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As many Departments of Nursing within universities consider raising their academic entry requirements in an attempt to attract a more high academic achieving entrant and also endeavour to attract more school leavers one of the fundamental questions that needs to be answered is--are high academic achieving school pupils really interested in pursuing a career in nursing? The aim of this paper is to report on the findings from paradigmatic case interviews of high academic achieving school pupils who at one stage in their career choice process had considered nursing as a possible career choice but had ultimately disregarded nursing and had decided to pursue medicine or another health care profession. The study reports interview data from a sub-sample of (n=20) high academic achieving 5th and 6th year school pupils who participated in a larger survey of 5th and 6th year school pupils (n=1062). These were paradigmatic cases--high academic achieving school pupils who had considered nursing as a possible career choice within their career preference cluster but had ultimately disregarded nursing and decided to pursue medicine or another health care profession as a career choice. Participants reported that nursing was eventually not viewed as using their examination grades to the maximum benefit. Also the participants reported a belief that the work of the doctor is more important and academic as they cure patients whereas the work of the nurse is practical and routine as they only care for patients. The pupils in addition asserted a negative image of nursing and a low status level of nursing as a career. They also articulated the unremarkable typical school pupils they perceived would pursue nursing as a career choice and the type of school pupil that they had witnessed being encouraged toward nursing within their schools, both of which conflicted with their own typology. Ultimately the high academic achieving school pupils were doubtful and suspicious as to the credibility of a degree in nursing and nursing as a university programme. Nursing is a very contentious career choice consideration for high academic achieving school pupils. There is strong evidence from the interview data to suggest that attracting high academic achieving school pupils into nursing could be hugely problematic.

This study investigated the association between social capital and health related quality of life in a sample of Australian adults. Information was collected from a sample of adults in Queensland, Australia relating to health status, health related quality of life and related social determinants of health by computer-assisted-telephone-interview survey. Significant associations were observed between social capital and physical health when adjusting for selected demographic measures. No significant association was observed between social capital and mental health. The research produced equivocal results regarding the associations between social capital and the selected measures of health-related quality of life. Evidence is presented in support of the association between social capital and physical health status, whereas no associations were observed between mental health status and social capital. The role and relationship between health and social capital remains elusive. More work is required to clearly support social capital's role in physical and mental health and well-being.

How social capital is related to an increasingly important disease risk-physical inactivity has not yet been investigated. In the present study the associations between social capital and physical inactivity were investigated in a sample of Queensland (Australia) adults. Data was collected from 1278 persons by means of a computer-assisted-telephone-interview survey. The association between the social capital variables and physical inactivity was studied using logistical regression. Multivariate analysis adjusted for the effects of selected socio-demographic factors in the investigation of the association between physical inactivity and quartile groupings of social capital scores. Physical inactivity was negatively associated with the measure of social capital. Individuals in the top two quartiles of social capital were significantly less likely to be physically inactive than those in the two lowest quartiles. In summary, low social capital was associated with physical inactivity. The results offer implications for health promotion programs aimed at increasing levels of physical activity at the community or population level.

There has been a trend of growth in part-time employment within the Australian nursing workforce and currently half of the profession work part-time. While the literature across disciplines has postulated reasons behind preferences for part-time employment, little is known about nurses' motivators to work part-time. In an era of nursing shortages that form considerable barriers to meeting healthcare service demands, a clear understanding of these motivators is critical for the effective planning and management of the nursing workforce. A grounded theory study that explored the phenomenon of part-time nursing found that nurses' motivators to work part-time were complex and identifiable with nursing, establishing that nurses' working time decisions are made in contexts that may be unique to the profession. This paper provides an exhaustive description and explanation of one cohort of part-time nurses that accounts for variations between nurses and provides an understanding of the complexity of factors that contribute to nurses' decisions to work part-time.

