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The COVID-19 pandemic has increased workload demands for many NHS staff including those working in the community. Nurse managers can make a difference by being authentic leaders, nurturing a supportive organisation where the workload is managed participatively and self-kindness is legitimate. Unfortunately some staff may experience burnout and this article presents a personal management plan to address the symptoms of burnout and aid recovery, although it cannot promote a total recovery if the cause of the symptoms remains unaddressed.

Background Globally there are mounting concerns about nurses’ job satisfaction because of its pivotal role in nurse turnover and the quality of care of patients. Objectives To identify a more comprehensive and extensive knowledge of the job satisfaction of qualified general nurses working in acute care hospitals and its associated factors drawing upon empirical literature published in the last five years. Design Literature review. Data sources A comprehensive electronic database search was conducted in PubMed (2012–2017), Web of Science (2012–2017), CINAHL (2012–2017), Embase (2012–2017), PsycINFO (2012–2017) and the Applied Social Sciences Index (2012–2017), CNKI (2012–2017), WanFang (2012–2017), SinoMed (2012–2017) and VIP (2012–2017) to retrieve relevant articles published in both English and Chinese between January 2012 and October 2017. Review methods Key terms and phrases associated with job satisfaction, occupational stress, professional commitment, role conflict and role ambiguity were utilized in the subject search in combination with nurses following guidelines for searching the OVID interface. The abstracts or full texts of research papers were reviewed prior to their inclusion in the review according to inclusion criteria and quality assessment using the Strobe guidelines. Results A total of 59 papers were included in this review. The impact of job satisfaction upon sickness absence, turnover intention, as well as the influencing factors of job satisfaction such as working shift and leadership, job performance, organizational commitment, effort and reward style has been identified in a number of research studies yielding equivocal findings. Job satisfaction of hospital nurses is closely related to work environment, structural empowerment, organizational commitment, professional commitment, job stress, patient satisfaction, patient-nurse ratios, social capital, evidence-based practice and ethnic background. Various mediating or moderating pathways have been identified with nurses’ job satisfaction being mediated by various factors. Conclusions It is vital to increase nurses’ job satisfaction because this has the potential both to improve patients' perceptions of care quality and ensure an adequate nursing workforce. The indirect relationships and predictors of job satisfaction contribute to a more comprehensive understanding of the complex phenomenon of job satisfaction, which in turn may aid the development of effective strategies to address the nursing shortage and increase the quality of patient care.

As survival increases worldwide, large numbers of young people will need to transition from child to adult cystic fibrosis (CF) services. Little is known about the best method for transitioning patients with CF and which transition programmes yield better outcomes. This paper provides a systematic review of the empirical literature on the outcomes and experiences of transition for young people with CF. Outcomes data were subject to a narrative synthesis and a thematic synthesis of experiences data. Structured transition programmes were associated with increased satisfaction, discussions about transition, self-care and self-advocacy skills, more independence, lower anxiety, and increased self-management and parent management of physiotherapy and nutritional supplementation. Young people's concerns included leaving behind previous caregivers, differences in care provision and infection risks. Lack of preparation was a consistent theme. The two most useful aspects of transition programmes were meeting the adult doctors/CF specialist nurse/team and visiting the adult centre. Young people want education about the differences between services, implications of their condition and self-care management. Structured transition programmes appear to impact positively on experiences but the contribution of the different components of transition programmes is unclear. The absence of high-quality studies indicates the need for more well-designed research.

Residents living in a care home are likely to have a number of long-term conditions for which they may be taking multiple medicines. Alison While offers some valuable advice for staff in relation to the importance of good staff training and record keeping

Background Obesity is a growing global public health problem which requires all healthcare professionals to deliver weight management care within their roles. Aim To describe nurses' perceived barriers, skills and practices regarding weight-related care and explore differences between English and Chinese nurses. Methods A cross-sectional, self-administered questionnaire survey was distributed to 588 English nurses employed in a range of clinical settings and healthcare organizations and attending a large university in London (October–November 2010), and 519 Chinese nurses working in one of the largest hospitals in Shanghai, China (February–April 2011). Perceived barriers, skills and practices regarding weight-related care were measured. Data analysis was undertaken using responses from 399 English and 466 Chinese nurses. Results English and Chinese nurses reported similar barriers to undertaking weight-related care practices which included two relatively new barriers, namely complex patients and the absence of clear practice guidelines. Both English and Chinese nurses reported being moderately skilled to perform weight-related care practices with the most mean skill scores at the moderate level. Up to 11–54% of the English nurses and 10–25% of the Chinese nurses reported providing recommended weight-related interventions for most of their patients. Generally, the English nurses reported more barriers, high-level skills and practices regarding weight-related care than the Chinese nurses. Limitations The convenience samples and self-report data may have been sources of bias. Conclusions A variety of barriers and limited skills may help explain the suboptimal weight-related practices among the nurses. Implications for nursing and health policy Skill development of pre-registration and qualified nurses is indicated as well as the development of the nurse role to include weight management care of obese patients. Evidence-based guidelines should be readily accessible to support the nurse role in weight-related care.

