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

This paper examines evidence that the contemporary use of the term autonomy is interpreted differently by different nurses. This is important because an understanding of autonomy is crucial to our approach to informed consent prior to nursing care procedures. There are many theories of autonomy. This may account for various interpretations of the term amongst nurses. In this paper it is argued that clarity may be achieved by commitment to one particular theory of autonomy. It is suggested that this commitment should be the subject of further debate within the nursing profession. It is argued that the ambiguous use of the term autonomy should be replaced by a concept that has specific meaning for nurses and which gives a working definition to a concept that is central to respect for patient choice and independence. [ABSTRACT FROM AUTHOR]

Title. The De-Escalating Aggressive Behaviour Scale: development and psychometric testing.Aim. This paper is a report of a study to develop and test the psychometric properties of a scale measuring nursing students' performance in de-escalation of aggressive behaviour.Background. Successful training should lead not merely to more knowledge and amended attitudes but also to improved performance. However, the quality of de-escalation performance is difficult to assess.Method. Based on a qualitative investigation, seven topics pertaining to de-escalating behaviour were identified and the wording of items tested. The properties of the items and the scale were investigated quantitatively. A total of 1748 performance evaluations by students (rater group 1) from a skills laboratory were used to check distribution and conduct a factor analysis. Likewise, 456 completed evaluations by de-escalation experts (rater group 2) of videotaped performances at pre- and posttest were used to investigate internal consistency, interrater reliability, test-retest reliability, effect size and factor structure. Data were collected in 2007-2008 in German.Findings. Factor analysis showed a unidimensional 7-item scale with factor loadings ranging from 0·55 to 0·81 (rater group 1) and 0·48 to 0·88 (rater group 2). Cronbach's alphas of 0·87 and 0·88 indicated good internal consistency irrespective of rater group. A Pearson's r of 0·80 confirmed acceptable test-retest reliability, and interrater reliability Intraclass Correlation 3 ranging from 0·77 to 0·93 also showed acceptable results. The effect size r of 0·53 plus Cohen's d of 1·25 indicates the capacity of the scale to detect changes in performance.Conclusion. Further research is needed to test the English version of the scale and its validity. [ABSTRACT FROM AUTHOR]

Title. Evaluation of empathy measurement tools in nursing: systematic review.Aim. This paper is a report of a systematic review conducted to analyse, evaluate and synthesize the rigour of measures used in nursing research to assess empathy, in order to identify a 'gold standard' for application in future studies.Background. Empathy is considered essential to the provision of quality care. We identified 20 different empathy measures used in nursing research. There are inconsistencies between tools, indicating both the inherent complexity of measuring empathy and the need to evaluate the rigour of the measures themselves. Data sources. An extensive search was conducted for the period 1987 and 2007 using the Medline, CINAHL and PsycINFO databases and the keywords 'empathy', 'tool', 'scale', 'measure', 'nurse' and 'nursing'. Twenty-nine studies were identified as relevant, in which 20 different empathy measurement tools were used. Twelve tools met the inclusion criteria for this review.Method. Twelve measures were critically reviewed and analysed. A 7-criterion framework was developed to appraise the rigour of the empathy measures, with a score range of 0-14 for each measure.Results. Quality scores obtained were low (2-8 of 14). Validity and reliability of data were commonly reported, but responsiveness to change was tested in only three measures. None of the measures were psychometrically robust or covered all the domains of empathy. User involvement was limited and only five were developed in nursing settings.Conclusion. Most measures have undergone rigorous development and psychometric testing, although none is both psychometrically and conceptually satisfactory. Empathy measures need to cover all relevant domains reflecting users' own perspectives and be tested with appropriate populations in relevant care settings. [ABSTRACT FROM AUTHOR]

