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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]

This paper argues that tutorial support should enhance the learning experience of students who enroll on a distance education programme. A rationale for such support is given as well as a definition of support for distance learners. The complex role of the tutor in distance learning is described which suggests the need for tutor preparation, particularly for tutors adapting to this mode of course delivery. The paper reports on two existing models used within distance education which have focused on the outcome of study. The paper introduces an alternative model of supportive learning which focuses on the development of the educational experience throughout the length of a distance-learning course. [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]

In this paper I will examine the concept of researcher intervention in nursing research. I will suggest that the concept is essentially problematic for both positivist and qualitative researchers, which may have some bearing upon its relative neglect as an area for discussion. I will examine the redundancy of the more popular moral frameworks in dealing with the problems raised by intervention and suggest that nursing research, being 'messy', requires the articulation of a more reflexive and contextual approach. This applies both to moral justification and to more pragmatic methodological issues. In the paper I suggest that humanistic action research, informed by recent feminist thinking, has potential to produce a more creative and clinically relevant future for nursing research than is currently so. [ABSTRACT FROM AUTHOR]

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 crate 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]

This paper reports on the findings of a study conducted into the perceptions of final year Project 2000 pre-registration students towards their pre-registration education programme. The aim of the research was to discover how students perceive their training in terms of value, relevance, intellectual potency, teaching methods and organization. Data were collected using the Hoste scale which has been developed for the evaluation of educational courses. A convenience sample of students (n = 131) within one college of nursing were invited to participate. Findings include a particularly high level of satisfaction with Project 2000 in terms of value, breadth and relevance. Organization and liveliness of the course were perceived much less satisfactorily. There was a trend for a statistically significant difference between the mean scores of the theoretical and practical components of the course. The findings are discussed with particular reference to the perceptions of theory and practice within the educational programme. [ABSTRACT FROM AUTHOR]

This paper describes the experiences of eight staff nurses who were students in the first cohort of a Project 2000 course in a pilot district during their post-qualification year. A qualitative approach, informed by phenomenological methodology, was adopted in order to present these experiences alongside the meaning attributed to them by the nurses. Taped, focused group discussions, using semi-structured interviews, were analysed. This yielded five themes which describe the structure of these experiences from 'coming out of school' through to the acknowledgement and confidence in themselves as a different kind of nurse to those trained on previous traditional courses. The findings suggest that the vision of the United Kingdom Central Council in proposing Project 2000 courses is likely to be realized. These nurses had gained the competent technical and clinical skills expected of any nurse. However, they also displayed skills previously absent in newly-qualified nurses, such as evidence of analytical decision-making and confident interpersonal skills, which are likely to enable them to take an equal place amongst other members of the multi-professional team in the future. Although competent practitioners, the process they had undergone to reach this had, at times, been traumatic. The implications arising from the study are that more attention needs to be paid to the personal and professional development needs of Project 2000 nurses, both at the end of the course and in their first post-qualifying year. [ABSTRACT FROM AUTHOR]

The existence of a theory-practice gap in nursing in the United Kingdom has been an issue of concern for many years. However recent events have resulted in a new dimension of the theory-practice gap emerging. This paper explores the origins of the contrasting values attributed to nurses and health care managers and identifies areas of conflict. It is argued that the theory-practice gap in nursing is being compounded by a more fundamental divergence of approaches to the delivery of health care and that this represents a major challenge to nurse educators. Nursing is at a crossroads in its development, and if it is to survive it must incorporate some elements of the new managerialism whilst demonstrating to managers the importance of recognizing professional values. The future of nursing can be secured, but it will involve partnership and cooperation with the new managers. [ABSTRACT FROM AUTHOR]