Loneliness can be defined as perceived social isolation and appears to be a relatively common experience in adults. It carries a significant health risk and has been associated with heart disease, depression and poor recovery after coronary heart surgery. The mechanisms that link loneliness and morbidity are unclear but one of the mechanisms may be through poor health beliefs and behaviours. The aims of this cross-sectional survey of 1289 adults were to investigate differences in health behaviours (smoking, overweight, BMI, sedentary, attitudes towards physical activity) in lonely and non-lonely groups. Lonely individuals were more likely to be smokers and more likely to be overweight - obese. The lonely group had higher body mass index scores controlling for age, annual income, gender, employment and marital status. Logistic regression revealed no differences in sedentary lifestyles. Lonely individuals were significantly less likely to believe it was desirable for them to lose weight by walking for recreation, leisure or transportation. The findings provide support for an association between health behaviours, loneliness and excess morbidity reported in previous studies.

The notion of social capital focuses attention on social connectedness within communities and the ways that this connectedness may affect health and well-being. There are many competing definitions of social capital but most suggest that it involves trust, social networks and reciprocity within communities, not necessarily geographically defined. The usefulness of social capital and related theories that help in understanding the function of nurses in rural communities are explored in this paper. Nurses and health service planners are becoming increasingly aware of the potential contribution of community nurses in rural and/or remote areas, as evidenced in the development of nurse practitioners. Through their interrelational role and status in rural communities, nurses are often 'immersed' or 'embedded' in the social networks that make up the fabric of rural life and may therefore be important contributors to social capital. For a concept such as social capital to be useful in nursing research, it must have distinct attributes, delineated boundaries, and well-described preconditions and outcomes in multiple contexts.

The inter-connections between educational, family and social spheres of life are integral to the experiences and outcomes of mature student participation in education. This relationship highlights the need to understand the educational experience in the context of the life of the mature student. Mature nursing students have been shown to experience many difficulties during their course. These problems include childcare, relationship and financial difficulties. What is not well documented are the problems and coping strategies of future nursing students who are undertaking Access to Nursing courses and whether these mirror those found in mature nursing students. This small scale exploratory study investigated the course-related problems and coping strategies of mature students undertaking an access to nursing in a Further Education College. This study is one part of a larger programme of research investigating mature students in nursing. In-depth interviews were conducted on mature students and data were analysed using content analysis methods. Content analysis revealed particular concerns regarding the obstacles faced by mature nursing students. In particular the findings suggested that financial difficulties and re-entry into tertiary education were the prominent concerns for these individuals. The coping mechanisms identified to overcome these problems included; support networks, prioritizing and organising, and positive expectations and attitudes for the future. Understanding how students cope with their difficulties will provide the building block for future intervention strategies designed to minimise problems and increase retention rates. Further longitudinal research is required on the long term and cumulative nature of stress and coping in this group from access to post-qualification.

Substantiated cases of elder self-neglect have been reported to be more common than either elder abuse or neglect. It is a problem that often requires the active involvement of a whole range of health, social, housing, police and voluntary agencies. The ways in which these various agencies respond to self-neglect and how they interact with one another is not known. This research explored the ways in which different health and social care organizations respond to the problems associated with self-neglect. Research methods involved qualitative in-depth interviews with housing, healthcare, environmental health and social workers and a sample of their clients who were described as living in self-neglecting circumstances. This study revealed a lack of joint working across the relevant professions in relation to self-neglect. Better co-ordinated intervention could improve effectiveness and help make available resources go further. The study also suggests a need for a preventative approach to self-neglect, although further work would be required to develop indicators for early intervention.

This study reports a comparative survey of mature students undertaking pre-registration undergraduate nursing education in Australia and Scotland. The study aimed to explore comparisons between the course-related and course-related financial difficulties faced by mature students in two very different educational and funding systems. Financial stress is a predictor of both physical and mental health problems. A similar pattern of course-related problems were reported by both Australian and Scottish students with the exception that Scottish students experienced more problems with childcare and caring for elderly relatives. Course-related problems may be inherent in the nature of undergraduate nursing education although the relatively time-intensive nature of Scottish curricula may explain the childcare and elderly relatives difference. Scottish students reported higher overall financial-related problems but Australian students reported more problems with funding placements. These findings have implications for both curriculum designers and policy makers.

