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Title. Expert nursing practice: a mathematical explanation of Benner’s 5th stage of practice development. Aim. This paper is a theoretical discussion of a mathematical explanation for Benner’s theory of practice development. Background. Benner’s practice development theory demonstrates how a nurse moves from a beginning, rule-based practice through to expert care. Her notion of expert practice as intuitive has not been well-accepted or understood in nursing. A new description of expert practice includes three types of intuitive practice (cognitive, transitional and embodied), the development of which are dependent on knowledge, experience and reflective time. Data sources. This paper is based on phenomenological research conducted in 2000–2003 and Benner’s publications, as well as recent discussions about the relationship between mathematics and phenomenology. Discussion. The mathematical explanation for Benner’s theory of practice development relates reflective time and knowledge to the mathematical power of experience and links the unique components of intuitive practice to expert care. On reaching expert practice, the three types of intuition include previously identified themes (knowledge, experience, connection, feeling, syncretism and trust) as differentials along the reflective time axis. When graphically represented, expert practice becomes a three-dimensional figure as practice becomes more complex, rather than a two-dimensional one as seen in previous stages. Conclusion. Having the intuitive component of expert practice further clarified from Benner’s first vision confirms it as a valid component of practice. It is important to recognize that experience is a powerful component of practice and that it is essential to the development of expertise. Although this discussion has been nested within nursing practice, it has wide implications for medical, psychological and educational practice. [ABSTRACT FROM AUTHOR]

Title. Bodily change following faecal stoma formation: qualitative interpretive synthesis.Aim. This paper is a report of a literature review conducted to answer the question 'How has the experience of bodily change following stoma formation been explored and interpreted through existing qualitative research?'.Background. A faecal stoma alters the function, appearance and sensation of the body. Quantitative research highlights the importance of bodily change following stoma formation but is limited in being able to explore what this experience means to ostomists. Qualitative research can identify ways in which ostomists experience their changed body but a conceptual framework of their experience drawn from qualitative findings which can inform patient-centred care has not yet been identified.Method. The Amed, ASSIA, CINAHL, Embase, Medline and Psycinfo databases were searched from inception to April 2009 using predefined inclusion criteria. Of 144 papers identified, 11 were selected for review. An interpretive review methodology for qualitative research synthesis was employed. Findings. Three broad themes of bodily experience following stoma formation were identified: loss of embodied wholeness, awareness of a disrupted lived body and disrupted bodily confidence. These highlight the impact of the experience of living with a stoma on the embodied self and the ostomist's embodiment within their lifeworld.Conclusion. A loss of embodied wholeness which underpins the experience of stoma formation can be represented through awareness of the disrupted lived body and impact on the lifeworld. Findings suggest the need for further research to identify a comprehensive conceptualization of bodily change, which can more closely match healthcare service to individual patient need. [ABSTRACT FROM AUTHOR]

