriers in nurses leading male LUTS clinics. Further research should be considered to gain a better understanding of where nurse‐led male LUTS clinics currently take place, what the role of the nurse is in leading a LUTS clinic and what enablers and barriers exist. [ABSTRACT FROM AUTHOR]

Across the globe, students with disabilities have been increasing in prevalence in higher education settings. In the twenty-first century the struggle to include individuals with disabilities into nursing schools and workplaces continues in different parts of the world. Historically, entry criteria in nursing schools have been based on essential functions, which were primarily designed to be used in the workforce, rather than technical standards for education. In other health professions, such as medicine, this is not necessarily the case. For example, the American Association of Medical Colleges has worked over the past two decades to develop appreciation among medical schools for the need to admit and accommodate students with disabilities. We argue that nursing has not followed suit. This paper presents an integrative literature review, consisting of material from the United States, Ireland, United Kingdom, and Australia, investigating compelling stories, legal mandates, websites, and extant literature looking at essential functions or technical standards as entry criteria for nursing schools. The results show that, when essential functions for employment are used in nursing education, they may be a barrier to entry into that program. The paper concludes with recommendations for well-defined technical standards for nursing schools to be used primarily as entry criteria.

Aim A discussion which aims to explore the diversity of decision-making during teenage and young adult cancer treatment. The discussion will be related to the concepts of autonomy, dependence and decision-making in this age group. Background The experience of cancer involves a significant series of treatment decisions. However, other non-treatment decisions also have to be made which can relate to any aspect of everyday life. These decisions occur against the backdrop of young people's disease experience. Design Discussion paper. Data sources A literature search for the period 1990-2013 was undertaken. This included searching the following databases: Cumulative Index for Nursing and Allied Health Literature ( CINAHL), SCOPUS, Medline, DARE, Applied Social Sciences Index and Abstracts ( ASSIA), (Psych Info) and The Cochrane Library. Implications for nursing There is a lack of evidence into the experience of everyday decisions made by young people during cancer treatment. This may affect them in the form of unmet needs that nurses, or other professionals, fail to appreciate. Conclusion Further exploration of how teenagers and young adults experience the range and process of decision-making during cancer treatment could be useful in helping to provide effective supportive care for this age group. [ABSTRACT FROM AUTHOR]

Aims This article explores the care British nurses provided to victims of typhus during the Second World War. Background Typhus is associated with poverty and overcrowding. During wars in the pre-antibiotic era, civilians were particularly susceptible to epidemics, which military governments feared would spread to their troops. Design This discussion paper draws on archival data from three typhus epidemics in the Second World War to examine the expert work of British nurses in caring for victims during these potential public health disasters. Data Sources The published sources for the paper include material from nursing and medical journals published between 1940-1947. Archival sources come from the National Archives in Kew, the Wellcome Library and the Army Medical Services Museum, between 1943-1945. Of particular interest is the correspondence with Dame Katharine Jones from nurses on active service overseas. Implications for Nursing Whilst epidemics of typhus are now rare, nurses in the present day may be required to care for the public in environments of extreme poverty and overcrowding, where life-threatening infectious diseases are prevalent. This article has demonstrated that it is possible for expert and compassionate nursing to alleviate suffering and prevent death, even when medical technologies are unavailable. Conclusion Expert and compassionate care, adequate nutrition and hydration and attention to hygiene needs are crucial when there are limited pharmacological treatments and medical technologies available to treat infectious diseases. The appreciation of this could have implications for nurses working in current global conflicts. [ABSTRACT FROM AUTHOR]

Aims A discussion on the case for nurse-led community delivery of health and social care interventions to ex-offenders. Background Ex-offenders re-enter their communities with limited pre-release preparation for the continuity of access to health care once outside prison. Once released, these individuals become hard to reach, do not consider health a priority and consequently use services to address their health and social care needs in a crisis-led way. Nevertheless, how nurses can best support these health-excluded group of individuals in the community remains vague and requires discussion. Design Discussion paper. Data sources Several databases were searched for papers published in English from 1990-2012 using the Population, Intervention and Outcome framework to help structure search. Discussion It is argued that current dominant discourses around equity of care are contradicted in the provision of health and social care services to ex-offenders in the community. Effective engagement with community interventions may be achieved if ex-offenders maintain contact with frontline providers who can support both their structural and health needs. Implication for nursing Nurses are uniquely positioned to initiate and sustain contact with ex-offenders, intervening at points of greatest need in the community to address the socially significant health and social care issues that plague them. Conclusion The use of nurses in the provision of health and social care interventions to ex-offenders is a strategy, which could increase equity in access to health care, reduce reoffending and improve both the health and life chances of these individuals. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This paper presents findings from a hermeneutical study which sought to explore how registered nurses experienced and perceived their professional accountability in clinical settings., Background: Professional accountability encompasses the ideals and standards of nursing practice. Nurses are accountable for their actions under civil, criminal and contract law to their; employing organisation, their regulatory body and the patients for whom they care., Design: This paper reports on a Heideggerian hermeneutical study involving seven registered nurses, working in clinical practice in the National Health Service in the United Kingdom. Methods The study adopted purposive sampling, collecting data by means of in-depth interviews. Data were analysed using the hermeneutic circle. COREQ checklist was used as a reporting guideline for this study., Results: The findings suggest that professional accountability in nursing practice is a complex phenomenon, which can be compromised by many factors which are historically, socially or politically driven Participants experienced challenges through a lack of resources and poor managerial support, which compromised their ability to deliver high-quality patient care. However, collegiality strongly impacted upon resilience and positively influenced their well-being., Relevance to Clinical Practice: Amid the challenges of the clinical workplace, a positive workplace culture with visible managerial support is a fundamental requirement in supporting professional accountability, development and retention of nurses. Findings highlight the view that leadership should be seen as a collective responsibility, which empowers staff to positively change the practice environment., (© 2020 John Wiley & Sons Ltd.)

