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This paper gives a brief description of a research project carried out to test the assumption that there is a relationship between a student nurse's description, on paper, of how she would care for a patient, and the actual observed behaviour. No relationship was found in more than two-thirds of subjects in 19 hospitals. The paper goes on to look at the possible reasons for this phenomenon and suggests alterations in the training programmes for nurses in England and Wales which could create a greater correlation between the theory and practice of nursing. The views expressed are those of the author and not necessarily of any organization. [ABSTRACT FROM AUTHOR]

Going home from hospital: the carer/patient dyad Aims. This study aimed to provide an in-depth understanding of the process of hospital discharge experienced by the carers of patients ‘at risk’ of unsuccessful discharge from medical wards in three hospitals in the North of England. Background. The Community Care Act and the Carers Recognition and Services Act placed responsibility on service providers to ensure the smooth discharge of patients from hospital making sure that appropriate community services are in place to support the patient and their informal carer following discharge from hospital. The study, from which this paper is taken, identified patients at risk of unsuccessful discharge and tracked the experiences of the patient and their carer through the discharge process. For the purpose of the study unsuccessful discharge is defined as unplanned readmission within 6 weeks of discharge or extended length of stay. Design. The study combined qualitative and quantitative methods to identify factors leading to unsuccessful discharge. Logistic regression was used retrospectively with the records of 1500 patients to identify factors predicting unsuccessful discharge. A sample of medical patients predicted to be at risk of unsuccessful discharge, their formal and informal carers, were followed through the discharge process using qualitative techniques to look at decision-making and outcomes related to discharge. Findings. This paper presents findings relating to patient/carer experiences of the discharge process. It explores the obligate moral climate in which the role of carer is negotiated between professionals, patients, family members, friends and neighbours and the differing assumptions about duty associated with caring roles in hospital and in family and community settings. Conclusion. The discussion adopts a critical theory perspective to examine the contradictions confronting practitioners, patients and carers arising from hospital policies which promote cost-effective and efficient use of expensive technical resources while simultaneously seeking to identify and meet the needs of patients and carers for care. [ABSTRACT FROM AUTHOR]

BACKGROUND: Successive governments have urged mental health service providers to target their attentions on people with severe and enduring mental illness (SEMI). However, community mental health teams (CMHTs) in general, and community mental health nurses (CMHNs) in particular, have been criticized for failing to meet this requirement. This paper reports selected findings from a wider study that assessed the impact of an initiative designed to facilitate service targeting: the establishment of registers of patients with SEMI in general practices throughout an English health district. The paper describes changes in the nature of community mental health nursing contacts with a sample of patients on these registers. METHODS: Six general practices were randomly selected from the 65 practices in the district and comparisons made between patients on the six mental health registers who either had, or did not have, community mental health nursing contact. These comparisons related to the year before the establishment of the registers, the year during which they were being established and the year following this. RESULTS: A total of 274 patients were included on the sample registers, with practices varying considerably in relation to proportions of mental health registered patients with community mental health nursing contact. Overall, the number of patients in contact with CMHNs was found to have decreased over time, except for those on level 2 of the Care Programme Approach. CONCLUSIONS: No evidence was found to support the hypothesis that the establishment of the registers had improved CMHN targeting of patients with SEMI. However, findings were inconclusive because shortages of CMHNs and the disruption associated with widespread service reorganization meant the registers were never fully implemented in practices during the study period. [ABSTRACT FROM AUTHOR]

Women with learning disabilities: risk behaviours and experiences of the cervical smear test This paper reports the findings of a study on the views and experiences of women with learning disabilities regarding the cervical smear test. The experience and opinions of the carers were also taken into account. The study was carried out between 1997 and 1999 in Cambridgeshire. The factors that influenced whether women with a learning disability had a smear test included: sexual activity; number of sexual partners; pregnancy; and a past history of smoking. Women with a learning disability who had a cervical smear test most often experienced pain and difficulty with the procedure. Factors that enable women with a learning disability to undergo a cervical smear test, according to their experiences, will be discussed in this paper. These include: the importance of prolonged preparation; issues surrounding communication; the giving of information; and support from the carers. The implications of these findings for collaborative working between learning disability nurses and primary healthcare professionals in clinical practice are highlighted. [ABSTRACT FROM AUTHOR]

This paper reports on the selected findings from a larger ethnographic study of the provision of individualized care by district nurses to patients from different ethnic backgrounds. Undertaken in an English community National Health Service (NHS) Trust serving an ethnically diverse population, the study comprised two stages. First, an organizational profile of the Trust was undertaken in order to analyse the local policy context. Data were collected by means of in-depth interviews with managers and a review of policy documentation and caseload profiles. Second, a participant observational study was undertaken focusing on six district nursing teams. Purposive sampling was used to identify four teams with high minority ethnic caseloads and two teams with predominantly white ethnic majority caseloads. Interview transcripts and field notes were analysed by drawing upon the principles of dimensional analysis. This paper focuses upon aspects of the second stage, namely how the nurses' conceptualized and practised individualized care. Six principles underpinning the philosophy of individualized care expounded by the nurses were identified: respecting individuality; holistic care; focusing on nursing needs; promoting independence; partnership and negotiation of care; and equity and fairness. Each is examined in turn and consideration given to how they were modified in their transformation into practice. Some implications for patients from minority ethnic backgrounds of the nurses' conceptualization and practice of individualized care are discussed. The lack of internal consistency within the nurses' discourse, the impact of policy directives on care delivery and the influence of factors outside the nurses' control, served to illuminate the complexity whereby the ideals of individualized care were adjusted and reworked in the realities of everyday nursing practice. This in turn raised questions about the appropriateness of the current interpretation and practice of individualized care in a multi-ethnic society. [ABSTRACT FROM AUTHOR]

This paper describes some of the findings of a qualitative study into the health and illness beliefs of Greek Cypriots living in London. Data were collected through group and individual in-depth interviews and were analysed using the grounded theory approach of constant comparison and saturation. Two of the six themes which were identified are discussed in this paper. The findings provide the reader with important insights into Greek Cypriots' beliefs of health and illness. The paper argues that the understanding of such beliefs from a cultural perspective is vitally important for all those involved in the provision of health care to this group. [ABSTRACT FROM AUTHOR]

