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There has been little professional debate in the UK literature about nursing diagnosis and this paper explores some of the reasons why nursing diagnosis has failed to gain momentum among nurses in the United Kingdom. The nursing diagnosis movement has now reached some European countries and in the light of the International Classification of Nursing Project (ICNP) and the Strategic Advisory Group for Nursing Information Systems (SAGNIS) project commissioned by the NHS Executive (NHSE), requires a close examination by British nurses. The unsuccessful attempt by the North American Nursing Diagnosis Association (NANDA) to have its taxonomy accepted for inclusion in the World Health Organization's 10th revision of the International Classification of Diseases, an innovation which would have made the NANDA taxonomy the definitive classification of nursing, should alert British nurses to the importance of nursing diagnosis. Although nurses effectively diagnose as part of the nursing process, adoption of the concept of nursing diagnosis as a driving force for practice evades many of them. This paper reflects upon some of the logistical and conceptual difficulties including issues of culture and terminology. It is suggested that nursing diagnosis has a great deal to offer British nurses in their efforts to improve the quality of care and to provide data in this area for both practice and research. [ABSTRACT FROM AUTHOR]

elliott l., crombie i.k., irvine l., cantrell j. & taylor j. (2004) Journal of Advanced Nursing 45(2), 117–125 The effectiveness of public health nursing: the problems and solutions in carrying out a review of systematic reviews In 1999 the Scottish Office, United Kingdom, intimated that the Chief Nursing Officer would undertake a policy review of nurses’ contribution to improving the public's health. The importance of reviewing the scientific literature on the effectiveness of public health nursing was recognized as a crucial part of the policy review. A final report was expected within a 6-month period. The reason for the short time period was to fit the policy-making schedule. This paper discusses our literature review for this work. The aim was to conduct a review of the international scientific literature that gave the greatest coverage of the role and potential role of nurses in improving the public's health in relation to 14 major health topics. This paper describes the methods used, outlines the rationale underpinning the methods, discusses the problems encountered and offers solutions to some of these problems. The initial search for relevant scientific literature revealed 709 suitable primary papers. Reviewing this number was beyond the time limit set by the funding organization. Therefore, a decision was made to concentrate on the evidence contained in systematic reviews. Reviewing systematic reviews raises a number of methodological problems to which there are often no predetermined solutions, such as ensuring that important interventions are included, assessing the relevance and quality of the reviews, and grading the strength of the evidence. Reviewing systematic reviews provides the scope to increase the number of topics that might be covered. However, it is possible that a number of interventions may be missed, particularly those that are not subject to review or those assessed using qualitative techniques. The definition of public health nursing used in the present study was also restrictive, and could be widened to include community interventions. Finally, assessing the quality of reviews and grading the evidence proved difficult and there is lack of consensus on how these tasks should be achieved. Nevertheless, the review presented policy makers with accessible information on a large number of relevant international studies. [ABSTRACT FROM AUTHOR]

AIM: The aim of this paper is to discuss the opinions of the key individuals involved in implementing the integration of nurse education into higher education in the United Kingdom (UK) about why nurse education moved into higher education and why this happened when it did. BACKGROUND: In 1995 the last of the old-style schools of nursing in the UK was fully integrated into higher education and were detached financially, legally and organizationally from District Health Authorities. However, only 6 years before, when Working Paper 10 was produced, there were only a few nursing degree courses located within higher education. What made this move into higher education particularly noteworthy was that there was never a clear statement of intent from the government that this integration of health care education was intended. Despite the fact that this is one of the most significant changes ever to take place in nurse education, there has been relatively little empirical research about why the development occurred. METHODS: A qualitative approach was selected for this study and the methods used were policy analysis and interviews. A purposeful sample of 70 implementers involved in the integration process was selected and asked for their views on this issue. FINDINGS: Participants believed that integration had occurred because of a combination of complex factors, but there was a division between those who thought that it was centrally planned and others who felt that it was an accidental outcome of the particular events of the time. CONCLUSIONS: It is not clear whether policy was influencing action or action influencing policy. Understanding of why this change occurred is needed if health care professionals wish to have greater control over future changes in education. [ABSTRACT FROM AUTHOR]

In the United Kingdom, the audio-visual revolution has steadily gained converts in the nursing profession. Nurse tutor courses now contain information on the techniques of educational technology and schools of nursing increasingly own (or wish to own) many of the sophisticated electronic aids to teaching that abound. This is taking place at a time of hitherto inexperienced crisis and change. Funds have been or are being made available to buy audio-visual equipment. But its purchase and use relies on satisfying personal whim, prejudice or educational fashion, not on considerations of educational efficiency. In the rush of enthusiasm, the overwhelmed teacher (everywhere; the phenomenon is not confined to nursing) forgets to ask the searching, critical questions: 'Why should we use this aid?', 'How effective is it?', 'And, at what?'. Influential writers in this profession have repeatedly called for a more responsible attitude towards published research work of other fields. In an attempt to discover what is known about the answers to this group of questions, an eclectic look at media research is taken and the widespread dissatisfaction existing amongst international educational technologists is noted. The paper isolates out of the literature several causative factors responsible for the present state of affairs. Findings from the field of educational television are cited as representative of an aid which has had a considerable amount of time and research directed at it. The concluding part of the paper shows the decisions to be taken in using or not using educational media as being more complicated than might at first appear. [ABSTRACT FROM AUTHOR]

Title. The Internet as a research site: establishment of a web-based longitudinal study of the nursing and midwifery workforce in three countries. Aim. The aim of this paper is to describe the development of a web-based longitudinal research project, The Nurses and Midwives e-cohort Study. Background. The Internet has only recently been used for health research. However, web-based methodologies are increasingly discussed as significant and inevitable developments in research as Internet access and use rapidly increases worldwide. Method. In 2006, a longitudinal web-based study of nurses and midwives workforce participation patterns, health and wellbeing, and lifestyle choices was established. Participating countries are Australia, New Zealand and the United Kingdom. Data collection is handled through a dedicated website using a range of standardized tools combined into one comprehensive questionnaire. Internet-specific data collection and a range of recruitment and retention strategies have been developed for this study. Discussion. Internet-based technology can support the maintenance of cohorts across multiple countries and jurisdictions to explore factors influencing workforce participation. However, barriers to widespread adoption of web-based approaches include website development costs, the need for fast broadband connection for large data collection instruments, and varying degrees of Internet and computer literacy in the nursing and midwifery workforce. Conclusion. Many of the issues reported in this paper are transitional in nature at a time of rapid technological development. The development of on-line methods and tools is a major and exciting development in the world of research. Research via the world-wide web can support international collaborations across borders and cultures. [ABSTRACT FROM AUTHOR]