Aim: Expanding and sustaining student nurse placements outside of the acute sector is a universal challenge. This paper aims to evaluate the Care Home Education Facilitator Role introduced in one area of Wales, United Kingdom, and to report on the outcomes achieved from this novel role. Methods: Semi‐structured interviews were undertaken with key stakeholders including the Care Home Education Facilitator postholder leading the pilot, care home managers, higher education institutions' placement managers/coordinators, student nurses and national health service staff. Results: Five key areas were identified, which included timing of introducing the post and establishing a clear rationale and understanding of the intention of the role. The benefits, challenges and suggested improvements to the Care Home Education Facilitator initiative are provided. Conclusion: Introducing the role of the Care Home Education Facilitator to work closely with key stakeholders resulted in increased placements for student nurses, but investing time in developing relationships with these stakeholders was critical to the success of the role. Summary statement: What is already known about this topic? There is a universal shortage of clinical placements for nursing students, particularly within a care home setting.The number of studies exploring how we might grow the number of nurses needed in this setting is limited. What this paper adds? This study evaluated a novel initiative introduced in South Wales, United Kingdom, that focuses on the development of nursing placements in the care home setting.Engaging with stakeholders involved in the development and implementation of the Care Home Education Facilitator initiative, a roadmap was provided to illustrate the stepped approach required to support an active care home placement including key governance arrangements. The implications of this paper: For those involved in identifying and developing student placements, this study provides valuable insight to a role that can help increase student numbers in a care setting often overlooked.It identifies viable career options for nurses at the point of registration.The role assists with widening networks for the care homes across health and social care sectors. [ABSTRACT FROM AUTHOR]

Aim: Rapidly evolving roles in nursing require exploration and description. This review aims to examine the role of the clinical nurse specialist (CNS) in stoma care from the UK perspective. Design: A scoping review was undertaken using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Data were synthesised using content analysis to derive meaning units and themes. Data sources: Three electronic databases were used to conduct the search: Embase, AMED and Ovid Medline. Additional sources identified through the reference lists of included studies and guidelines were also included. Methods: Two reviewers undertook the search for articles that described the role of the stoma care CNS in the UK. Any disagreements were to be resolved through discussion. Results: Seven papers met the eligibility criteria. Analysis resulted in 184 unique meaning units. Meaning units were grouped into themes reflecting the four pillars of advanced practice: advanced clinical practice; leadership; facilitation of education and learning; and evidence, research and development. The fewest meaning units were attributed to the evidence theme (n=13) and the most related to advanced clinical practice (n=107) such as having specialist knowledge and skills to manage complications. Conclusion: The stoma care CNS role reflects the four pillars of advanced practice. These practitioners are valuable, carrying out a complex role that involves high-level, specialist decision-making skills. The results from this scoping review could be useful in service development; they will be used to inform the Association of Stoma Care Nurses UK modified Delphi consensus to examine the views of stoma care CNS practitioners. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to assess the contribution of scenario-based learning aimed at raising awareness of sustainability in health-care practitioners. The Lancet Countdown on Climate Change calls for urgent action on health and climate change; this requires appropriate knowledge, skills and competencies that can be gained through undergraduate education. The International Council of Nurses calls for leadership in nursing for sustainability; however, climate change and health are given little attention in nursing and health-care curricula. Design/methodology/approach: A cohort of nursing and midwifery students was introduced to sustainability and climate change in the context of health care through scenario-based learning sessions in each of their three years of undergraduate education. Questionnaires were used to collect data on participant's attitudes toward sustainability and climate change, how useful the educational sessions were and the extent to which their clinical practice had changed. Findings: Significant differences were found between scores in Years 1 and 2 suggesting greater awareness of the importance of sustainability in nursing education and practice. Comparison of Years 2 and 3 scores found participants more likely to apply sustainability principles in clinical practice and challenge unsustainable practices in the work environment. Research limitations/implications: Further research is required to explore sustainability practice in postgraduate nurses/midwives. However, this study supports the need for sustainability education to be embedded within health-care professional degrees through applied and participatory pedagogical approaches. Originality/value: To the best of the authors' knowledge, this is the first study to evaluate sustainability education and its impact on nursing attitudes towards practice.

This paper describes the current challenges facing nurses and other professionals who care for people with profound and multiple intellectual disabilities. This particularly vulnerable group of service users often rely on a repertoire of non-verbal behaviours to communicate their needs and wishes. These challenges include the requirements of Person Centred Planning, the Mental Capacity Act 2005 and the evidence-based practice movement. Drawing on nursing and some other relevant professional literature, this paper explores the latter in particular and how it relates to the intuitive knowledge base that professionals use to interpret NVC behaviours in this ?eld. It concludes with a discussion of the dangers and limitations of this knowledge and skill base and posits a professional need to discipline its deployment by re?ective practice (re?exivity) within well-established therapeutic relationships. A theoretical example of re?ective practice is included.

The concept of the independent learner has become increasingly important within the higher education sector. However, there appears to be no consensus and rarely any clarification of what is meant by the term. As a result, students may fail to understand what is expected of them as independent learners, with implications for retention, progression and the student experience. This paper describes a research project that aimed to clarify what students and staff understood by the phrase. The results suggest that while most staff and students were familiar and comfortable with the concept, there remains potential for misunderstanding and confusion. (Contains 4 tables and 1 figure.)

This paper describes the conception and progress to date of the development of work-based learning as part of post-qualifying education in the School of Nursing at the University of Salford. There is a changing culture in the university in relation to the delivery of programmes via non-traditional routes. In this context, work-based learning is a radical change from current teaching and learning strategies in the School of Nursing and in the university as a whole. This creative approach contrasts significantly with the more traditional methods of teaching and learning in higher education. The paper reports on the development, introduction and evaluation of a work-based learning module as a pilot project. It then outlines the development of a work-based learning degree using the lessons learnt from the pilot.