Many registered nurses (RNs) are not achieving the recommended daily levels of physical activity. This study collected data from 623 RNs about their personal health behaviours and their professional, physical activity-related health-promotion practices. The findings showed that 75% of the sample reported engaging in personal physical activity, 25% were at risk of hazardous drinking or active alcohol use disorders, 17% were past smokers and 11% were current smokers, 47% reported having a normal body weight-size, and 73% desired to be a normal body weight-size. Nearly half of the sample reported that they were promoting physical activity within their clinical practice. Personal physical activity behaviour, perceived health status, length of clinical practice, clinical specialty, and actual body weight-size were significantly related to the RNs' professional, physical activity-related practices. This study highlights a need for training on physical activity-related counselling, including awareness of the latest recommendations and strategies to promote physical activity. Health-care employers should also consider addressing nurses' barriers to the promotion of physical activity within their clinical practice so that all health-care contacts are able to maximise opportunities to promote active ageing.

The ward manager’s role is a complex one that involves meeting financial targets, responding to changes in organisational structures and ensuring the delivery of quality patient care. Whilst the ward manager’s role remains key to service delivery, there has been limited research on the current role from the perspective of ward managers. A survey of ward managers, exploring aspects of their working lives and potential enablers of the ward manager role, is described. The variety of activities within the role was a source of job satisfaction despite the challenge of ‘keeping on top of everything’. Potential role enablers included having protected time for the managerial aspects of the role. The study findings indicate the need to understand the role of the ward manager with particular reference to job satisfaction, and the underpinning support required to enable ward managers to execute the role effectively.

Background Unplanned extubations in PICU are used as a measure of quality in clinical governance strategies. While many factors, such as sedation or unit activity, impact negatively on unplanned extubations, high nurse-patient ratios reduce adverse patient events and improve patient safety. However, optimal nurse-patient ratios and the impact of the level of nursing expertise on the quality of care are unknown. Aim The study aimed to examine the impact of PICU nursing expertise on the unplanned extubations of children. Design Audit and analysis of existing adverse event patient and nurse workforce data. Method This single-centre study examined unplanned extubations at a mixed general and cardiac tertiary PICU in the UK. Routinely collected data from nursing and adverse incident databases were examined. The dataset included over 74,477 nurse allocations between August 2006 and April 2011. Unplanned extubations were the adverse event of interest. Results A total of 78 unplanned extubations occurred between April 2006 and April 2011. The majority of unplanned extubations occurred when patients were looked after by junior nurses. The seniority of the nurse in-charge and the qualifications of the patient's nurse were not related to unplanned extubations. However, more unplanned extubations occurred at times of higher patient occupancy. Conclusions Nursing expertise and nurse-patient ratios were not related to unplanned extubations in this study. Further research is needed to explore the non-workforce factors such as the securing of endotracheal tubes, sedation levels and unit activity and their relationship with adverse events. Relevance to Clinical Practice In paediatric intensive care units where nurse-patient ratios are high, further investigation is needed to establish what impact non-workforce factors have on unplanned extubations.

The UK faces a public health challenge arising from unhealthy behaviours. Some health care workers engage in the same unhealthy behaviours as the general population. This paper explores the issues arising from some primary care staff adopting unhealthy behaviours upon healthcare organisations, professional practice and patient perceptions in terms of the promotion of health in the primary care setting.

Health professionals’ personal health behaviors have been found to be associated with their practices with patients in areas such as smoking, physical activity and weight management, but little is known in relation to alcohol use. This review has two related strands and aims to: (1) examine health professionals’ alcohol-related health promotion practices; and (2) explore the relationship between health professionals’ personal alcohol attitudes and behaviors, and their professional alcohol-related health promotion practices. A comprehensive literature search of the Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, British Nursing Index, Web of Science, Scopus and Science Direct (2007–2013) identified 26 studies that met the inclusion criteria for Strand 1, out of which six were analyzed for Strand 2. The findings indicate that health professionals use a range of methods to aid patients who are high-risk alcohol users. Positive associations were reported between health professionals’ alcohol-related health promotion activities and their personal attitudes towards alcohol (n = 2), and their personal alcohol use (n = 2). The findings have some important implications for professional education. Future research should focus on conducting well-designed studies with larger samples to enable us to draw firm conclusions and develop the evidence base.