Health and illness beliefs of Greek Cypriots living in London This paper describes some of the findings of a qualitative study into the health and illness beliefs of Greek Cypriots living in London. Data were collected through group and individual in-depth interviews and were analysed using the grounded theory approach of constant comparison and saturation. Two of the six themes which were identified are discussed in this paper. The findings provide the reader with important insights into Greek Cypriots' beliefs of health and illness. The paper argues that the understanding of such beliefs from a cultural perspective is vitally important for all those involved in the provision of health care to this group. [ABSTRACT FROM AUTHOR]

This paper summarizes a research study which explored the experiences of older people being discharged from hospital to nursing and residential homes in the North East of England. While there has been considerable research which has looked at the discharge of patients from hospital to their own homes, little literature could be found which addressed discharge to care homes. While this may reflect an assumption that this form of discharge is less problematic, it is arguable that this is only the case for staff - there is a body of literature on re-location which suggests that the move to a care home is a major life event for older people. Taking a qualitative approach, this study interviewed 20 older people and 17 of their family members after discharge from hospital to a care home. We found that few people had been offered opportunities to discuss their move with nurses, and that older people tended to adopt a stoical attitude. In focus groups, interviews and written responses from 23 members of staff in the hospital and in care homes, we found that there was a lack of clarity over whose role it was to initiate such discussions. The paper concludes with some discussion of the implications for nursing practice of changing care interfaces. [ABSTRACT FROM AUTHOR]

The planning and commissioning of nurse education by consortia of NHS trusts and others in England is examined. These arrangements are analysed in terms of quasi-market theory, investigating their ability to co-ordinate effectively the demand for nurse education and workforce demand for nurses. Hence the paper examines evidence concerning the success or failure of consortia to co-ordinate these aspects, discussing the arguments over nurse and student nurse shortages, and the procedure for assessing the demand for nurse training places. The paper argues that current nurse shortages illustrate past planning errors in commissioning nurse training. Consequently, the central body (National Health Service Executive) is still aiding consortia in their decision-making concerning numbers of nurse training places, modelling workforce plans and suggesting increases in training places (and producing the money to pay for this). As such, it is argued, the quasi-market is not as yet a completely devolved one. It is suggested in the concluding discussion that if qualitative benefits of consortia fail to materialize (as suggested elsewhere), and the quantitative functions are inadequate, the utility of consortia as planners and commissioners of nurse education may be questioned. [ABSTRACT FROM AUTHOR]

This paper describes one part of a feasibility study carried out in England which examined the costs, quality and effectiveness of continence services in areas with different approaches to provision. It involved the design of instruments to collect the views and perceptions of patients and an investigation of ways to develop a methodology to implement comparative studies. It is the design and piloting of the questionnaires and the way patients responded that forms the focus of this paper. The main sample group recruited for the study were women who had recently sought formal help with urinary incontinence and were likely to receive conservative treatment or management in the community. They were interviewed and asked to complete four questionnaires at two points in time. A smaller sub-group of disabled women, interviewed only once, were included to compare cost profiles for different client groups. The questionnaires which were developed address the impact of urinary incontinence (using a standard scale), the effectiveness of service provision in terms of patients’ clinical history, expectations and hoped-for outcomes, service receipt and its cost, and patients’ satisfaction with several aspects of service provision. In total 118 women were interviewed, including 28 disabled women. The study generated a set of survey instruments which might be used for a variety of purposes including audit and future research and which could inform purchaser and provider decisions by using patients’ perspectives of quality of life outcomes to enhance service development. [ABSTRACT FROM AUTHOR]

This paper proposes a disputing model (territory model) which is particularly useful and effective for disputing clients who persistently hold on to their dysfunctional thinking and/or core irrational beliefs. Their 'stubbornness' to change is compounded by unhealthy negative emotions during sessions. The intense emotion makes it difficult to access the belief system, and therefore any attempt to dispute it often proves futile. This model advocates the shift of disputing onto a different 'territory/ground' where the client can be facilitated to acquire higher, abstract and objective thinking, and at the same time his/her emotional level is susceptible to rational and logical arguments. The new thinking would act as a catalyst for the client to reflect on his/her dysfunctional thought/irrational beliefs. In this paper, the author uses a case example to illustrate and discuss the ineffectiveness of the 'traditional' way of disputing the dysfunctional thinking/core beliefs of a difficult and emotional client. This is contrasted with the 'territory' model. [ABSTRACT FROM AUTHOR]

This paper provides a conceptual framework upon which action plans can be built to enable registered nurses to reflect upon their work and practice activities. This conceptual framework has been used by the author in his work with various nursing development units within Yorkshire, England, in his role as their academic nurse advisor. The framework has been useful in helping nurses not only to reflect upon current work and practice activities but also as a guideline for future development. The paper provides examples of such nursing development activities and includes a personal view of how nursing development units can act as catalysts for change. [ABSTRACT FROM AUTHOR]

The nursing development unit movement has recently generated a lot of financial and professional interest. This is demonstrated by the large financial investment by the Department of Health, England, and the growing number of papers in the nursing literature. The benefits of these units, however, are not as well documented. This paper seeks to contribute to the debate by: reviewing some of this literature and putting the movement in a historical perspective; discussing the purposes of the units; critically examining the characteristics of such units; evaluating their effectiveness; and suggesting a way forward for the future. [ABSTRACT FROM AUTHOR]

This paper describes a research study designed to evaluate a community health service development in one health authority in rural England. The study compared two types of primary care teams working towards the same objectives. Surveys of patients and staff in the health authority were conducted about a range of issues, defined by the original aims of the scheme. Measures were made of care received by people over 75 years of age, consumer satisfaction, staff experiences of the multi-disciplinary team, job satisfaction and liaison with social services personnel. Few differences existed between the two forms of care on all of these measures. This paper contains a discussion of the findings alongside an examination of the implications for future health service developments, particularly flagship enterprises such as nursing development units. The importance of well established baseline measurements is emphasized by both the research findings and the discussion. [ABSTRACT FROM AUTHOR]