Purpose: The purpose of this paper is to report a work-based learning innovation developed in response to the skills agenda affecting post-registration continuing professional development for nurses. Design/methodology/approach: The experience of learners, mentors and assessors using the "Skills Bank" are illustrated as part of an ongoing evaluation of work-based learning. This was captured by semi-structured interviews and the observations of the author as innovation was implemented and to the quality issues for academic rigour were addressed. The study is set in the context of the debate about skills and competence. Findings: The study finds that learners responded well to the innovation because they were motivated and self-directed. The experience exceeded their expectations of continuing professional education. Some did not engage with the database of skills and learner-generated skill design was consequently of poor quality. The assessment strategy is well-defined and rewards excellence in practice with the use of a grading tool. Practical implications: Content of skills templates reflect current evidence-based practice, which can be mapped to Skills for Health workforce competences. Maintaining the Skills Bank in terms of currency and authenticity is challenging. Originality/value: This paper will be of interest to education and training providers keen to address the preparation of health care staff fit for purpose and practice. It attempts to articulate skills as a notion of competence. (Contains 5 figures.)

Purpose: The School of Nursing and Midwifery at De Montfort University has been consistently successful in producing student midwives who are, by the end of their chosen programme, fit for practice, purpose and award according to the DMU. This paper aims to investigate this claim. Design/methodology/approach: The paper looks at De Montfort University where an innovative tripartite assessment process has been developed to support midwifery students in practice. This involves the student, his/her personal tutor and his/her clinical midwife mentor. All three are involved in the planning of appropriate learning experiences to facilitate the student in meeting the clinical learning outcomes, utilising a personal professional portfolio. Findings: The paper finds that the close working relationships between the placement providers and the university have improved the assessment of practice and enhanced the student experience. Clinical midwife mentors have commented on how well the tripartite approach works and they appreciate the clear lines of communication that this relationship provides. The personal tutor role is well established in the School of Nursing and Midwifery and the midwifery team have developed this role to include the assessment of students within the tripartite structure. This is beneficial from a quality perspective; while clinical midwife mentors will obviously change due to differing student placements, the personal tutor is the variable that is the constant through the student's progression on the programme. Originality/value: The tripartite approach to the practice assessment of pre-registration midwifery education investigated in this paper has proved to be a robust approach to ensuring students are fit for practice, purpose and award at the point of qualification and eligible to register as a midwife with the Nursing and Midwifery Council.

This paper highlights perspectives on action research in education, health and social care and was originally presented as a keynote at the International Practitioner Research Conference and Collaborative Action Research Conference in 2005. The paper links with the other conference keynote given by Stephen Kemmis, co-author of "Becoming Critical". It reflects on the importance of Being Caring in action research in the context of health and social care; particularly in relation to emotionally supporting practitioners to improve their practice in settings which do not always welcome more emancipatory or critical approaches often used in education. The paper begins by exploring the nature of practitioner research and action research in health and social care and its links with quality. It argues that health and social care professionals have often drawn their methodological understanding from the literature written by colleagues in education. This literature tends to support critical and emancipatory forms of action research, which health and social care professionals have tended to adopt in an uncritical manner. Reflecting on some of the contextual constraints in health and social care, it argues that many of these factors are beyond the control of individual practitioners and suggests a need to focus on the neglected area of emotions, in addition to, contextual issues. To illustrate the usefulness of this approach an example of psychodynamically informed action research is given. The paper concludes that in the quest to be critical, practitioner researchers/action researchers in education, health and social care may be ignoring the emotional contexts in which they work. It suggests that being caring may be the key to being critical.

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]

Introduction: The role of the clinical nurse specialist is complex but is defined differently across the world. The role of clinical nurse specialist stoma care is undefined and it is uncertain what aspects of the role are included in the general day‐to‐day working role. Aims: The aim was to gain consensus opinion to answer the research question: 'What is the role of the clinical nurse specialist in stoma care?' Design: Delphi consensus. Methods: Previous data gained from a scoping review and expert consultation was utilized to form role statements. At a UK conference the 13 statements and 173 sub‐categories were voted upon. Consensus was agreed if 75% of voters voted agree or strongly agree. Two stages of voting occurred with results from the first vote being shared in the second voting session. Results: All 13 statement and most (150/193) statement sub‐categories reached consensus, with 20 sub‐categories added during voting session one. Conclusions: The four pillars of advanced practice were met by the 13 statements with clinical and education reaching higher consensus and agreement than leadership/management and research. The results of the consensus study provide a clearer articulation of the clinical nurse specialist stoma care role, which is complex and multifaceted which has not been described previously. Implications for Practice: Consideration of role evolution is made possible, to gain a greater expertise in the scope of practice it is necessary to include prescribing, management and research which could improve service delivery and optimize patient outcomes. There was no patient or public contribution, which in hindsight would have potentially improved the process but it was considered that patients might not recognize the full role of the nurse, understanding only aspects of the role that were patient‐centred. Patient or Public Contribution: No patients or public were involved in any aspect of this paper—in hindsight this might have been useful. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand the complexity of the needs of people with delirium superimposed on dementia • To enhance your knowledge of second-generation activity theory • To recognise the consequences of the separation of physical health and mental healthcare. Background: Delirium superimposed on dementia (DSD) affects the physical, mental and cognitive well-being of the person. The separation of physical health and mental health means that the care of people with DSD is at odds with the multifaceted aetiology and presentation of the condition. There is a lack of research on DSD from a mental health perspective. Aim: To explore UK mental health nurses’ experiences of providing care for people with DSD. Method: Individual semi-structured interviews were conducted with seven mental health nurses from one NHS trust in England. Participants’ experiences were considered through the lens of second-generation activity theory. Data were analysed using framework analysis. Findings: Six themes were identified: awareness of guidance and tools; guidance or tools as ‘paper exercises’; knowing the patient; the multidisciplinary team; care burden; and mental health versus physical health. Conclusion: When providing care for people with DSD, mental health nurses use their skills in knowing patients as individuals. However, this aspect of ‘knowing’ cannot be readily translated into the use of a numerical scoring tool. An integrated approach is required to support the care of people with DSD. [ABSTRACT FROM AUTHOR]