Community health councils (CHCs) were set up in the United Kingdom in 1974 as part of the reorganization of health care delivery. They were intended to have a 'watch dog' function, monitoring the quality of health care in their own district and acting as a link between the providers of care and the public, who are the health care consumers. This paper describes a year-long survey undertaken by one CHC to monitor the quality of information-giving in acute hospital care. A large sample of 1500 discharged patients were sent questionnaires relating to satisfaction with information-giving, and a good response rate was achieved. Results indicate a generally high level of satisfaction, particularly relating to information about surgical and other technical procedures. Information was less satisfactory about non-technical aspects of care and about administrative procedures. [ABSTRACT FROM AUTHOR]

In this paper the author argues that the development of community psychiatric nursing can be understood as a professional project. However, the case of community psychiatric nursing cannot be adequately understood from mainstream literature on the subject of professionalization within the health care division of labour. The inadequacy of such literature is that it either concentrates upon the pre-eminent case of medicine or regards nursing's professionalization as being unitary. The author posits that the professional projects of general nursing and community psychiatric nursing have different and even opposing interests. To contextualize community psychiatric nurses' (CPNs') professional project the author examines: the history of mental nursing, from which community psychiatric nursing evolved; the development of community mental health care, which allowed for the inception of community psychiatric nursing; CPNs' relationships with both psychiatrists, whose patronage assisted CPNs' initial growth as para-professionals, and general practitioners, who later assisted a more functionally autonomous role for CPNs in primary care; and social policy towards community care that enhanced CPNs' growth. In conclusion the author argues that recent government-led changes in the management of community mental health care now impel CPNs to change the direction of their strategy for occupational survival and advancement. [ABSTRACT FROM AUTHOR]

This paper reports a small study which explored the management arrangements of the providers of community services in five health districts and the influence these had on the way research findings were utilized by nurses in their clinical practice. Insights were sought into the nature of the organizations in which district nurses worked. With the co-operation of the service managers, all the nurses had previously been involved in testing a model of dissemination of research information. The study reported here arose from that original research and explored the links between management arrangements and research utilization in clinical practice. Interviews using a semi-structured schedule are reported from 22 service managers in the five health districts. Data on managers' professional roles and backgrounds, the organizational structures and processes and external social and political factors were collected and analysed. A selection of findings is discussed in relation to influence on research utilization in clinical practice. [ABSTRACT FROM AUTHOR]

Parent participation has become a central tenet of paediatric nursing in the United Kingdom. The purpose of this paper is to explore the meaning of parent participation, to clarify the concept to benefit children and their families, and to increase understanding among practitioners. The concept analysis utilized was directed by Rodgers' 'evolutionary approach' that views concept development as an ongoing dynamic process. A review of British literature and research studies indicated that parent participation is a complex and multi-dimensional concept. In the evolution of parent participation, the terminology changed from 'parental involvement' to 'partnership in care', to 'care-by-parent' and finally to 'family-centred care'. The analysis reveals a lack of coherence in the descriptions, with the terminology changing but the underlying theme remaining parent participation. Parent participation can be conceptualized as a composite of attributes that relate to the family, the nurse and their relationships. Those attributes include: negotiation, control, willingness, competence and autonomy. The concept of family-centred care is gradually assuming importance in the literature. This acknowledgement of the family is long overdue. However the concept remains poorly defined and urgent clarification is needed in this area. To adopt a family-centred care approach, a radical paradigm shift is required. [ABSTRACT FROM AUTHOR]

Recent changes to nurse education within the United Kingdom (UK) have proved to be a source of great confusion in many respects, much of which is based on a manifest lack of appreciation of the nature and basis of the changes which are in fact driven by the requirements of European integration. This paper argues that the lack of clarity and publicity, 'transparency', in the process of transposing the requirements of European policy relating to nurse education into UK domestic policy can be blamed for aspects of the lingering confusion within the profession. [ABSTRACT FROM AUTHOR]