Title. Adequacy of health-related quality of life measures in children under 5 years old: systematic review Aim. This paper is a report of a systematic review to assess the adequacy of measures evaluating generic health-related quality of life outcomes in children less than 5 years old. Background. Evaluating generic health-related quality of life outcomes in children is important to assess the effectiveness of interventions, nursing care and services. Methods. A methodological systematic review was carried out for the period 1980–2005 in accord with the UK Centre of Reviews and Dissemination guidelines on systematic reviews. We searched multiple electronic databases, hand-searched key texts, and contacted investigators. We included all English language publications describing primary empirical research of generic health-related quality of life, health status, functional status or wellbeing measures, with published psychometric evidence. All measures (proxy and/or self-complete) for use in children under 5 years were included; single dimension measures were excluded. Results. Seventy-six papers (70 studies) referring to 16 generic health-related quality of life measures met our inclusion criteria. None of the 16 measures were adequate in terms of their conceptual content or psychometric criteria; quality scores were poor (0–8). No current, generic health-related quality of life measure is both psychometrically and conceptually robust, although the Health Utilities Index has the most comprehensive psychometric data published. However, not all dimensions of health are assessed, with little evidence of reliability in children under 5 years of age. Conclusion. There is a need to develop empirically robust and conceptually comprehensive health-related quality of life measures, particularly in the context of proxy-completion measures for very young children. [ABSTRACT FROM AUTHOR]

The scheduling of nursing time on hospital wards is critical to the delivery of patient care, resource utilization and employee satisfaction. Over the past decade many hospital wards in the United Kingdom (UK) have moved away from the traditional planning of rosters by a single manager, towards more participative processes known as self-rostering and team rostering. This paper tests the hypothesis, developed from the literature, that the three types of rostering approach may be positioned along a continuum. Self-rostering at one extreme, is conducive to staff empowerment, motivation and roster effectiveness, whilst departmental rostering, at the other, leads to perceived autocracy, reduced empowerment, lower levels of staff motivation and roster effectiveness. Team rostering is positioned mid-way on this continuum. This paper reports the findings of an empirical study of nurse rostering practices in the UK National Health Service (NHS), with a view to developing an understanding of the implications of implementing these three rostering approaches and testing the above hypothesis. The survey of rostering practices in 50 NHS wards, and in-depth case studies of seven wards, revealed that each of the three rostering approaches has benefits and limitations and a picture emerges quite different from that implied by the research hypothesis. Whilst the literature suggests that the choice of rostering approach determines the level of perceived autocracy, staff motivation and roster effectiveness, it is proposed in this paper that selection of rostering approach should be contingent upon operational context. The paper concludes with a framework which stipulates that the choice of rostering approach for a ward should be determined on the basis of four contingent variables, namely, ward size, demand variability, demand predictability, and complexity of skill mix. It is recommended that departmental rostering be applied in large wards with complex rostering problems, whilst team rostering is more appropriate for medium sized wards, and self-rostering appropriate for small wards. [ABSTRACT FROM AUTHOR]

This article presents consultation papers of the United Kingdom Central Council for Nursing, Midwifery and Health Visiting. Consultation papers prepared by the working groups are now being given a wide distribution throughout the professions of nursing, midwifery and health visiting. The task of the working groups, in considering comments will be greatly assisted if views on the recommendations and proposals in the consultation paper are channelled back through an appropriate professional organization or trade union. The Council has set up seven working groups. Each working group is looking at a particular aspect of the 1979 Act and the related future responsibilities which the Council will inherit.

This paper presents the results of an appraisal of the evidence for the effectiveness of methods of nutritional assessment currently in use by nurses and from this develops concepts which may be applied to many areas of nursing practice. The paper first shows how the approach to nutritional assessment by nurses has changed over time, producing the present search for methods which are relatively quick and easy to use. It then describes the limited nature of the evidence of effectiveness of these methods and considers the reasons for this situation. It suggests that the difficulty of validation is an important factor and describes the three most common approaches to validation, showing how problems arise from lack of clarity in the definition of terms and the assumption of a simple relationship between the level of risk of nutritional compromise and actual nutritional status. In conclusion, it is suggested that these difficulties illustrate principles applicable to many areas of nursing care, and a definition of 'segments' of care processes, each with well-defined purposes and outcome measures, is proposed. Such an approach will help to demonstrate the complexity and value of nursing activity. [ABSTRACT FROM AUTHOR]

Title. Fatigue in patients with rheumatoid arthritis: British and Dutch nurses’ knowledge, attitudes and management. Aim. This paper is a report of a study conducted to compare the knowledge, attitudes and current management of rheumatoid arthritis-related fatigue in British and Dutch rheumatology nurses. Background. After pain, fatigue is the most important symptom for patients with rheumatoid arthritis, but little is known about the current management of this fatigue by healthcare professionals. Methods. A questionnaire was mailed in 2007 to rheumatology nurses who were members of British Health Professionals in Rheumatology ( N = 267) and the Dutch Society of Rheumatology Nurses ( N = 227). Descriptive statistics, independent samples t-test and Pearson chi-square tests were used for statistical analysis. Results. A total of 494 nurses returned questionnaires (response rate 48%). In general, their knowledge about rheumatoid arthritis fatigue was in accordance with the literature and all indicated a positive attitude towards assessing and managing rheumatoid arthritis-related fatigue. However, respondents reported contradictory views about managing fatigue. Although they believed that other team members could help patients, they seldom referred patients on to other professionals. Although nurses believed that other advice besides pacing and balance between activity and rest might help, they did not offer this to patients. Despite acknowledging that there is poor communication about fatigue between patients and nurses, respondents reported that it is patients rather than nurses who raise the issue of fatigue in consultations. Conclusion. British and Dutch rheumatology nurses are sympathetic but do not know how to manage rheumatoid arthritis-related fatigue. Strategies to support self-management for this fatigue, and to increase communication between healthcare professionals and patients, should be initiated to help improve patient outcomes for rheumatoid arthritis-related fatigue. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of an integrative literature review to investigate: (a) the extent of entrepreneurial activity by nurses, midwives and health visitors in the United Kingdom and (b) the factors that influenced these activities. Background. Internationally, social and commercial entrepreneurial activity is regarded as important for economic growth and social cohesion. Methods. Seventeen bibliographic databases were searched using single and combined search terms: 'entrepreneur$', 'business', 'private practice', 'self-employ$', 'intrapreneur$' 'social enterprise$' 'mutuals', 'collectives', 'co-op' and 'social capital' which were related to a second layer of terms 'Nurs$', 'Midwi$', 'Visit$'. 'Entrepreneur$' Private Midwi$, Independent Midwi$, and 'nursing workforce'. In addition, hand searches of non-indexed journals and grey literature searches were completed. The following inclusion criteria were: (a) describing nurses, midwife and/or health visitor entrepreneurship (b) undertaken in the UK, and (c) reported between January 1996 and December 2005. Results. Of 154 items included only three were empirical studies; the remainder were narrative accounts. While quality of these accounts cannot be verified, they provide as complete an account as possible in this under-researched area. The numbers of nurses, midwives and health visitors acting entrepreneurially were very small and mirror international evidence. A categorization of entrepreneurial activity was inductively constructed by employment status and product offered. 'Push' and 'pull' influencing factors varied between types of entrepreneurial activity. Conclusion. Empirical investigation into the extent to which nurses and midwives respond to calls for greater entrepreneurialism should take account of the complex interplay of contextual factors (e.g. healthcare legislation), professional and managerial experience and demographic factors. [ABSTRACT FROM AUTHOR]