District nursing services are relentless in adapting to change and continuously seek different methods to improve the care they offer to service users. One of the relatively new changes where adaptation has been necessary is the use of digital devices to record assessments and work in real time. As documented in The NHS Long Term Plan (NHS) (2019), the NHS is being required to grow into the new digital age and, subsequently, district nurses (DNs) have needed to embrace the use of a paper-lite system. Although beneficial overall, the use of technology is a threat to the person-centred nursing approach used in assessment, which is the highest fundamental value in nursing. This article will seek to conceptualise the importance of a person-centred initial assessment with a service user who has either a long-term and/or a lifelong condition whilst considering the use of digital devices, benefits, and drawbacks of their use. It will emphasise the role of the DN, encompassing the multidisciplinary services throughout, whilst also considering any recommendations for further development. [ABSTRACT FROM AUTHOR]

This paper responds to the Alpine Rendez-Vous "crisis" in technology-enhanced learning. It takes a contested area of policy as well as a rapid change in the National Health Service, and documents the responses to "information overload" by a group of general practitioners practices in the North of England. Located between the spaces identified by Traxler and Lally as "competitive industrialisation" and web 1.0, and the consumer/customer focus and ubiquitous ownership enabled by portable and devices and web 2.0, in this work we see the parallels of the responses of publicly funded bodies moving towards privatisation as part of a neo-liberal agenda. Interviews with health professionals (HPs) revealed marginalised spaces for informal learning in their workplaces, and a desire to build a community that would enable them to overcome the time/space barriers to networking. The EU Learning Layers Integrating Project develops mobile and social technologies that unlock and enable peer production within and across traditional workplace boundaries. Through the HP narratives, we capture insights into their daily life, which enable the articulation of their needs for an online "Help-seeking" networking service, underpinned by their desire to consult what Vygotsky calls "the more capable peer."

There is conflict between the views projected by nurses and by policy directives about what constitutes care and caring. While there is a plethora of works on the conceptualization of care and caring, the influence of discourse remains unexplored. There is a small number of studies from the perspective of social constructionism, but very few take a Foucaultian-influenced analysis to identify the prevailing discourses and their power in the socially constructed situation of care and caring. This work explores the discursive roots of the current debate and shows how the power associated with the discourses of each social arena have shaped nursing practice. The findings are drawn from a grounded theory project using situational analysis. A total of 22 one-on-one interviews were completed with 14 community-based practitioners. The analysis revealed the social construction of four distinct arenas, each containing differing constructs of a caring nurse. Each specifically constructed social arena had associated discourses, to which it aligned. It revealed the conflicts between the four social arenas, the negotiation that took place, and how these conflicts and negotiation both gave power and repressed the differing world views of a caring nurse. The paper shows how alignment to discursive positions constructed three distinct senses of care.

There has been little professional debate in the UK literature about nursing diagnosis and this paper explores some of the reasons why nursing diagnosis has failed to gain momentum among nurses in the United Kingdom. The nursing diagnosis movement has now reached some European countries and in the light of the International Classification of Nursing Project (ICNP) and the Strategic Advisory Group for Nursing Information Systems (SAGNIS) project commissioned by the NHS Executive (NHSE), requires a close examination by British nurses. The unsuccessful attempt by the North American Nursing Diagnosis Association (NANDA) to have its taxonomy accepted for inclusion in the World Health Organization's 10th revision of the International Classification of Diseases, an innovation which would have made the NANDA taxonomy the definitive classification of nursing, should alert British nurses to the importance of nursing diagnosis. Although nurses effectively diagnose as part of the nursing process, adoption of the concept of nursing diagnosis as a driving force for practice evades many of them. This paper reflects upon some of the logistical and conceptual difficulties including issues of culture and terminology. It is suggested that nursing diagnosis has a great deal to offer British nurses in their efforts to improve the quality of care and to provide data in this area for both practice and research. [ABSTRACT FROM AUTHOR]

Provides information on the strategy of the National Health Service of Great Britain to manage its paperworks. Role of nurse managers in paperwork management; Practices that contributed to paper load in the agency.

This article aims to draw attention to increasing genericism in nurse education in the United Kingdom, which sees less specialist mental health education for mental health nursing students and offers opposition to such direction. In 2018, the Nursing and Midwifery Council produced the 'Future Nurse' standards which directed changes to pre‐registration nurse education. This led to dissatisfaction from many mental health nurses, specifically regarding reduced mental health content for students studying mental health nursing. Concerns have been raised through public forum and evolved into a grassroots national movement 'Mental Health Deserves Better' (#MHDeservesBetter). This is a position paper which presents the perspective of many mental health nurse academics working at universities within the United Kingdom. Mental health nurse academics collaborated to develop ideas and articulate arguments and perspectives which present a strong position on the requirement for specialist pre‐registration mental health nurse education. The key themes explored are; a conflict of ideologies in nursing, no parity of esteem, physical health care needs to be contextualized, the unique nature of mental health nursing, ethical tensions and values conflict, implications for practice, necessary improvements overlooked and the dangers of honesty and academic 'freedom'. The paper concludes by asserting a strong position on the need for a change of direction away from genericism and calls on mental health nurses to rise from the ashes to advocate for a quality education necessary to ensure quality care delivery. The quality of mental health care provided by mental health nurses has many influences, yet the foundation offered through pre‐registration education is one of the most valuable. If the education of mental health nurses does not attend to the distinct and unique role of the mental health nurse, standards of mental health care may diminish without assertive action from mental health nurses and allies. [ABSTRACT FROM AUTHOR]

Nursing and the construction industry arguably enjoy uneasy membership of the academy. As both move closer towards university-based learning, debates remain about where discipline-specific training should best be provided and the importance of softer, graduate skills for the professions. This paper contextualises that debate by describing both professions route into the academy and the similarities and differences in that historical journey and their present position. What emerges is a complex picture of negotiation and shifting priorities that can present challenges for students as well as teaching staff. Whilst students may be vocationally orientated, the need for generic, critical attributes has increased. A model of academic skills provision has been developed at one university in order to accommodate these potentially conflicting priorities. The devolved, embedded approach allows for the creation of support tailored to specific cohorts and aligned to professional identity and language and, thus far, has proven successful in engaging students.