Aim To explore critical care nurses' views of their job satisfaction and the relationship with job burnout, practice environment, coping style, social support, intention to stay in current employment and other work-related variables. Background Nurse shortage is a global issue, especially in critical care. Job satisfaction is the most frequently cited factor linked to nurses' turnover. Method A convenience sample of cardiac critical care nurses (n = 215; 97.7% response rate) from 12 large general hospitals in Shanghai was surveyed from December 2010 to March 2011. Result Over half of the sample reported satisfaction with their jobs. Nurses with 10–20 years of professional experience and those who had taken all their holiday entitlement reported higher levels of job satisfaction. The independent variables of practice environment, intention to stay, emotional exhaustion, personal accomplishment and positive coping style explained about 55% of the variance in job satisfaction. Conclusion Chinese cardiac critical care nurses' job satisfaction was related to work related variables, which are amenable to managerial action. Implications for nursing management Our findings highlight the imperative of improving intrinsic and extrinsic rewards, together with the flexibility of work schedules to promote job satisfaction and staff retention. A clinical ladder system is needed to provide promotion opportunities for Chinese nurses.

It is increasingly recognised that end-of-life care is suboptimal, especially for those with advanced non-malignant diseases. This study shows that individuals living with heart failure have a number of palliative care needs, including education, communication, symptom management and psychosocial needs. Clinicians struggled to discuss palliation with heart failure patients due to the unclear disease trajectory and cardiac-specific barriers to identifying palliation needs. Carers reported a need for greater social support and better guidance on best practice care. Furthermore, patients struggled to cope physically and psychologically with their reduced physical capabilities and were fearful of being a burden to their carers. Both patients and clinicians recognised a discontinuity between secondary and primary care, which has particular resonance in the context of the intention to relocate care nearer home.

The remodelling of the NHS requires a strong general practice nurse (GPN) workforce within general practice. The challenges facing general practice nursing are set within the current policy context and recent available evidence and illustrated by drawing upon the experience of a current GPN working in London. It is argued that there is a need to support the professional development of GPNs and nurture the next generation of potential GPNs if the current shortage of GPNs is to be addressed.

Background The role of the ward manager is integral to service delivery, however, they may lack the necessary authority and autonomy to achieve the organisation and delivery of patient care. Aim To identify initiatives that have strengthened the ward manager role. Methods A review of published literature was undertaken. Data included were drawn from a variety of sources, including policy, professional literature and research studies. Findings Three policy initiatives were identified along with two innovations from ward managers and two recent professional organisation campaigns. One innovation was identified that could improve the process of care delivery thus empowering ward managers' decision making. The literature identified the need for a review of the role, and adequate administrative support and training for the role. Conclusion The literature reviewed provided little evidence of initiatives to strengthen the role of the ward manager, highlighting the imperative to develop an evidence base. There was consensus on the importance of education and training before and during appointment to the position. Implications for nursing management The role of the ward manager remains pivotal in care delivery. The focus should be on how best to support ward managers in achieving their role within health-care systems.

There are two reasons why promoting wellbeing should be prioritised. Firstly medical advances have secured ever-increasing life expectancy so that for those aged over 65 years there has been an upwards trend in life expectancy since the 1980s (Public Health England (PHE), 2015). Both males and females in all English regions are living longer, although there are variations in life expectancy. However, many of those living longer have long-term conditions and are in poor health, where their quality of life is compromised. Thus, the second reason for promoting wellbeing is the importance of enhancing quality of life so that life extension includes a meaningful life which has quality. It also seems that promoting wellbeing is a preventative intervention for those with longterm conditions, and helps prevent further health deterioration; thereby avoiding the need for costly medical or specialist interventions (Dayson et al, 2013). Social prescribing involves primary care connecting individuals and their carers with local non-medical sources of support. In the Rotherham Pilot Project general practices referred their patients to voluntary or community projects, which were supported by grant funding to increase their capacity to respond as needed. The services most frequently accessed comprised: community-based activities, information and advice, befriending and community transport. Remarkably, it seems that the Rotherham Pilot Project (Dayson and Bashir, 2014) had numerous benefits, both for the individuals and their carers, and also the wider health econo my. The individuals became more independent and able to access the support of the voluntary and community projects and required less intensive support. The individuals also became better at managing their health conditions, with both the individuals and their carers reporting being less socially isolated. The evidence after 1 year also indicated a significant reduction in hospital usage in terms of hospital admissions, hospital out-patient appointments and attendance at A&E departments. Additionally, 83% of those receiving social prescribing reported at least one positive change, which included feeling positive, improved lifestyle, improved self-care, improved management of symptoms, improved engagement in activities including work and social groups and improved finances through wider access to welfare benefits. In addition to the social benefits, the evaluation reported economic benefits in terms of cost reductions in return for the invest ment in the local services suggesting that all costs would be recovered within 18–24 months. Echoing the value of social engagement to health and wellbeing, Steffens et al’s (2016) report of a longitudinal study of matched samples transitioning into retirement indicated that group membership, and the social engagement that such membership offers, was related to a better quality of life and a reduced risk of dying. The beneficial effect was similar to that of physical activity. They have recommended that retirement planning should include social planning alongside financial planning for the life change so that retirees continue to feel a sense of purpose and belonging. This has relevance both for community nurses on the cusp of retirement, as well as for their clients.