One in five women in the United Kingdom will have a hysterectomy by the time they reach the age of 65. This paper explores the experiences of women as they seek advice in outpatient clinics, as they go into hospital for surgery, and as they return home to convalesce. Differences in doctor—patient communication between private sector and National Health Service patients are discussed. The results of this study point to the inadequacy of current practice in providing information to patients about this potentially serious operation. [ABSTRACT FROM AUTHOR]

This paper seeks to ‘problematize’ the British government’s wider intentions for public health, as they are shaped by free-market economics and technological medicine. A variety of epidemiological studies have revealed evidence of declining health among low socio-economic populations who are particularly affected by economic and social changes. The government is responding to the potential crisis by targeting specific groups of the most visible and costly victims of public ill-health. Recipients of health care with a lower public profile, such as pregnant women, are being subjected to the same policy. Current governmental strategies are regarded as an example of a medically oriented approach that focuses on special strategies for pregnancy and birth but ignores the long-term requirements for public health. [ABSTRACT FROM AUTHOR]

Community psychiatric nurses (CPNs) in the United Kingdom are increasingly working in primary health care settings with less serious mental health problems. This paper describes an economic evaluation of their work using a randomized controlled trial in which 231 patients were assigned to continuing general practitioner care or one of two conditions of CPN intervention. This is only the third systematic economic analysis of community mental health nursing in the UK and the first carried out by mental health nurses. Various costs to patients, their families and the health care system were determined. Results showed that patients receiving CPN intervention experienced less absence from work and that this resulted in a net benefit. However, the cost per quality adjusted life year for intervening with this group of patients was probably several times more than for intervening with the seriously mentally ill. Therefore, if one considers both the clinical and economic results of the study, taken together with the recent results of the review of mental health nursing, there seems little justification for CPNs continuing to work in this area. [ABSTRACT FROM AUTHOR]

Ideas currently postulated around the way health care should be delivered and costs controlled, often referred to as health care rationing, are increasingly coming to dominate the agenda of health care in the 1990s. British nursing has yet to take a noticeably visible role in this debate, despite the fact that it poses a serious dilemma for a profession whose cultural ethos has been shaped by the concepts of universal access and comprehensiveness of care and is wedded to the idea of holism. In the USA debate amongst nurses is further advanced and whilst this discourse may be of limited value to British nursing, owing to a differing historical and cultural attitude to health care, recent changes to the organizational values in the NHS are leading to similar issues arising already faced by American nurses. This paper considers the broad parameters of the debate on health care rationing and examines how these parameters have been reflected within relevant North American and British nursing literature, differentiating factors between the two countries. [ABSTRACT FROM AUTHOR]

The purpose of this study was to understand what impact nurses perceived continuing professional education (CPE) to have on the quality of nursing care. Given that CPE will become mandatory once the necessary legislation has been implemented, the value and worth of CPE with regard to the quality of nursing care, in both a consumer-led and financially-driven NHS, merits serious consideration. Little research has been conducted into the real impact that CPE has on the quality of nursing care and this paper begins by providing an overview of the current debate within the profession. The method chosen for the study was qualitative and 18 nurses from a large hospital in the South of England were interviewed. The data were analysed using the grounded theory method and three categories emerged. The categories are described in detail and reveal some of the problems with which the nursing profession is faced. The study demonstrates how issues of finance were particularly high, with service managers sometimes negating nurses’ CPE needs. However, the study reveals the real importance that nurses attatched to CPE in supporting their professional status and the real impact that CPE and knowledge have on professional competence and the quality of patient care. [ABSTRACT FROM AUTHOR]

This paper reports on research commissioned by the English National Board for Nursing, Midwifery and Health Visiting into mentorship and clinical support arrangements for Project 2000 nursing students in the adult and mental health branches. Interviews and observation data were gathered from staff and students in three of the demonstration centres. Findings showed that the terms 'mentorship', 'assessor' and 'supervisor' were used interchangeably and covered diverse roles in both clinical and community settings. Generally there was an impression that staff were willing to help students learn from their experience but felt unprepared for the 'new nursing students'. Several factors emerged which seemed either to promote satisfactory experiences for students or inhibit their learning and enjoyment of the placement. These are discussed under the themes 'supernumerary status', 'team spirit', 'theory and practice', 'diploma level practice' and 'organization of nursing teams'. [ABSTRACT FROM AUTHOR]