This methodological paper discusses and critiques the 'insider' and 'outsider' models of action research described in the nursing literature. It highlights tensions and problems with these models and demonstrates how the models developed by the authors -- the 'double-act' and 'collaborative group' partnerships -- overcome these difficulties. The success of this approach suggests that such partnerships of nurse practitioners and a researcher should be considered when practitioners want to introduce innovation and facilitate change in practice and generate and test theory which is relevant to practice. The paper is presented in the form of a commentary, interspersed with reflective conversations in which the authors illustrate and reflect upon their attempts to make the methodology described a reality. [ABSTRACT FROM AUTHOR]

During the past decade, the professional journals have contained numerous papers authored by nurses and nurse -- researchers describing the gap which persists between research and clinical practice. Problems have been highlighted and challenges explored in the quest to discover ways of encouraging practitioners to become more aware of research evidence as a knowledge base for practice. Many of the identified issues may be transposed into a midwifery setting but other factors may be recognized which are specific to the practice of midwifery. This paper considers both conceptual and pragmatic issues in an attempt to explore the complexity of the influences which may affect the integration of research into midwifery practice. [ABSTRACT FROM AUTHOR]

This paper explores the literature on the role of the nurse teacher in the United Kingdom, in order to support a research study on the role of the nurse teacher as it emerges in Project 2000 programmes in England. Explicit within the reform of nurse education is a change in the role of the teacher. It is being influenced, first, by the creation of colleges of nursing and midwifery and their links to higher education, secondly, by the content and academic level of the course and, thirdly, by the supernumerary status of the student. Studies carried out on the activities nurse teachers undertake highlight the complex and multifaceted nature of the role. Excessive paper work, meetings and lack of autonomy are given as dissatisfying aspects of their work leaving only a small proportion of their time for classroom and clinical teaching. The literature suggests that the nurse teacher is required in Project 2000 to be a nurse, a teacher, a graduate in a specialist subject and clinically and academically credible. The study, which is mentioned briefly in this paper, will critically analyse the key components of the role of the nurse teacher as it emerges in the Project 2000 courses in England. The methodology and findings will be discussed in a later paper. [ABSTRACT FROM AUTHOR]

This paper examines some of the data obtained from the Joint Board of Clinical Nursing Studies Course Number 650, which ran at the Bethlem Royal and Maudsley Hospitals, London, 1978-1979. During this particular training programme, eight nurse therapist trainees treated a total of 251 patients assessed as suitable for behaviour therapy. Data were collected from patients by trainees on four separate occasions; before treatment, after treatment, and at follow-up intervals of 1 and 6 months. It was suggested that therapists would vary systematically in terms of the assessment scores used to measure outcome. This was explored using analysis of variance techniques, where several treatment outcome measures were used as dependent variables. The analyses, which were undertaken using SPSS and GLIM computer packages, clearly demonstrated therapist variability. The results are discussed within the theoretical framework of Sudman & Braburn's (1974) interviewing model and O'Muircheartaigh & Wiggins' (1981) consideration of response errors. The implications for the selection and training of nurse therapists are presented. The final conclusion of the paper is that, although the patient's clinical outcome may be related to therapist allocation, the eight trainees allowed themselves to 'open' their activities to this evaluative approach - which in turn demonstrates their professionalism. [ABSTRACT FROM AUTHOR]

Title. Retaining older nurses in primary care and the community. Aim. This paper is a report of a study conducted to examine issues associated with the impact of age on the retention of female primary and community care nurses in the National Health Service in England. Background. Little is known about why older nurses in the primary and community care workforce leave and what might encourage them to stay. Methods. A cross-sectional survey using a semi-structured postal questionnaire was carried out during 2005. Responses were received from 485 (61%) district nurses, health visitors, school nurses and practice nurses in five primary care trusts in England. Data were analysed to test for associations. Results. Older nurses were more likely than younger ones to report that their role had lived up to expectations ( P = 0·001). Issues important for older nurses were feeling valued and being consulted when change was implemented. Important factors encouraging nurses to stay were pension considerations, reduced working hours near retirement, and reduced workload. For those with degree-level qualifications, enhanced pay was a factor encouraging retention ( P = 0·044). Nurses might leave in response to high administrative workloads, problems in combining work and family commitments ( P <= 0·001), and lack of workplace support ( P = 0·029). Retirement and pensions advice was not widely available. Conclusion. Since two-thirds of nurses were generally happy in their role, it is important that the conditions necessary to maintain this level of satisfaction are continued throughout a nurse's working life. Nurses may all too easily consider leaving prematurely unless policy makers and managers ensure that their working environment reflects the issues nurses consider to be conducive to retention. [ABSTRACT FROM AUTHOR]

