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This paper describes a framework used by the National Institute for Nursing in Oxford to integrate research, development and practice. With the increasing attention given to the topic of how research findings are implemented into clinical practice, it was felt important to share the challenges that have arisen in attempting to combine traditional research activities with more practice-based development work. The emerging conceptual framework, structures and functions are described, highlighting the variety of partnerships to be established in order to achieve the goal of integrating research into practice. While the underpinning principles of the framework -- generating knowledge, implementing research into practice and evaluating the effectiveness of programmes -- are not new, it is the way they have been combined within an organizational structure that could be helpful to others considering such a strategy. Both the strengths and weaknesses of the framework are discussed, a number of conclusions drawn as to its robustness and consideration given to its replication. [ABSTRACT FROM AUTHOR]

Over the past 15 years, the 'theory-practice gap' has been a recurrent theme in the nurse education literature. Numerous explanations are put forward for its existence, along with many suggestions as to how the apparent divide can be bridged. A key component of nursing practice is problem-solving but not all nurses are competent at finding suitable solutions to the problems they face in practice settings. Therefore ways of developing learner proficiency in problem solving is crucial and should occupy a substantial part of teacher activity. One recent educational method for promoting problem-solving skills is problem-based learning [PBL] using the hypothetico-deductive technique. This approach encourages students to work through problem situations, generating hypotheses and testing these against the relevant literature and personal experience. The process itself is seen as the essential element in developing problem-solving skills, so that when the students are qualified they can apply the same methods to patient care. This paper explores the use of the PBL approach with a group of 11 fourth-year undergraduate students. The method employed was a case study design using observation as the main data collection technique. Subsequent analysis focused on: (a) practice; (b) teaching method; (c) knowledge attainment; and (d) the role of the teacher. [ABSTRACT FROM AUTHOR]

As western society becomes increasingly pluralistic, nurses are confronted by fundamental controversies, such as those moral, philosophical or religious in nature. One strategy to deal with such pluralism is to dismiss a nurse’s fundamental moral, philosophical or religious commitments as unprofessional bias. In this paper, however, I would like to analyse the presence and function of religious commitment, in particular to see if it could have a justified and relevant function in nursing care. This function will be elicited by interpreting nursing care as a practice and applying a certain theory of theorizing, focusing on the function of ‘control beliefs’, of which professionalism is one particular set. [ABSTRACT FROM AUTHOR]

Spirituality is a universal human phenomenon, yet conceptual confusion, ambiguity and scientific scepticism have prevented adequate investigation into its potential healing effects. A recent resurgence of interest in non-medical sources of healing and holistic medical practices is causing increased speculation regarding the nature of spirituality. The lack of conceptual clarity, and absence of a precise theoretical definition, prevent recognition of spiritual distress and, hence, appropriate nursing intervention. In this paper, current usage and definitions of spirituality are discussed and a philosophical definition of 'spirituality as integrative energy' is proposed. The metaphysical nature of this phenomenon makes it the proper concern of philosophy; consequently, a philosophical analysis of the aforestated proposition was completed using the five predicables of logic theory: species, genus, differentia, logical property and logical accident. Implications of this definition for providing holistic nursing care are also presented. [ABSTRACT FROM AUTHOR]

Dickoff & James assert that theory comes from practice for practice. This paper will explore the reality of this statement in nursing today. The nature of nursing knowledge from an historical perspective facilitates an understanding of where nursing theory development is today. The purpose of theory is debated and the motivation for its development considered. Practice theory, theory which is developed from practice for practice, is analysed, and this is advocated as one method to reduce the theory-practice gap in nursing. Whether practitioners are able to undertake the development of practice theory is discussed and some obstacles identified. Reflection and action research have been offered as methods to facilitate the development of practice theory by practitioners. [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]