This paper describes the historical developments and current role of new public management (NPM) in the British National Health Service (NHS). It is argued that NPM concern for efficiency improvements has resulted in threats to equality and needs-based service delivery. The relevance of NPM values to health care and nursing is explored. Finally, comments are provided on how nurses can advocate for a more loving NHS environment, and one which is therefore more conducive to nurse and patient health. [ABSTRACT FROM AUTHOR]

During the past decade nurse theorists and educationalists have been attempting to establish nursing as an academic discipline. Nurse education is rapidly moving away from monotechnic colleges of nursing into institutes of higher education. This paper presents a discussion of some of the issues associated with the emergence of nursing as an academic discipline. The definition of a discipline is ambiguous and, although nursing may be said to exhibit some of the desired elements required to be classified as a discipline, it is apparent that many of these elements have not been developed sufficiently. Many attempts have been made to classify nursing as 'art' or 'science' or a combination of the two. Nursing epistemologists, educationalists and practitioners appear unable to determine the essence and uniqueness of nursing in order to inform practice, which is still heavily weighted toward the established academic disciplines. If nursing is to survive in the echelons of higher education and gain respect as an emerging academic discipline, these recurring arguments need to be resolved. [ABSTRACT FROM AUTHOR]

Nurses have known about unpopular patients for over two decades. Influential studies such as Stockwell's in the UK have had considerable impact upon students of nursing. Stockwell's book, The Unpopular Patient, is widely cited and was reprinted in 1984. Further, a critical review of the wider literature by Kelly & May threw down a challenge to researchers to investigate the phenomenon using an interactionist perspective and ethnographic methods. This paper reports a study which should begin to reinforce doubt that evaluative labels, unpopular or otherwise, are in any way 'predictable', as Stockwell and a host of others have hoped and assumed. The process through which evaluative labels of people are socially constructed is explored and the context, explanations and some consequences of what we call social judgement are discussed. [ABSTRACT FROM AUTHOR]

A comprehensive search of the research literature was undertaken to explore the relationship between skill substitution and quality of care. It was possible to identify three central assumptions based upon the studies reviewed. The first suggests that a rich skill mix of mostly qualified nurses is often an ineffective and inefficient way of providing health care. The second assumption is based on research which appears to indicate that a skill mix of mostly unqualified staff is an inneffective approach to health care provision. Finally, there is a plethora of research findings which suggest that the most effective and efficient way to provide health care lies in the employment of high numbers of qualified staff. This paper examines the evidence for each of these positions and highlights the inherent limitations of the underlying studies. [ABSTRACT FROM AUTHOR]

Examines the involvement of National Health Service trusts is decisions with regard to the nature and location of education contracts in Great Britain. Creation of a market for education; Development of a delegated system for the South East Thames Regional Health Authority; Key features of the system.

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]

The construction of the nursing subject is discussed. The paper takes a historical perspective, arguing that the range of speaking positions available to the nurse is limited by gender, class and education. It evaluates the position of nursing in the university, showing how this also has the propensity to limit the development of the nursing profession. [ABSTRACT FROM AUTHOR]

Early research has established that burden exists and has identified certain behaviours of mentally ill relatives that family members find most distressing. Further research has confirmed the accuracy of the early work and has focused on the severity of mental illness. Recent research has stressed the importance of social support in the study of caregiver burden. This paper explores the research literature that covers the concept of caregiver burden in the area of mental illness and also presents developed instruments for the study of caregiver burden. [ABSTRACT FROM AUTHOR]