Aim: The aim of this scoping review is to synthesise current evidence around the clinical skill development of preregistration registered nurses (RNs) in Australia, United Kingdom (UK), Ireland, United States (US), Canada and New Zealand, to inform nurse education, policy and clinical practice. Background: Nursing is a practical profession, and registered nurses require specific skills, knowledge and attributes in order to care for patients safely. The context for health care delivery is shifting, and the education of nurses must adapt to effectively equip the registered nurse of the future. Design: A scoping review was conducted of clinical skill development in preregistration nurses. CINAHL Plus, MEDLINE, Health Source (Nursing/Academic edition) and Scopus were searched. Included studies were primary Australian studies and international literature reviews, which focussed on preregistration nursing education. Papers were written in the English language and focussed on clinical skill development. Results were synthesised narratively. The review is reported here in accordance with the Preferred Reporting Items for Systematic Review and Meta‐analyses Scoping Review extension (PRISMA‐ScR) guidelines. Results: One hundred fifty‐five Australia studies and 89 international reviews were included in the review. Six key themes were identified, namely clinical skills, approaches to teaching and learning, interprofessional education, assessment of learning, clinical placement and simulation. Conclusion: There is substantial variation in strategies and programmes to facilitate clinical skill development both within Australia and internationally, indicating a genuine shift away from traditional didactic pedagogy. New graduate registered nurses were expected to be "work‐ready," albeit at a novice level, when they enter the workplace. Future research should consider measures of impact on actual clinical practice and focus on developing work‐ready graduates for the range of clinical settings in which they may practice. Educators, policymakers and educational institutions can use these findings to inform curriculum developments to ensure that clinical skill development is evidence‐based. [ABSTRACT FROM AUTHOR]

The British model of nurses as finders, appraisers, and users of research in practice is unattainable, given the technical complexity of research and the skills and time required. Clinical governance mechanisms and accountability demands further undermine the approach. An alternative is development of nursing research specialists and research-based clinical guidelines. (Contains 20 references.) (SK)

The article discusses the British government's White Paper, entitled "Our health, our care, our say: A new direction for community services" about primary care reform. There are concerns about the failure to mention nurses in the British government's plan to strengthen and invest in primary care and over the move to put health services out to tender. Royal College of Nursing (RCN) General Secretary Beverly Malone claims that there is no mention of school nurses and health visitors who can play a vital role in preventing ill health.

In this paper I revisit Isabel Menzies's classic 'nursing paper' (I.E.P. Menzies [1960]. A case-study in the functioning of social systems as a defence against anxiety: A report on a study of the nursing service of a general hospital. Human Relations, 13, 95-121). I outline the main findings of the paper and connect it to the major theoretical developments made by the Tavistock Institute of Human Relations and consider the current relevance of the paper in the contemporary field of health and social care. [ABSTRACT FROM AUTHOR]

Aim: To assess the knowledge, attitudes and practices of Registered Nurses working in residential aged care facilities pertaining to pain management for residents living with dementia. Background: Sub-optimal pain management continues for people living with dementia in residential aged care. Registered Nurses are the pivotal staff responsible for complex assessment and management of people residing in residential aged care facilities. Design and methods: :This integrative literature review was informed by Whittemore (2005). Searching and screening followed the PRISMA guidelines. Results: Thirteen papers were identified, the major themes identified were gaps in knowledge and skills, uncertainty of assessment, and delays in treatment. Conclusion: Registered Nurses require education on pain management for people living with dementia in residential aged care. Broader issues in residential aged care contribute to the problem and require examination. Research pertaining to Registered Nurses' roles pain management for residents living with dementia is required. [ABSTRACT FROM AUTHOR]

Aims and objectives: To review relevant literature that addresses the challenges of the biosciences in nurse education. More precisely, the review aims to explore the literature, concerning students’ learning, learning contexts and methodological issues and identify any significant gaps. Background: Knowledge of anatomy, physiology and biochemistry is essential for the understanding of human beings and for full appreciation of the concepts of illness and disease. The current status would seem to be that the required competencies within bioscience subjects are difficult to acquire and students have high rates of failure. Design: Integrative review. Methods: The research was performed on CINAHL, ERIC, Medline and British Nursing Index databases in a period from 2013–2017. Descriptive analytical methods were used for the initial research trawl. Findings: The search strategy resulted in 23 papers. The results of this review shed light on certain deficiencies in the research field looking at the biosciences in nurse education. There is a distinct lack of intervention studies and, thereby, knowledge of how best to support students’ learning in effective ways. Of note is that there are no field study approaches identified in the review sample. Conclusion: Many of the papers are single studies and course evaluations which may be seen as too narrow and inadequate as perspective. Students appear satisfied with the courses in the biosciences, but there seems to be no correlation between satisfaction and achievement. Relevance to clinical practice: Understanding and being able to give coherent rationales for the bioscience content in the nursing curricula are crucial and must be established in relation to its relevance to the dynamic nature of patient care, technological advances and demographic realities. Only on that basis can the primacy of this content be seen as relevant to the aspiring student nurse. [ABSTRACT FROM AUTHOR]