andrews j. manthorpe j. & watson r. (2004) Journal of Advanced Nursing 46(3), 303–310 Involving older people in intermediate care Intermediate care has become a crucial part of the United Kingdom government's programme for improving services for older people. Older people comprise a substantial part of the user base for these services, and it is increasingly recognized that there is a need for greater user involvement in service development for intermediate care. National initiatives undertaken in intermediate care have sought to widen and deepen the remit of such services, and in this way promote greater independence and improved quality of care for older people. In particular, the government has set out clear plans for reshaping services for older people in the National Health Service Plan and the rationale for greater involvement of older people in service development. This article considers ways in which these national and local objectives may be achieved and considers some of the implications for nursing. This paper aims to explore the concept of intermediate care and to identify trends and existing evidence of user involvement in care. In this way it charts a possible way forward for the development of a more ‘user sensitive’ approach. The following databases were searched: Medline, Cochrane Library, the Social Science Citation Index and CINAHL. Key words were ‘intermediate care’, ‘older people’, ‘formal care’, ‘primary care’, ‘social services’ and ‘geriatrics’, used in combination. The findings from this study indicate that there is considerable scope for increased user involvement in service development for intermediate care. Such challenges may be more effectively met through greater clarity of the concept of intermediate care, and a bridging of user involvement at the practice and policy levels. Nurses are key providers of intermediate care in the community. The involvement of older people in intermediate care service development must be premised on a shared comprehension of the purpose and function of intermediate care. Nurses must be involved in shifting intermediate care from being service-focused to patient-centred. Effective participation eschews the application of global constructs for older people, while supporting greater participation at all levels and robust implementation processes. [ABSTRACT FROM AUTHOR]

croghan e. & johnson c. (2004) Journal of Advanced Nursing 45(2), 155–161 Occupational health and school health: a natural alliance? The United Kingdom National Health Service aims to provide a holistic ‘cradle to grave’ service. In order to achieve this, systems are in place for effective communication between providers of services for babies and children. However, when children leave school, communication between the school health services and workplace health services to protect and promote the health of the new workforce is rare. Working together is a commonly-stated rhetoric of contemporary nursing theory, but often this is not applied in practice. School health and occupational health have similar aims and objectives and, by working together, may be able to improve the health of large populations for a lifetime. This paper aims to examine the similarities in principles and practices between school health and occupational health nurses, and to identify areas of overlap in which collaboration could improve care for clients of both services. The paper examines the nature of nursing in occupational and school settings, and similarities and differences in policy, law and principles. It also examines these two areas of practice within a public health framework, looking for areas of overlap. A basis is suggested for collaborative working between the two areas, and barriers, facilitators and benefits of this practice are examined. We conclude that there does exist a natural alliance between occupational and school health nursing, and that the two should work together to provide continuity of care for clients on leaving school, and to prepare children and young people for the workplace and any special health issues in their chosen careers. [ABSTRACT FROM AUTHOR]

Background and aims. This paper draws on recent research conducted in two contrasting NHS hospitals: one a large District General, the other a small Community hospital; to look at hospitals as organizational spaces. This includes both the physical environment as well as how these spaces are inhabited and used. This paper aims to explore the ways in which hospital spaces impact on the working lives of nurses. Methods. The research employed two main methods. Two phases of round the clock non-participant observation were carried out within each hospital, one at the beginning of the research period and one at the end. This generated thick description of the diversity of spaces, as well as individuals' use of space. In addition, more than 50 in-depth unstructured interviews were conducted with both nurses and doctors. Findings. Three aspects of the relationship between nurse and hospital spaces are considered. First, the degree of access that nurses have to the different hospital spaces is limited, and many are confined to the wards in which they work. The high proportion of female nurses working on wards means that there are marked gender differences in access to hospital spaces. There are also marked professional differences when nurses are compared to doctors who have much greater freedom to roam and there are differences in the amount of private space allocated to nurses and doctors. Second, styles of bodily movement in space are also highly differentiated by profession and gender. Third, different spaces have very different meanings attached to them, and this has a strong impact on styles of performance and identity. Attention to space thus offers original insights to nurses working conditions as well as to inter-professional relations. [ABSTRACT FROM AUTHOR]

This paper reviews some of the key policy changes in the United Kingdom in relation to older people that have influenced assessment practice across health and social care, and have implications for nursing within emerging primary care groups. The role of assessment in purchasing care packages raises tensions and paradoxes for health and social care professionals that the paper sets out to elucidate with particular reference to district nurses. The issues for nursing have not been well described previously and questions such as key accountability, rationing, multiagency and interprofessional working, and the consumer voice, are discussed. [ABSTRACT FROM AUTHOR]

Reflects on the 50th anniversary of the creation of the British National Health Service (NHS) in July 1998. Thoughts on changes in nursing care from the 1940's to the 1990's; The author's experience as a nurse treating tuberculosis patients in the 1950's; Progress in nursing scholarship; Quality of papers submitted to the 'Journal of Advanced Nursing.'