This paper is a preliminary study, part of a larger project which is endeavouring to ascertain the views of both users of mental health services and those of mental health branch students as to their perceived and desired role of the mental health nurse. Four groups of users (n = 28) and four groups of students (n = 44) were contacted, and recorded group discussions took place in gaining qualitative data that would feed into the main body of research. The views expressed by both users and students are interestingly convergent, but much concern was expressed as to the needed changes in the provision of the service and the danger for students on qualifying to become quickly incorporated into the prevailing dominant culture. [ABSTRACT FROM AUTHOR]

Critical incident analysis has been espoused as a valuable method of promoting reflective nursing practice and as a tool for developing curriculum content. Despite an obvious application to mental health nursing, however, there has been little detailed examination of the practicalities and educational value of critical incident analysis within a mental health nursing curriculum. This paper is based on the use of critical incident analysis within the mental health branch of a Project 2000 diploma course. It presents the content of material brought by students, teaching methods used to facilitate learning, and the progressive development of students' reflective processes over the course of a complete branch programme. Using Benner's (1984) From Novice to Expert, the authors explore questions regarding the nature and effects of the critical incident technique in attaining competence in mental health nursing skills. The authors conclude with a theory-based evaluation and analysis of this student-centred experiential approach to learning as a method for developing reflective practice, and suggest areas for educational research. [ABSTRACT FROM AUTHOR]

The role of community nurses, such as health visitors, in the prevention of child abuse and neglect by home visits is reviewed. The paper evaluates the potential of community nurses for predicting and identifying families at high risk for child maltreatment in order to support them through the promotion of positive parental knowledge, attitudes, skills and behaviour. The success of health visitor interventions to prevent family problems is also evaluated. The review concludes that accurate prediction of child-maltreating families requires more than one screening procedure to reduce the number of false alarms, and suggests that health visitors might be trained in the objective assessment of parent-child interaction. Few health visitor interventions were deemed a success, indicating that greater support and training is required for community nurses if they are to be used to prevent child abuse and neglect. However, recent changes in the community nursing services and the purchaser-provider split in health care has reduced this possibility. [ABSTRACT FROM AUTHOR]

There are many reported problems with auditory warnings in critical care areas of hospitals such as the intensive care unit (ICU) and operating room. There are too many alarms; many of them are unnecessarily loud and continuous, which can be irritating and annoying for staff. The problem of excessive alarms is further complicated by the fact that there are no standards agreed between manufacturers on the auditory warnings used for medical equipment. Therefore, the same piece of equipment manufactured by different companies will have different alarms that could result in confusion. Another possibility as to why confusion could occur is because alarms are often inappropriate in terms of their 'urgency mapping.' This means there is generally no relationship between the urgency of a medical situation and the perceived urgency of the alarm that signals that condition. A further problem involves the number of false alarms that occur; that is, alarms that are not signalling a medical emergency. The following paper discusses these problems and suggests attempts to remedy some of them. There is also a brief discussion of the amount of monitoring that occurs on the ICU as the more monitors there are the greater the number of alarms there will be. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to examine intraprofessional teamworking between district nurses. Data from an exploratory study, conducted in the United Kingdom, of 130 home visits of 16 district nurses describes intraprofessional relationships in community nursing teams. Participant observation and in-depth interviews were the methods of data collection. The findings suggest that the professional culture of community nursing has led to the development of organizational rules which, in a quest to avoid conflict between team members, potentially militate against patient choice. The data presented here explore three areas of the nurses' practice: committing services, changing care and working unsocial hours. [ABSTRACT FROM AUTHOR]

The future role of the nursing profession in providing health care for older people is considered. It is argued that, despite claims to holism, nursing has maintained a narrow focus, concentrating mainly on acute hospital care. The concepts of professional protectionism and professional reductionism are used to explain the manifest failure of nursing and other professions working with older people and their carers to place the needs of their clients at the top of their agendas. A reorientation of nursing practice is advocated in order that the profession fulfils its potential with respect to older people. [ABSTRACT FROM AUTHOR]

