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Widespread, and sometimes inappropriate use of psychotropics in adults with intellectual disability has been an international concern. These medicines have been used to treat mental health conditions, but also, controversially, some types of behaviours not necessarily associated with the diagnosis or in the absence of a relevant diagnosis. Results from the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA) study of older adults with intellectual disability in Ireland revealed that 60% were taking psychotropics in 2010. In the intervening decade changes in regulations, policy, and increased decongregation of people with intellectual disability have taken place likely influencing the use of psychotropics. The HSE National Clinical Programme for People with Disability (NCPDD) established in the 2020 has medicines optimisation as a key priority. Existing multi-wave data from the IDS-TILDA study and the HSE national prescribing database offers an opportunity to better understand psychotropic use and prescribing patterns. This is a novel collaboration on lived experience, research, practice and policy. The aim of this research is to examine the quality and trends of psychotropic use of older adults with intellectual disability over a ten-year period in Ireland to evaluate the effects of and to inform both practice and policy to optimise medicines use and health outcomes. Health and medication data from ten years (four waves) of the IDS-TILDA study and corresponding medicines data from the HSE-PCRS prescribing database are available. Descriptive and longitudinal analysis will examine association between long-term psychotropic use, changes in trends of use, and the impact of decongregation on medicines use. This research will inform the development of national guidance on medicines optimisation for older people with intellectual disability and has the potential to change prescribing practices and improve health and wellbeing for older people with intellectual disability.

As various agencies increasingly advocate interprofessional care (IPC), it is paramount that the educational implications of this approach are considered. Interprofessional learning (IPL) is necessary for IPC and this paper argues that an emerging educational model, narrative-based virtual communities (VCs), meets this goal. We therefore argue for the fusion of narrative pedagogy with the VC approach to further the IPL agenda. Using stories to teach is not new. Technological innovations now make the possibility of using narrative, a way to enable students to experience greater reality in complex situations. Recently, two multimedia VCs have been developed. Here, we review the use of "The Neighborhood" and "Stilwell", as IPL tools. Early evaluation of these communities has been very positive and they offer a unique and innovative approach to IPL in ways that immerse learners from many professions into the context of the lives of individuals requiring health and social care, and the people who provide that service. Thus, it is possible to more fully realize and teach about collaboration and partnerships among professionals and patients.

Child sexual abuse is a highly emotive subject and nurses have a key role to play in caring for survivors. Educating students about this role is difficult because a conventional classroom approach does not prepare students adequately or give them sufficient insight into the experiences of victims. The Stilwell virtual simulation model is a radical new approach which aims to assist learning by immersing students in a realistic multimedia simulation of a typical community. This model allows insightful learning about difficult areas such as child sexual abuse. Its use and contribution to learning in this area are discussed.

Narrative pedagogy has been developed over the last decade in nursing as a means of complementing a conventional content and competency driven pedagogy. It focuses attention on the human experience of health care by deriving shared meanings from interpretation of stories. This allows students to explore the different perspectives of those involved. The emotional experiences of participants can be understood, conventional wisdom challenged and new knowledge emerge as students work together to construct their learning. Individual stories are embedded within the narrative and teachers have successfully used literature and film as narratives to help them explore the meaning of health care with students. Modern technology has opened up a new range of electronic narratives such as virtual simulation. These are considered and rejected as devices for a health care narrative due to their dehumanized and unrealistic nature. However it is argued that a multimedia online simulation of a typical neighbourhood can achieve the goal of providing a suitable narrative. Human actors replace avatars and real world settings replace gaming environments as the stories of people in this community are related and used to support narrative pedagogy. An example of such a narrative developed jointly in the UK and Canada is discussed.

Narrative pedagogy has emerged in the last decade as a new approach designed to complement the conventional approaches to education. It is concerned with understanding the meaning of events to people, appreciating multiple perspectives and the emotional content of health care. However there is a paucity of evaluative research concerning its impact. We have used narrative pedagogy to create Stilwell, a realistic narrative telling the stories of 60 characters living in a typical community. Stilwell is a real place (fictional name) and our multimedia model brings the community to life as a virtual practicum for a wide range of health professional students. This paper presents the results of our initial focus group evaluation of student learning experiences with Stilwell. The data indicates students found it a very different way of learning which allowed them to relate theory to practice in ways they had never done before. The realism of Stilwell was a challenge and generated considerable student emotional involvement with the characters, leading to significant novel learning activity.We reflect on how student feedback has allowed us to shape and improve Stilwell as it develops.

The recent growth of the nurse practitioner (NP) movement has coincided with rising interest in the area of professional development. Nurse practitioners have been criticised for moving away from nursing and becoming 'mini-doctors', a charge which they hotly deny, pointing out that they are actually trying to become 'maxi-nurses'. How do nurses and nurse practitioners see their future professional development? If NPs really are intent on becoming 'mini-doctors', might there be evidence of this in their aspirations for professional development? In the second of two articles comparing the perspectives of nurses with those of nurse practitioners, this study investigates opinions about future professional development.

This article follows up a previous article on community nurses' perceived barriers to implementing research (Walsh 1997). Here the author examines the perceived barriers to research use among a sample of 63 hospital and 78 community nurses. The major barriers identified relate to the clinical setting and understanding research reports. The results have significant implications for managers of the service and educators who seek to promote research-based practice.