The ‘greying’ of the United Kingdom nursing workforce: implications for employment policy and practice One in five nurses on the United Kingdom (UK) professional register is aged 50 years or older. Over the next few years, the profession will lose, through retirement, many of its most experienced practitioners. The significance for policy makers and for employers of this age-shift is two-fold. Firstly it is clear that greater numbers of nurses and midwives are reaching, or soon will reach, potential retirement age. Secondly many more nurses are now reaching their middle years and they are likely to have different requirements and attitudes to nursing work. This paper examines the employment policy and practice of the ageing of the UK nursing population. The paper examines data from official sources, and information from attitudinal surveys and case studies with employing organizations to assess the major effects of the ageing of the nursing workforce. Key findings are that the age profile of those nurses working in the National Health Service appears to be ‘younger’ than that of the total population, with the age profile of nurses working in nursing homes and as practice nurses being older than that of the NHS nursing workforce. However, the overall age profile of NHS nurses masks considerable variation between specialties and trusts, and the ‘pool’ of potential nurse returners from which the NHS and other employers attempts to recruit, is declining in numbers, as it too ages. Other major issues requiring policy attention are the provision of appropriate flexible hours to older nurses who have caring responsibilities, improving access to continuing professional development, and reducing pension provision inflexibility. [ABSTRACT FROM AUTHOR]

An evaluative study of clinical supervision based on Proctor’s three function interactive model This paper reports on a study of the benefits reported from participation in clinical supervision by registered nurses (n=201) working in a large English community and mental health NHS Trust. It summarizes the emergent practical and theoretical ‘key ingredients’ of clinical supervision in the United Kingdom and argues that these provide a basis for generalizable research practice. The study is based on Proctor’s three function interactive model previously commended as a guide for supervisory practice and evaluation. Within this study, the three functions underpin instrument design but are also a primary focus of evaluation. The development of this instrument through semi- structured interviews with supervisors and supervisees is described. The study aims to assess and compare reported benefits in each of the three functions of accountability, skill development and support in order to examine the effects of contract use, length of experience of clinical supervision and length of service as a registered nurse on reported benefits by using non-parametric statistical analysis. The results indicate that reported benefits are experienced in almost equal proportion across each of these three functions. Statistical analysis indicates a significant positive correlation between experience of clinical supervision and its reported benefits. An inverse correlation is reported between length of service and overall benefits; however, no similar reduction over time against normative benefits was found. There was no relationship between contract use and reported benefits. Limitations of the study are discussed with reference to bias, interview transcription and overlap between the three functions. The paper concludes that nurses report clear benefits from clinical supervision in each of the three functions. This validates the three function interactive model and demonstrates that clinical supervision is used to critically examine and change nursing practice. The content and usage of contracts is identified as an aspect that merits further study. [ABSTRACT FROM AUTHOR]

This paper describes how within a study on the experiences of district nurses since the introduction of general practitioner purchasing, participants were encouraged to describe and define the district nursing service. The identification of terminal care by district nurses and others as a significant and defining example of district nursing work is explored and the possible reasons for its emphasis over other aspects of patient care. The extent to which terminal care was used within contract and purchasing discussions to aid general practitioner understanding of district nursing work and achieve extra funding is described. The paper concludes by questioning the extent to which terminal care is a helpful and accurate representation of what district nursing work entails, and the implications there may be in emphasizing one aspect of care within a purchasing environment. [ABSTRACT FROM AUTHOR]

Assessing patients' satisfaction with the care they receive is assuming greater importance in the new-style National Health Service. This paper reviews recent developments in the measurement of patients' satisfaction with nursing, including new approaches and taking into account increased interest in users' opinions. Studies published since 1990 generally demonstrate lack of clarity with regard to the purpose and intent of the study, as well as a lack of conceptual rigour and methodological investment. However, several new approaches were found upon which future nursing research could build. [ABSTRACT FROM AUTHOR]

The findings of research into the implementation of the Project 2000 reforms of nurse education in England and Wales are reviewed in this paper. The work of nine research teams who have published their findings between 1990 and 1994 is reviewed. Following a brief summary of the major Project 2000 recommendations, the findings of the various research teams are presented. Both successes and difficulties in implementing Project 2000 are highlighted. The findings are discussed in the light of the original Project 2000 proposals, and it is concluded that, notwithstanding 'teething' difficulties, the project 2000 reforms are proving workable in practice. [ABSTRACT FROM AUTHOR]

This paper examines the progress made in the measurement of the 'outcomes' of nursing. Although nursing has a long history of outcome research which extends as far back as Florence Nightingale, an examination of the literature over the past 30 years gives little impression of progress. Significant difficulties still remain in identifying outcomes relevant to nursing intervention, measurement techniques and appropriate study designs. However, progress has been made. The paper examines various recent trends which point to ways forward for outcome research. In particular it is emphasized that future work should build upon the strengths of past work in the use of measurement tools and the identification of relevant variables. Outcome research in nursing should not be limited to identifying the immediate results of nursing intervention, nor should research into 'structure' or 'process' variables be neglected. Such concepts are vital to determining the nursing contribution to changes in a patient's health and well being. The future of outcome research depends on a range of appropriate research methods and measurement techniques. [ABSTRACT FROM AUTHOR]

Many nurse educators in the United Kingdom are currently faced with the challenge of change, of leaving the culture of the British National Health Service and integrating into the culture of tertiary education. This paper reports on a study of the process of developing collegial relationships in the context of a new collaboration to develop a combined curriculum for nurses within a tertiary institution. The aims of the study were to analyse this process of integration and to identify the conditions that enhanced the development of collegiality between members of the nursing group. The case study centred on the analysis of data collected on video during unstructured interviews with the five members of the group. Data were analysed using Burnard's method of thematic content analysis. The paper argues that during the transition from the National Health Service to tertiary education, individual nurse educators and their managers must address problems related to issues such as 'ingroupism', nursing the students, perceived difference between nurse academics and other academics, and expectations of power-relationships. [ABSTRACT FROM AUTHOR]

Nursing was rated as lowest of all 72 subjects reviewed in the 1992 assessment of research in British universities. Of the 29 academic nursing departments assessed, 17 received the lowest possible rating and only five were given an average or above average rating. Immediate coverage of these results in the nursing press was slow and superficial, and sometimes misleading. This paper explains how the Research Assessment Exercise (RAE) was carried out. It is argued that academic nursing departments are crucial to the profession in its current pursuit of an improved research capability and productivity and, therefore, that the results of the RAE should be of interest and concern to nurses. The analysis presented of nursing's results shows that the larger, longer-established departments based in research-strong 'old' universities have more research-active staff, and it was these departments that received the best ratings in the RAE. In contrast, most of the nursing departments assigned the lowest possible rating were small, recently established departments in 'new' universities that could not have been expected to distinguish themselves in their first research assessment. It is suggested, however, that any new academic nursing departments should be strategically placed in research-strong universities. Although this paper is concerned with nursing in British universities, the general notion of research funding being allocated on the basis of performance is (or is likely to become) pertinent to other countries, especially those in Europe, North America and Australasia. [ABSTRACT FROM AUTHOR]

In this paper, the author seeks to address issues of personal and professional development that may occur during the research process. Whilst research reports now abound in the nursing literature, this personal aspect is often neglected. As we seek to encourage research awareness within the profession, many student and qualified nurses now produce a small research project, and this often concentrates on measurable outcomes. By examining her own perceived learning in resolving epistemological pluralism whilst undertaking such a project as a tutor student, the author has attempted to resolve the problem of ignoring the personal. Indeed, she believes that increased self-awareness can only enhance nursing professionalism. [ABSTRACT FROM AUTHOR]