There is evidence that the process of transition from paediatric (child) to adult health services is often associated with deterioration in the health of adolescents with chronic conditions.Transitional care is the term used to describe services that seek to bridge this care gap. It has been defined as 'the purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child-centred to adult-oriented health care systems'. In order to develop appropriate services for adolescents, evidence of what works and what factors act as barriers and facilitators of effective interventions is needed.To evaluate the effectiveness of interventions designed to improve the transition of care for adolescents from paediatric to adult health services.We searched The Cochrane Central Register of Controlled Trials 2015, Issue 1, (including the Cochrane Effective Practice and Organisation of Care Group Specialised Register), MEDLINE, EMBASE, PsycINFO, and Web of Knowledge to 19 June 2015. We also searched reference lists of included studies and relevant reviews, and contacted experts and study authors for additional studies.We considered randomised controlled trials (RCTs), controlled before- and after-studies (CBAs), and interrupted time-series studies (ITSs) that evaluated the effectiveness of any intervention (care model or clinical pathway), that aimed to improve the transition of care for adolescents from paediatric to adult health services. We considered adolescents with any chronic condition that required ongoing clinical care, who were leaving paediatric services and going on to receive services in adult healthcare units, and their families. Participating providers included all health professionals responsible for the care of young people.Two review authors independently extracted data from included papers, assessed the risk of bias of each study, and assessed the certainty of the evidence for the main comparisons using GRADE. Discrepancies were resolved by discussion. Authors were contacted for missing data. We reported the findings of the studies as pre- and post-intervention means and calculated the unadjusted absolute change from baseline with 95% confidence intervals (CI).We included four RCTs (N = 238 participants) that explored: a two-day workshop-based transition preparation training for adolescents with spina bifida; a nurse-led, one-on-one, teaching session with the additional support of a 'health passport' for adolescents with heart disease; a web- and SMS-based educational intervention for adolescents with a range of different conditions; and a structured comprehensive transition programme with a transition co-ordinator for adolescents with type 1 diabetes.One study evaluating a one-on-one nurse-led intervention, and one evaluating a technology-based intervention suggested that these interventions may lead to slight improvements in transitional readiness and chronic disease self-management measured at six- to eight-month follow-ups (low certainty evidence). Results with the TRAQ self-management tool were: MD 0.20; 95% CI -0.16 to 0.56 and MD 0.43; 95% CI; -0.09 to 0.95; with the TRAQ self-advocacy tool: MD 0.37; 95% CI -0.06 to 0.80; and with the PAM tool were: MD 10; 95% CI 2.96 to 17.04. In contrast, transition-preparation training delivered via a two-day workshop for patients with spina bifida may lead to little or no difference in measures of self-care practice and general health behaviours when measured using the DSCPI-90©.Two studies evaluated the use of health services. One study evaluated a technology-based intervention and another a comprehensive transition programme; these interventions may lead to slightly more young people taking positive steps to initiate contact with health professionals themselves (Relative risk (RR): 4.87; 95% CI 0.24 to 98.12 and RR 1.50; 95% CI 0.32 to 6.94, respectively; low certainty evidence.Young people's knowledge of their disease may slightly improve with a nurse-led, one-on-one intervention to prepare young people for transition to an adult congenital heart programme (MD 14; 95% CI 2.67 to 25.33; one study; low certainty evidence).Disease-specific outcome measures were reported in two studies, both of which led to little or no difference in outcomes (low certainty evidence). One study found little or no difference between intervention and control groups. A second study found that follow-up HbA1c in young people with type 1 diabetes mellitus increased by 1.2% for each percentage increase in baseline HbA1c, independent of treatment group (1.2%; 95% CI 0.4 to 1.9; P = 0.01).Transition interventions may lead to little or no difference in well-being or quality of life as measured with the PARS III or PedsQ (two studies; low certainty evidence). Both the technology-based intervention and the two-day workshop for young people with spina bifida found little or no difference between intervention and control groups (MD 1.29; 95% CI -4.49 to 7.07). One study did not report the data.Four telephone support calls from a transition co-ordinator may lead to little or no difference in rates of transfer from paediatric to adult diabetes services (one study; low certainty evidence). At 12-month follow-up, there was little or no difference between groups of young people receiving usual care or a telephone support (RR 0.80; 95% CI 0.59 to 1.08)). They may slightly reduce the risk of disease-related hospital admissions at 12-month follow-up (RR 0.29; 95% CI 0.03 to 2.40).The available evidence (four small studies; N = 238), covers a limited range of interventions developed to facilitate transition in a limited number of clinical conditions, with only four to 12 months follow-up. These follow-up periods may not be long enough for any changes to become apparent as transition is a lengthy process. There was evidence of improvement in patients' knowledge of their condition in one study, and improvements in self-efficacy and confidence in another, but since few studies were eligible for this review, and the overall certainty of the body of this evidence is low, no firm conclusions can be drawn about the effectiveness of the evaluated interventions. Further research is very likely to have an important impact on our confidence in the intervention effect and likely could change our conclusions. There is considerable scope for the rigorous evaluation of other models of transitional care, reporting on clinical outcomes with longer term follow-up.