AIM: This paper presents an integrative literature review conducted to describe the utility of the objective structured clinical evaluation (OSCE) as a strategy of measuring one form of clinical competence in nursing. BACKGROUND: The emergence of the OSCE, one form of evaluation of clinical competence used in medicine, is gaining more scrutiny and consideration in nursing education. DATA SOURCES: The review was conducted through an initial search of computerized databases CINAHL, Cochrane Database of Systematic Reviews, Academic Search Premier and MEDLINE for the period from 1960 to 2008. METHODS: An integrative review was performed and 41 papers met the inclusion criteria. RESULTS: The complexities of evaluating clinical competence can be addressed through use of an OSCE process. Concerns related to the conceptual limitations and the lack of psychometric properties of the tools available for measurement in nursing education have been identified. CONCLUSION: Major gaps exist in the nursing literature regarding the examination of the psychometric properties of the OSCE, the suitability of the design of the OSCE structure and tools for nursing to measure clinical competency, and the associated costs in the application of this evaluative method. Research conducted on the psychometric properties of the OSCE tool used and correlations to other evaluative methods currently used to evaluate nursing clinical competence would inform educational practices. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a concept analysis of fatigue in children with long-term conditions. BACKGROUND: There is little research focused on the experience of fatigue in children. Previous work has focused primarily on children living with cancer. It is necessary to clarify and refine the concept, and add to the knowledge base that supports ongoing theoretical work in order to improve the clinical care of children with long-term conditions who experience fatigue. METHOD: English language literature published from 1989 to 2007 was searched using the CINAHL, Medline and PsychINFO data bases. Sixty-two papers and two book chapters were used in this concept analysis. Rodgers' method of evolutionary concept analysis was used. This inductive method helps us to view the concept in a sociocultural and temporal context. FINDINGS: The number of publications focusing on fatigue in children is increasing. The analysis yielded two surrogate terms, five attributes, three antecedents and seven consequences. Based on this analysis, fatigue in children with long-term conditions appears to be a subjective experience of tiredness or exhaustion that is multidimensional and includes physical, mental, and emotional aspects. CONCLUSIONS: Evidence suggesting children with long-term conditions experience fatigue is increasing, but conceptual gaps remain. This analysis has yielded a view of fatigue in children that illustrates healthcare professionals' limited yet growing awareness of the symptom. Ongoing study as a means to refine our understanding of the concept could potentially lead to important contributions to clinical care of children with long-term conditions. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a concept analysis of patient acuity. Background. Patient acuity is a widely-used term in the health sciences literature, but often without specification of its exact meaning. Concept clarification is therefore needed to delineate the meaning of patient acuity. Data sources. A review of the Pubmed, CINAHL, MEDLINE and PsychInfo databases for the keyword 'acuity' in the title or abstract of papers in English language journals, as well as searches for the term 'acuity' and 'acute' in the Merriam-Webster and Oxford English Dictionaries were the data sources for this concept analysis. Papers were excluded if 'acuity' was not present in the title or abstract. Publication dates of the literature included in the review ranged from 1974 to 2008. Findings. The attributes of acuity are severity, intensity and the pairing of acuity measurements with another concept. These attributes were organized according to Holzemer's Outcomes Model for Health Care Research as patient-, provider- or system-related. The sub-categories of attributes identified were physical, psychological, nursing care needs, workload, complexity, case-mix, patient classification systems, urgency/triage scales and other uses. Conclusion. Researchers are encouraged to specify which attribute of acuity they are studying and to develop measurement tools specific to that attribute, in order to move the science towards standardization of the concept of acuity and its measurement. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a review conducted to provide an overview of the evidence in the literature on task-oriented training of stroke survivors and its relevance in daily nursing practice. BACKGROUND: Stroke is the second leading cause of death and one of the leading causes of adult disability in the Western world. The use of neurodevelopmental treatment in the daily nursing care of stroke survivors does not improve clinical outcomes. Nurses are therefore exploring other forms of rehabilitation intervention, including task-oriented rehabilitation. Despite the growing number of studies showing evidence on task-oriented interventions, recommendations for daily nursing practice are lacking. DATA SOURCES: A range of databases was searched to identify papers addressing task-oriented training in stroke rehabilitation, including Medline, CINAHL, Embase and the Cochrane Library of systematic reviews. Papers published in English between January 1996 and September 2007 were included. There were 42 papers in the final dataset, including nine systematic reviews. REVIEW METHODS: The selected randomized controlled trials and systematic reviews were assessed for quality. Important characteristics and outcomes were extracted and summarized. RESULTS: Studies of task-related training showed benefits for functional outcome compared with traditional therapies. Active use of task-oriented training with stroke survivors will lead to improvements in functional outcomes and overall health-related quality of life. CONCLUSION: Generally, task-oriented rehabilitation proved to be more effective. Many interventions are feasible for nurses and can be performed in a ward or at home. Nurses can and should play an important role in creating opportunities to practise meaningful functional tasks outside of regular therapy sessions. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a review to analyse studies using the BARRIERS Scale to determine (a) if the identification of perceived barriers to research utilization influences nurses' use of research, (b) if the extent of nurses' perceived barriers to research utilization and most frequently cited barriers have changed over the past 15 years and (c) if nurses' most frequently cited barriers to research utilization differ across countries.Background. The BARRIERS Scale has been used to identify nurses' untoward perceptions or barriers to research utilization.Data sources. A computer search was conducted using the Cumulative Index of Nursing and Allied Health Literature, MEDLINE, Dissertation Abstracts International and Academic Abstracts to identify relevant literature from 1991 to 2006. The Internet and citations within studies were also searched.Review methods. Studies were included if they were in English, used the entire BARRIERS Scale and reported nurses' responses. Studies were coded for author(s), publication year, country, population, sample size, response rate, the three-most frequently cited barriers, mean per cent of items rated as moderate or greater, and number of items identified as a barrier by 50% or more of respondents. Quality appraisal of the included papers was not performed.Results. Forty-five studies met the inclusion criteria and predominantly identified the same barriers. No evidence was found that identification of barriers to nurses' use of research influenced nursing practice.Conclusions. It appears that there would be minimal benefit from further descriptive research using the BARRIERS Scale. Research is needed to investigate whether relationships exist between perceptions of barriers to nurses' use of research and the use evidence-based practice. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a concept analysis of ethical sensitivity. BACKGROUND: Ethical sensitivity enables nurses and other professionals to respond morally to the suffering and vulnerability of those receiving professional care and services. Because of its significance to nursing and other professional practices, ethical sensitivity deserves more focused analysis. DATA SOURCES: A criteria-based method oriented toward pragmatic utility guided the analysis of 200 papers and books from the fields of nursing, medicine, psychology, dentistry, clinical ethics, theology, education, law, accounting or business, journalism, philosophy, political and social sciences and women's studies. This literature spanned 1970 to 2006 and was sorted by discipline and concept dimensions and examined for concept structure and use across various contexts. The analysis was completed in September 2007. FINDINGS: Ethical sensitivity in professional practice develops in contexts of uncertainty, client suffering and vulnerability, and through relationships characterized by receptivity, responsiveness and courage on the part of professionals. Essential attributes of ethical sensitivity are identified as moral perception, affectivity and dividing loyalties. Outcomes include integrity preserving decision-making, comfort and well-being, learning and professional transcendence. Our findings promote ethical sensitivity as a type of practical wisdom that pursues client comfort and professional satisfaction with care delivery. CONCLUSION: The analysis and resulting model offers an inclusive view of ethical sensitivity that addresses some of the limitations with prior conceptualizations. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a systematic review to identify and analyse the main factors affecting the utilization of antenatal care in developing countries. BACKGROUND: Antenatal care is a key strategy for reducing maternal mortality, but millions of women in developing countries do not receive it. DATA SOURCES: A range of electronic databases was searched for studies conducted in developing countries and published between 1990 and 2006. English-language publications were searched using relevant keywords, and reference lists were hand-searched. REVIEW METHODS: A systematic review was carried out and both quantitative and qualitative studies were included. RESULTS: Twenty-eight papers were included in the review. Studies most commonly identified the following factors affecting antenatal care uptake: maternal education, husband's education, marital status, availability, cost, household income, women's employment, media exposure and having a history of obstetric complications. Cultural beliefs and ideas about pregnancy also had an influence on antenatal care use. Parity had a statistically significant negative effect on adequate attendance. Whilst women of higher parity tend to use antenatal care less, there is interaction with women's age and religion. Only one study examined the effect of the quality of antenatal services on utilization. None identified an association between the utilization of such services and satisfaction with them. CONCLUSION: More qualitative research is required to explore the effect of women's satisfaction, autonomy and gender role in the decision-making process. Adequate utilization of antenatal care cannot be achieved merely by establishing health centres; women's overall (social, political and economic) status needs to be considered. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a literature review exploring genetics education for nursing professionals. The aim was to contribute to the debate about the future direction of such education. Background. Advances in genetics science and technology have profound implications for health care and the growing importance and relevance of genetics for everyday nursing practice is increasingly recognized. Method. A search was conducted in February 2005 using the CINAHL and Google Scholar databases and the keywords nurse, midwife, health visitor, education and genetics. Papers were included if they were published in English between 1994 and 2005 and included empirical data about genetics education in nursing. In addition, attempts were made to access the grey literature, with requests for information on research, for example, to members of the Association of Genetic Nurses and Counsellors and searches of relevant websites. Findings. Agreement on the relevance of genetics for nursing practice is extensive. Empirical evidence of the learning needs of practitioners highlights widespread deficits in knowledge and skills, and low confidence levels. Provision of nursing education in genetics is patchy and insubstantial across a number of countries, further hampered by lack of strategic development. Significant progress has been made in the identification of learning outcomes for nurses. Research on the delivery of genetics education is limited, but the role of skills-based training, use of clinical scenarios, and importance of assessment have all been identified as factors that can promote learning. Conclusion. Whilst areas of good performance were revealed, many studies identified gaps in professional competence and/or education. New initiatives are underway to support genetics education and its integration into professional practice, but further research is needed on the most effective forms of educational delivery, and an international collaborative approach to this should be considered. [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 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]