Title. A communication intervention for nursing staff in chronic care.Aim. The paper is a report of a study conducted to evaluate the effect of a brief, focused educational intervention on the quality of verbal interactions between nursing staff and patients in a chronic care facility.Background. Positive nurse-patient communication in chronic care is crucial to the quality of life and well-being of patients. Despite this, patients are dissatisfied with these interactions and nursing staff indicate the need for additional training.Method. A repeated-measures design was used to collect data between April 2003 and February 2004, by audiotaping verbal interactions between nursing staff and patients during morning care. Baseline data were analysed and an educational intervention was developed based on the results of the pretest. Five months after the educational intervention, interactions between the same nursing staff and patients were audiotaped. Twenty-seven randomly chosen patients and selected nursing staff participated in the study. Data were analysed using a qualitative comparative method, and a quantification technique was developed to compare the quality of the interactions before and after the intervention.Findings. Preintervention interactions were task-oriented, superficial and dominated by nursing staff. Results statistically significantly improved after the intervention was implemented. Nursing staff were less authoritative, used more solution-focused communication and interactions had a statistically significantly higher positive ratio.Conclusion. Brief interventions can change nursing staff's communication practice and they realized the importance of effective communication as a fundamental component to deliver patient-focused care. [ABSTRACT FROM AUTHOR]

Title. Principle-based concept analysis: recognition in the context of nurse–patient interactions. Aim. This paper is a report of a principle-based concept analysis of recognition in the context of nurse–patient interactions. Background. Recognition is a concept employed in practice and research. Since nursing is patient-centred and care is problem-driven, the specificity and accuracy of recognition may have an impact on how nurses label patient phenomena, interventions initiated and patient outcomes. Data sources. The data set included 98 English language articles published from 1997 to 2008 and retrieved through Medline and CINAHL searches. Methods. Principle-based concept analysis was used to examine the state of the science according to major perspectives of the philosophy of science. Conceptual components were integrated into a theoretical definition and the process of recognition was conceptually modelled. Findings. The scientific literature dealing with recognition in the context of nurse–patient interactions relies on implied meaning. Recognition is a process marked by an awareness of evidence coupled with the formulation of a conceptual label summarizing the identified pattern of patient phenomena. Contextual features of the nurse, patient and organization are relevant during nurse–patient interactions, resulting in pivotal points in nursing care. These pivotal points are the moments of recognition when the nurse consciously applies a summary label to interpreted evidence. Outcomes of recognition include a choice to act or not to act, each option carrying significant outcomes for nurses, patients, and at times, organizations. Conclusion. A working definition was produced that will serve as a foundation for future concept-driven research to advance the concept toward greater precision and usefulness in nursing science. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of the development of a theoretical framework of nursing practice based on the convergence of the concepts art of nursing, presence and caring. Background. Convergence of similar concepts to form broad yet useful theories is a relatively unexplored area, despite the fact that systematically examining and integrating nursing concepts can help to build theory and leads to enhanced understanding of the discipline. Research results suggest that unarticulated similarities exist among the art of nursing, presence and caring; thus, qualitative convergence of these concepts is justified. Data sources. Findings from qualitative studies of the art of nursing (published between 1993 and the third quarter of 2006) and meta-syntheses of presence and caring (published in 2006 and 2007 respectively) were inductively analysed and integrated. Results. A theoretical framework of nursing practice was developed to illustrate the areas of convergence among the concepts art of nursing, presence and caring. Nursing involves an intimate relationship-centred partnership between the nurse and patient. Situation-specific nursing actions result from multiple forms of personal and professional knowledge and are based on a value system of holistic beneficence and patient empowerment. Nursing actions are promoted by a conducive work environment and result in enhanced well-being among patients and nurses. Conclusion. Results of this concept convergence provide an enhanced understanding of nursing practice and offer insight into areas of nursing practice that are not encompassed within the concepts art of nursing, presence and caring. Further work is recommended to expand the proposed framework, especially in terms of the wide variety of nurse-patient relationships that exist. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of an investigation of the impact of prescribing on a group of recently qualified nurse prescribers in the United Kingdom. Background. The creation of advanced nursing roles, and specific skills such as nurse prescribing, has resulted in nurses taking on roles that have traditionally been associated with doctors. The non-doctor prescribing initiative is continually developing and many nurses are now able to prescribe independently from almost the same range of medicines as doctors. Despite the advantages that appear to stem from nurses prescribing, some nurse researchers have been cautious about the impact that prescribing may have on the nursing profession. Method. Interviews were conducted during 2005 and 2006 with 45 nurse prescribers. All nurses had successfully qualified and registered as prescribers. Interviews were analysed thematically in line with the principles of grounded theory. Findings. Prescribing allows nurses to overcome difficulties in the healthcare system that previously delayed patients' access to medicines. Prescribing is viewed as more than an 'add on' to current roles, it complements many aspects of nursing and integrates previously diffuse aspects of the nursing role. This enables nurses to adopt a more holistic approach to patient care and prescribing. Prescribing has the potential to increase job satisfaction and autonomous working, with the result that nurses are more likely to involve patients in decision-making about their care. Conclusions. Prescribing enhances nurses' knowledge about medication and increases their confidence to engage in prescribing decisions across the healthcare team. Nurse prescribing has the potential to improve service-user care, enhance collaboration and widen discussions about medicines. However, team members need to be prepared for the impact nurse prescribing could have on the dynamics of the multidisciplinary team. Preparatory information about nurse prescribing should be provided to all team members by trainee nurse prescribers. Information could include details about the proposed scope of future prescribing roles, allowing team members to consider how their roles could develop. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a study to describe patients’ conceptions of how the spiritual dimension is addressed in mental health care. Background. Spirituality is a broad concept, and is highly subjective, multidimensional and difficult to define. Spirituality and religiousness are two separate concepts but have several common features. In mental health care, it is essential that nursing care be built on a holistic view, and the spiritual dimension has an important function in nursing care. The notion of spirituality is full of nuances, and in a multi-cultural society patients express their spirituality in different ways. Method. Data were collected by interviewing 12 strategically selected patients in mental health care and analysed according to a qualitative method inspired by the phenomenographic approach. The data were collected in 2003 in Sweden. Findings. Three descriptive categories emerged: patients wish to have their spiritual needs addressed; patients must see to it that their spiritual needs are addressed; patients lack confidence in nurses with regard to discussing spirituality. The findings show that patients actively sought the assistance of nurses to meet their spiritual needs. They turned their thoughts inwards and found community with other patients, while nurses often avoided addressing the spiritual dimension. Conclusion. Nurses should work actively to seek new knowledge about how they can address patients’ spiritual needs. It is also important that there be scope for discussing and reflecting on spiritual questions at the workplace. Additional research is needed to explore how knowledge about spirituality should be implemented in mental health care and nursing education. [ABSTRACT FROM AUTHOR]