Aims and objectives To field test a parental self-efficacy scale regarding its acceptability and feasibility and to describe parental self-efficacy in a convenience sample of parents with children aged 6 years old or less. Background Self-care within families is increasingly emphasised in health policy as a means of maximising healthcare resources. This study reports the field testing of a scale designed to measure parental self-efficacy. Design Cross-sectional survey of parents of children aged 6 years old or less. Methods Subjects were recruited through a parenting internet website (n = 84) and local parenting and community organisations (n = 68) and asked to complete a questionnaire containing the scale. Data collection took place between January and August 2011. Results The scale, previously validated with an expert panel of professionals, gathered information about parental self-efficacy when administered either directly or through an on-line data collection portal, although there were more missing data when administered via the Internet. Although convenience and self-selecting samples precluded parameter estimation, areas of concern highlighted were difficulties differentiating children with serious illnesses and the use of the Personal Child Health Record. Use of the Internet was widespread, as was use of community pharmacists and nursery staff. Conclusion Although the primary purpose was not to collect specific data, the data indicated the continuing concern of parents regarding serious illness and where additional investment may be required to meet parental needs and expectations. Relevance to clinical practice The previously validated scale can be used to collect information about parental self-efficacy either through a paper questionnaire or the Internet. Although there was slightly more missing data from the Internet version, the ease of its administration makes this an attractive option. Parents generally reported high levels of self-efficacy and satisfaction with services; however, the scale was able to identify areas where further investment might be useful.

Aim and objectives: The overall aim of this study was to investigate the medication administration practices of children' nurses. The specific objective was to identify practices that may improve the medication administration process, where necessary. Design: Using a non-experimental survey design, a ‘Medication Administration Practices Survey’ was developed for use in this study. The survey was designed to include questions based on medication administration practices and not solely on medication errors. Ethical approval was obtained from the local research ethics committee where data were collected. All clinical staff working in all areas in a children's hospital were included. Results: Interruptions in the medication process, a heavy workload and fatigue were some of the findings that emerged from this study. Inadequate knowledge and skills and a failure to comply with hospital policy were also identified. Conclusion: A lack of adherence to hospital policy and the frequency of interruptions in the medication administration process are important practices that require change as indicated by this study. Several recommendations are made, directed toward preventing or reducing medication errors and supporting children's nurses in providing best practice.

Background The current nursing shortage and high turnover is of great concern in many countries because of its impact upon the efficiency and effectiveness of any healthcare delivery system. Recruitment and retention of nurses are persistent problems associated with job satisfaction. Objective To update review paper published in 2005. Design This paper analyses 100 papers relating to job satisfaction among hospital nurses derived from systematic searches of seven databases covering English and Chinese language publications 1966–2011 (updating the original paper with 46 additional studies published 2004–2011). Findings Despite varying levels of job satisfaction across studies, sources and effects of job satisfaction were similar. Hospital nurse job satisfaction is closely related to working conditions and the organizational environment, job stress, role conflict and ambiguity, role perception and role content, organizational and professional commitment. Conclusions More research is required to understand the relative importance of the many identified factors relating to job satisfaction of hospital nurses. It is argued that the absence of a robust causal model reflecting moderators or moderator is undermining the development of interventions to improve nurse retention.

This study aimed to estimate the vaccination coverage against the pandemic H1N1 influenza in a group of nurses and determine the factors associated with their vaccination behaviours. An anonymous, self-administered questionnaire was distributed to a convenience sample of nurses who were enrolled on continuing professional education courses in a university in London. The survey response rate was 77.7% (n=522). A total of 172 (35.2%) nurses reported receiving the pandemic H1N1 vaccine in the 2009-2010 influenza season and only 22.3% of them had the intent to accept the vaccine in the next season. Compared to nurses with low knowledge scores, those with high knowledge scores were more likely to receive the pandemic H1N1 vaccine (p=0.017), recommend the vaccine to their patients (p=0.003), and have the willingness to recommend vaccination to patients in the future (p=0.009). There was a higher vaccination rate among nurses with higher risk perception scores than with lower scores (p=0.001). A small, positive correlation between H1N1 knowledge and risk perception scores was identified (p

SUMMARY The health promotion practice of nurses working in Saudi Arabia is unidentified. The purpose of this study was to investigate the perceived health promotion practice of staff nurses in Saudi Arabia. This was achieved by surveying the views of nurses (n ¼ 614), doctors (n ¼ 130) and patients (n ¼ 322) in 10 hospitals located in the Eastern Province of the country using a self-report questionnaire. There was agreement that nurses had the necessary skills to promote health in general and had sufficient knowledge to promote health in the three specific areas explored: physical activity, smoking cessation and weight control. However, the findings also showed that the majority of participants wanted nurses to give priority to acute care over health promotion within the hospital setting and that patients dislike nurses asking about health-related behaviours when these are not directly relevant to their presenting health problems. Concerns were also raised about the language and cultural competency of a largely migrant nursing workforce to effectively communicate health promotion messages to patients. In view of the findings, policy-makers in Saudi Arabia need to consider providing appropriate training programmes for nurses to introduce the wider concept of their health promotion role. Health promotion protocols, strategies and standards to support nurses to more effectively implement health promotion with their routine practice are also required. It is suggested that, while reliance on a largely migrant workforce who do not speak Arabic continues, the potential benefits of a good quality interpretation service to improve nurse –patient communication should be considered.