Title. Nurse prescribing in dermatology: doctors’ and non-prescribing nurses’ views. Aim. This paper is a report of a study conducted to explore doctor and non-prescribing nurse views about nurse prescribing in the light of their experience in dermatology. Background. The cooperation of healthcare professionals and peers is of key importance in enabling and supporting nurse prescribing. Lack of understanding of and opposition to nurse prescribing are known barriers to its implementation. Given the important role they play, it is necessary to consider how the recent expansion of nurse prescribing rights in England impacts on the views of healthcare professionals. Method. Interviews with 12 doctors and six non-prescribing nurses were conducted in 10 case study sites across England between 2006 and 2007. Participants all worked with nurses who prescribed for patients with dermatological conditions in secondary or primary care. Thematic analysis was conducted on the interview data. Results. Participants were positive about their experiences of nurse prescribing having witnessed benefits from it, but had reservations about nurse prescribing in general. Acceptance was conditional upon the nurses’ level of experience, awareness of their own limitations and the context in which they prescribed. Fears that nurses would prescribe beyond their level of competence were expected to reduce as understanding and experience of nurse prescribing increased. Conclusion. Indications are that nurse prescribing can be acceptable to doctors and nurses so long as it operates within recommended parameters. Greater promotion and assessment of standards and criteria are recommended to improve understanding and acceptance of nurse prescribing. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of an evaluation of the English national pilot education programme preparing Community Matrons to fulfil their role. Background. Investment in community services has been important in introducing new ways of working in the United Kingdom National Health Service, particularly for patients with complex long-term conditions. Development of the Community Matron role in England is an exemplar in the creation of modern nursing careers that are fit for purpose. Method. A mixed methods approach to data collection was adopted. This included documentary analysis of a range of sources used in the development and evaluation of the programme. In addition, during 2006, a self-administered questionnaire was sent to all Community Matrons undertaking the programme (n = 70), with a response rate of 67% (n = 47). Individual telephone interviews were conducted with 17 students and six mentors. A focus group was also undertaken with the education programme Development Team (n = 5). Quantitative data were analysed using SPSS and qualitative data analysed using content and thematic analyses. Findings. The majority of students (n = 25) believed that the programme had met their expectations and had helped them to achieve the functions of the Community Matron role as defined in national competence statements. However, 17 students experienced difficulties in the level of organisational readiness to support them in their role, including, for example, lack of facilitation of their work-based learning. Conclusion. In spite of the successful programme design, there is a need for organisations to develop their infrastructure to support new roles as well as offering protected time to learn in practice. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a study to compare factors influencing the development of evidence-based practice identified by junior and senior nurses. BACKGROUND: Assessing factors influencing the achievement of evidence-based practice is complex. Consideration needs to be given to a range of factors including different types of evidence, the skills nurses require to achieve evidence-based practice together with barriers and facilitators. To date, little is known about the relative skills of junior and senior clinical nurses in relation to evidence-based practice. METHOD: A cross-sectional survey was undertaken at two hospitals in England, using the Developing Evidence-Based Practice Questionnaire administered to Registered Nurses (n = 1411). A useable sample of 598 (response rate 42%) was achieved. Data were collected in 2003, with comparisons undertaken between junior and senior nurses. FINDINGS: Nurses relied heavily on personal experience and communication with colleagues rather than formal sources of knowledge. All respondents demonstrated confidence in accessing and using evidence for practice. Senior nurses were more confident in accessing all sources of evidence including published sources and the Internet, and felt able to initiate change. Junior nurses perceived more barriers in implementing change, and were less confident in accessing organizational evidence. Junior nurses perceived lack of time and resources as major barriers, whereas senior nurses felt empowered to overcome these constraints. CONCLUSION: Senior nurses are developing skills in evidence-based practice. However, the nursing culture seems to disempower junior nurses so that they are unable to develop autonomy in implementing evidence-based practice. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a study to develop a social outreach model of care, including the role of a link worker in developing collaborative care pathways, for marginalized groups with tuberculosis. BACKGROUND: Social risk factors such as homelessness and substance misuse are associated with poor treatment outcomes. Models of interprofessional practice to address the health and social care of patients are needed to improve outcomes. METHODS: A process evaluation involving a prospective cohort study of 100 patients and interviews with eight agencies involved in their care was conducted in London between January 2003 and April 2005. Outcome measures included a profile of patient need to guide service development; referrals to care providers; goal attainment; social improvement and treatment outcomes; and agencies' views on the benefits of link working. FINDINGS: The median age of the sample was 32.4 years and 62% were males. Reasons for referral to the link worker included housing need (56%); welfare benefits (42%); immigration (29%) and clinical management issues (28%). One-third of the patients were referred to other agencies. Goals, as agreed in the care plan, were attained totally or partially for 88% (59/67) of patients and 78% of patients successfully completed treatment. Barriers to attaining goals included service criteria which excluded some groups of patients and, in some cases, a patient's inability to follow a course of action. CONCLUSION: Link workers can mitigate some of the social risk factors that complicate the treatment of tuberculosis by enabling integrated health and social care. [ABSTRACT FROM AUTHOR]

Title. Verbal abuse experienced by nursing students Aim. This paper is a report of a study to describe the nature, severity, frequency and sources of verbal abuse experienced by nursing students while gaining clinical experience. Background. Verbal abuse of healthcare workers is currently receiving considerable attention and nursing students have been identified as a group vulnerable to experiencing workplace verbal abuse. Method. Questionnaires were distributed in 2005 to a convenience sample of 156 third year nursing students from one pre-registration nursing programme in England. A total of 114 questionnaires were returned, giving a response rate of 73·0%. Findings. Experience of verbal abuse was reported by 45·1% of respondents, 34·5% had witnessed other students experiencing this and 65·5% reported that they were aware of other students experiencing verbal abuse. The incidents involved patients in 64·7% of cases, 15·7% involved visitors or relatives and 19·6% involved other healthcare workers. Students reported experiencing threats to kill them, racial abuse and sexually oriented verbal abuse, with the majority of incidents occurring in general medical, mental health and general surgical clinical areas. Conclusion. Education and healthcare providers should prepare students to manage negative verbal exchanges during nursing education, and policies and support networks relating to managing verbal abuse in clinical practice should be available to nursing students. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to examine the operational impact of a police custody nursing service on healthcare delivery in one police service in the north of England. Background. Medical practitioners, trained specifically for the role of forensic medical examiner, have traditionally provided forensic and custodial medical services. However, there is a trend for police authorities in the United Kingdom to replace forensic medical examiners with custody nurses. Restructuring health care in police custody suites to a multidisciplinary team approach is a practical response to the challenges faced by an overburdened service. However, very few evaluations of the impact of a nursing addition to forensic medical services have been published. Method. One nursing service was evaluated by comparing performance indicators over a 6-months period with retrospective data from records of the traditional forensic medical examiner service. Data were extracted from 9000 calls made by the police for medical assistance across five police stations, and analysed for response and consultation times. Five custody nurses, 20 custody officers and six forensic medical examiners were also interviewed, and the study was conducted in 2003. Findings. In comparison to the traditional service, nurses demonstrated faster response times, comparable consultation times, and were perceived by custody staff as more approachable than their medical colleagues in providing handover information. Conclusion. As nurses take on the roles previously performed by medical colleagues, so it will become increasingly important to define role boundaries and assess the impact on the quality of care of detainees. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to examine the impact of social factors on the management of tuberculosis including engagement with services, hospitalization and extended treatment. Background. Rates of tuberculosis in major European cities have increased greatly in the last 10 years. The changing epidemiology of the disease, concentrated in marginalized groups, presents new challenges to the control of tuberculosis. Methods. A prospective cohort study of 250 newly diagnosed tuberculosis patients was conducted in London between January 2003 and January 2005. Data were collected by means of a risk assessment tool and from medical records. Outcome measures included missed appointments, frequency and duration of hospitalization and length of treatment. Results. The median age of the study sample was 33.82 (range 16.4-92.5) and 56.8% were male. Thirty-two per cent were hostel/street homeless or temporarily sharing accommodation with friends or relatives. Thirty-nine per cent were in receipt of welfare benefits and 13.2% had no income. Over a third anticipated difficulties taking their medicines and 30.3% had noone to remind them of this. Increased hospitalization was associated with hostel/street homelessness, drug or alcohol use and having noone to remind them to take their medicines (all P