In this paper, a model describing nurses' responses to patients who are suffering is presented. The nurse's level of engagement with the patient is affected by whether the caregiver is focused on him-/herself or on the sufferer (i.e. embodied with the patient) and whether the caregiver is responding reflexively or with a learned response. Four types of communication patterns are identified: engaged responses (first-level) are used in a connected relationship; when the nurse responses reflexively and is focused on him-/herself, the response is reflected; when the caregiver is patient-focused, a learned response is labelled a professional response; and a self-focused, learned response is labelled detached. Examples of each type of response are provided. [ABSTRACT FROM AUTHOR]

jonsdottir h., litchfield m. & pharris m.d. (2004) Journal of Advanced Nursing 47(3), 241–250 The relational core of nursing practice as partnership Consideration of the relational core of nursing has gained significance in today's health systems, where the work of nurses is dominated by technologically-driven, prescriptive, and outcome-oriented approaches. This has led to disregard for individual experiences of living life with diverse health conditions. The aim of this paper is to articulate the relational core of nursing practice as partnership. The relational core of nursing practice is explicated as a process of professional partnership, focusing on the evolving dialogue between nurse and patient. In partnership, the dialogue is open, caring, mutually responsive and non-directive. The nurse attends to that which is of concern to patients in relation to their health predicaments and the meaning in the health experience unfolds. Nurse and patient reach insight that represents more useful ways of comprehending and acting on their health predicaments. Partnership represents theoretically-driven practice that invites nurses to meet patients where they are in understanding their health predicaments and what can be done about them. As such, partnership strengthens the resolve of nurses to resist the pressures of contemporary health service delivery to provide a technical form of practice and it protects the relational core of a fully professional practice. [ABSTRACT FROM AUTHOR]