Aims and objectives. To develop an instrument to measure nurses’ knowledge, risk perception and health beliefs towards influenza and influenza vaccination and their vaccination behaviours and evaluate its construct validity and internal consistency reliability. Background. Although instruments to assess predictors of nurses’ vaccination behaviours have been developed, their validity and reliability have not been reported. Design. Instrument development and initial validity and reliability testing. Methods. The instrument was developed drawing on a literature review and expert consultation and was refined through pilot work. A cross-sectional survey using a revised version of the instrument was conducted among a convenience sample of 520 registered nurses (response rate 77·4%). Cronbach’s alpha coefficient was calculated to determine internal consistency of the sub-scale in the instrument. Principal components analysis with varimax rotation was carried out to evaluate the instrument’s construct validity and examine its internal structure. Results. Cronbach’s alpha coefficients for the three newly developed scales ranged from 0·70–0·76. Principal components analysis produced a good fit and confirmed the internal design of the instrument. In the seasonal influenza knowledge sub-scale four factors explained 44·8% of the total variance; in the H1N1 knowledge sub-scale two factors explained 44·7% of the total variance. Three factors in the risk perception scale contributed 50·5% of the total variance and two factors in the vaccination behaviours scale contributed 62·1% of the total variance. Conclusions. An instrument has been developed to assess nurses’ knowledge, risk perception and health beliefs towards influenza and influenza vaccination and their vaccination behaviours. The instrument was valid and reliable for the setting where it was used. Relevance to clinical practice. This instrument could be used to assess nurses’ knowledge, risk perception, health beliefs towards influenza and influenza vaccination and their vaccination behaviours. The three newly developed scales could also be used independently to measure variables influencing nurses’ vaccination practices.

SUMMARYThe relationship between knowledge, risk perceptions, health belief towards seasonal influenza and vaccination and the vaccination behaviours of nurses was explored. Qualified nurses attending continuing professional education courses at a large London university between 18 April and 18 October 2010 were surveyed (522/672; response rate 77·7%). Of these, 82·6% worked in hospitals; 37·0% reported receiving seasonal influenza vaccination in the previous season and 44·9% reported never being vaccinated during the last 5 years. All respondents were categorized using two-step cluster analyses into never, occasionally, and continuously vaccinated groups. Nurses vaccinated the season before had higher scores of knowledge and risk perception compared to the unvaccinated (PP

This paper traces the development of information and communication (ICT) within health care and the emergence of telehealth as a key component of modern health care delivery as health care moves from the 'face to face age' to the 'information age'. The paper examines the interface of ICT and nursing practice and highlights the limited evidence relating to the nursing contribution within telehealth particularly beyond data input and output analysis for other health care personnel. Additionally, the absence of research relating to the impact of ICT upon nurses and their working lives is identified. The paper concludes that nurses need to engage more fully with ICT so that they contribute to shaping the care system and emerge as leaders of the new care systems delivering future clinical activity.

GUI L., WHILE A.E., CHEN G., BARRIBALL K.L. & GU S. (2011) Nurse teachers’ working lives: a questionnaire survey of nursing schools in Mainland China. International Nursing Review 58, 505–511 Aim: The study aimed to explore Chinese nurse teachers’ views and experience regarding different components of their working lives. Methods: A cross-sectional survey of 18 schools of nursing offering nationally accredited baccalaureate nursing programmes across Mainland China was conducted. A total of 227 nurse teachers completed questionnaires yielding a response rate of 72%. Findings: The sample comprised mainly female, married lecturers younger than 44 years with an average teaching experience of about 10 years. The respondents were satisfied with their overall job, work, supervision and co-workers, but dissatisfied with their pay and promotion opportunities. There were statistically significant differences in several facets of job satisfaction across the respondents of different age groups, education levels, job titles and those working in the schools of different sizes. The respondents perceived their work environment to be only somewhat empowering. Their average level of professional identification was relatively high, but their overall role conflict, role ambiguity and sense of coherence were relatively low. Conclusion: Chinese nurse teachers had a positive feeling towards their working lives, but strategies should be developed to enhance their sense of coherence and professional commitment. It is worth noting that there is still much adjustment to be made towards the new higher education roles, but the findings may only be generalizable to similar settings.