This paper describes a case study detailing one approach to tackling the problems of knowledge transfer in an undergraduate course on Research, Decision-Making and Evaluation in Family Health Nursing. Transfer is the ability to access and utilise ones intellectual resources in situations where these may be needed [Nursing Diagnosis 3(4) (1992) 148-154]. The discussion will explore the related issues of transfer of learning, casuistry, and teaching and learning on a course for experienced community practitioners. This course serves as a case example to tease out how teaching and learning can be structured to promote effective transfer of knowledge from the classroom and virtual classroom to clinical practice.

Background: The World Health Organisation HEALTH21 strategy has firmly placed families and family oriented services at the core of health care delivery., Objective: In this article we argue that a fundamental reorganisation of primary health care practices in remote and rural Australia needs to be undertaken., Discussion: Nurses have been shown to be equally effective and less costly than general practitioners. Family nurse practitioners should be a first point of contact, and family health nurses should be responsible for responding to problems of multiple deprivation and social exclusion in remote and rural areas. These practitioners would, in their respective areas of responsibility, identify, diagnose, refer or treat individuals, families and communities. In effect they would act as gatekeepers to health and social care services. Family health nurses would also aim to support the community in developing and sustaining the capacity to take responsibility for its own health and social care. The main obstacles to these initiatives are concerns of general practitioners and nurses, the inertia of large organisations when faced with the need to undertake radical change and the highly unionised and rule bound nature of Australian nursing.

Due mainly to increasing difficulties in recruiting and retaining health professionals to work in remote and peripheral areas of Scotland, there is discussion of the need to implement new models of primary health care provision. However, innovative service models may imply a reduction in the number of health professionals who live and work in remote communities. Currently decisions about remodelling service provision are being taken by National Health Service stakeholders, apparently with little consideration of the wider social and economic impacts of change. This paper aims to argue that health professionals contribute to the fabric of rural life in a number of ways and that decisions about health service redesign need to take this into account. As well as fulfilling a wide health and social care role for patients, the authors seek to show that health professionals are important to the social sustainability of rural communities as, due to their unique position, they are often at the heart of networks within and between communities. The wider economic contribution of health services in remote communities is important, but often underplayed. The authors propose that theories of capital, principally the concept of social capital, could help in investigating the wider contribution of health professionals to their local communities. Ultimately, it is proposed that health services, as embodied in nurses, doctors and others, could be highly important to the ongoing livelihood and social infrastructure of fragile remote communities. Since this area is poorly understood, there is a need for prospective primary research and evaluation of service redesign initiatives.

This study investigated the perceptions of students regarding their therapeutic commitment, role competency, role support and empathy towards working with people who have mental health problems. These qualities play a key part in the development of therapeutic relationships, an important goal for working with individuals in most nursing situations. The sample comprised of three cohorts of nursing students undertaking the Diploma in Higher Education (Nursing) in Scotland. There were no significant differences in perceptions of empathy and therapeutic commitment among three cohorts of students, but third year students felt they received less role support than other cohorts. The findings also revealed that preregistration nursing students have perceptions of their role competency and empathic skills which are considerably greater than has been previously reported by registered nurses. The implications of these findings for nurse education are discussed.

Critical thinking is often seen as the hallmark of the educated professional.The conceptualization and measurement of critical thinking have been topics of much debate for over 70 years. This study reports a small scale comparative study of critical thi nking skills in standard and non-standard entry diploma students. A significantdifference in critical thinking skills between these groups at the point of entry was observed. There were no significant differences in critical thinking skills between the start of the course and the end of the common foundation course for both groups. This finding is consistent with many other studies investigating critical thinking in nurse education. The implications of these findings and the wider issue of the measur ement of critical thinking are discussed.

Self-neglect can be understood as the failure to engage in those activities which a given culture deems necessary to maintain a socially accepted standard of personal and household hygiene and carry out activities needed to maintain health status. Self-neglect is bound up in a discourse which equates dirt with disease and in which transgressions of self-care norms can be labelled as a medical syndrome. The notion of self-neglect as a social construction is the theoretical perspective which provides the framework for the study reported here. Judgements regarding self-neglect may be social judgements influenced by professional socialisation and cultural values. The belief that different groups of nurses may have different constructions of self-neglect will be investigated and the factors which influence these judgements will be explored in three groups of nurses. The inclusion of nursing students will allow some picture to emerge as to whether judgements develop over time or are relatively constant across the career path, albeit within the limitations of a non-longitudinal design.