This paper is concerned with the development of theory in the discipline of nursing as it is practised in Great Britain. It stems from dissatisfaction with the generally uncritical adoption by British nurses of models of nursing which have been developed to explain and enhance North American practice. After the introductory paragraph, four roles for nursing theory are proposed. These are: to define nursing by describing nursing phenomena; to form a realistic basis for curriculum design; to provide tools for the professional practice of nursing; and to provide a nursing language. It is then argued that although British nurses have recognized the need for an adequate theoretical basis for practice, their response has been rather uncritical adoption of American models of nursing. As a basis for practice, it is argued the American models generally fail to meet the needs described above, and therefore fail to have impact on clinical work. Structural and philosophical reasons for this failure are identified. Following a brief discussion of the inductive and deductive approaches to the development of theory, the paper closes with the argument that British nurses should be concerned with the development of new theory which, if grounded in the reality of practice, would be likely to be both useful and realistic. [ABSTRACT FROM AUTHOR]

This article presents information related to nursing. At a reception given by Her Majesty Queen Elizabeth the Queen Mother at St James's Palace, London to mark the thirtieth birthday of The British Commonwealth Nurses War Memorial Fund, future plans were announced. The Council of the Royal College of Nursing of Great Britain has decided to create fellows from amongst its members of at least five years' standing who have made exceptional contributions to the advancement of the science and art of nursing. Fellows will be expected to have completed a course in post-basic nursing education where appropriate, and to present a paper or thesis and/or demonstrate innovation or exceptional competence in advancing nursing.

This paper intends to analyse the effects of recent health policy changes in the United Kingdom upon nursing, examining some of the anomalies raised by the rhetoric of the politics and the actualities of the change process and exploring and analysing nursings' presence within that change process. Specific reference will be paid to the philosophy and ideology of the reforms and comparisons made with some of the original factors underpinning the purpose and functioning of the British National Health Service and professional groups within it. In particular, this paper considers the functioning of nursing as an holistic, intuitive, humanistic, and caring act within the context of the scientific, rational, performance and outcomes-orientated new public management ideology presently sweeping the health service. The resultant tensions this apparent dichotomy is causing nursing will be tentatively explored. Lastly, an agenda for change will be proposed which will identify ways in which nursing can respond and, more importantly, be proactive within the contextual changes highlighted. [ABSTRACT FROM AUTHOR]

Aim. This paper reports the findings from a naturalistic enquiry undertaken in the United Kingdom into the extent to which the ideals and values of the preregistration nursing course are adopted by individual newly educated Registered Nurses. Background. Research in several countries provides consistent evidence of the existence of a theory–practice gap in nursing. Clear disparities have been demonstrated between the best practice ideals and values that are taught and those actually encountered in everyday practice. Nurse education ‘Project 2000’ reforms in the United Kingdom were designed, in part, to address this issue. Few studies to date have examined the impact of these reforms on newly qualified Registered Nurses’ ability to translate theory into practice. Methods. A longitudinal study was carried out in three educational institutions in the United Kingdom from 1997 to 2000. Final year nursing students ( n = 72) in three colleges of nursing completed questionnaires to elicit views on their ideals and values for practice. In-depth interviews with a purposive subsample of 26 participants (at 4–6 and 11–15 months postqualification) indicated the extent to which these ideals and values were adopted in practice. Interviews were tape-recorded, transcribed, and data were analysed using constant comparison and negative case analysis. Findings. Although new nurses emerged from their programmes with a strong set of nursing values, a number of professional and organizational factors effectively sabotaged implementation. Professional sabotage includes obeying covert rules, lack of support and poor nursing role models. Organizational sabotage includes structural and organizational constraints such as time pressures, role constraints, staff shortages and work overload. Conclusion. The disparity between nursing as taught and as practised may have profound implications for the future of the profession both in the United Kingdom and internationally, in terms of morale, job satisfaction and retention. Measures to improve resources and reduce the professional–bureaucratic work conflict are discussed. [ABSTRACT FROM AUTHOR]

narayanasamy a., clissett p., parumal l., thompson d., annasamy s. & edge r. (2004) Journal of Advanced Nursing 48(1), 6–16 Responses to the spiritual needs of older people The literature suggests that the notion of holistic health has gained popularity in the nursing of older persons. Holistic care, based on the premises that there is a balance between body, mind and spirit, is important for well-being, that each of these is interconnected, and that each affects the others. Human spirit is considered to be the essence of being and is what motivates and guides us to live a meaningful existence. However, there is little evidence in the nursing literature about how nurses caring for older people respond to their spiritual needs. The aim of this paper is to report a critical incident study to: (1) explore nurses’ perceptions of their role in addressing the spiritual needs of older people; (2) describe what constitutes spiritual care of old people in the light of the findings. Descriptions of critical incidents were obtained from a convenience sample of 52 nurses working in the East Midlands Region of the United Kingdom (UK) and subjected to content analysis and construction of a data classification system. Respondents were prompted to identify patients’ spiritual needs by factors such as religious beliefs and practice (prayer); absolution; seeking connectedness, comfort and reassurance, healing or searching for meaning and purpose. The interventions initiated to meet patients’ spiritual needs included respect for privacy; helping patients to connect; helping patients to complete unfinished business; listening to patients’ concerns; comforting and reassuring; using personal religious beliefs to assist patients and observation of religious beliefs and practices. The findings provide empirical evidence of some practices related to spiritual care of older people. Further empirical research is needed to guide practice and education with regard to conceptual clarity and the delivery of spiritual care of older people. [ABSTRACT FROM AUTHOR]

clouder l. & sellars j. (2004) Journal of Advanced Nursing 46(3), 262–269 Reflective practice and clinical supervision: an interprofessional perspective In the United Kingdom, the drive to encourage reflective practice through clinical supervision, as a means of ensuring quality of provision in nursing and other health care professions, is now well-embedded, not only in policy but also in practice. However, debate and critique of these concepts is limited. The aim of this paper is to draw on research, conducted with undergraduate occupational therapy students and qualified physiotherapists, in order to contribute to the debate about the functions of clinical supervision and reflective practice in nursing and other health care professions. Upholding the notion that clinical supervision has the potential to constitute a form of surveillance, we counter the assumption that it is inevitably confessional in nature. A social constructionist perspective is used to illustrate how clinical supervision might involve a complex interplay of factors that dispel notions of predictability, control and rationality. Despite acknowledging tensions, we argue that clinical supervision is both necessary and beneficial. It can be advantageous to individual practitioners and professional groups in enhancing practice and accountability, and promoting professional development. [ABSTRACT FROM AUTHOR]