dunckley m., hughes r., addington-hall j.m. & higginson i.j. (2003) Journal of Advanced Nursing 44(4), 420–426 Translating clinical tools in nursing practice The widespread use of clinical tools in nursing practice reflects their usefulness in guiding patient care, evaluating treatment effectiveness and conducting audit. Cultural awareness and the provision of culturally competent care is a high priority for nurses in the United Kingdom (UK), given patterns of increasing ethnic diversity. However, meeting the individual needs of patients can be difficult when language barriers hinder communication. One way to address these difficulties is to translate existing clinical tools. The aim of this paper is to appraise the potential for, and limitations of, translating clinical tools for use in nursing practice. Drawing on a range of studies from the disciplines of health and social science, this review describes and discusses some key considerations relevant to translating clinical tools in nursing. These considerations include the need to ensure cultural equivalence, lack of familiarity with clinical tool formats in some cultures and its impact on responses, and low literacy levels in some populations. Clinical tools provide benefits in identifying patients’ problems, guiding patient care, and evaluating treatments and interventions. Translating these tools can help to bridge the language gap that hinders good communication between nurses and patients. Translated clinical tools can be of acceptable cultural equivalence and validity if high quality translation methodologies are employed, together with an awareness of culturally relevant issues when interpreting the information gained from the tools. [ABSTRACT FROM AUTHOR]

At the heart of the 'new nursing' is an emphasis on developing a close, holistic relationship between nurse and patient. Through this not only will healing be facilitated, and patients be encouraged to take responsibility for their own health, but the nurse will be placed firmly at the centre of the network of health professionals. Individual practitioners and the profession as a whole will achieve a clearer and more satisfying mission. This casting of the nurse as pivotal enabler parallels attempts to systematize social work theory and practice in the 1970s, and many common intellectual sources on relationship-building are used. But what are the supposed characteristics of the 'good relationship?' The paper argues that, while the new nursing endeavours to emphasize the social context of patients, health and illness, much of the psychotherapeutic literature called in support is essentialist: the social world is treated as a hindrance to the goal of 'authenticity.' Thus acquired professional knowledge and skills are devalued. Added to the potential of this for personal stress are risks for the profession itself. In circumstance of permanent financial pressure, foregrounding hard-to-measure criteria of success, like the quality of relationships, is very hazardous. [ABSTRACT FROM AUTHOR]

This paper reports a small-scale phenomenological study of registered nurses' experiences with their client education role. Its purpose was to investigate phenomena associated with actual experiences as they were encountered by participants. A review of the literature provides an overview of client education in terms of its definition and utility, and draws attention to the notion of compliance and the influence of power in health provider-client relationships. Phenomenology offers an appropriate methodological framework for investigating symbolic experiences, and three central concepts are yielded from aggregate data in the form of confirming experiences, disconfirming experiences and educational processes. Findings indicate that nurses' value the uniqueness of the client and, where possible, tend to initiate educational processes that actually empower individuals. However, disconfirming experiences are associated with demands on nurses' work schedules, low client motivation and non-compliance. Physician interjection is also perceived as problematical, resulting in feelings which undermine the nurses' professional integrity, and which lead to a diminished sense of self-worth. [ABSTRACT FROM AUTHOR]

The section comments on the article "Beyond Empathy: Expanding Expressions of Caring," by J. M. Morse, et al, which appeared in the 1992 issue of the "Journal of Advanced Nursing." It expresses opinion on the authors' reference to therapeutic empathy as being a learned communication response. It suggests that there is a need for the nurse to use cognitive-behavioral empathy in order to understand the patient's state of readiness to accept pity. It also discusses the paper's findings.