Aim: This paper sets out to explore the utility of self-care theory in understanding self-neglect. Further theoretical development of both self-care and self-neglect theory and attending core concepts is an important objective., Background: The notions of self-neglect and self-care are frequently linked in the literature. The relationship between self-neglect and self-care is not clear and the strengths and limitations in using self-care theory to facilitate a greater understanding of self-neglect will be addressed. Specifically the issues of self-care agency, self-care requisites, objectivity, class and culture, and lifestyle choice will be critically evaluated in the context of self-neglect theory., Conclusion: Self-care theory has a useful role to play in furthering our understanding of self-neglect. Self-care theory is able to explain some aspects of self-neglect but not others, although this may be a reflection of the relatively underdeveloped state of self-care theories or alternatively may reflect a more fundamental limitation in our ability to fully explain human behaviour.

District Nurses in rural areas frequently fulfil, in some permutation, the functions of district nursing, health visiting, school nursing, and community midwifery. This complex role can bring them into contact with a wide range of mental health problems. The extent, nature and type of mental health problems, and their response to these problems, is not well documented in the literature. The findings of this qualitative study indicate that District Nurses do in fact have contact with a wide range of mental health problems. The role of District Nurses in caring for this client group is more substantial than has been previously recognized. It is suggested that this role be formally acknowledged and that systems put in place to optimize the effectiveness of District Nursing interventions.

Aim of the Study: This paper reports a two-part study relating to the further psychometric development of the Mental Health Problems Perceptions Questionnaire., Background: The instrument was developed and used originally in a study to investigate the role of district nurses in caring for people with mental health problems, who live in rural settings. It is underpinned by an explicit theoretical framework in which therapeutic commitment, role support and role competency are core concepts., Design: A two-part study is described. Part One used a test-retest method to examine the stability of the instrument on repeated administration. Part Two examined the instrument's internal reliability and construct validity by calculation of Cronbach's alpha coefficients and exploratory factor analysis., Results: Satisfactory internal reliability for a new instrument was demonstrated. Exploratory factor analysis supported the previously proposed theoretical framework. Significant correlations were demonstrated between the scales which constitute the instrument, thereby providing further evidence of construct validity., Conclusions: The Mental Health Problems Perceptions Questionnaire provides a potentially useful instrument in relation to future educational, clinical and managerial research.

This paper reports the development and psychometric testing of the Mental Health Problems Perception Questionnaire. This questionnaire was developed to measure the therapeutic commitment, role support and role competency of non-mental health specialist nurses (generalists) to working with patients with mental health problems who live in rural communities. The instrument was demonstrated to be valid and reliable in this population. The questionnaire was underpinned by an explicit theoretical model which facilitates an understanding of the factors that influence effective psychosocial nursing interventions with this client group.

The construct of transfer has enormous importance to nursing as it begins to highlight potential problems in the transfer of knowledge and skills from the campus to the clinical area, from one part of the clinical area to another (e.g. surgical to medical), and from community to the clinical area. Thus, any adequate conceptualization of transfer must account for problems of practice-practice transfer as well as theory-practice transfer. These potential problems are the concern of educators, students and managers who have a responsibility for agency nurses and bank nurses who may find themselves in different specialities on a regular basis. Transfer has relevance to a whole raft of other issues ranging from the application of theories to nursing practice, through to the validity of claims that courses which develop intellectual skills prepare nurses for lifelong learning.

Nurses frequently encounter patients who neglect their personal hygiene and household cleanliness. Self-neglect is usually understood within the parameters of the medical model, with its need to objectify and categorize. The medicalization of self-neglect obscures the fact that patients and professionals may have different ideas about what self-neglect is and what it is not. This paper explores how the medical construction of self-neglect has come to dominate the self-neglect discourse and will also explore other possible ways of understanding self-neglect.