AIMS: This paper reports a study evaluating whether expanding a specialist nursing role to provide outreach education and support to stroke patients and carers after discharge from hospital is effective in promoting recovery. BACKGROUND: Building therapeutic relationships with patients and carers is a key component of the nursing role in stroke rehabilitation, although this is limited by the constraints of service organization. METHODS: A pragmatic randomized controlled trial was undertaken. Patients with a diagnosis of stroke were randomized to receive continued support from a stroke nurse (n = 87) or usual care and follow-up (n = 89) after discharge from hospital. Patients were recruited from two hospitals in the north-west of England from November 1999 to April 2001. Patient dependence (Barthel Index), general health (Nottingham Health Profile), activities of living (Frenchay Activity of Living Index), depression (Beck Depression Inventory) and carer strain (Carer Strain Index) were assessed at 3 and 12 months after stroke. RESULTS: The continued intervention of a stroke nurse after discharge was associated with improved patient perceptions of general health at 12 months (median difference 42.6, P = 0.012), and in particular reduced negative emotional reaction (P = 0.037) and perceived social isolation (P = 0.002). In addition, the intervention reduced carer strain at 3 months (P = 0.045), and reduced deterioration in physical dependence from 3 to 12 months (P = 0.049). CONCLUSION: The provision of continued intervention from a stroke nurse after discharge from hospital, focusing on education and support, has tangible benefits for patients and carers. [ABSTRACT FROM AUTHOR]

baker j.a., richards d.a.&campbell m. (2005) Journal of Advanced Nursing49(5), 522–529Nursing attitudes towards acute mental health care: development of a measurement toolThis paper reports the development, piloting and validation of a tool to measure attitudes for use with nursing staff working in acute mental health care units.The quality of care provided for service users in acute mental health care has come under both scrutiny and severe criticism. The attitudes of staff working in these environments have been cited as a contributory factor in poor care. No measure of attitudes specific to acute mental health has been reported.A 64-question measure was constructed and distributed to a sample of qualified and unqualified nurses drawn from seven mental health care units in the North of England. Exploratory factor analysis and a number of other statistical tests were performed to validate the questionnaire.Preliminary analysis reduced the original 64 questions to 37. Five components were retained, accounting for 42% of the variance, and the five rotated factors were identified. The resultant‘Attitudes Towards Acute Mental Health Scale’ (ATAMHS) achieved good internal reliability, with a Cronbach's alpha of 0·72.The construction and validation of the ATAMHS measure will enable improved understanding of the attitudes of nursing staff working in acute mental health care settings to occur. This measure is available for use in a clinical area of nursing in which attitude change is of fundamental importance for future development of care. [ABSTRACT FROM AUTHOR]

staniszewska s.h.&henderson l. (2005) Journal of Advanced Nursing49(5), 530–537Patients’ evaluations of the quality of care: influencing factors and the importance of engagementThis paper reports a study exploring the process of patient evaluation and identifying the factors which influence this.Patient experiences of health care have become a central focus for researchers, policymakers, clinicians and patient groups in many countries. While surveys of patient experiences have become increasingly common internationally, concerns about the validity of concepts such as satisfaction have cast doubt on the utility of their findings. These concerns reflect our limited understanding of patient evaluation and the factors that can influence this process.A qualitative design was adopted, using semi-structured interviews with a sample of outpatients in their homes in one county in England. In total, 41 patients participated in the study and were interviewed before their appointment. Of these patients, 37 were interviewed again after their appointment. Six of the latter were then re-interviewed 6 weeks after the appointment to explore whether evaluations had changed.Patient evaluation was influenced by a number of factors, including gratitude, faith, loyalty, luck and equity. The overall effect was to prompt positive evaluation, even when care was poor. These factors should be accounted for in the interpretation of patient experiences surveys. Patient experiences were further influenced by their sense of engagement with the system. A negative sense of engagement could have a major impact on the patient, resulting in disappointment or fear and a desire to leave the health care system, and in a negative evaluation of a specific aspect of care.Engagement may provide a more appropriate indicator of negative experience than dissatisfaction. The influence of these factors should be considered in future attempts to develop more sensitive and appropriate methods of eliciting patient experiences. [ABSTRACT FROM AUTHOR]

hart a.&freeman m. (2005) Journal of Advanced Nursing49(5), 502–512Health‘care’ interventions: making health inequalities worse, not better?The aim of this paper is to present a model, the‘Effect of the Professional Ego’, which provides a psychodynamically informed analytical framework for examining professional practice in arenas where issues of inequalities need to be addressed.There is a great deal of literature on the psychosocial aspects of inequalities in health care provision. However, the impact of intrapsychic and professional cultural elements has not been explored in this context. Moreover, the body of work which does explore these elements in relation to health care workers does not address how they might impact on health inequalities.Drawing on empirical work, we discuss ways in which intrapsychic and professional cultural elements feed into the dynamic between clients and health care professionals in a way which can subvert espoused, positive client health outcomes. Based on this discussion, we propose the Effect of the Professional Ego model, which identifies two main aspects of the professional ego– the grandiose self and self-preservation– and how they influence the professional/client dynamic.Systematic self-reflection on the part of professionals would be a valuable contribution to the development of professional practice. This applies particularly to conceptualizing the links between the actions of service providers and the adverse health of clients. [ABSTRACT FROM AUTHOR]