peckover s. (2003) Journal of Advanced Nursing 44(2), 200–208 Health visitors’ understandings of domestic violence Feminist work has made visible the extent and nature of domestic violence and the problems women face in having their experiences recognized by health and welfare professionals. Research has demonstrated that many health care professionals, including nurses, midwives and health visitors have little working knowledge about this issue. This impacts on their ability to recognize and respond to domestic violence within their practice. This paper is based upon a study of British health visitors, which explored their practice in relation to domestic violence. Drawing upon empirical data from interviews with health visitors, it explores their understandings of the extent and nature of domestic violence in the context of their work. Semi-structured interviews were undertaken with 24 health visitors selected by convenience and purposive sampling. Data collection took place during 1997–1998. The research draws on the theoretical perspectives of feminist poststructuralism. The findings demonstrate considerable differences between health visitors in their understandings of the extent of domestic violence in their caseloads and their recognition of different types of abuse experienced by women. There were also differences between participants in their willingness to name situations other than physical violence as abusive, as well as the extent to which they recognized domestic violence within different social groups. A feminist perspective provides critical insight into the professional knowledge base in relation to domestic violence, demonstrating the need for health visitors to develop their understandings further in order to respond appropriately to women and children experiencing domestic violence. This is discussed in the context of ongoing struggles for professional identity within an ever-changing arena of health and welfare provision. [ABSTRACT FROM AUTHOR]

BACKGROUND: This paper examines the current systems and structures for ethical review of health services research in the United Kingdom (UK). Past criticisms and the adequacy of recent governance arrangements for Ethics Committees in addressing these are discussed. The implications for nurses are then considered. RATIONALE: This examination of the situation is prompted by the demand for more innovative research designs in health care evaluation, new regulations and guidance, and a climate of public anxiety regarding research conduct in the UK. FINDINGS: The evolution of Research Ethics Committees (RECs) has been slow and resulted in a lack in consistency. Criticisms made of RECs can be categorized into four main areas. New governance arrangements for RECs have emerged as potential solutions to these criticisms. This review identifies the limitations of the new governance arrangements in addressing past criticisms because of two factors. The first is insufficient funding. The second is confusion about the confidentiality and consent requirements of clinicians working in areas where research is conducted and on whom recruitment processes often rely. The current situation regarding health research ethical review has implications for nurses, whether they are working as researchers, members of Ethics Committees or clinicians where research is conducted. CONCLUSION: The new governance arrangements may go some way to addressing past problems. However, investment in RECs is required. It is also important to realize that maintaining ethical probity in health service research is a tripartite concern. It is reliant as it is on the actions of Ethics Committees and clinical research partners as well as those of the researchers themselves. [ABSTRACT FROM AUTHOR]

Rationale and aims. Family planning nurses have been identified for early development for prescribing authority in the United Kingdom (UK). Currently, no psychometrically founded training needs analysis instrument exists that can reliably assess the nature and extent of the specific educational provision required for this role. This paper is concerned with the development of an instrument capable of defining the development needs for family planning nurse prescribing. Methods. A national survey was conducted with 388 family planning nurses, using a modified training needs analysis instrument. Respondents were required to assess the importance of 40 tasks, firstly for the role of the family planning nurse (FPN), and again for the role of the family planning nurse prescriber (FPNP). The data from each set of ratings were separately factor analysed using orthogonal Varimax rotations and Cronbach's alpha was computed for each factor. Results. Six factors emerged from the family planning nurse ratings ('professional development', 'managing patient consultations', 'critical appraisal', 'clinical information giving and professional accountability', 'collaborative working and current National Health Service (NHS) issues' and 'dispensing of drugs') and nine factors emerged from the FPNP ratings ('research and practice development', 'prescribing and professional accountability', 'management/leadership', 'clinical decision making and risk assessment', 'advanced health assessment', 'critical appraisal', 'referral processes', 'core nursing skills' and 'dispensing of drugs'. This suggests that the role of the FPNP is more extended and, moreover, that the two roles are configured very differently but in a way that makes logical and coherent sense within existing research and government policy. This indicates that the instrument is valid. Moreover, all but two of the factors had a Cronbach's alpha score of >0 x 7 and so can be considered reliable. Conclusions. The results indicate that the modified instrument is valid and reliable and therefore can be used with confidence to assess the training needs of FPNPs. In addition, the factors have outlined a cogent definition of the role of the FPNP, which can be used both to inform educational programmes and to assess their efficacy. [ABSTRACT FROM AUTHOR]

Research information in nurses’ clinical decision-making: what is useful? Aim. To examine those sources of information which nurses find useful for reducing the uncertainty associated with their clinical decisions. Background. Nursing research has concentrated almost exclusively on the concept of research implementation. Few, if any, papers examine the use of research knowledge in the context of clinical decision-making. There is a need to establish how useful nurses perceive information sources are, for reducing the uncertainties they face when making clinical decisions. Design. Cross-case analysis involving qualitative interviews, observation, documentary audit and Q methodological modelling of shared subjectivities amongst nurses. The case sites were three large acute hospitals in the north of England, United Kingdom. One hundred and eight nurses were interviewed, 61 of whom were also observed for a total of 180 hours and 122 nurses were involved in the Q modelling exercise. Results. Text-based and electronic sources of research-based information yielded only small amounts of utility for practising clinicians. Despite isolating four significantly different perspectives on what sources were useful for clinical decision-making, it was human sources of information for practice that were overwhelmingly perceived as the most useful in reducing the clinical uncertainties of nurse decision-makers. Conclusions. It is not research knowledge per se that carries little weight in the clinical decisions of nurses, but rather the medium through which it is delivered. Specifically, text-based and electronic resources are not viewed as useful by nurses engaged in making decisions in real time, in real practice, but those individuals who represent a trusted and clinically credible source are. More research needs to be carried out on the qualities of people regarded as clinically important information agents (specifically, those in clinical nurse specialist and... [ABSTRACT FROM AUTHOR]

John Heron’s six-category intervention analysis: towards understanding interpersonal relations and progressing the delivery of clinical supervision for mental health nursing in the United Kingdom Aims. This paper provides a critique of how Heron’s six-category intervention analysis framework has been adopted by nursing in the United Kingdom (UK) as a theoretical framework in nursing research and model for clinical supervision. From this, its merits as an analytic framework and model for clinical supervision in nursing are discussed. Background. Heron’s six-category intervention analysis has been acknowledged as a means by which nursing could develop its therapeutic integrity. It has also been used as a theoretical framework in nursing research focusing on nurses’ perceptions of their interpersonal style. More recently descriptions of this framework have been proposed as a structure for clinical supervision. However, its use as a theoretical framework to underpin research investigating the interpersonal skills of nurses and as a model of clinical supervision must firstly be scrutinized. Findings. Returning to Heron’s original description and comparing this with its current adoption in the UK, misconceptions of this framework can be identified. Its value as an analytic tool investigating interpersonal relations in nursing has still to be evaluated. Furthermore, nursing’s emphasis on certain intervention categories has undermined the potential potency of this framework and its contribution as a model for clinical supervision in nursing. Conclusion. We argue that Heron’s six-category intervention analysis as a framework to investigate the interpersonal competence of nurses, particularly mental health nurses, requires investigation. This, in turn, would provide an opportunity to challenge the framework’s theoretical standpoint. In addition to its value as an analytic tool, all six categories of Heron’s... [ABSTRACT FROM AUTHOR]