Aim. This paper reports the evaluation phase of an action research project that promoted face-down posturing of patients following vitreo-retinal surgery for macular hole to enhance patient outcomes. The evaluation phase identified areas of practice needing further development from the perspectives of those involved with the care of patients. Background. To achieve best results following surgical repair of macular hole, patients are required to posture face down for several weeks. As a consequence, patients complain of severe back and neck ache and find it difficult to persist with the posturing. Work to advance nursing practice as surgical developments occur has relevance beyond ophthalmology and the particular context of this project. Method. The first three phases of this action research - problem identification, planning and action - have been reported in another paper. Throughout the project an action research group comprising of representatives of key stakeholders were actively involved in researching and changing practice. During the evaluation phase, a qualitative methodology was chosen. Interviews with 17 members of staff from the inpatient area were carried out to elicit their perspectives on the posturing of patients. Qualitative interviews were selected to facilitate comparison with interview data from Phase 1. Data analysis ran concurrently with data collection, so that one could inform the other. Findings. Overall, nurses and healthcare support workers felt that patients were more agreeable to posturing and after surgery began to posture more quickly. Communication was still an issue in some instances, and patients having urgent as opposed to planned surgery were found to be more difficult to prepare and the psychological care of patients still posed problems for nursing staff. Conclusions. The evaluation suggests that improvements in the care of this group of patients have occurred. A 10-point plan to promote face-down posturing has been developed which will be of use to practitioners in other settings. Some aspects of practice remain less well-understood, for example, the psychological care of patients. [ABSTRACT FROM AUTHOR]

AIM: This paper reports a literature review to examine the effectiveness of inducing hypothermia to decrease neurological deficit after out-of-hospital cardiac arrest. BACKGROUND: After cardiac arrest, severe neurological impairment is a major problem. Outcome after anoxic brain injury following cardiac arrest varies from normal function to brain death. However, a large proportion of these patients are left with severe disability and completely dependent on others for basic needs. Since the 1950s, several studies have shown how hypothermia can be neuroprotective. Recently, these studies have been taken to human trials in populations experiencing out-of-hospital cardiac arrest. METHODS: A literature search was conducted using the Ovid and MDConsult databases for the years 1966-2004 and the keywords included hypothermia, therapeutic hypothermia, and cardiac arrest. Only English language papers were retrieved. Six human trials were found. RESULTS: All six studies showed improved neurological outcomes and four of these showed a decrease in mortality. Minimal complications exist from inducing mild hypothermia after cardiac arrest, and include decreased heart rate, increased systemic vascular resistance, transient electrolyte abnormalities (increased serum potassium and glucose), possible increase in pneumonia or other infectious processes, possible rebound hyperthermia, possible hypotension, and possible arrhythmias. CONCLUSIONS: Based on the review of these studies and the recommendations from the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation, advanced practice nurses should promote this practice, but look for further research on specific treatment recommendations. [ABSTRACT FROM AUTHOR]

AIM: The aim of this paper is to suggest that the study of ethics and ethical theories can enhance nursing practice. DISCUSSION: Knowledge of ethical theories can be of practical use to nurses in at least three ways. First, it can help nurses uncover to what extent a problem is an ethical one. The questions faced in practice can be empirical, formal or philosophical. Very often, a practical decision requires us to tackle all three types. In the example of a 'Do not attempt resuscitation' order, deciding on whether such an order is appropriate requires us to answer empirical questions such as how likely any attempt is to achieve success. It also requires us to answer formal questions such as whether the law permits such an order in the present circumstance. Finally, it requires us to answer ethical/philosophical questions, such as how we should weigh up quality of life against quantity. Second, it can enable practitioners to develop skills and tools to tackle ethical/philosophical questions. In this paper I describe two such tools: Socratic questioning and Aristotelian dialectic. Third, it can help practitioners to develop the soundness of their ethical values and beliefs. All ethical reasoning requires us to use our values and beliefs, and attending to them enhances the quality of our reasoning. CONCLUSION: The study of ethics can enhance nursing practice. [ABSTRACT FROM AUTHOR]

AIM: This paper describes how discourse analysis, and in particular critical discourse analysis, can be used in nursing research, and provides an example to illustrate the techniques involved. BACKGROUND: Discourse analysis has risen to prominence in the 1980s and 1990s in disciplines such as the social sciences, literary theory and cultural studies and is increasingly used in nursing. This paper investigates discourse analysis as a useful methodology for conducting nursing research. Effective clinical reasoning relies on employing several different kinds of knowledge and research that draw on different perspectives, methodologies and techniques to generate breadth of knowledge and depth of understanding of clinical practices and patients' experiences of those practices. DISCUSSION: The steps in a discourse analysis include: choosing the text, and identifying the explicit purpose of the text, the processes used for claiming authority connections to other discourses, construction of major concepts, processes of naming and categorizing, construction of subject positions, construction of reality and social relations and implications for the practice of nursing. The limitations of discourse analysis, its relationship to other qualitative approaches and questions for evaluating the rigour of research using discourse analysis are also explored. The example of discourse analysis shows how a text influences the practice of nursing by shaping knowledge, values and beliefs. CONCLUSION: Discourse analysis can make a contribution to the development of nursing knowledge by providing a research strategy to examine dominant discourses that influence nursing practice. [ABSTRACT FROM AUTHOR]