The process of choosing a nursing model or theory to guide one's clinical practice, curriculum development or theoretical framework for research can be facilitated by analysis of and comparison of existing theories, with each other and then with one's personal philosophies. This paper summarizes the major concepts and assumptions of Dorothea Orem's self-care model and Hildegard Peplau's interpersonal theory, and then compares the two for similarities and differences in their origins of theory development, meanings related to nursing metaparadigm concepts, logical adequacy, usefulness and generalizability, parsimony and testability. [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]

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

In recent years increasing awareness and interest in different approaches to caring for elderly people have produced improvements in their psychological and social care. This paper evaluates the change in the quality of life which was brought about by the introduction of activity nursing into a continuing care unit. Significant changes were observed in cognitive functioning and quality of life. The benefits to both relatives and staff were also considerable. [ABSTRACT FROM AUTHOR]

Is elderly care nursing a speciality? This paper reports results from an interview-based study which aims to uncover the distinctive elements of nursing work with elderly people. Within the context of sociological literature on specialism it is concluded that a case for seeing elderly care nursing as a speciality area can be made. However, that case has implications for the continued marginalization of elderly people in society. [ABSTRACT FROM AUTHOR]

This paper describes the first stage of a research project investigating unmet needs for community nursing services. The research analyses the relationships between differences in perception of valid needs between the public and staff, ways of working and organizational constraints on community nursing practice, and the incidence and nature of consumer-defined unmet needs. The aim of the first stage was to analyse the level and kind of consumer-defined need amenable to community nursing intervention and identify possible shortfalls in current provision. The study used a postal questionnaire and samples were selected using proportional, stratified random sampling from a Community Health Index. The sample size was 1770 and the response rate 38%. Analysis involved frequency counts for all variable data and statistical analysis of relationships between variables, using the chi-square test with the level of significance set at 5%. Analysis of the questionnaire identified possible latent need in relation to activities of daily living and health problems. The 57-69 and 70+ age groups were found to have the highest level of self-perceived difficulties with the above, many of which were said to be unmet. Fewer respondents in the younger age groups experienced these difficulties; however, those who did were less likely to be receiving help. In most cases, respondents with perceived unmet needs had never sought help. In relation to community nursing, this may be associated with the lack of knowledge and misconceptions about the roles of community nurses which were identified from questionnaire responses. This study also indicated possible unmet need among carers for education and guidance about the services available for them and how to gain access to them. Possible unmet need was identified in relation to health promotion activities. Analysis of attendance and interest in health groups and sessions suggested the need for more of this type of activity and more education on the possible benefits which can be gained from them. [ABSTRACT FROM AUTHOR]

This paper commences by observing that psychiatric nurses tend not to interact with their clients in a therapeutic fashion. It is not clear, however, whether this is due to the nature of psychiatric institutions or to the attitudes of individual nurses. Contrasting social theories which posit either the importance of social structures, or of individual interpretations as determinants of behaviour, are outlined. These are then applied to the problem of psychiatric nursing practice. It is argued that while there are strengths in both theoretical positions, neither on their own can adequately characterize the complexity of the problem. Rather than attempting to explain influences upon psychiatric nursing practice in terms of either structure or action, we should appreciate the importance of, and relationship between, both factors. Given the rapid changes occurring in mental health nursing, research into factors influencing practice will become increasingly important. In order to explain developments adequately, researchers will need to take account of the duality of structure and action. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to analyse the concept of feminism in order to clarify a sociological concept for its use in nursing theory and practice. This analysis is carried out using the Walker & Avant (1988) model. It includes: a literature review, an overview of the uses of the concept drawn from the literature, the defining attributes and the justification of their choice, the cases to demonstrate the concept, and the concept criteria. The concept was chosen out of an interest in developing a feminist nursing theory and desire to enhance nursing practice. The literature search proved most fruitful in the sociological literature. The nursing sources were fewer and concerned with practice rather than articulating any feminist nursing theory. Many of these sources were sociologists and nurses. The concept of feminism was defined as the concern with gender equality and the promotion of equal rights for men and woman, the expression of these concerns through theory or action, and the valuing of individuals for their contributions to society rather than their biological or sexual characteristics or roles. Although the concept of feminism was defined and analysed within the model suggested by Walker & Avant, the author found that the concept became oversimplified, losing much of the richness of the literature. The author felt that, for any development of theory or practice, this analysis would have to be expanded. It is argued that their model is too restrictive as it is based on positivist philosophy which seeks to establish divisions where, in fact, there is a blurring of meaning. Contrary to Walker & Avant, it is argued that if concepts overlap this does not necessarily diminish the potential usefulness of the concept in theory or practice. [ABSTRACT FROM AUTHOR]