This paper begins by reviewing the small number of studies of staff nurses’ work satisfaction. Subsequently, an examination is made of the differences in work satisfaction between staff nurses and other grades of nursing staff in psychogeriatric wards in National Health Service hospitals in Scotland. These data are part of a larger study into work satisfaction and the quality of care in these settings. Significant differences in satisfaction at work are identified between the staff nurse group and the other grades taken as a whole. Analysis of the components of job satisfaction suggests that these differences arise from: first, the experience of the work itself; second, the quality of the supervision which takes place; and third, the assessment of hospital policies, such as the transfer of staff to other wards. [ABSTRACT FROM AUTHOR]

This paper is based on an analysis of the role of external examiners and a discussion of the various aspects of the role. Fifteen facets of the role have been identified and each facet is discussed with reference to the relevant literature. Among the issues discussed are the powers of external examiners in the decision making process; their role as the custodians of standards; and the significance of their reports. The discussion spans four levels of academic awards including diploma, bachelor's degree, master's degree and doctoral degree and deals with matters of principle as well as the mass of written and other material which external examiners are faced with. Some strengths and weaknesses of the external examining system have been identified and finally a question is raised about its future. [ABSTRACT FROM AUTHOR]

This paper explores the role of contemporary mental health nursing and challenges practitioners to acknowledge the influence that power relationships have on therapeutic practice and client outcomes. It is argued that empowerment and advocacy remain central concepts for nursing and that the art of accurate empathy is a pre-requisite for contemporary mental health care. [ABSTRACT FROM AUTHOR]

This paper presents a discussion on the assessment of mental competence of patients and relatives in the health care setting. Their decision-making ability is explored with particular reference to the giving of consent for nursing intervention and medical treatment. It is suggested that, in addition to obvious psychological or neurological disorders, decision-making ability will be influenced by psychological stress and the ability to communicate effectively. It highlights the ambiguity of mental competence assessment and concludes that such assessments will, to a greater or lesser extent, be subject to value-laden judgement. [ABSTRACT FROM AUTHOR]

British literature related to the care of children in hospital states that they have 'special needs.' This concept is not defined; neither are different writers in total agreement about what these needs may be. This paper attempts to define needs, concluding that they are 'requirements that should be met.' Children are seen as dynamic beings because they are in a state of constant development, both physically and psychosocially. It is this state of development that makes their needs special to them. They have special requirements, which should be met in specific ways. Through the presentation of indicators of behaviours which would enable such needs to be met, it can be demonstrated that children should be cared for by people with the appropriate knowledge and understanding. When children are admitted to hospital there may be a number of different people involved in determining how a need should be met. An important part of this process should be nurses who have been specially educated for work with this age group. [ABSTRACT FROM AUTHOR]

Pressure sores result in patient morbidity and mortality as well as commanding considerable resources within the British National Health Service. To assess the impact of preventive measures, accurate and reliable rates of prevalence and incidence are required. This information is likely to be used as a measure of quality of care as well being included in future purchaser/provider contracting. A number of prevalence studies have been carried out in the United Kingdom using a variety of populations and different methods. The methods employed in these studies need to be considered before any meaningful comparisons can be drawn. In particular, there are variations in the reported rates possibly related to the under-reporting of pressure sore prevalence. This paper describes a recent point prevalence study which suggested that this may be the case. The need for caution when comparing crude rates is highlighted and the importance of standardizing the methods used for determining prevalence rates is discussed. [ABSTRACT FROM AUTHOR]