Aim. The aim of this paper is to discuss six issues influencing the introduction of advanced practice nursing (APN) roles: confusion about APN terminology, failure to define clearly the roles and goals, role emphasis on physician replacement/support, underutilization of all APN role domains, failure to address environmental factors that undermine the roles, and limited use of evidence-based approaches to guide their development, implementation and evaluation.Background. Health care restructuring in many countries has led to substantial increases in the different types and number of APN roles. The extent to which these roles truly reflect advanced nursing practice is often unclear. The misuse of APN terminology, inconsistent titling and educational preparation, and misguided interpretations regarding the purpose of these roles pose barriers to realizing their full potential and impact on health. Role conflict, role overload, and variable stakeholder acceptance are frequently reported problems associated with the introduction of APN roles.Discussion. Challenges associated with the introduction of APN roles suggests that greater attention to and consistent use of the terms of the terms advanced nursing practice, advancement and advanced practice nursing is required. Advanced nursing practice refers to the work or what nurses do in the role and is important for defining the specific nature and goals for introducing new APN roles. The concept of advancement further defines the multi-dimensional scope and mandate of advanced nursing practice and distinguishes differences from other types of nursing roles. Advanced practice nursing refers to the whole field, involving a variety of such roles and the environments in which they exist. Many barriers to realizing the full potential of these roles could be avoided through better planning and efforts to address environmental factors, structures, and resources that are necessary for advanced nursing practice to take place.Conclusions. Recommendations for the future introduction of APN roles can be drawn from this paper. These include the need for a collaborative, systematic and evidence-based process designed to provide data to support the need and goals for a clearly defined APN role, support a nursing orientation to advanced practice, promote full utilization of all the role domains, create environments that support role development, and provide ongoing evaluation of these roles related to predetermined goals. [ABSTRACT FROM AUTHOR]

kearney p.m. & pryor j. (2004) Journal of Advanced Nursing 46(2), 162–170 The International Classification of Functioning, Disability and Health (ICF) and nursing Nursing conceptualizes disability from largely medical and individual perspectives that do not consider its social dimensions. Disabled people are critical of this paradigm and its impact on their health care. The aims of this paper are to review the International Classification of Functioning, Disability and Health (ICF), including its history and the theoretical models upon which it is based and to discuss its relevance as a conceptual framework for nursing. The paper presents a critical overview of concepts of disability and their implications for nursing and argues that a broader view is necessary. It examines ICF and its relationship to changing paradigms of disability and presents some applications for nursing. The ICF, with its acknowledgement of the interaction between people and their environments in health and disability, is a useful conceptual framework for nursing education, practice and research. It has the potential to expand nurses’ thinking and practice by increasing awareness of the social, political and cultural dimensions of disability. [ABSTRACT FROM AUTHOR]

woo h. & twinn s. (2004) Journal of Advanced Nursing 45(6), 595–602 Health needs of Hong Kong Chinese pregnant adolescents The outcomes of adolescent pregnancy have been associated with health risks such as obstetric complications and depression, and educational risks such as school dropout and reduced employment opportunities. These outcomes arise from a range of needs including perceived health needs, which are the focus of this paper. This paper reports a study to identify the perceived needs of Hong Kong Chinese adolescents following confirmation of an unintended pregnancy. An exploratory qualitative approach was used with a purposive sample of 10 Hong Kong Chinese pregnant adolescents. The study was undertaken during their stay in a non-government organization maternal shelter. Semi-structured interviews were used to explore adolescents’ perceptions of their psychological, social and health needs and the extent to which each of these needs was met. Six major categories were identified within the context of need, of which three were related to health needs: acceptance of the pregnancy; psychological reactions to the pregnancy; and use of contraception and health advice. The findings contribute to an understanding of the perceived health needs of Chinese adolescents, in particular those that are culturally determined. Implications for nursing practice indicate the significance of comprehensive health assessments and health promotion strategies to help adolescents increase their knowledge about sexual health and contraception. [ABSTRACT FROM AUTHOR]

taylor j.s. (2004) Journal of Advanced Nursing 45(6), 633–643 Salutogenesis as a framework for child protection: literature review The aim of this paper is to demonstrate the usefulness of salutogenesis in work relating to child protection. A systematic review to explore the links between parenting, social factors and failure to thrive was carried out using 17 CD ROM and online databases using keywords in appropriate medical subject headings (MeSH terms) and Boolean operators refined for the studies. The salutogenic framework was then used as a way of clarifying what benefit particular research findings may have in identifying and using factors which can be associated with protection, safety and well being of children. Cross-referencing the evidence from the systematic review against Antonovsky's generalized resistance resources created a salutogenic matrix. Four factors in the systematic review were found crucially important: parent factors; parenting factors; child factors; and social factors. However, it is probable that these are useful within all child protection research and the evidence gathered in particular cases (here failure to thrive) could be plotted against each factor. Application of a salutogenic framework to the results was further illuminating and has utility for both systematic review methodology and other child protection explorations. The matrix created a warp and weft effect that identified gaps in current evidence and practice and was able to disentangle some of the complexities inherent within failure to thrive situations. By beginning to shed understanding on such processes, the concept of salutogenesis added further depth and rigour to the analysis. The concept of salutogenesis is widely used in some areas of nursing practice and research, and can also be regarded as a theoretical tool that has potential in child care and protection research, development and practice. The paper also illustrates the importance of a sound theoretical framework in ensuring depth and rigour in analyses of literature review findings. [ABSTRACT FROM AUTHOR]

Supporting and policing mothers: an analysis of the disciplinary practices of health visiting Aim. This paper draws on the notion of disciplinary power developed by Michel Foucault to discuss whether the professional practices inherent in British health visiting can be understood in terms of support or surveillance. Background. The notion of disciplinary power embedded within Foucault's writings has been widely applied to the sociological analysis of health care professions. While a number of studies have focused on nursing practice, there has been little empirical work developing these ideas in the context of British health visiting. Methods. A qualitative approach using interviews with 24 health visitors and 16 women who had experienced domestic violence was used. For reasons of confidentiality, the women were not matched to the health visitors. Data analysis was continuous with data collection and led to identification of a number of categories. The theoretical framework of feminist poststructuralism underpinned the analysis. Findings: The women who participated in this research described their engagement in a number of disciplinary practices. These included the discursive production of themselves as good mothers, subjects and objects of the health visiting gaze, as well as their practices of resistance to health visiting work. Analysis of the health visitors' interview data provided further evidence concerning the exercise of disciplinary power in their everyday work of providing support and health care to women and children. Conclusions. The paper highlights tensions within the health visitor's role between welfare and surveillance, as well as differences between lay and professional perspectives. [ABSTRACT FROM AUTHOR]