This article builds on the research paper published in the last issue of Dermatological Nursing, to look at the use, safety, prescribing, recommended dilution and storage of potassium permanganate. [ABSTRACT FROM AUTHOR]

elliott l., crombie i.k., irvine l., cantrell j. & taylor j. (2004) Journal of Advanced Nursing 45(2), 117–125 The effectiveness of public health nursing: the problems and solutions in carrying out a review of systematic reviews In 1999 the Scottish Office, United Kingdom, intimated that the Chief Nursing Officer would undertake a policy review of nurses’ contribution to improving the public's health. The importance of reviewing the scientific literature on the effectiveness of public health nursing was recognized as a crucial part of the policy review. A final report was expected within a 6-month period. The reason for the short time period was to fit the policy-making schedule. This paper discusses our literature review for this work. The aim was to conduct a review of the international scientific literature that gave the greatest coverage of the role and potential role of nurses in improving the public's health in relation to 14 major health topics. This paper describes the methods used, outlines the rationale underpinning the methods, discusses the problems encountered and offers solutions to some of these problems. The initial search for relevant scientific literature revealed 709 suitable primary papers. Reviewing this number was beyond the time limit set by the funding organization. Therefore, a decision was made to concentrate on the evidence contained in systematic reviews. Reviewing systematic reviews raises a number of methodological problems to which there are often no predetermined solutions, such as ensuring that important interventions are included, assessing the relevance and quality of the reviews, and grading the strength of the evidence. Reviewing systematic reviews provides the scope to increase the number of topics that might be covered. However, it is possible that a number of interventions may be missed, particularly those that are not subject to review or those assessed using qualitative techniques. The definition of public health nursing used in the present study was also restrictive, and could be widened to include community interventions. Finally, assessing the quality of reviews and grading the evidence proved difficult and there is lack of consensus on how these tasks should be achieved. Nevertheless, the review presented policy makers with accessible information on a large number of relevant international studies. [ABSTRACT FROM AUTHOR]

Aim: To examine how school nurse practice evolved as a result of the Covid‐19 pandemic. Design: A scoping review of international literature, conducted and reported in line with Arksey and O'Malley's (2005) framework. Data Sources: Searches were conducted in September 2021. Ten databases were searched: The British Nursing Database, CINAHL, Cochrane Library, Consumer Health Database, Health and Medicine, Nursing and Allied Health, Public Health, PsycINFO, PubMed and Web of Science. Relevant grey literature was identified through hand searching. Review Methods: A minimum of three reviewers independently screened articles and two reviewers independently undertook data extraction, with any decisions made collaboratively with the wider team. Much of the literature was not empirical work and so it was not possible to apply a traditional quality appraisal framework. Results: Searches identified 554 papers (after deduplication) which were screened against title and abstract. Following the full‐text review, 38 articles underwent data extraction and analysis. The review findings highlighted that school nurses adapted their practice to ensure they were able to continue providing their formal and informal school health offer to children, young people and their families and continued working closely with the multidisciplinary team. In addition, the expanded public health role generated by Covid‐19 for school nurses' work was considerable, multi‐layered and added to their routine workload. School nurses displayed resilience, adaptability and creativity in their response to delivering services during Covid‐19. Conclusion: School nurses took on a leading public health role during the Covid‐19 pandemic. Some developments and practices were highlighted as beneficial to continue beyond the pandemic. However, formal evaluation is needed to identify which practices may merit integration into routine practice. Continued investment in staff and infrastructure will be essential to ensuring school nurses continue to expand their practice and influence as public health experts. [ABSTRACT FROM AUTHOR]

Background: Childhood immunisation is a critically important public health initiative. However, since most vaccines are administered by injection, it is associated with considerable pain and distress. Despite evidence demonstrating the efficacy of various pain management strategies, the frequency with which these are used during routine infant vaccinations in UK practice is unknown. Aim: This study aimed to explore primary care practice nurses' (PNs) use of evidence-based pain management strategies during infant immunisation, as well as barriers to evidence-based practice. Methods: A questionnaire was developed and distributed to nurses throughout the UK via convenience sampling in paper and online formats. Questions assessed the frequency of pain management intervention use during infant immunisation and barriers to their use. Findings: A total of 255 questionnaire responses were received. Over 90% (n  = 226) of respondents never used topical anaesthetics or sweet solutions during immunisations, while 41.9% advised breastfeeding occasionally (n =  103). Parent-/caregiver-led distraction was the most frequently used intervention, with most nurses using it occasionally (47.9%, n =  116) or often (30.6%, n =  74). Most practices had no immunisation pain management policy (81.1%, n =  184), and most PNs' previous training had not included pain management (86.9%, n =  186). Barriers to intervention use included lack of time, knowledge and resources. Excluding distraction, pain management strategies were infrequently or never used during infant immunisation. Key barriers to using evidence-based strategies were lack of time, knowledge and resources. [ABSTRACT FROM AUTHOR]

This paper examines the emerging use of complementary therapies in British nursing practice at the end of the twentieth century. Many nurses turned to complementary therapies as a means to provide a closer therapeutic relationship with their patients and this paper will establish how nurses were informed and empowered. The paper places complementary practices in the context of nursing developments in the closing decades of the twentieth century and concludes that the extent of the supporting networks that encouraged nurses to incorporate these therapies into their work was more significant than has been previously recognised and exemplifies a distinct period in the history of modern nursing. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To explore the collaborative nature of an international research project with other advanced practice nurse researchers and critically analyse the process. Background: Research within the nursing community is recognized internationally as important to ensure that nurses participate in cutting‐edge health care and promote evidence‐based practices, yet there is little detail found in literature on how a successful collaborative relationship is initiated and conducted in advanced practice research. Design: Discussion paper: The purpose of this paper is to discuss the process of collaboration on a research study among advanced practice nurses from four countries who are members of an international organization. Implications for Nursing: The collaborative process in international nursing research can be challenging and rewarding. It is important to remember that there is a relationship between the complexity of the study and the time required to complete it. Keys to success include following established guidelines. Conclusion: This project was a valuable experience in developing collaborative relationships as well as creating partnerships for future research to build on the knowledge gained. The authors' linkages to universities facilitated their participation in the research and completion of the ethical review processes. The use of social media and university resources was indispensable. [ABSTRACT FROM AUTHOR]