AIM: This paper reports on the perceptions of experienced health visitors working with refugee families in Inner London. BACKGROUND: Women who are refugees and asylum seekers in the United Kingdom are more likely to experience depression than either non-refugee women or male asylum seekers. Health visitors provide a universal public health service to all women on the birth of a child, or with children aged under five, and as such are well placed to identify emotional and mental health problems of women who are refugees. Despite successive waves of refugees to the United Kingdom in the 20th century, there are no empirical studies of health visiting practice with this vulnerable group. There is also no body of evidence to inform the practice of health visitors new to working with asylum seekers and refugees. METHODS: An exploratory study was undertaken in Inner London in 2001. Semi-structured interviews were conducted with a purposive sample of 13 health visitors experienced in working with women and families who are refugees. FINDINGS: A range of structural challenges was identified that mediated against the development of a health-promoting relationship between health visitors and refugee women. With refugee families, who were living in temporary accommodation, health visitors were prioritizing basic needs that had to be addressed: in addition, they prioritized the needs of children before those of women. Health visitors were aware of the emotional needs of women and had strategies for addressing these with women in more settled circumstances. Health visitors considered themselves ill-prepared to deal with the complexities of working with women in these situations. CONCLUSIONS: This study identifies issues for further exploration, not least from the perspective of refugee women receiving health visiting services. Health visitors in countries receiving refugee women are framing their work with these women in ways that reflect Maslow's theory of a hierarchy of needs. This study suggests ways that public health nursing practice could be improved, and identifies issues for further study. [ABSTRACT FROM AUTHOR]

AIM: The aim of this study was to explore and identify nurses' clinical expertise in surgical ward and intensive care settings in England. One of the objectives of the study and the focus of this paper was the exploration of these nurses' understanding and use of intuition in the context of their practice. BACKGROUND: Since 1980 many studies have investigated qualified nurses' use of intuition within aspects of their practice. However, it was Benner's (1982, 1984) seminal work that firmly established the relationship between intuition and expert clinical practice. Since that time a possible relationship between intuitive components of decision-making and nonexpert nurses' practice has remained relatively unexplored until recently. METHODS: This constructivist qualitative study incorporated observation and interview to explore 61 qualified nurses' expertise through their assessment of patients following major surgery. FINDINGS: Specific findings highlighted refinement in nurses' use of intuitive and analytical elements of decision-making across the four identified levels of expertise. The most fluent and effective use of intuitive and analytical components of decision-making was found in the expert group. CONCLUDING REMARKS: These results are discussed in relation to current understanding of the components of expert decision-making in nursing practice. Both intuitive and analytical elements should be recognized in any model that seeks to depict the true nature of nurses' decision-making as they develop clinical expertise. [ABSTRACT FROM AUTHOR]

Limitations, frustrations and opportunities: a follow-up study of nursing graduates from the University of Birmingham, England This paper reports an ongoing study of the progress of nursing graduates from the University of Birmingham, England. The aim of the research was to follow-up early graduates from the programme, to assess their progress and study feedback indicators that could help further the development of this relatively new programme. The study also aims to contribute to the growing body of knowledge about United Kingdom nursing graduates, following the recent shift of nurse education from Schools/Colleges of Nursing into universities. Due to objection from some quarters as to the value of a university education for nurses, even such a small-scale study is considered to be important. A questionnaire was sent to the first three cohorts of graduates. It revealed interesting findings in relation to work patterns, continuing professional and academic development and perceptions of the value of the degree in practice. The graduates made recommendations regarding changes that might enhance the quality of the Birmingham degree and nursing practice generally. [ABSTRACT FROM AUTHOR]

This paper reports on midwives' support needs as they were described by midwives in a large study of the supervision of midwives in England. The data are derived from six sites: five, very different, National Health Service (NHS) sites, and one composed of midwives outside the NHS. In-depth, ethnographic interviews were conducted with 168 midwives and a grounded theory approach was used for the analysis. The findings identified midwives' many and varied support needs. Midwives also clearly described the culture of midwifery in the NHS. This culture inhibited midwives from arranging to have their support needs met and acted as an obstacle to progress in developing midwifery practice. The dilemmas and tensions inherent in this situation are explored and suggestions made as to the way forward. [ABSTRACT FROM AUTHOR]

This paper explores the role of nursing interaction within the context of handovers and seeks to identify the clinical discourses used by registered nurses, student nurses and care assistants in acute elderly care wards, to determine their influence on the delivery of patient care. The study design involved an ethnographic approach to data collection which involved: observations of formal nursing end of shift reports (23 handovers) and informal interactions between nurses (146 hours); interviews (n = 34) with registered nurses, student nurses and care assistants; and analysis of written nursing records. A grounded theory analysis was undertaken. Data were collected from five acute elderly care wards at a district general hospital in the south of England. Results from this empirical study indicate that handovers were formulaic, partial, cryptic, given at high speed, used abbreviations and jargon, required socialized knowledge to interpret, prioritized biomedical accounts and emphasized physical aspects of care. Patients' resuscitation status was highly salient to all grades of nurse. Doing 'paperwork' was accorded less status and priority than patient care, and was regarded as excessively time consuming. Despite this, there was evidence of repetition in nursing documents. Moreover, the delivery of clinical nursing appeared to be guided by personal records rather than formal records. [ABSTRACT FROM AUTHOR]