Getting evidence into practice: the meaning of `context' Aim of paper. This paper presents the findings of a concept analysis of `context' in relation to the successful implementation of evidence into practice. Background. In 1998, a conceptual framework was developed that represented the interplay and interdependence of the many factors influencing the uptake of evidence into practice [Kitson A., Harvey G. & McCormack B. (1998) Quality in Health Care 7 , 149]. One of the key elements of the framework was `context', that is, the setting in which evidence is implemented. It was proposed that key factors in the context of health care practice had a significant impact on the implementation and uptake of evidence. As part of the on-going development and refinement of the framework, the elements within it have undergone a concept analysis in order to provide some theoretical and conceptual rigour to its content. Methods. Morse's [Morse J.M. (1995) Advances in Nursing Science 17 , 31; Morse J.M., Hupcey J.E. & Mitcham C. (1996) Scholarly Inquiry for Nursing Practice. An International Journal 10 , 253] approach to concept analysis was used as a framework to review semi-nal texts critically and the supporting research literature in order to establish the conceptual clarity and maturity of `context' in relation to its importance in the implementation of evidence-based practice. Findings: Characteristics of the concept of context in terms of organizational culture, leadership and measurement are outlined. A main finding is that context specifically means `the setting in which practice takes place', but that the term itself does little to reflect the complexity of the concept. Whilst the themes of culture and leadership are central characteristics of the concept, the theme of `measurement' is better articulated through the broader term of `evaluation'. Conclusions. There is inconsistency in the use of the term and this has an impact on claims of its importance. The concept... [ABSTRACT FROM AUTHOR]

AIMS: This paper provides a theoretical understanding of narrative research and its use in research. It aims to expose the ways narrative research, when taken beyond the researcher's lone analysis of text, can contribute to the development of clinical knowledge. BACKGROUND: Methodological approaches involving the construction of narratives are increasingly apparent in the nursing and allied health literature. Narratives, constructed from stories of nursing practice, become texts available for analysis. This is undertaken predominantly by a researcher engaged in a lone activity with little involvement of those contributing the stories. METHODS: This paper is drawn from a critical praxis study of nurse-patient friendship utilizing participatory research processes. The nurses involved in the study were co-researchers in an indepth study of their relationships with patients. FINDINGS: The paper traces the movement from naive story, through individual narratives during interviews with each nursing and demonstrates the changes in understanding about the narrative accounts that occurred during the participatory group process. CONCLUSION: The nurses involved in this study were able, through the use of narrative stories reexamined in a group context, to develop new insights and understandings about their practice. Knowledge generated in these ways remains grounded in the real life world of clinical nursing and gives voice to the complexity of those aspects of nursing practice that are taken for granted. [ABSTRACT FROM AUTHOR]

Language, research and nursing practice Aim of the paper. This paper highlights the centrality of language in constructing knowledge. It aims at making us sensitive to the political nature of knowledge production and the complex power relationships that may emerge as a result of our efforts to create new knowledge. Background: Science, as understood here, is a linguistic construction, rather than a mirror reflection of reality. A number of examples are presented, demonstrating the complex ways in which language is central in shaping all our attempts to know, science included, and nursing practice. Conclusion: Based on the analysis presented in this paper an argument is made for a substantial re-thinking of nursing research and its relationship to nursing practice. Research needs to be an integral part of everyday nursing practice, a way of posing questions and reflecting on answers. Further, nurses need to be aware of the potentially coercive nature of knowledge as well as its liberating effect. [ABSTRACT FROM AUTHOR]

Concerns have been expressed that bioscience education is not meeting the needs of nursing students in the UK. This paper explores the situation further by comparing student perceptions with those of experienced practitioners (Part One of the study) and also evaluates the confidence of staff nurses in explaining the rationale for care applied to a common but specific disorder (influenza; Part Two). Questionnaires were used. Responses were elicited from DipHE Nursing (Project 2000) adult/child branch students (n=153) from two universities and from adult/child care staff from their local clinical placements (n=171 in Part One of study; n=266 in Part Two). The questions asked followed two themes: (1) confidence in understanding biological science and (2) issues of teaching and learning. Most questions utilized a rating scale from 1 to 10; this scale provides no central value and a vertical line was drawn to encourage respondents to identify which half of the scale their responses came under (basically, a negative or positive viewpoint). The significance of the data distribution either side of the midline was analysed statistically (simple sign test), as were any differences in distribution between the groups (chi-square test). Median values were also determined. The data do not provide support for views that the biosciences are being significantly diminished by modern curricula, but also show no evidence for a great improvement in the bioscience knowledge base in recent years. What was surprising was the lack of confidence expressed by staff nurses: one illuminating finding was the lack of confidence in articulating their knowledge to patients and, even less so, to other health professionals. The paper reiterates a need for a national teaching and learning strategy for pre- and postregistration education in the biosciences. In particular, a means to raise the level of understanding of staff nurses must be identified urgently so that the mentoring of students in these subjects is improved. [ABSTRACT FROM AUTHOR]

Caring from Islamic perspectives is not well versed in Eurocentric nursing literature. There is widespread misunderstanding of the concept and practice of Islam within the context of health care and nursing practice. The areas of contention, in the context of health care systems, are whether the western paradigm to nursing care and management are applicable to Muslims and non-Muslims in both Islamic and non-Islamic countries. What is lacking in some of the conceptual frameworks and models of care is not only the fundamental spiritual dimension of care, but also the significance of spiritual development of the individual towards healing. The focus of this paper is to provide an awareness of Islamic health practices, health behaviours, code of ethics and the framework of Islamic perspectives of caring and spirituality. A brief overview of the Muslim world, the historical development in caring and health and the pillars of the Islamic faith provide the context of the paper. The development of a model of care based on the Islamic perspective is suggested. [ABSTRACT FROM AUTHOR]