English nursing and medical students’ attitudes towards organ donation The purpose of the study reported in this paper was to examine nursing and medical students’ attitudes towards organ and corneal donation. A sample of 72 nursing and medical degree students from a British University, completed a 61-item self-administered quantitative questionnaire, adapted by) from an original tool devised by). The findings revealed that all but one of the respondents had an overall positive attitude towards organ donation; a significant relationship was found to exist between the extent of this positive attitude held by each student and their personal willingness to donate organs. In total, 74% of the student nurses had already signed a donor card, compared to only 43% of the medical students, and the difference in the two groups’ personal commitment towards donation was significant (P=0·005). However, this disparity between the nursing and medical students was not evident when students were questioned about personally accepting organs, for survival. Most respondents agreed that they would take some form of transplanted organ or tissue into their body, if it was needed to maintain life. Overall, the study revealed that although this group of student nurses seem to be in favour of organ donation, with many willing to sign a donor card, doubts still exist in the medical student group. Further work is required to understand this phenomena. A comparison of the data with an earlier study completed by) indicate that student nurses may have a more positive orientation to donation than qualified staff. [ABSTRACT FROM AUTHOR]

A theoretical description of the nursing role in stroke rehabilitation remains elusive in the literature. The United Kingdom strategy for health service development will increasingly require nurses from all clinical specialities to collaborate with other health care professionals and stakeholders to evaluate the services they provide. In stroke rehabilitation, an understanding of the contribution that nursing makes is essential, if that collaboration is to be effective. This paper details a study undertaken to describe the nature of the nursing role in stroke rehabilitation, and the factors that shape this role. A reflective enquiry was used to enable the collection of data grounded in the realities of clinical practice. Study participants were qualified nursing staff (n=13) working in a rehabilitation unit in the north-west of England. A total of 35 in-depth reflections were obtained for analysis. Three role categories were identified in the data: the nurse as care giver, facilitator of personal recovery and care manager. Sub-categories of nursing intervention were identified within each category, together with anticipated outcomes and contextual features that shaped the category. The results of the study were verified by a purposive sample of nursing staff from the rehabilitation unit. [ABSTRACT FROM AUTHOR]

Recent changes in long-term care policies in the United Kingdom have resulted in many more older patients/clients, previously nursed in long-term hospital facilities, now being cared for in the community. This change has had a significant impact on nurses, forcing many to make the transition from working in hospital to within the community. This transition calls for appropriate professional educational preparation to enable these nurses to undertake their new roles effectively. The literature search that forms the basis for this paper revealed relatively little material focusing specifically on the educational needs of such nurses in transition. However, literature that addresses the needs of nurses caring for the older individual in the acute setting, and in the community environment, was found and is explored. [ABSTRACT FROM AUTHOR]

This paper reports findings from a study conducted in one community health care trust where 62 members of the district nursing team (grades B-H) were interviewed. An adaptation of the critical incident technique was used to determine factors which contributed or detracted from high quality care for a number of key areas including palliative care. The centrality of knowing the patient and his/her family emerged as an essential antecedent to the provision of high quality palliative care. Factors enabling the formation of positive relationships were given prominence in descriptions of ideal care. Strategies used to achieve this included establishing early contact with the patient and family, ensuring continuity of care, spending time with the patient and providing more than the physical aspects of care. The characteristics described by the community nurses are similar to those advocated in 'new nursing' which identifies the uniqueness of patient needs, and where the nurse-patient relationship is objectified as the vehicle through which therapeutic nursing can be delivered. The link with 'new nursing' emerges at an interesting time for community nurses. The past decade has seen many changes in the way that community nursing services are configured. The work of the district nursing service has been redefined, making the ideals of new nursing, for example holism, less achievable than they were a decade ago. This study reiterates the view that palliative care is one aspect of district nursing work that is universally valued as it lends itself to being an exemplar of excellence in terms of the potential for realizing the ideals of nursing practice. This is of increasing importance in the context of changes that militate against this ideal. [ABSTRACT FROM AUTHOR]

Weaving the seamless web of care: an analysis of parents’ perceptions of their needs following discharge of their child from hospital Changes in children’s nursing services in the United Kingdom in recent years have focused on the need for adequate and efficient services to be provided in the interests of the child. Early discharge is now the norm and children are often sent home in an earlier recovery stage than adults with comparable conditions. Whilst the contributions of paediatric community nursing services have gone some way to providing specialist nursing care for children and their families in their own homes, the majority of children are discharged home without such support being available. This may place an overwhelming responsibility of caring for a recovering child onto parents. The purpose of the qualitative research reported in this paper was to identify any gaps in nursing services for acutely sick children and their families following discharge, and to suggest ways to improve integration and communication between hospital and primary care to facilitate a ‘seamless web of care’ for families. Families were surveyed following discharge (n=164) and interviews carried out with those experiencing problems (n=20). General practitioners were also surveyed for their opinion as key contributors of primary care. Findings revealed the isolation felt by parents following discharge, with their need for information about a child’s illness and expected recovery, and for reassurance and specific advice through some means of support, which was clearly not being met. The perceived benefit of continuity of care was a common theme, with both parents and professionals acknowledging the importance of closer liaison between hospital and primary health care services. This study is valuable in providing preliminary qualitative information regarding the gaps in children’s nursing services and how these can be overcome by using our... [ABSTRACT FROM AUTHOR]

Nursing and the Research Assessment Exercise: past, present and future In this paper we examine approaches to undertaking nursing research and building research capacity in higher education institutions in the United Kingdom (UK). First we review some of the main responses in the literature to the last two Research Assessment Exercises (RAE), then we report findings from a small study of nursing departments which entered the last RAE and finally we speculate on the likely future of nursing research in the light of recent education and health policy. We suggest that many of the difficulties experienced are an effect of contradictory health and education policies and rival ways of assessing research performance. Nursing education is caught in the ‘pincer movement’ of stringency in both sectors. In addition, the challenges of the RAE and the necessity to earn income from contracting with National Health Service (NHS) education and training consortia for teaching represent an outworking of two rival views of the role of higher education, broadly an elitist view and one that sees higher education as a supplier of the workforce needs of industry. In addition to this, the NHS R&D (research and development) strategy provides an alternative arena for collaboration, funding and reputation to that constructed by the RAE. [ABSTRACT FROM AUTHOR]