Although nurses' role in rehabilitation has been generally ill-defined and consistently undervalued, of all professional groups, nurses working with stroke patients have potentially the greatest contribution to make. Stroke patients are believed to benefit from good posture yet they can spend long periods in inappropriate positions. This study examined the positioning, handling and mobilizing of stroke patients in hospital. Non-participant observation was used to gather data on stroke patients' position and nurses' activities. This paper addresses two basic questions--what causes the adjustment of patients from poor to good position and who is involved in achieving this adjustment. Poor position was observed to end 158 times in 380 'patient hours' of observation. The most frequent causes of positional improvement were activities whose primary intention was unrelated to position correction. The deliberate adjustment of patients' position by nurses was a rare event which occupied a small part of nurses' time. The potential for a more considered and consistent nursing approach appears to be great. [ABSTRACT FROM AUTHOR]

Understanding how stroke sufferers experience their stroke and recovery is essential if the development of rehabilitation services is to be effective and appropriate. Previous research in this area has tended to be either cross-sectional or with a limited amount of informant follow-up, and consequently has limited utility. This paper describes a study underpinned by a phenomenological approach, which tracked the experiences of six patients admitted to a rehabilitation unit in the north-west of England. Informants were followed for at least 12 months after stroke, and a total of 73 interviews were undertaken during the study. The data demonstrate that recovery from stroke involved restructuring and adaptation in physical, social and emotional aspects of an individual's life. Two important features of recovery were highlighted. First, whilst aspects of pre-stroke life may be used to describe individual progress, no end-point to recovery was identified as informants described and anticipated life with stroke. Second, informants focused on the social context of recovery where engagement in the social world was emphasized over discrete physical function. Although no common path of recovery was found, it is recommended that stroke services are structured to take account of the long-term needs of stroke patients and their families in their home environment. [ABSTRACT FROM AUTHOR]

A significant number of incidents of suicide and self-harm occur whilst patients are in receipt of care as in-patients. This audit comprises 31 cases which were referred to the first author for expert opinion, each case being the subject of legal action brought by patients and/or their families. The cases were referred from 31 different NHS trusts across England. All concerned suicide/serious self-harm in people in receipt of in-patient care. The aims of this audit were to carry out a detailed assessment of the 31 individual cases, so as to provide a nursing dimension to already established enquiries in this area and also to examine whether specific issues might be the subject of more systematic research. Further, this paper aims to provide some insights in the area of litigation, where nurses are becoming increasingly involved. The same broad approach to information-gathering and analysis was used, comprising a systematic review of case records, trust policies, expert reports and, where appropriate, inquest transcriptions. The sample comprised 12 suicides and 19 cases of serious self-harm. Factors associated with these events include: being male, having a dual diagnosis of mental illness and drug/alcohol abuse, and age between 21 and 30 years. Of the 12 deaths, five occurred in hospital, four by hanging and one by drowning. The audit highlighted environmental factors associated with these events which, arguably, could be simply addressed. There was a considerable variation in the content and quality of observation policy and practice. The results of this audit point to the need for further research but, above all, provide evidence requiring urgent action by the Department of Health regarding the setting of national standards. [ABSTRACT FROM AUTHOR]

Developing a concept analysis of control for use in child and adolescent mental health nursing The need to help children and young people with significant mental health problems develop a sense of personal control in their everyday lives, in a manner which does not endanger themselves or others, was recognized by nurse practitioners working in an English regional multidisciplinary child and adolescent mental health residential unit. A concept analysis of control was undertaken and used to develop a framework for analysing control. This deductive framework was modified iteratively by nurses who developed new knowledge from a qualitative exploration of current practice and the application of the evolving framework to practice problems. The paper describes this process and highlights three main findings: (i) the evolving attributes of the concept analysis helped nurses steer a course through the complexities of practice; (ii) the research highlighted and enabled nurses to confront the paradoxical nature of control; (iii) the process enabled nurses to recognize the mutuality of feelings aroused simultaneously when both the nurse and the child are challenged to maintain personal control. [ABSTRACT FROM AUTHOR]

Discussion in this paper is drawn from a phenomenological study carried out in England describing the views and experiences of young 'ventilator-dependent' people aged 6-18 years, regarding their health and social care, education, and aspirations for the future. This study presented many methodological and ethical challenges in order to elicit and present their views in a meaningful way. Data were elicited through focused face-to-face interviews with 18 young people. Innovative methods of data collection were used with younger children and those who had a range of communication impairments. In addition, family members of 15 young people were interviewed. Presentation of findings is limited to views and experiences of the young people's care in hospitals. Findings reveal that a significant number of Articles in the United Nations (UN) Convention on the Rights of the Child were not respected or upheld. Young 'ventilator-dependent' people were discriminated against when trying to access health services because of their need for assisted ventilation. They were particularly excluded from making important decisions about their lives and were not always offered the full protection of the Children Act 1989 (England). Some young people were not able to maintain adequate contact with their families, first language, culture, nationality and religion. Almost all spent prolonged periods of time (in some cases years) in hospital when they no longer wanted or needed to be there. All those interviewed wanted to be discharged home far sooner. The generalizability of findings is unknown; however, important questions are posed in relation to nursing practice and research regarding the overall management of this group of young people. Issues include: respecting and upholding human rights; and challenging the boundaries of current nursing practice in order to move towards child-centred, appropriate and effective models of care. [ABSTRACT FROM AUTHOR]

This paper offers a unique insight into the factors affecting the functioning of the Nurse Executive Director(s) and their views on the realities of nursing management in the new National Health Service in England. It is based on the findings of the Exploring New Roles in Practice (ENRiP) project which was carried out for the Department of Health. As part of this project interviews were undertaken with Nurse Executive Directors from a 20% sample of acute hospital trusts in England. The interviews were designed to explore the Nurse Executive's perceptions of the process of new role development. The findings highlight a tension between the drive for professional development and the pragmatics of service delivery in a health care system which lacks dedicated funding for nursing development. It was evident that most Nurse Executives vacillated between responding either in an ad hoc way to internal and external pressures or leading and supporting managed development. [ABSTRACT FROM AUTHOR]

Focuses on a conference titled 'Auditing Quality' organized by the Queen's Nursing Institute at the CBI Conference Centre in London, England on November 14, 1991. Facts put forth by project officer to Audit Commission Russ Philips in his paper 'Which Quality Matters'; Paper presented by regional nursing adviser to the South Thames Regional Health Authority Ami Davis.