Current health care policy and practice contexts in the UK point to the importance of nurses' ability to make an effective contribution to educating patients about medication, as part of their role in health education and health promotion. Nurses' potential contribution to this important activity will inevitably be dependent on knowledge and skills acquired during preregistration and postregistration programmes of education. Against this backdrop, changes in pre and postregistration nurse education in the UK in the past decade highlight the importance and timeliness of evaluating the adequacy of educational preparation for a medication role. This paper reports on the findings from an evaluation of UK educational preparation for a medication education role in practice. A case study design was used to investigate current educational preparation at three education institutions. Multiple methods of data collection at each site involved focus group discussions with lecturers and practitioners, individual interviews with key personnel, nonparticipant observation of teaching sessions, postobservation interviews with students and curriculum analysis. Findings highlighted the importance of a number of dimensions of preparation for practice of such a role: the need for sufficient taught pharmacology; opportunities for application and integration of prerequisite knowledge and skills; the importance of practice-based learning; the need for an evidence-based curriculum, and the importance of clarifying outcomes and competencies required for a medication education role within pre and postregistration curricula. The paper concludes with a discussion and implications of the findings. [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]

Over the last 15-20 years we have witnessed a dramatic interest in the moral domain of clinical practice. There has also been a growing focus on the patient as an individual whose individuality and perspective must be respected. It is argued in this paper that a key to both these concerns is a consideration of the role of empathy in both perceiving the moral aspects and issues of practice, and in providing adequate support for patients. In this paper the meaning and components of empathy are discussed in the context of human receptivity and preconditions of moral performance. However, we also draw attention to empirical studies which suggest that even following adequate educational preparation, if the clinical environment and the structures within which care is delivered are not supportive, the practitioner's ability to perceive the moral is limited. In such circumstances, patients are in danger of receiving less than appropriate care - from both the moral and professional perspective. [ABSTRACT FROM AUTHOR]

The development of clinical guidelines as one means of implementing evidence-based practice is currently a topical issue. The recent Government White Paper, The New NHS. Modern. Dependable, proposes the establishment of a National Institute for Clinical Excellence whose expressed aim will be to produce and disseminate guidelines based upon evidence of clinical effectiveness in health care. There will be an expectation that practitioners adapt these national guidelines for local needs and particularize them to individual patients. There has been considerable debate in the medical press between the critics and advocates of evidence-based medicine surrounding the relative usefulness of clinical guidelines. However, there has been limited corresponding debate within the nursing literature, which has largely limited itself to descriptions of the implementation of guidelines. This paper examines some of the advantages and limitations of clinical guidelines as a means of operationalizing research evidence to promote effective health care. Finally, some recommendations surrounding the implementation of guidelines will be made. [ABSTRACT FROM AUTHOR]

Inequalities in service provision: an examination of institutional influences on the provision of district nursing care to minority ethnic communities This paper reports on the selected findings from a larger ethnographic study of the provision of district nursing care to patients from different ethnic backgrounds. The two-stage study was undertaken in an English community National Health Service (NHS) trust serving an ethnically diverse population. The first stage comprised an organizational profile in order to analyse the local policy context, including specific responses to ethnic diversity. Data were collected by means of in-depth interviews with managers. The second stage entailed a participant observational study focusing on six district nursing teams. Purposive sampling was used to identify four teams with high minority ethnic caseloads and two teams with predominately white ethnic majority caseloads. Interview transcripts and field-notes were analysed by drawing upon the principles of dimensional analysis. The paper focuses upon institutional influences on the provision of care to minority ethnic communities. An analysis of the allocation of district nursing resource to different general practitioner (GP) practices identified marked inequalities in the district nursing provision which impacted upon the services provided to minority ethnic patients. Single-handed, inner city GP practices with a large minority ethnic practice population received a much smaller allocation of nursing staff than single group practices serving a smaller and predominately white practice population. The reasons why this situation existed are explored and an explanation offered as to why it had not been rectified. Observation of caseload management indicated that despite differences in the size of the practice populations served by the respective teams, all patients referred for nursing care received it. However, several covert processes appeared to limit the caseload size of those teams with large practice populations so that it remained manageable within the limited nursing resource available. It is concluded that although nurses at an individual level did not appear overtly to disadvantage minority ethnic patients, institutional forces conspired to perpetuate the disadvantage experienced by minority ethnic communities. [ABSTRACT FROM AUTHOR]

This paper argues that the current conception of evidence-based medicine has its limitations in the promotion of research which effects the quality of service in any health care system. It also poses something of a difficulty for the development of evidence-based nursing in particular. This paper advocates the more broad based concept of evidence-based practice and discusses its potential for addressing theory/practice problems and the uptake of nursing research. The broader conceptualization of evidence-based practice focuses on the integration of available evidence and the tacit knowledge of the investigator. An evidence-based practice project undertaken in Hong Kong is outlined as this provided the basis of many of the conclusions made in this paper. Three vignettes are given in order to demonstrate the nature of the evidence-based practice projects which have been conducted. The critical elements of evidence-based practice projects are outlined. Finally issues concerning the process of generating evidence, the relationship to continuous quality improvement and the cost effectiveness of evidence-based practice are discussed in more detail. [ABSTRACT FROM AUTHOR]

This paper utilizes data generated during a qualitative study in palliative and maternity care settings to guide discussion of the current discourse, which emphasizes patient autonomy and derides paternalism. Data are presented which illustrate that this ideology is established in nursing practice. Respect for patient autonomy is identified as an essential element of individualized, patient-centred and ethical care but conversely, it is suggested that overemphasis may confuse and suppress beneficent intervention. The value of ethical theory to provide an objective means to explore ethical dilemmas in practice is not debated, but exploration of the issues raised by the data suggest, that principle-based ethical theory suffers the following constraints: the predetermined balance of ethical principles in favour of respect for autonomy prevents an unbiased perspective and optimum guidance; in contrast to caring relationship, application of ethical theory does not reveal the particulars necessary to guide ethical decisions aimed at promoting good for the individual; current discourse appears to disregard the inherent inequality in the relationship between the helped and helper and practitioners' need to preserve their own moral integrity. Consequently, this paper argues that beneficence derived through caring should not be superseded uncritically and suggests that mutual nurse-patient relationship, which balances respect for patient autonomy and beneficent guidance based on practitioner's clinical expertise, protects the moral integrity of both patient and practitioner. For conciseness, the term patient will be used to indicate recipients of both nursing and midwifery care and while both nurses and midwives are not always specified, any term referring to nurses, denotes both. [ABSTRACT FROM AUTHOR]