Aim: To explore perspectives of Mesothelioma UK clinical nurse specialists (CNSs) on their role in providing palliative care for patients with mesothelioma and their families. Design: A qualitative descriptive approach using focus group and interview methods. Methods: Focus groups and semi‐structured interviews were conducted with 16 Mesothelioma UK clinical nurse specialists using the online software Google Meet. Data collection was carried out in Jan‐Feb 2021 and data were analysed using thematic analysis. The consolidated criteria for reporting qualitative research (COREQ) was used as the reporting guideline for this paper. Results: Four main themes were identified from the data: Mesothelioma UK clinical nurse specialist role in relation to palliative care; joint working with specialist palliative care and community services; patients and family carer's willingness to engage with palliative care services; and the impact of COVID‐19 on palliative care for mesothelioma patients. Conclusion: This study provides valuable insights into palliative care needs in mesothelioma. Patients with mesothelioma and their families have significant palliative care needs throughout the course of their illness from diagnosis to the end of life. Mesothelioma UK CNS's play a crucial role in supporting patients' and families palliative care needs, and are highly skilled in providing this care. Impact By acknowledging the role of Mesothelioma UK CNS's in palliative care provision, and supporting collaborative working between specialist and generalist palliative care providers, there is the capacity to significantly improve palliative care in mesothelioma and improve outcomes for patients and their families. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to explore the impact of the pandemic on the emotional and mental well‐being of family carers, care home staff and residents, in light of changing restrictions, increased testing and vaccination rollout in the UK. Design Longitudinal, qualitative semi‐structured interview study. Methods: Remote semi‐structured interviews were conducted with family carers of care home residents with dementia and care home staff from different care homes across the UK. Baseline and follow‐up interviews were conducted in October/November 2020 and March 2021, respectively. Data were analysed using inductive thematic analysis involving members of the public with caring experiences. Results: In all, 42 family carers and care home staff participated at baseline, with 20 family carers and staff followed up. We identified four themes: (1) Developing anger and frustration; (2) Impact on relationships; (3) Stress and burnout; and (4) Behavioural changes, and perceived impact on residents. The mental health of everyone involved, including family carers, care home staff and residents, has been negatively affected, and relationships between family carers and staff have been severely strained. There was a general lack of adequate mental health support, with little relief. Conclusions: The pandemic has had a detrimental impact on the lives of those surrounding care homes—from residents and staff to family carers. Consideration should be given on how to best support the mental health needs of all three groups, by providing adequate easily accessible mental health care for all. This should also focus on rebuilding the relationships between family carers and care home staff. Impact This is the first paper to highlight the effects of the long‐lasting and miscommunicated restrictions on residents, carers and care home staff, and highlight the urgent need for continued mental health support. [ABSTRACT FROM AUTHOR]

Conceptual and theoretical frameworks for person-centred community nursing practices have not yet been fully developed. There is a need to explore this further in order to guide future district nursing, which forms part of the community nursing discipline in the UK. The contemporary district nursing role is undergoing change, although there appears to be little consensus about the district nurse's (DN) vision across the UK, and little indication of the theoretical position underpinning this change. Meeting strategic requirements (National Health Service (NHS), 2019; Scottish Government (SG), 2017a&b), DNs have advancing clinical expertise and are recognised for their technical skills. However, one may contend that this emphasis on 'doing' in practice contributes to practice decisions made exclusively on task performance by strategic decision-makers, and DNs continually viewing themselves as invisible (National Assembly for Wales,, 2019; Queens Nursing Institute (QNI), 2006; Dickson 2018; 2020). District nursing education may contribute to this lack of clarity as curricula are based on borrowed theory from other disciplines that continue to focus on 'how to do', with little emphasis on 'how to be' a DN, and the continued decrease in DN numbers across the UK may be a consequence. In this paper, I explore current evidence that underpins district nursing practice, education and research in the UK, and advocate the use of the Person-centred Practice Framework (PCPF) (McCormack and McCance, 2017) as a means of unifying and guiding 'being a person-centred DN.' This will enable practitioners who can draw on multiple forms of evidence to inform their advancing practice. This article offers philosophical and pedagogical principles to underpin person-centred education going forward. I argue this will promote congruence between 'doing' and 'being' a DN, giving a voice to DNs, and direction to their specialism. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore moral distress empirically and conceptually, to understand the factors that mitigate and exacerbate moral distress and construct a model that represents how moral distress relates to its constituent parts and related concepts. Background: There is ongoing debate about how to understand and respond to moral distress in nursing practice. Design: The overarching design was feminist empirical bioethics in which feminist interpretive phenomenology provided the tools for data collection and analysis, reported following the COREQ guidelines. Using reflexive balancing, the empirical data were combined with feminist theory to produce normative recommendations about how to respond to moral distress. The Moral Distress Model presented in this paper is a culmination of the empirical data and theory. Methods: Using feminist interpretive phenomenology, critical care nurses in the United Kingdom (n = 21) were interviewed and data analysed. Reflexive Balancing was used to integrate the data with feminist theory to provide normative recommendations about how to understand moral distress. Results: There are five compounding factors that exacerbate/ mitigate nurses' experiences of moral distress: epistemic injustice; the roster lottery; conflict between one's professional and personal responsibilities; ability to advocate and team dynamics. In addition to the causal connection and responses to moral distress, these factors make up the moral distress model which can guide approaches to mitigate moral distress. Conclusions: The Moral Distress Model is the culmination of these data and theorising formulated into a construct to explain how each element interacts. We propose that this model can be used to inform the design of interventions to address moral distress. [ABSTRACT FROM AUTHOR]