This paper reports on a replication study of the first national survey commissioned by the RCN Ophthalmic Nursing Forum to assess the changing skill-mix of staff caring for ophthalmic patients and the nature of ophthalmic services. After minor modifications to the original questionnaire, it was circulated to the total population of ophthalmic units and hospitals in the United Kingdom (n=181). Following quantitative data analysis, it was found that the numbers of nurses holding ophthalmic nursing qualifications has risen to almost 50%, although this did not reach statistical significance. This increase has occurred alongside a significant rise in numbers of institutions offering ophthalmic nurse education and the expansion of day case surgery. Regional variations exist, however, to the extent that the increase in ophthalmic nurses and provision of ophthalmic nurse education has not been reflected nearly as much in Scotland as the rest of the UK. Overall, it was also found that the proportion of C, G and I grade nurses has fallen significantly, whilst the numbers of nurses graded D and F has risen. The implications of the results are discussed and recommendations for future research made. [ABSTRACT FROM AUTHOR]

Passivity versus militancy: a Q methodological study of nurses’ industrial relations on Merseyside (England) This paper describes a Q methodological study of accounts of nurses’ industrial relations expressed by a sample of nurses (n = 60) drawn from the geographical area of Merseyside, United Kingdom (UK). The participants completed a 65-item Q sort made up of statements which could be ranked in terms of their relevance to an understanding of their industrial relations situation. Of interest was the importance of the narrative accounts which nurses draw upon in making sense of their employment relations, having the potential to underpin or delimit their actions. The notion of industrial action was an important focus of this research. Q methodology was chosen to allow the meaningful investigation of such subjectivity, with interesting tensions between differing notions of professionalism and militancy apparent from the analysis. Six accounts of industrial relations, which are available to be drawn on by nurses, are described and interpreted within a social constructionist framework. Some implications for the conduct of nurses’ industrial relations in the UK are contemplated. [ABSTRACT FROM AUTHOR]

The objective of this paper is to describe one study undertaken in the north of England which sought an understanding of family care-giving for people with dementia. Data were collected by interview and diary with 14 family carers, by questionnaire with 60 professional carers, and by interview and diary from nine case studies. Family carers were found to value their continuing relationship with the person with dementia. This emphasis on their relationship together influenced the contact which they had with professional carers. The implications of this research for policy and professional practice are explored through illumination of the tensions in professional responses to family carers. [ABSTRACT FROM AUTHOR]

The following paper reports on a survey of nursing homes in three health regions in England which formed part of a wider study to evaluate educational preparation for the nursing care of older people. The aims of the survey were to describe the educational preparation of staff employed within nursing homes and to explore relationships between educational preparation and one indicator of quality of care. A self-completion questionnaire was addressed to the senior nurse within a random sample of nursing homes. The instrument included a previously validated scale to measure resident autonomy. A total of 976 questionnaires were posted and 676 were returned, a response rate of 69%. The survey revealed wide variation in the educational preparation of staff in nursing homes and in the degree of contact with local centres providing nurse education. Statistically significant associations were found between resident autonomy and a composite measure of educational preparation, the proportion of qualified staff undertaking continuing professional education and the degree of contact with educational centres. The findings have implications for both purchasers and providers of education in this field. [ABSTRACT FROM AUTHOR]

The adequacy of postoperative pain management in British hospitals appears insufficient to improve patient care, and much of the research and clinical audit in postoperative pain has failed to seek the patient's perspective. This paper reports on the findings from a semi-structured telephone interview survey which formed part of a hospital-wide audit on postoperative pain at a district general hospital in the south of England. Of a total of 360 completed audit questionnaires, 114 patients left their telephone number and 29 were interviewed. Content analysis revealed five main themes: inadequate information, pain at home, staff attitudes, expectations of pain, and ward atmosphere. Several patients identified insightful strategies that potentially could improve pain management. The telephone interview generated a richness of data that had not been reported before in this important area. Some authors view clinical audit and research as having different characteristics but this work raises important questions for both approaches when using the semi-structured telephone interview. The ethical issues pertaining to collection of audit data using the telephone interview are discussed. [ABSTRACT FROM AUTHOR]

Given the substantial increase in the numbers of community psychiatric nurses (CPNs) in England in the last 15 years this paper asks the question: is CPN activity where it should be? In-other words is activity distributed around the country according to need? Various indicators of need are suggested including population age structure, deprivation indices and suicide rates. We find no evidence -- based on information from scatterplots, Spearman correlations and more innovative measures of inequality -- that CPNs are distributed according to need. If this is confirmed by further research it is cause for alarm -- CPNs should be where they are most needed. [ABSTRACT FROM AUTHOR]

In this paper an attempt is made to illustrate the experience of lecturers in a department of nursing preparing to implement the adult branch component of the pre-registration Higher Education Diploma in Nursing Studies. The study was conducted in a college of health in England at a time when the college was only beginning to discuss the possibility of closer links with universities. It highlights the grief responses associated with change exhibited by nursing lecturers during a period of organizational upheaval and curriculum change and maps the transition through stages of adaptation over a 2-year period. The analysis of the effects of change and the coping strategies adopted by nursing lecturers presented here is most relevant to educational managers who are charged with integrating nurse education into higher education. [ABSTRACT FROM AUTHOR]

There is an expectation for Nursing Development Units (NDUs) to explore and develop the clinical leadership role. This paper describes how 28 Department of Health funded NDUs in England sought to meet this objective. We describe the personal and professional characteristics of NDU clinical leaders (CLs) and their perceived responsibilities. We identify 10 elements which appear to be central to the CL role and together form a core role set of the leader which is applicable, to some extent, across clinical specialties and settings. The position of the CL in the organizational hierarchy emerges as crucial to his/her ability to act on these responsibilities and fulfil a leadership role. [ABSTRACT FROM AUTHOR]