The evaluation of the `stages of change' model for use in counselling client's undergoing predictive testing for Huntington's disease Nurses are increasingly working in new and novel situations which may be outside the realms of traditional nursing practice. Therefore when evaluating theories and models that may be utilized in these situations it may be necessary to look beyond established nursing theories and concepts. This paper therefore attempts to evaluate Prochaska & DiClemente's (1983) stages of change model for its goodness of fit when counselling people as part of the predictive testing programme for Huntington's disease. The model demonstrates that in order to provide effective communication it is important to recognize the particular stage a client is at in his/her decision-making process concerning predictive testing. The relevance of the model to generic genetic counselling in nursing practice is discussed and the importance of stage-matched nursing interventions is emphasized. The model's non-reliance on the medical model or the concept of illness means that it may also be a useful model when applied to other nursing situations. [ABSTRACT FROM AUTHOR]

The leadership discourse in the United Kingdom has to date been concerned with professional issues and as a result has focused upon developing nurses and nursing. This paper reports on the findings of a research study which examined the broader socio-political factors impacting upon nursing leadership. The study forms an integral part of the Royal College of Nursing's leadership programme. The principal aim of the research was to examine critically contemporary nursing leadership within the context of health policy. An ethnographic approach was used. Informal semi-structured interviews were undertaken with a purposive sample of 24 leaders who were recognized for their effectiveness in leading nursing. Data were analysed for themes. The main themes are presented and discussed here. The findings of the study question the political success which the internally focused nature of leadership has had for the profession. Nursing and therefore nursing leadership is shaped dramatically by the impact of politics and policy. The research discovered that in recognition of this, contemporary nursing leadership has both an internal and an external focus. That is, effective nursing leadership currently is a vehicle through which both nursing practice and health policy can be influenced and shaped. The research also identified the profile of the effective nurse leader, together with the processes through which leaders interpret and translate between the macro issues of policy and the micro issues of practice. In addition, an understanding of what nursing leadership is, has been proposed. Appropriate recommendations for the future of nursing and nursing leadership are outlined. [ABSTRACT FROM AUTHOR]

The impact of higher education for post-registration nurses on their subsequent clinical practice: an exploration of students’ views ¶ In recent years there has been a large increase in the number of qualified nurses in the United Kingdom, who have raised the academic level of their nursing qualification to diploma level or above. Correspondingly, there has been little research that assesses the value of post-registration education offered by universities. In particular, there is a paucity of research regarding the effects of courses on the subsequent clinical practice of participants. Studies of post-registration education appear to be small scale and limited in scope. This paper examines the views of diplomates as to the effect of a Diploma in Professional Studies in Nursing course on clinical practice. A questionnaire was sent to all nurses (n = 169), from the first seven cohorts, who successfully completed the course. A response rate of 66·8% (n = 113) was achieved. The respondents reported themselves to be more questioning, more able to apply research findings and to have a wider knowledge for practice following completion of the course. The findings are discussed, limitations of the study addressed and recommendations for further research are made. [ABSTRACT FROM AUTHOR]

Many authors have commented on the invisibility of nursing in policy development, implementation and analysis. Some of this invisibility may be attributed to the lack of an easily accessible framework to assist analysis of policy from a nursing perspective. In this paper we offer a framework for nursing policy analysis based on the domain concepts of nursing. We use continuing care for older people, a topical policy issue and fundamental nursing speciality, as a case study to demonstrate the utility and potential of such a framework in action. The resulting analysis helps identify areas of potential policy interest to nurses, raises questions for further policy analysis and offers a coherent position statement for action. [ABSTRACT FROM AUTHOR]

In 1994, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) completed its framework for post-registration education and practice. The UKCC's strategy was based upon the two principles of compulsory re-registration for all practising nurses and graduate-level (or equivalent) entry to specialist practice. It may be seen as the culmination of a gradual process of professionalization, as well as a response to changes in the organization and delivery of health care in the late 20th century. This paper uses both primary and secondary sources to trace the development of the new strategy, and its wider implications for the profession. [ABSTRACT FROM AUTHOR]

This paper tries to describe the nature of the subject-area known as philosophy of nursing. It is suggested that attempts to offer such a description are beset with difficulties surrounding both nurses' and philosophers' conception of philosophy. Nonetheless, this paper does seek to offer a description of what philosophy amounts to. Schrock's suggestion that philosophy can be characterised partly by its methods and the distinctive nature of its questions is tentatively endorsed. Her proposal is buttressed with an account of Carnap's distinction between internal and external questions. It is shown that this distinction helps to identify philosophical questions. Further, an attempt is made to show the importance of the distinction between a philosophy of nursing and philosophy of nursing. It is concluded that philosophy involves conceptual analysis and assessment of argument, concern with highly general metaphysical and epistemological questions, and that such questions can be regarded as 'external' questions. It is then shown how these three elements of philosophy also characterise philosophy of nursing. [ABSTRACT FROM AUTHOR]

The term 'facilitation' appears to be open to a wide variety of definitions and interpretations. If teachers are to act as facilitators of learning they need a clearer understanding of facilitations as a strategy for nursing education. This concept analysis uses Walker and Avant's framework. Following a review of the literature related to facilitation, the paper postulates that there are four critical attributes for effective facilitation: genuine mutual respect; a partnership in learning; a dynamic, goal-orientated process; and critical reflection. The necessary antecedents and likely consequences are identified. Model and alternative cases are offered. A distinction is made between educational facilitation and facilitation in counselling. Recommendations are given regarding the future development of empirical referents. To enhance the reader's understanding of concept analysis, the paper incorporates a reflection on the process, together with a discussion of the way in which decisions regarding the attributes were reached. [ABSTRACT FROM AUTHOR]

Using an evaluative approach, this paper explores the concept of critical thinking and its development within a recently revised study skills programme, preparing practitioners for the academic post-registration courses in one college of health. The current and almost explosive move of nurse education in the United Kingdom into the halls of higher education seems to recognize the need for higher-order thinking skills in preparation for the unpredictability of nursing practice. Using a quasi-experimental design, the qualitative data analysed from two groups of students who undertook the study skills programme were measured against a control group of students undertaking the same short professional development course through the more traditional university approach of 2 years part-time academic study. The findings acknowledge that the development of critical thinking needs time and exposure to others seeking similar goals. In addition, to encourage the process of critical thought, study skills applied to content should be offered, as well as attention to teaching/learning strategies. If higher education means a change in culture, of attitude towards learning, then a more comprehensive foundation programme may better commence this process. It is anticipated that through such a programme current practitioners may be enabled to achieve successfully within the new academic courses and ultimately be better equipped for the complex decision-making in practice. [ABSTRACT FROM AUTHOR]