This paper explores the notion that nursing education is a political process which reproduces traditional practices. There is evidence to suggest that dominant ideologies, embedded in the social processes of education and health care, shape the consciousness of nurse teachers and students towards conformity and compliance with established practices in hegemonic institutions. Traditional practices or 'common sense' reinforces the structural arrangements which contribute to the contradictions that students experience between knowledge they are 'given' in the classroom and knowledge they derive from their clinical learning experiences. It is clinical placements which bring students face to face with their position in the established hierarchy of knowledge, professional relationships and routinized practices. In this sense students may experience their classroom education as a denial of their lived experience in clinical settings. They may learn to negotiate among the different meanings and explanations they encounter and learn to act in ways that are personally and professionally 'safe', thereby reproducing traditional nursing culture. Project 2000 in Great Britain and the calls for a 'curriculum revolution' from North America promise transformation of traditional practice. But it is the political processes of teaching and learning and their practical effects which must be revealed for critique and transformation if professional ideals of reflective practice, emancipatory knowledge and professional autonomy are to play an integral part in transforming professional nursing practice within hegemonic institutions. [ABSTRACT FROM AUTHOR]

In this paper, the authors present their analysis of the concept of mobility as a starting point for the development of relevant theory. Multiple uses of the concept are considered and provisional criteria identified. Case examples, together with antecedents and consequences, of the concept are presented. Finally, research questions that would form the basis of fieldwork have been generated. [ABSTRACT FROM AUTHOR]

The paper discusses the effects of a nursing supervision programme on nursing practices, more specifically on how nurses take their patients' needs into account. The analysis is based on the need theory by Yura and Walsh and examines the changes initiated by the programme on the basis of the subjects' own experiences. The study was carried out in three Finnish public health care organizations. A total of 26 specially trained nurses took part in the supervision programme. The data were collected by a questionnaire immediately before and after the programme and, in order to evaluate long-term effects, 1 year later. Log-linear models were the main method of analysis. The results indicate that the programme had some very favourable effects. According to the nurses involved, their freedom of action and willingness to act, as well as nursing activity itself, had greatly improved. The change was most noticeable in the case of willingness to act. The nurses also felt that the programme had helped them to understand better the relationship between these three components. The results provide some useful clues with regard to the effects of nursing routines and the organization's nursing culture on the nurse's job and her activity. [ABSTRACT FROM AUTHOR]

In this paper, the consequences were there greater autonomy in nursing practice, are considerd. Autonomous practice implies accountability which entails both personal and professional responsibility: a personal responsibility to endorse ethical conduct consistent with professional practice; and a professional responsibility to exercise discretionary powers to the ultimate benefit of the patient. In this context, discretionary responsibility implies: recognizing a patient's wants may not be consistent with a patient's needs; abstaining from collusion with noncompliant patients; supporting the patient's right to refuse treatment only after full psychological exploration; understanding the psychological ramifications of informed consent from a practitioner and recipient point of view; maintaining appropriate personal and professional boundaries; and fostering collegiate relationships with the medical fraternity grounded on egalitarian principles. The author provides a philosophical and psychological analysis of responsibility in an effort to achieve a deeper understanding of the relationship this has with the concepts of 'freedom' and 'accountability'. [ABSTRACT FROM AUTHOR]