Patients who neglect personal hygiene, household cleanliness and their own health are familiar to most nurses. Despite this familiarity, self-neglect is a poorly conceptualized and little researched phenomenon. This multiple case study design uncovers the perceptions of self-neglect held by professionals, patients and relatives. The assumptions which underpin Orem's Theory of Self-Care and the medical model construction of self-neglect are explored and it will be suggested that there are limitations in understanding self-neglect using these theoretical frameworks.

Self-neglect is a familiar concept to all community nurses. Nevertheless there have been few empirical studies undertaken in this area over the last 30 years. The study of self-neglect has been hampered by inadequate conceptualization and a lack of theoretical frameworks. This article reports a study of patients who did and did not self-neglect, drawn from district nursing caseloads. Patients with self-neglect had lower levels of operable self-care agency than patients in a comparison group. Only self-neglecting patients had the nursing diagnoses 'ineffective management of therapy' and 'non-compliance'.

In recent years there has been a significant change in the type of student entering nurse education. There has been a move towards widening access, and as a result, more mature students have gained entry to courses. What seems less clear is the types of course-related problems experienced by mature students. The study reported in this paper investigated the financial and family problems that mature students experience as a direct result of undertaking a course in nursing education. It was found that most mature students experience financial, childcare, relationship and family problems. It was also found that a large number of mature students thought about leaving the course as a result of these problems. It may be necessary, in the light of the findings, to consider how future course designs can accommodate mature students and their particular experiences.

Student nurses actively interact with their experiences and construct theories about nursing in an attempt to make sense of their experiences. These alternative theoretical frameworks (ATFs), it will be suggested, do not conform to the types of structures that are thought to be the hallmark of formal theories but instead the knowledge of students can be understood as a series of narratives. The relationship between ATFs and the formal theories presented by educators may create difficulties for both students and teachers.

Alternative theoretical frameworks are the tacit assumptions and logical structures of practical action. Student nurses have alternative theories in which ethical and technical knowledge are combined to form high-level heuristics which assist with understanding and responding to client problems. The alternative theories of student nurses can be observed to guide care giving and therefore the theory-practice gap may not be as wide as is often assumed. The values and beliefs about nursing held by student nurses are broadly similar to those advocated for the profession as a whole.

The relationship between the way nurses think and the actions they perform is one of the key debates within the nursing profession. It has been assumed that the thinking that precedes and follows nursing actions has been described within the reflective practitioner doctrine. It is suggested that this is not so, as the reflective doctrine has not only failed to explicate the link between theory and practice but some reflective theorists have perpetuated the theory-practice gap by separating thought and action. Instead it is argued that Aristotle's conceptions of Practical Wisdom and the Practical Syllogism provide a framework in which the link between thinking and doing are described. Practical wisdom is a form of knowledge that can be claimed by those who purport to deal with human good. Unlike theoretical knowledge, practical wisdom ends not in an intellectual conclusion but in the actual performing of some action designed to produce good for fellow humans. These actions are taken only after the practically wise person decides, consciously or unconsciously, the most effective and morally right option. The practical syllogism is that particular feature of critical thinking that links theory and practice in practice professions. The practical syllogism describes the means-end considerations that underpin all actions undertaken by nurses. It is not suggested that all the deliberations of those with practical wisdom is syllogistic in nature but that this is a central feature of the way in which nurses approach the care they deliver.

Vertigo is a distressing problem which can leave sufferers feeling disorientated and lacking in confidence. There is much nurses can do to offer practical advice on how to minimise the risk of attack.

Too often age is equated with pathology. Health promotion strategies need to be modified for the elderly. They must include social and political action as well as life-style changes.

The auditing of clinical areas is an important aspect of evaluating and maintaining standards in the Project 2000 scheme of nurse education. The auditing process brings many unexpected additional benefits, including increased ownership of the course and a developing sense of partnership between clinicians and educators. It is not an endeavour that should be undertaken lightly, and many problems can be prevented by good planning, which may include extensive piloting of the audit tool and process.

Nursing science has been described as being either alive or inert. Acceptance of one or the other paradigm has important implications for the way in which theories of nursing are taught in the curriculum. In this paper these conflicting paradigms are discussed and the implications for nurse teachers are outlined. It is suggested that this may involve a reconceptualisation of where nursing theories are derived and a consequent shift of power from nurse teachers to the practising nurse.