The growing debate about the ability of the nurse to empower patients has featured frequently in the nursing journals over recent years. This paper seeks to address the issue around the need to empower dying patients by an examination of nurses' written reflections on critical incidents in their practice. Geertz's 'thick description' has been used to interpret the data. The issues of power and professionalism are central to the discussion. The results are tentative given the sample size but point towards a redefinition of the empathetic approach and the adoption of a 'facilitative' approach to the sharing of power. The paper recommends careful examination of the role of the nurse and the communication process to identify further barriers to patient empowerment. [ABSTRACT FROM AUTHOR]

The aim of nursing research is generally agreed to be the generation of knowledge, and whilst this is a relevant aim in theory-based disciplines such as sociology, the primary concern of nursing is with practice. Using examples drawn mainly from the field of mental health, it will be argued in this paper that the application of generalizable, research-based knowledge to individual, unique, person-centred practice, the so-called 'research-based practice' advocated by the Department of Health, is one of the main causes of the theory-practice gap. It will be further suggested that nursing requires a paradigm of clinical research which focuses on the individual therapeutic encounter in order to complement the existing sociological paradigm of theoretical research which is best suited to the generation of generalizable knowledge and theory. The paper will conclude by suggesting that such a clinically based research paradigm must not only focus on the individual nurse-patient relationship, but that it must be carried out by the nurse herself. Clinical research, if it is to make a difference to practice, must therefore be practitioner-based research. [ABSTRACT FROM AUTHOR]

This paper sets out a new approach to dementia that may be used to underpin mental health nursing practice. The paper begins by examining the development of community care. Various models of service provision to people with dementia are then critically examined. As an alternative to these approaches a new model of dementia is developed which highlights the position of various family members in the provision of dementia care including the person with dementia and also the importance of linguistic devices such as narrative and discourse. Finally the implications of this approach upon the mental health nursing practice are examined together with various suggestions for the development of research. [ABSTRACT FROM AUTHOR]

This paper develops a framework of empowerment within which to examine the commissioning process for nurse education arising from market reform of the British National Health Service (NHS). The paper argues that an imbalance in this commissioning process favours theoretical products, such as the diploma-level nursing curricula (Project 2000). Also, the university setting of nurse education is seen as clinically de-skilling both nurse teachers and student nurses as well as influencing the discourses on clinical skills. The paper further argues that the effects of such trends are a captive market in nurse education contracting and a displacement of nursing knowledge. An approach to commissioning nurse education is described which may counter such trends and positively impact on NHS organizational development and quality. Further reform of the commissioning process is described in context of pragmatic health legislation. [ABSTRACT FROM AUTHOR]

This paper examines general nurses' views of the nursing record and its routine usage in contemporary hospital practice. It draws on ethnographic data generated on a surgical ward and a medical ward in a single District General Hospital in the United Kingdom (UK). A key research finding was ward nurses' equivocal attitudes to the nursing record. On the one hand, because of its links with the nursing process, the nursing record was highly valued as a symbol of professionalism and ward staff were loathe to criticise it directly. On the other hand, however, the nurses in this study clearly found it difficult to reconcile their professional ideals with the ways in which the nursing record was routinely employed on the wards. In this paper it is suggested that at one level, nurses' ambivalence towards the nursing record reflected the distortion of its founding philosophy by the new managerialism in the contemporary UK health care context. At another level, however, there are also difficulties which arise from the tension between the assumptions about the nature of nursing work which underpin the nursing record and the workplace reality on hospital wards. [ABSTRACT FROM AUTHOR]

This paper is based on the authors' experience of teaching and supervising the first intake of the management unit of the diploma for charge nurses offered by the Department of Professional Development and Training, Glasgow College of Nursing and Midwifery, Glasgow, Scotland. The students on this course undertake a project comprising of a documented research-based action plan aimed at the achievement of a selected topic for change directly linked with their practice. All the students except one were G grade charge nurses from a wide variety of clinical backgrounds. This paper will briefly consider the work of Barriball et al. who suggest categories of outcomes of continuing professional education. This is contrasted with Scheller, who highlights three problems when attempting to measure the impact of continuing education on practice. Despite these problems, it is beneficial to attempt to consider the impact of continuing professional education on practice. The work of Francke et al. will be featured in which they ascertain the determinants of changes in nurses' behaviour after continuing professional education. The authors believe that the management of change project, undertaken by the students, enhances the possibility that knowledge gained from the management unit will impact on their practice. Two examples of students' projects will be used to support the paper. The first concerns changing to a 12-hour shift pattern in an intensive care setting and the second relates to the implementation of the named nurse system. [ABSTRACT FROM AUTHOR]

The term 'loss' is used frequently in the nursing literature and by nurses in the clinical setting. However, loss as a concept has not been defined comprehensively. In this paper, an attempt will be made to analyse the concept. The paper will begin with an overview of approaches to concept analysis. Subsequent sections include a literature review examining current and classic usage of the concept. General and specific definitions of loss provide a template for discussion. The paper will conclude with the identification of critical attributes for the concept which will form the basis for an exploration of explicit empirical referents. [ABSTRACT FROM AUTHOR]

Informed consent, essentially a legal doctrine, is designed to protect the rights of patients. However, in an area of practice such as psychiatry, informed consent imposes many problems if one considers it to be a static process. In this paper we propose that process consent, the type of consent considered essential in qualitative research projects, is not only appropriate but necessary for mental health nursing practice. This type of consent is an ongoing consensual process that involves the nurse and patient in mutual decision making and ensures that the patient is kept informed at all stages of the treatment process. We have used neuroleptic medications as an example throughout the paper and have suggested that seeking informed consent should be added to the role of the nurse in the mental health setting. [ABSTRACT FROM AUTHOR]

Clinical supervision is an emerging force in nursing practice in the United Kingdom. However, much of the nursing literature suggests uncertainty with regards to what clinical supervision is and the resources needed for safe professional practice. This paper explores a method of introducing clinical supervision to nurses in such a way as to model the skills and competencies required for developing productive working relationships. The main recommendation of this paper is that procedures for introducing clinical supervision mirror qualities required for developing effective nursing relationships. [ABSTRACT FROM AUTHOR]