Aims and objectives. To develop a scale to measure parental self-efficacy in the care of pre-school children during periods of health and minor illness. Background. Children account for many health service consultations at all levels, but particularly in primary care. There are logistical, financial and social reasons for encouraging self-care by parents and other family members during periods of health and minor illness. In the absence of valid parental self-efficacy measurement tool, this paper describes the development of such a tool. Design. A psychometric approach combining elements of social policy and health scale development is outlined. Method. UK health and social policies were searched and from this a systematised concept was developed. This was assessed for international durability by checking the concept against other policies, including those from major international organisations. Statements were developed from this and sent to a panel representing a wide range of stakeholders who were asked to rate the proposed items of the scale and changes were made accordingly. Results. Widespread agreement among panel members supported the systematised concept. Some alterations to the proposed items, particularly increasing the range of health service providers, were made. Conclusions. The study suggests a new method for clinical health policy research, including elements of social policy and health services research. The resulting scale can be contextualised for different circumstances and now needs extensive field testing and refinement. Relevance to clinical practice. There is increasing diversity in the provision of healthcare; however parents remain the primary carers of young children in both health and illness. This tool can be used to measure the impact of health and social policy upon their confidence and knowledge, and to evaluate new initiatives. The emphasis upon health and social policy ensures that those using the tool have a holistic approach to evaluation.

Objective To provide an overview of current research and development on the organization and delivery of diabetes education and self-care support, incorporating stakeholder perspectives. Method Four methods were used: literature review (159 papers and 52 grey literature items); patient participation event (n 5 38); online survey of professionals (n 5 423) and patients (n5 495); and, a conference. Results The literature review identified themes relating to the organization and delivery of diabetes and self-care support: structure and flexibility in models of education; accessibility; patient choice; integrating self-care within the overall care system; quality improvement; peer educators; health literacy; efficiency in delivery; telecare models; feedback technologies; care planning; psychological intervention; and self-care outcome measures. This generated four models to provide a framework to help shape the development of diabetes self-care: a diabetes education pathway; integrating self-care and clinical care; choice as a method of optimizing care; and an integrated framework for delivering diabetes self-care. Conclusion The clinical benefit of the identified models need to be evaluated.

jones k., edwards m. & while a. (2010) Nurse prescribing roles in acute care: an evaluative case study. Journal of Advanced Nursing 67(1), 117–126. Abstract Aim. This paper is a report of an evaluation of the implementation of nurse prescribing in an acute care hospital in England. Background. At the time of the study, evaluation of nurse prescribing had taken place in community settings, but little was known about its impact and effectiveness in acute care. Although nurse prescribing has permitted doctor–nurse substitution in acute episodic care, some doctors have expressed concerns about patient safety in relation to nurse prescribing. Methods. A mixed methods single-case study was conducted in 2005–06, using purposive sampling. Semi-structured interviews were carried out with 18 hospital staff, non-participant observation of two nurses and two doctors undertaking 52 patient-prescriber consultations with 47 patients, and a questionnaire survey with 122 patients (response rate 61%: n = 74). Results. Nurse prescribing was found to benefit patients through service delivery improvement and using staff skills differently. Nurse prescribers and their colleagues were positive about role and service changes and their impact on patient care. No differences were found between the ways in which nurses and doctors performed prescribing roles, but there was a statistically significant difference between the medication-related information satisfaction ratings of patients who had seen a nurse prescriber, compared to those seen by a doctor. Conclusion. Nurses and doctors were found to provide equivalent care. Shared vision, local champions, action learning and peer support were the enabling factors that helped to embed the new prescribing roles within the study site.

Objective: To investigate the knowledge of university students regarding pandemic and seasonal influenza. Design: Online questionnaire-based survey of undergraduate and postgraduate students, including those on nursing, medical, other health and non-health related courses. Method: The sample was recruited using the university email system, and the survey was administered using SurveyMonkey. The questionnaire sought the following data: demographics; general knowledge; intentions with regards to vaccines, pharmacological and behavioural interventions; personal susceptibility and the symptoms of influenza; and the provision of information. Results: Approximately half (56 per cent) of respondents were on health-related courses. There was a good level of knowledge about influenza and its severity, and the importance of vaccination, although few intended actually receiving the seasonal or pandemic vaccines (23 per cent and 21 per cent respectively). However, in the event of a pandemic most students would still attend college (60 per cent) and almost half would still attend social events (47 per cent). Many thought that there had been hype by the government (44 per cent) and the media (89 per cent). Conclusions: There was a good level of knowledge about influenza, although this was not always reflected in intended behaviours with regards to vaccination and isolation.

