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Recent health care policies have resulted in patients having access to an integrated system of care that is quick and reliable. In concert with these changes, opportunities for professional development in nursing have increased, together with a reduction in the numbers of doctors. Advanced Nurse Practitioners (ANPs) have, therefore, developed to meet the complex demands of health care systems. This paper reports on a study that aimed to explore the current role of ANPs in primary care in the West Midlands region of the UK and how ANPs within three different nursing disciplines in primary care developed their roles over time. The study utilized a qualitative exploratory design incorporating a longitudinal element. Twenty-one ANPs were interviewed during phase one, 15 of whom were interviewed again during phase two, approximately 15 months later. Their managers (where appropriate) were also interviewed during phase one. The findings reveal that the nature and focus of practice varies between disciplines. At the extreme practice end of the practice-strategic continuum, Practice Nurse ANPs' expertise lies in their advanced practical assessment and diagnosis of individual patients, with little opportunity for strategic development. Health Visitor and District Nurse ANPs operate at the strategic end of the practice-strategic continuum, but operate differently at this level. Health Visitors, being community and public health focused are involved in multi-agency work, practice development and policy formulation. District Nurses work with individual patients/carers and the nursing team, thus their involvement in strategic developments tends to focus at the patient care level, such as protocol and practice developments, although their work also involves work in all three other domains. Overall, the findings reveal a unique role for all three with a potential career pathway for ANPs to become Nurse Consultants in the future. [ABSTRACT FROM AUTHOR]

Nursing is currently striving to ensure that its body of practitioners is reflective of the cultural diversity that exists in the population of healthcare consumers it serves. This is perceived as desirable to reflect and accommodate cultural differences within ethnic communities. The aim of this study was to investigate the rationale for the low recruitment of young South Asian people into nursing and midwifery education from an area of rich cultural diversity in the West Midlands. A triangulated approach was used involving four phases and sources of data collection. The study participants included students from secondary school (n = 70), parents of young South Asian students, career advisers and a small group of South Asian nurse practitioners. Data collection involved focus group interviews and a postal questionnaire for parents. The data revealed that very few young South Asian females and fewer young South Asian males had ever considered a career in nursing. The students' insight into the nature and scope of nursing as a profession was limited and based upon several misconceptions. Interaction with South Asian nursing role models was virtually non-existent. Their views of the physical, social and psychological demands placed on nurses made nursing an unattractive career option. Portrayals of an NHS in turmoil contributed to this view. Cultural issues also created problems for some students such as uniform policies and caring for the opposite gender. Further work needs to be undertaken to raise the profile of nursing and midwifery as a career option for young South Asian people. [ABSTRACT FROM AUTHOR]

* The recent profusion of new nursing roles in the UK has led to much confusion in the minds of health care consumers, employers, nursing practitioners and educationalists regarding the meaning, scope of practice, preparation for, and expectations of such roles.* Titles such as Clinical Nurse Specialist (CNS), Nurse Practitioner (NP), Advanced Nurse Practitioner (ANP), Higher Level Practitioner (HLP) and more recently Nurse Consultant (NC) are being adopted in a variety of care settings with little understanding or consensus as to the nature of or differences between such roles.* Further, the former United Kingdom Central Council for Nursing, Midwifery and Health Visiting (1992) initiative for extending the scope of professional practice allows for the prospect that nurses can adopt additional clinical tasks or alter the nature of service provision provided that they acquire the appropriate education or training, levels of competence and are prepared to be accountable for their new practices.* Consequently, nursing practice is becoming more diverse than ever before and the boundaries of inter- and intraprofessional practices are becoming increasingly blurred.* The UKCC (1999a) has recently contributed to an understanding of the levels of clinical practice undertaken at the specialist level but the situation at advanced or consultant levels remains unclear. [ABSTRACT FROM AUTHOR]