In this paper, an objective concept analysis was undertaken to examine the attributes, characteristics and uses of the concept of empowerment. A review of the literature and selected empirical referents indicated that empowerment is a complex and multi-dimensional concept. Within a nursing context, empowerment can be conceptualized as a composite of (a) attributes that relate to the client, (b) attributes that relate to the nurse, and (c) attributes that belong to both the client and the nurse. In a broad sense, empowerment is a process of helping people to assert control over the factors which affect their lives. This process encompasses both the individual responsibility in health care and the broader institutional, organizational or societal responsibilties in enabling people to assume responsibility for their own health. Antecedents to and consequences of empowerment, from a nursing perspective, are presented. To adopt truly an empowerment model in nursing, a radical paradigm shift is needed. The final conclusion is that this concept has great utility for nursing practice, education, administration and research. [ABSTRACT FROM AUTHOR]

The last 25 years have witnessed a growing support for and recognition of the importance of nursing theory, both in education and practice. This paper seeks to explore this movement, and also the issues in theory development, study and application. Definitions of theory are reviewed, and linked to the purpose of theory and theory development in nursing. The origins and motivation for developing nursing theory are identified, and arguments for the use of theory in nursing are raised. Further questions from the discussion of these issues are identified, questions likely to provide continued debate and investigation within the profession for decades to come. [ABSTRACT FROM AUTHOR]

The scientific knowledge on which nurses may base their clinical practice is often lacking. Not withstanding this, scientific knowledge in isolation is sterile unless it is invoked to address nursing hypotheses. This paper explores how such nursing questions can be both identified and answered within a scientific framework. Using the example of infection control, the complexity of the problem is examined and the contribution that various research approaches including in vitro investigations, can offer is evaluated. Nursing practice research has a vital role to play in determining the effective prevention of nosocomial infection. The necessity for a collaborative and flexible approach to such research and the value of multidisciplinary teams of nurses and other scientists is emphasized. [ABSTRACT FROM AUTHOR]

The discipline of nursing is in a process of rapid transition. In this paper, the developments are discussed that have affected nursing in its advancement to a full-grown profession. Nursing and medicine are the products of Cartesian thinking that has fragmented our perspectives on man and his living world. The consequences of this scientific viewpoint are reflected in all aspects of life. Attention is paid to advances in nursing practice and education, the development of nursing research and the emergence of a nursing science. These aspects are discussed in the context of professionalization and the position of nursing in the health care system and in society. The study findings of the Styles Report Project on the Regulation of Nursing (1985) serve as a framework of analysis. Links are made between the recommendations given in this report and the development of primary health care, the new tomorrow of a modern discipline. [ABSTRACT FROM AUTHOR]

This paper discusses the use of a variety of quantitative and qualitative methods of measuring quality in a nursing unit. It reports the results of comparing the quality of nursing care between patients admitted to the nursing unit concerned (in Oxford, England) following admission to an acute ward, with patients who spent the whole of their hospitalization in an acute ward. The findings suggest that quality can be best assessed by using a number of methods, and the quality of nursing care delivered in a unit which focuses on therapeutic nursing is significantly and consistently higher than that delivered in acute hospital wards. [ABSTRACT FROM AUTHOR]

Over the past decade there has been an explosion of interest and activity in the nursing profession directed toward the development of a theory base for nursing education and practice. Although we support the overall thrust of nursing theory development, we have concerns about its utility, scope and stated purposes. We are especially sensitive to the plight of the practising nurse who might attempt to use the current nursing theories to guide and explain choices made in daily practice. In this paper we examine current use of the word 'theory' and describe problems inherent in nursing's efforts to apply educationally derived conceptual frameworks to nursing practice. We identify a need for the development and use of many theories for nursing and argue that there is a logical need for a 'meta-model' which will guide the use of multiple theories in practice. A model is presented which allows the practising nurse to examine the various theories in terms of their applicability to a given client situation. We believe the model is also useful to nurse educators and researchers who may be attempting to use nursing theories for educational purposes or develop nursing's knowledge base through empirical work. [ABSTRACT FROM AUTHOR]