Carers of people with dementia can experience reduced health and well‐being, but little is known about how best to support them. There is some evidence to suggest that case management may improve outcomes for carers but less evidence about the features of case management services that can effectively support carers of people with dementia. Admiral Nursing operates a case management approach staffed by specialist nurses and is the only service of its kind in the United Kingdom dedicated to helping people with dementia and their carers. This paper reports qualitative findings from a mixed methods study of Admiral Nursing. For the qualitative strand of the project, data were collected in focus groups and in‐depth interviews with carers of people with dementia (n = 35) and analysed thematically using the framework approach. The aim of this analysis was to understand differences between the experiences of the carers in our sample with and without Admiral Nursing, applying Freeman's model of continuity of care (Freeman et al., Continuity of care, 2000). Participants who had received Admiral Nursing were recruited from two geographical locations and carers without experience of this service were recruited from two different areas. We found that carers in our sample felt 'supported' in circumstances where they received an ongoing service from an Admiral Nurse or other professional with expertise in dementia who was able to develop a meaningful relationship with them over time. We conclude that ongoing support, expertise in dementia and a meaningful relationship are key features of relationship continuity common in carers' reports of feeling supported. Specialist nurses are well placed to provide this continuity. [ABSTRACT FROM AUTHOR]

Purpose – Observations have been made that mental health students receive very little support following observing patients displaying suicidal behaviour. The purpose of this paper is to conduct a small-scale empirical study to investigate this issue further. Design/methodology/approach – The approach used in this study is phenomenological. Qualitative data were obtained through semi-structured interviews consisting of a range of questions asking mental health student nurses about their experiences of support in practice. The data are analysed using thematic analysis. Findings – As well as issues relating to the support of mental health student nurses in practice, there are many ethical issues raised in this paper. These include student responsibilities while in placement areas; students as having a supernumerary status; and the inclusion of students in supervision and debriefing sessions following traumatic incidents. Research limitations/implications – This small-scale exploratory study was conducted with a small number of students in one University. However, the study provides a strong starting point for further research on the support students receive during their mental health nurse training. Originality/value – This paper makes some recommendations on ways to improve the support of students in practice, including maintaining and supporting the role of Practice Experience Managers who spend a considerable amount of time in placement areas interacting with students and feeding back relevant practice concerns to University staff. [ABSTRACT FROM AUTHOR]

thompson c., yang h. & crouch s. (2012) Clinical simulation fidelity and nurses' identification of critical event risk: a signal detection analysis. Journal of Advanced Nursing 68(11), 2477-2485. Abstract Aims. This article is a report of a study exploring the effect of increasing fidelity on nurses' risk detection in clinical simulation and the effect of clinical experience on nurses' risk detection ability. Background. Clinical environments can be recreated successfully using simulation. However, how judgement changes as simulation fidelity increases is unknown. Knowledge of the effects of increased fidelity on judgement may help in the design of educational interventions seeking to improve clinical judgement in nurses. Design. Quasi experimental signal detection study. Method. During 2008-2009, using a quasi experimental signal detection design, 63 nursing students and 34 experienced nurses were presented with 25 paper and 25 human simulator 'cases' based on real patient records from a single UK National Health Service hospital. Nurses judged whether a simulated case was 'at risk' or 'not at risk' of a critical event. Clinical judgement performance was measured using standard signal detection measures. Findings. Judgement performance, as measured by hit rates and signal detection ability were significantly lower in higher fidelity clinical simulations. False alarm rates and bias (β) did not differ according to the fidelity of simulation. Clinical experience did not predict the ability to detect risk. Conclusion. As fidelity of simulation increased, both novice and experienced nurses' were less likely to be able to separate important clinical risk from clinical noise in a simulated clinical environment. [ABSTRACT FROM AUTHOR]

Aim. This paper is a review of the effectiveness of non-surgical, non-pharmaceutical interventions designed to promote weight loss in people with a learning disability and how qualitative evidence on people's experiences and motivations can help understanding of the quantitative research outcomes. Background. The health risks of obesity underline the importance of effective evidence-based weight loss interventions for people with learning disabilities as they are at increased risk of being overweight. Data sources. Papers published from 1998 to 2009 were identified through searches of the Cumulative Index for Nursing and Allied Health Literature, Proquest, Medline (PubMed), PSYCHINFO databases, and the Cochrane Library. Review methods. An integrative review method was used. Studies included were non-surgical or non-pharmaceutical interventions aimed at weight reduction for people with a learning disability. Synthesis of the findings related to study design, participants, types of interventions, outcome measures and participant perspectives. Results. Twelve studies met the inclusion criteria. The most common research design was quasi-experimental pretest and post-test. Few researchers used a clinical trial approach, and there was only one predominantly qualitative study. Interventions were mainly focused on energy intake, energy expenditure or health promotion. Only a few studies incorporated behaviour modification approaches. Conclusion. Nurses who work with clients with learning disabilities have a key role to play in the management of obesity. Future research needs to focus on qualitative studies of the perceptions of clients and their families, controlled trials investigating the effectiveness of interventions and their costs and sustainability, and longitudinal studies examining weight loss over time. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of this paper is to reflect on how an acute hospital trust involved a youth council comprising 17 young people aged 11–18 years to improve children’s service delivery in one NHS trust in the UK. Background. Over the last decade, there has been an increased emphasis on the active involvement and participation of children and young people in the decision-making processes that affect them. However, one challenge in involving users in acute hospital trusts is how their views are used to develop services. For this reason, University Hospitals Coventry and Warwickshire NHS Trust, UK (University Hospitals Coventry and Warwickshire NHS Trust have given permission to have their name cited in the publication of this article) recognising the emerging national patient and public involvement agenda, planned and developed a youth council for the Trust in 2006. Process. The process of setting up the youth council is outlined. An evaluation workshop took place with 15 members of the youth council and their views are incorporated around three specific areas: • Evidence that their involvement has improved trust services; • Barriers to young people’s voices being heard in service delivery; • What could promote young people’s involvement in healthcare services. Conclusion/Relevance to clinical practice. This paper describes the setting up of a youth council but also discusses the potential barriers and how to overcome them to promote young people’s involvement in hospital trust service planning and development. Whilst the focus of the council was young people, the principles are of use to a wide range of clinical professionals faced with similar challenges. [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]