Aim. This paper is a report of a study conducted to describe Greek critical care nurses’ views on professional autonomy and its relationship with job satisfaction and other work-related variables. Background. Professional autonomy is generally considered a highly desirable nursing attribute and a major factor in nurse job satisfaction. In the critical care environment, a high level of accountability, responsibility and autonomy are required to optimize outcomes of critically unstable patients. Method. A questionnaire survey was conducted with a convenience sample of Greek critical care nurses (n = 431; response rate 70%) in 2007. Data were collected on professional autonomy, job satisfaction, role conflict and role ambiguity. Results. Overall, nurses reported acting moderately autonomously. Younger nurses reported statistically significant lower levels of autonomy. Higher levels of autonomy were reported by female nurses. Multiple logistic regression revealed that appointment level, type of critical care unit and registration with a professional organization were independently associated with autonomy. A positive moderate association was found between reported autonomy, job satisfaction, role conflict and role ambiguity, but there was no relationship between job satisfaction and reported role conflict and role ambiguity. Conclusion. Further education, role enhancement and support are required for nurses working in critical care in Greece if they are to achieve the maximum potential of their professional role. Failure to address the perceptions of professional autonomy may have an impact on staff retention, because of job dissatisfaction.

while a.e. & clark l.l. (2009) Journal of Nursing Management 18, 166–172 Overcoming ignorance and stigma relating to intellectual disability in healthcare: a potential solution Aim To propose a strategy for overcoming stigma and discrimination against people with intellectual disabilities within healthcare. Background Evidence of poor healthcare for those with intellectual disabilities resulted in an independent inquiry. The subsequent report has charged healthcare organizations to address current organizational failings. Evaluation The origins of discriminatory practices in health services and the evidence of persisting poor care and stigmatization of this patient group despite UK Government policy are set out. Key issue The stigmatization and resulting discrimination of people with intellectual disabilities persists. Conclusion In addition to investment in core training, organizational change is needed to bring about change and a reduction in health inequality. Implications for nursing management The development of a new framework for nursing is recommended with leadership at all levels of healthcare so that people with intellectual disabilities and their families can expect to receive high quality care in all healthcare settings.

People with multiple sclerosis depend heavily upon their families and other informal carers as they receive limited support from health-care professionals or health-care services. Adopting the carer role results in a life-changing experience, which may bring rewards and challenges to the carer. This paper reviews the research addressing the experiences of carers of people with multiple sclerosis published between 2002 and 2007 building upon an earlier review. The literature suggests that carers have needs across various domains and that spouses/partners have particular needs. Much of the evidence has limited generalizibility although the geographical spread of the evidence indicates considerable consistency of need. The review describes ongoing carer needs which require supportive care and provides the basis for the development and testing of carer interventions for use by health-care professionals.

Aim: To describe the perceived role of nurses and other carers of people with multiple sclerosis from the perspective of different stakeholders (people with multiple sclerosis, non-specialist nurses, specialist nurses and other health care professionals). Background: Multiple sclerosis is one of the commonest causes of disability in young adults. People with multiple sclerosis require supportive care during the disease trajectory. The role of different health and social care providers has not been reported previously. Design, Survey, Method: Questionnaire data collected in 2002 during the first phase of scale development (health professionals n = 459; people with multiple sclerosis n = 65; total response rate 59·4%). The data were reanalysed to compare responses across sample groups. Results: There was consensus that neurologists and specialist nurses were the most appropriate professionals in the provision of specialist care with specialist nurses also being identified as key providers of emotional support. However, there were also significant differences in nominations reflecting the different perspectives of the stakeholder groups and a self-report bias. Each stakeholder group frequently emphasised their own perceived contribution to care. The different perspective of people with multiple sclerosis was also noteworthy with their greater emphasis on social care and lay support. Conclusions: The findings indicate a dissonance in the views of different stakeholders within the care system. The division of labour associated with nursing care requires further exploration. The contrasting paradigms of health care professionals and people with multiple sclerosis regarding models of disability were highlighted. Relevance to clinical practice: Multiple sclerosis, like other chronic illnesses, requires substantial nursing care. There is a growing number of specialist nurses in the workforce, however, little is known how their role interfaces with other nurses.

This paper explores the nature of the nursing contribution to chronic disease management (CDM) and identifies a number of key nursing activities within CDM both at the individual patient and care system levels. The activities were identified following a detailed review of the literature (160 reports and studies of nursing practice) relating to three tracer disorders: diabetes, chronic obstructive pulmonary disease and multiple sclerosis. The paper examines these activities collectively to generate models expressing some of the core functions of nursing within CDM. The paper illustrates some of the changing characteristics of nursing roles within CDM. More fundamentally, the paper questions the position of nursing in relation to the technologies that define CDM systems and proposes four levels of contribution: the nurse as technology; the nurse as technologist; the nurse as system engineer; and the nurse as architect. These different levels reflect distinctions in the nature of the nursing gaze and power relations within the health care workforce. The paper also highlights how nurses are failing to develop the evidence for their practice in CDM. The paper concludes that there is a need for some clear principles to guide clinical practice and encourage innovation in CDM. It is argued that the principles should not be rule-bound but define a distinctive nursing gaze that will position the nursing profession within the health care system and in relation to other professions. The gaze should incorporate the needs of the individual patient and the care system that they inhabit.