The aim of this paper is to show the way in which the decision trail of a qualitative research process can be maintained. It is argued that the trustworthiness (rigour) of a study may be established if the reader is able to audit the events, influences and actions of the researcher. The actual study containing the recording of this decision trail aimed to express the concerns of older patients who were admitted to the acute care sector. The study took place in two care of the elderly wards in a 1000-bed National Health Service hospital in the UK, in 1991. Eventually, 14 patients were interviewed, each on several occasions, and their concerns are expressed in themes, namely: routine geriatric style of care, depersonalization, care deprivation and geriatric segregation. I describe the preparations that were undertaken before patient interviews could commence. The literature recording the process of the interviewer's experience as data in qualitative research is scarce. I show the researcher's participation in making the data as part of an existential phenomenological research process. Existential phenomenology relies on recording influences while generating data such as significant literature, media reports, my value position and journal data. [ABSTRACT FROM AUTHOR]

Using information collected from more than 100 district health authorities in England for the year 1989-1990, this paper examines turnover rates amongst a range of nursing and other staff groups in the National Health Service (NHS), and their relationship to the age and length of service characteristics of the labour force. The evidence collected suggests that the NHS employs a significantly younger workforce than is found in the economy as a whole. The age profile of nurses is even more skewed towards younger age groups than that of non-nursing staff working in the NHS. Nurses tend on average to have longer lengths of service than non-nursing staff groups, and it would seem that the average length of service has increased over the last 20 years, certainly amongst registered nurses. Overall, the study found an annual turnover rate amongst all NHS staff of 13.6%. Turnover rates were significantly higher among full-time staff than part-time, and amongst non-nursing staff groups compared with nurses. Broadly, turnover rates decline with age then rise close to retirement. However, there is a more complex relationship between length of service and turnover: turnover rates tend to be high in the first year of service, and to remain high or even rise during the second year of service, before declining. Turnover remains a poorly understood issue in the NHS. The evidence presented here should move some aspects of debate onto a more solid empirical foundation. [ABSTRACT FROM AUTHOR]

This paper acknowledges that the successful utilization of nursing research in practice is a highly complex task. Basic requisites include a positive research culture associated with the essential interest and support needed to promote change. Within this framework factors concerned with the research culture within nursing and the NHS are considered, as well as the research-practice gap, the role of researchers, educational issues and the need for both local and national support. Comparisons are made with the more positive research culture in the USA, and some American research utilization models are mentioned. It is suggested that research is not highly regarded in the UK and that the required level of interest and support depend on nursing research becoming an expected, valued and rewarded activity. Some general suggestions for actions which should promote research utilization are made. [ABSTRACT FROM AUTHOR]

The ideas discussed in this paper are derived from a longitudinal study of student nurse socialization. The emergent views of a cohort of student nurses were explored by the researcher, over a period of 3 years, utilizing the approach referred to as grounded theory. 'Patients to people' represents a continuum of changing perceptions about those whom the students were nursing. It seemed that the cohort had to move along this continuum in order for them to be able to empathize with those they nursed. In the context of the students' changing perceptions, several things were of significance. For example, encounters with individuals who failed to demonstrate the passive and compliant attitude associated with 'typical patients.' such as children, challenged the cohort's thinking about those they nursed. During their training the students matured as both nurses and adults and this was also important, as was their recognition of their own 'personhood.' The cohort's emergent views suggested that there was a reciprocity between the way they viewed themselves and the perceptions they held about those they nursed. Such findings are important to people involved in preparing individuals to enter the caring professions. However, it should be noted that the experiences described in this study represent those of 'traditionally' trained rather than of Project 2000 students. The names used to describe people involved in this research are pseudonyms. [ABSTRACT FROM AUTHOR]

The current socio-political philosophy in the United Kingdom promotes the belief that consumers of health care should exercise choice and express opinions about the care they receive. This view challenges the traditional paternalistic approach to health care which espoused that 'the professional knows best.' In association with general socio-political trends, nursing is undergoing radical reform. The nursing literature widely promotes the importance of a nurse-patient relationship which fosters the involvement of the patient in negotiation and decision-making regarding this care. Nurses who advocate individualized, holistic care must hold such an ideology as a central tenet to their philosophy. However, it is questionable whether this philosophy is widely expressed in the reality of clinical practice. There is also an absence of empirical evidence to support the assumption that patients wish to participate in decision-making. This paper critically reviews some of the debate centred around the concept of nurse-patient negotiation. It is suggested that the issues are complex and that there remains a need for further research which takes into account multiple factors, including the social and organization context of nursing care. [ABSTRACT FROM AUTHOR]