In the fourth and final part of his series, Mike Walsh explores the reasons for patients choosing to attend AE patient and staff definitions of what constitutes 'appropriate' can be very different. The series closes with the author suggesting that increased responsibilities placed upon GPs by the Government's reforms require health service managers to urgently review why a significant proportion of attenders did not have any kind of GP cover.

This article will give an overview of abdominal trauma and provide a broad framework for the initial management of injuries to the abdomen. Abdominal injury carries a high morbidity and mortality in all age groups, therefore a sound understanding of the patterns of injury, examination, investigations and resuscitation procedures is vital to the trauma surgeon's armamentarium.

When public money is invested in research it is necessary to have in place accounting systems that demonstrate its value. By this we mean its social as much as its economic value to society. This paper traces the collective experiences of a group of service user, professional and academic researchers about the annual reporting of research activity supported by NHS R&D Support funding. The stance taken is partisan as it represents one that defines the scope of our work within a regional NHS user-centred research programme. We critique the NHS research accounting system in England and the thinking upon which it appears to be based, suggesting that it devalues less traditional forms of research. It is argued that reductionism written into the present accounting system strips it of sensitivity to the values, operational arrangements and timescales involved in a lot of service user-centred research, and marginalises the value of many of its outputs. We set down some challenges for the redesign of the annual reporting system relating to NHS Research and Development (R & D) Support Funding.

The concluding article in this series will explore the patients' perspective of their A&E experience through the use of evaluative questionnaires. Developments in quality assurance and the impetus from the Patient's Charter have led to staff being more concerned with patients' evaluation of their experiences, and A&E is no exception. The study revealed that patients are poor predictors of their treatment but the majority are satisfied with their experience. A smaller study of patients who walked out before treatment showed that a third did not seek subsequent help. The author argues that the study supports the need for nurse triage and nurse practitioners.

This article looks at the challenges facing practice development today and uses key topics in the natural sciences as metaphors to try and stimulate fresh ways of thinking about the way forward. The fundamental challenge we face is one of borders and boundaries, and this is a theme I will keep returning to in this paper.

Some people perceive nurse practitioners (NPs) as 'mini doctors' concerned more with the biomedical and technical aspects of health care than with the holistic, psychosocial elements. In the first of two articles, these assertions are tested. The views of a group of nurse practitioner graduates and undergraduates are compared with the views of a group of other nurses taking continuing education courses. The results may surprise you.

Patient satisfaction is a popular way of evaluating nursing practice, but there are doubts about its reliability and validity. This article describes a study which assessed the usefulness of one tool for measuring patient satisfaction--the Newcastle Satisfaction with Nursing Scale.

This article reports the findings of a study of community nurses to determine their perceptions of barriers to the implementation of research findings in practice. A questionnaire survey using a scale developed in the US (Funk and Champagne 1991) asked community nurse students to rank a series of perceived barriers in order of greatest to least obstruction. The results were also compared with those from Funk and Champagne's study (1991). The authors found that UK nurses considered lack of authority and the inaccessibility of research reports were major barriers to implementing research findings. The authors emphasise the need for collaboration between managers, academics and practitioners to overcome such barriers.

Little research has been carried out into pain and anxiety in the A&E department. In the third article in this series, a study of 200 patients is described which revealed that only a small number of A&E patients reported having no pain or anxiety while substantial numbers were reporting high pain and/or anxiety levels. A statistically significant linkage between high pain and anxiety levels was demonstrated. The author reviews what factors cause anxiety and fear in patients attending A&E and concludes that nurses can alleviate worry and pain by better communication.

In the first article of a new four-part series, Mike Walsh analyses the reasons why patients delay before attending an accident and emergency (A&E) department. Interviews with a sample of 200 A&E patients were conducted to find out why people attend when they do. Factors such as presence of a wound, access to the department and type of condition were found to be significant in their decision. The concepts of utilisation time, illness time and appraisal time are essential in understanding why patients may delay their attendance. Subsequent articles will address questions such as why people attend A&E rather than their GP, pain and anxiety in A&E, and patients' opinions of their experience.

In the third part of his series on trends in A&E attendance, Mike Walsh focuses on the significance of social factors and finds considerable influence being exerted by employment status and gender. Unemployed people comprised a disproportionate number of attenders, while women formed the larger group suffering injuries related to accidents in the home. The author urges nurses to take social factors into consideration when planning care.

Mike Walsh demonstrates how the technique of multiple regression analysis can be used to clarify the significance of several variables in determining the geographical factors which affect A&E attendance. The results indicate that travelling distance to A&E, social status of the catchment area and the proportion of the population in the 15-29 age group are significant factors in a complex equation.

Mike Walsh introduces a four-part series on the factors influencing accident and emergency attendance by considering the attendance trends in Bristol Royal Infirmary A&E department in 1988. Important findings include objective evidence of increases in assault injuries associated with excessive alcohol intake at nights and weekends, and a disturbingly high rate of patients who register at A&E but do not wait to be seen by a doctor. The implications of these and other findings will be discussed in future papers in the series.

Exhorted to provide evidence-based practice, be accountable practitioners, provide a value for money service and to expand the nursing role, nurses can be forgiven for wondering just how they can meet these laudable targets while coping with all the other stresses that are part and parcel of life in today's NHS This article reports on a network which offers appropriate support.

As many readers will know, the annual Royal College of Nursing Congress will soon be upon us, and by now copies of the agenda should be finding their way to various membership groups.