This paper demonstrates, through a specific case study, the relationship of nursing practice and research. The author discusses how a clinical problem stimulated research and how the research findings, then, were utilized in practice. Client attrition in an obesity program for high-risk clients was defined as the clinical problem. The researcher worked with the staff to further delineate the problem for research. The research findings concluded that body image was a more important motivating factor for entering treatment than were physiological health concerns. The author/researcher and clinicians then utilized the findings in the program, altering their approach to clients to include the client's goal for treatment; improved body image. The attrition rate in the clinic improved. The roles of the practitioner and those of the researcher in this relationship are discussed as well as specific factors which facilitated this important relationship. [ABSTRACT FROM AUTHOR]

This paper examines one study of nursing practice that utilized ethnography as a research approach. The general overview of the ethnographic method and the symbolic interaction framework used are described. An overview of the specific approach is included. The findings of the study are presented. The strengths and problems of the approach for nursing research are then reviewed. Some potential uses of an ethnographic approach for clinical nursing research are outlined. [ABSTRACT FROM AUTHOR]

The objectives for this paper are fourfold. Evaluation is put into perspective, including measurement and assessment, in relation to the curriculum as a whole. The elements included in the evaluation of educational programmes arc outlined. The process of evaluation is related to learning abilities in the cognitive, affective, psychomotor and experiential domains. Finally, some conclusions arc made about the process of evaluation. [ABSTRACT FROM AUTHOR]

This paper reviews the development of nursing in Britain in the light of an assumption that professional groups will seek to gain autonomy and control over others. Such an assumption is familiar to sociologists who tend also to argue that autonomy and control are gained via the creation of dependency. It is shown here that nurses have pursued a different occupational strategy, elements of which include subordination to doctors, acceptance of a wide range of tasks, and, in particular, routinization of their work. A range of reasons, both historical and contemporary, are suggested for this. Although not necessarily recognized in the form described here, the strategy of nursing is a coherent solution to a particular set of circumstances and eventualities. [ABSTRACT FROM AUTHOR]

The section comments on the article "Putting Nursing Research Findings into Practice: Research Utilization As an Aspect of the Management of a Change," by J. M. MacGuire, which appeared in the 1990 issue of the "Journal of Advanced Nursing." It comments on how MacGuire explored issues analytically in the paper. It asserts that MacGuire's analysis strangely framed much of the discourse on evidence utilization. It further points out that much of the paper is as true of professional practice in 2005 as it was in 1990.

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 opening sentence of the paper which suggests that empathy has been touted as appropriate and desirable. It asserts that the paper is unsatisfying and, from a contemporary perspective, seems naive. It states the reasons for the paper's lack of substance.

The section comments on the article "Establishing Rigour in Qualitative Research: The Decision Trail," by Tina Koch, which appeared in the 1994 issue of the "Journal of Advanced Nursing." Ways of representing rigour in research are discussed. It points out the things that made the paper fascinating, including how Koch constructs her case for rigour and validity. The paper's significance in the nursing field is mentioned.

The section presents the author's opinion on her article "Learning for Reality," which appeared in the 1976 issue of the "Journal of Advanced Nursing." It discusses the challenges the author faced while writing the paper. It describes the state of nursing education in the early 1970s when the research was undertaken. The significance of the study was mentioned.

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.

The section comments on the article "Is the Professional Code Still the Cornerstone of Clinical Nursing Practice?," by P. Esterhuizen, which appeared in the 1996 issue of the "Journal of Advanced Nursing." It asserts that the paper provided an excellent overview of the problems that confront ethical codes in nursing. It emphasizes the need for more research on nurses' awareness and knowledge of their ethical codes. It focuses on three of the insights provided by Esterhuizen.

The author comments on the paper published in the issue by Svavarsdottir and Orlygsdottir that examined the use of clinical guidelines in nursing practice. She believes that the development of clinical guidelines is a step toward evidence-based practice. The barriers to facilitate the use of clinical guidelines are addressed. She hopes that more nurses and midwives will be motivated to use clinical guidelines to enhance public health.