Through an exploration of the realms of professional responsibility this paper aims to illustrate its implications in nursing practice with particular reference to the area of cardiothoracics. Throughout the paper issues surrounding the 'Code of Professional Conduct for the Nurse, Midwife and Health Visitor' and the 'The Scope of Professional Practice' released by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (U.K.C.C.) in 1992 are considered. 'The Code' as it will subsequently be referred to, and the 'The Scope of Professional Practice' (U.K.C.C.) address issues of current change within the nursing profession and provide a focus for discussion. While recognising both current constraints to clinical practice and the complexity of professional responsibility, it is concluded that the delivery of research based, quality patient care remains central to the role of all nursing professionals. With a primary focus on others before the self, nursing professionals must continue to address issues surrounding the maintenance and development of this care. [ABSTRACT FROM AUTHOR]

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

It is suggested in this paper that the potential barriers to facilitating research-based practice can be comprehensively understood using a communication model approach. Barriers can thus be explored related to the research findings' message, to the ways in which this message is encoded and transmitted by nurse researchers and to the ways in which the message is received, interpreted and accepted by nurse practitioners. The role of research-based practice as a communication feedback mechanism is also described. The paper concludes by proposing that strategies for increasing the research base of our profession are more likely to be successful if all of these potential barriers are taken into account. [ABSTRACT FROM AUTHOR]

The paper begins with a review of the nature of theory-based practice and how it is evidenced. This is then used to demonstrate that theory is based upon practice and that there is not a gap between theory and practice but rather there is a theory-theory gap which is evidenced by a lack of experiential knowledge. The paper continues by exploring ways in which theory can be integrated in practice to provide the student with experiential knowledge and the challenge this creates for nurse teachers. It finishes with a proposal for the way in which the nurse teacher might develop his/her clinical role to address the gap whilst securing their basis for the future in higher education. [ABSTRACT FROM AUTHOR]

Nursing scholars from around the world have written extensively in the past decade of the need to transform current health care systems and of the role of nursing education in achieving this goal. Proposals for change abound in the literature and are beginning to emerge in practice but not without difficulties. Having examined new curricular developments, this paper will discuss barriers to further progress. It is suggested that emphasis on reforming schools of nursing and teaching practices has tended to overlook broader institutional influences, in particular the clinical settings in which 50% of nurse education occurs. This paper will outline the major themes of the curriculum revolution, examine the ways in which educational institutions, health care settings and nursing organizations hinder the progress of curricular reform, and discuss possible solutions and their limitations. [ABSTRACT FROM AUTHOR]

In the early 1980s Canadian professional nursing associations officially adopted the goal of baccalaureate entry to practice by the year 2000. In the ensuing years, nursing educators have explored a variety of means to work toward achieving this goal. This paper describes a collaborative model of baccalaureate programme delivery developed between a university school and a hospital-based diploma school in Vancouver, British Columbia. The paper documents the history of the collaboration and the organization of human and physical resources for implementation. The issues and challenges encountered in the transition, the strategies used to facilitate the process, and the benefits gained by each partner are discussed. [ABSTRACT FROM AUTHOR]

The paper focuses on a significant nursing initiative for staff development undertaken in South Australia. The initiative arose out of Health Commission funded consultancy which sought to develop a staff development model for registered nurses. The outcome of this consultancy was the development of a multi-generational staff development model, known as the DPS Staff Development Model. This model provides a framework through which staff development activities can be analysed, consolidated and extended. The paper outlines the DPS Staff Development Model, the context in which it was developed and its implications for nursing staff development programmes. The development of the model was premised on a number of assumptions. These included the need to ensure flexibility, longevity, offer a perspective of staff development that is realistic and practical, and facilitate in registered nurses a sense of ownership and personal responsibility with respect to their development. The model comprises six broad areas of focus: the Career Development Model for registered nurses in South Australia, the structure of the model, locations in which staff development occurs, elements which assist in maintaining skills and knowledge, elements which inhance growth and development and the processes and relationships necessary for the successful implementation of staff development programmes. [ABSTRACT FROM AUTHOR]

Comfort is a term that has a significant historical and contemporary association with nursing. Since the time of Nightingale, it is cited as designating a desirable outcome of nursing care. Comfort is found in nursing science, for example in diagnostic taxonomies, and in references to the art of nursing, as when practice is described. Roy, Orlando, Watson, Paterson and others use comfort in major nursing theories. The term can signify both physical and mental phenomena and it can be used as a verb and a noun. However, because comfort has many different meanings, the reader has had the burden of deciding if the term is meant in one of its ordinary language senses or if its context reveals some special nursing sense. The purpose of this paper is to analyse the semantics and extension of the term 'comfort' in order to clarify its use in nursing practice, theory and research. The semantic analysis begins with ordinary language because the common meanings of the term are the primary ones used in nursing practice and are the origin of technical nursing usages. Comfort is discussed as the term is found in nursing, including texts, standards of care, diagnoses and theory. An account of patient needs assessment is used to cull three technical senses of the term from its ordinary language meanings. After contrasting these senses in order to justify their separateness, they are shown to reflect differing aspects of therapeutic contexts. Defining attributes of the three senses are then explicated and presented in table format. The last section of the paper addresses some of the ways that the extensions of the senses can be measured. [ABSTRACT FROM AUTHOR]

Until recently discussion about nursing research centred on the need to get it carried out. Attention is now being focused on how to get nursing research used, since so far, such research findings have not, on the whole, been assimilated into practice. Until this occurs the practice of nursing will not and cannot be research-based in any meaningful way. It is postulated that nursing research findings provide nurses with indicators for practice. This assumes that such findings are available and that the main barrier to their use is the poor communication of this research, (in a form they can understand) to nurse practitioners. However recent research into the use of research findings casts doubt on this assumption and it can be argued that such a view is too simplistic. In this paper therefore, three questions are asked: (1) Are relevant nursing research findings available which provide indicators for practice? (2) What indicators do such findings provide? (3) Are such findings used by nurse-practitioners? Using specific examples from nursing research, ideas and suggestions are put forward which provide a basis for possible answers. Finally the paper discusses the interdependence of research and practice and the need for them to develop together. [ABSTRACT FROM AUTHOR]