RATIONALE: Critical thinking is currently a highly valued educational outcome throughout the educational spectrum, but particularly so in relation to higher and professional education. Nursing education worldwide is also embracing the construct critical thinking as a desirable educational outcome, to the extent that some commentators refer to the importance of critical thinking in nursing as a given. The body of evidence relating to the impact that nursing education has upon the development of critical thinking is currently inconclusive. Many commentators claim that this may be because the instruments used in many studies are not sufficiently domain-specific. STUDY AIMS: The primary purpose of this descriptive-illuminative study was to explore and develop an alternative domain-specific method for identifying critical thinking in student nurses' reasoning processes. DESIGN: A longitudinal multimethod design incorporating across-method triangulation has been utilized for this purpose. Data collection from a group of student nurses involved the combination of the Watson and Glaser (1991) critical thinking appraisal test and a researcher developed think aloud technique incorporating a videotaped client simulation, a cognitive task and stimulated recall strategy. FINDINGS: Findings indicate no significant differences in pre and postprogramme Watson-Glaser mean scores. With regard to the think aloud evidence the sample consistently displayed evidence of reasoning that reflected an absolutist epistemology portraying limited evidence of critical thinking. In instances where more complex reasoning was demonstrated there was evidence to suggest that metacognitive strategies may contribute to this phenomenon. CONCLUSIONS: The findings make a further contribution to the assessment of critical thinking and raise interesting challenges to future curriculum development in nursing education, assessment of learning and nursing practice. [ABSTRACT FROM AUTHOR]

Critical thinking is currently a highly valued educational outcome throughout the educational spectrum, but particularly so in relation to higher and professional education. International concerns have focused upon citizen's thinking abilities and thus the nations' abilities to function and compete in complex societies and economies. Educationalists are questioning the wisdom of teaching content as opposed to teaching how to think as a means of dealing with relentless information development and change. Nursing education is also embracing the construct critical thinking as a desirable educational outcome. Some commentators refer to the importance of critical thinking in nursing practice as a central component or in some cases a given. This paper intends to examine the background to the construct and address in detail some of the important questions surrounding critical thinking, and its association with competent nursing practice. [ABSTRACT FROM AUTHOR]

Nursing is currently striving to ensure that its body of practitioners is reflective of the cultural diversity that exists in the population of healthcare consumers it serves. This is perceived as desirable to reflect and accommodate cultural differences within ethnic communities. The aim of this study was to investigate the rationale for the low recruitment of young South Asian people into nursing and midwifery education from an area of rich cultural diversity in the West Midlands. A triangulated approach was used involving four phases and sources of data collection. The study participants included students from secondary school (n = 70), parents of young South Asian students, career advisers and a small group of South Asian nurse practitioners. Data collection involved focus group interviews and a postal questionnaire for parents. The data revealed that very few young South Asian females and fewer young South Asian males had ever considered a career in nursing. The students' insight into the nature and scope of nursing as a profession was limited and based upon several misconceptions. Interaction with South Asian nursing role models was virtually non-existent. Their views of the physical, social and psychological demands placed on nurses made nursing an unattractive career option. Portrayals of an NHS in turmoil contributed to this view. Cultural issues also created problems for some students such as uniform policies and caring for the opposite gender. Further work needs to be undertaken to raise the profile of nursing and midwifery as a career option for young South Asian people.

Background: Portfolios have been used to incorporate accreditation of prior learning into nursing and midwifery assessment. This article aims to review the available literature on the use of portfolios., Conclusion: There needs to be a thorough evaluation of portfolios to determine their effectiveness as assessment tools in relation to the curriculum.

Patient accounts management today is facing new challenges. And the patient accounts manager is beseiged by a multitude of threats and opportunities, forcing the manager to seek ways to improve productivity, maintain cash flow, and enhance working relationships. In response, HFMA conducted a roundtable discussion with patient accounts managers from the American Guild of Patient Account Management and HFMA to determine some of these threats and opportunities confronting the manager. This article presents the highlights of that discussion.