The increasing proportion of culturally diverse groups within the United Kingdom has meant that the issue of language barriers in the research situation must be addressed. The recruitment of respondents with English as a second language (ESL) to research studies is essential if their potentially unique and valid perspective is to be acknowledged. This can, however, pose several difficulties for the researcher which need to be recognized and addressed if valid data are to be collected. This paper outlines some of the challenges encountered in one study and describes strategies which were employed to meet these challenges. [ABSTRACT FROM AUTHOR]

Organ transplantation is becoming more important as a viable method of treatment for certain severe medical conditions. It is a complex and demanding process for all involved. Nursing as a developing science must respond to cultural and economic changes. Therefore, a need exists to develop a body of empirically based knowledge to understand and support the process of organ transplantation. This paper will argue that as trading in organs is unacceptable to the moral standards of western society and outlawed in many countries, an alternative framework must be considered for understanding the mechanisms through which organs are donated and utilized. The donating and receiving of organs may be equated with gift-giving, as there is no barter of commodities involved. Therefore, a useful framework to explore this phenomenon will be one that underpins the process of giving and receiving of gifts. Gift Exchange Theory will be evaluated and critically examined in relation to organ transplantation and the role of nurses in this process. [ABSTRACT FROM AUTHOR]

This paper discusses the use of the concept of 'persons', and its related principle 'respect for persons', in health care ethics. It is suggested that the main use of the concept is in attempts to answer the questions: 'Who owes moral respect?' and 'To whom is it owed?'. An examination of different writers and their use of the concept of 'persons' show it to be unsuccessful in answering the first question, and dangerous and unacceptable in answering the second. Therefore, it is suggested the concept should not be used at all in health care ethics. An alternative idea is suggested, based on the work of Hursthouse (1992). [ABSTRACT FROM AUTHOR]

Forecasting the demand for nurses is a complex and difficult problem. However, in a climate of economic cutbacks and disadvantageous demographic trends, it is essential that adequate methods are developed to predict both the supply and demand for nurse manpower. To this end a number of methods have been constructed, particualrly in the last decade. In this paper we survey the work that has been done to provide an effective way of forecasting nurse manpower demand. The two most common approaches are from the 'top-down' or 'bottom-up'. However, an evolutionary method which allows for modification and detailed refinement is more likely to provide a means of taking into account the complexities of the system. Finally, we focus on the nursing hours per patient (NHPP) ratio as a possible tool for demand forecasting. This index is easily calculated and is readily adaptable to the bottom-up approach. [ABSTRACT FROM AUTHOR]

This paper reports our experience of analysing what may well be one of the largest datasets gathered on nursing practice in the United Kingdom. The study produced both quantitative and qualitative data and a method had to be devised both for analysing each form of data and for relating the two. An inexpensive relational database was chosen for the purpose, and experience of using it is reported. Detailed examples are given. We look at the strengths and weaknesses of such a tool, and in general it received a positive evaluation. For many nursing research projects, it offers some advantages over a conventional statistical package, especially in the following areas: offering ease of use, and hence control of the data, by the domain (nursing) specialist; facilitating the analysis of free-text data; allowing the linking of free-text and structured questionnaire data; permitting the testing of conjectures which arise during analysis; handling varying amounts of data per case; providing non-redundant storage of data; permitting the association of machine-readable codes and human-readable labels; and encouraginhg an exploratory rather than merely analytical approach. [ABSTRACT FROM AUTHOR]