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Increasingly, it is being recognized that nursing knowledge derives from many forms. Chinn and Kramer (1991) suggest that there are four types of knowledge, i.e. ethical, empirical, aesthetic and personal, while Sarvimaki (1988) identifies nursing as a moral, practical, communicative and creative activity.

The concept of the expert patient is an increasingly important one in healthcare policy and delivery. To date, however, there has been relatively limited consideration of the nature and characteristics of the knowledge and skills underpinning the role of expert patient or the relationship to more traditional health professional expertise. This article considers the emerging concept of the expert patient in the UK, its relationship to the emergence of the expert patient elsewhere (notably in Canada), together with exploration of the supporting rationales, assumptions and possible implications associated with the initiative.

This is the first of two articles which collectively consider the evolving concept of ‘consumerism’ within the NHS and the degree to which this can be seen as having informed preregistration nursing and midwifery education within England. The impact upon preregistration education is the focus of the second article within which findings from a four-stage study will be explored. This first article considers the nature of consumerism in relation to the health service. It seeks to explore the place of consumerism within the NHS reforms heralded in 2000, while acknowledging that as a concept it remains problematic. The potential distinction between the individualistic and more collectively based notion of consumerism is highlighted. Finally, the article suggests that in order to adopt fully the consumer ethos in the NHS -— more latterly redefined as a user- or partnership-based service — appropriate resources and education are required.

Nurse practitioners have been used in the USA for 30 years and have been shown to provide better and more cost-effective care than doctors in primary care settings. Consequently, they are a powerful vehicle for professional change in the current cost-cutting healthcare reforms. This article examines the American experience.

This article considers the potential reasons for the increasing importance of ethical concerns in the context of nursing management and its implications.

Jane Fox discusses quality of care today

I suspect that my recent conversation with two nurses is one that many readers will be able to echo. One of the nurses had recently completed a diploma of higher education in nursing but had not been successful in securing a full-time post. The second, who had been a registered nurse for some years, was fearful that she might shortly be unemployed as a result of service changes.

The Royal College of Nursing recently published a ‘Working Well – At breaking Point’ survey (RCN, 2005) which in summary indicated that

This article presents findings from an 18-month case study of a web-based news group used by individuals with alopecia universalis. Content analysis of 228 episodes of web-based communication that occurred in relation to themes of discussion was undertaken supported by the use of concept mapping (Northcott, 1996). Analysis identified a core concept relating to that of a community of shared experience together with four supportive themes. The themes were the search for understanding and meaning, carrying on, seeking balance between past, present and future, and relating to new self, others and the world. The article discusses the increased growth in the use of the web as a vehicle for exploring health concerns and the specific ethical and methodological issues raised by research in this area.

This article, the second of two parts, presents findings from a four-stage study exploring the extent to which consumerism and its related aspects have been incorporated into the preregistration nursing and midwifery curriculum. The study was undertaken in recognition that NHS policy (as considered in the first article: Vol 12(5): 321–6) increasingly gave emphasis to the development of a health service that was more consumer and user focused. The study involved use of a Delphi panel, postal questionnaire, review of curriculum documentation, and timetables, together with a small focused group discussion. Findings indicate some aspects relevant to consumerism in health care, e.g. communication and ethical principles were included in the curriculum. Other aspects, such as advocacy, quality assurance, and lay health beliefs, were viewed logically from the perspective of the professional role. In essence, no curriculum transparently addressed consumerism in a central and focused way, although midwifery — and to some extent mental health, learning disabilities, and child branches — gave more overt attention to consumerism than adult branches.

Recently I found myself reflecting on the maintenance of appropriate professional standards, and how it seems to emerge regularly as a substantial challenge or at least as an item worthy of public and professional interest. (Indeed one only needs to peruse recent editions of BJN to find evidence of this.)

The release earlier this year of a position paper on clinical supervision, commissioned by the Department of Health (DoH), is both timely and significant (Faugier and Butterworth, 1994). The report highlights the fact that clinical supervision is often confused with concepts of preceptorship and mentorship.

The Audit Commission report Trusting in the Future: Towards an Audit Agenda for NHS Providers, published on 13 April 1994, may not be many nurses' first choice as bedtime reading. Nonetheless, it does offer insight into two important pillars of government thinking.

February 17 1994 may be viewed as a watershed in years to come. For on that date a House of Lords select committee discussed the issue of living wills in the wider context of euthanasia and medical ethics. The result was a recognition that a living will might be taken into account when deciding the appropriateness of treatment. The select committee also decided that it was desirable for guidelines governing the use of living wills in such decision making to be established.

The increased attention given to the concept of care within the nursing literature must be considered in the light of the relatively superficial consideration given to the same concept within the educational curriculum. This article offers possible explanations for such brief consideration before discussing the development of a new framework for analysis of care.

Sceptics might claim that quality assurance has become the battle cry of the late 1980s and ‘90s. Certainly, the concept of quality assurance is at the forefront of any current professional debate. Its prominence is perhaps not surprising when viewed in the context of health provision based on market economy and its related consumerism. The notion of quality in health care can only be applauded; difficulties and dissents arise only when the practicalities of defining and determining quality have to be addressed.

The concept of care has always been of central concern to nurses, in terms of both academic definitions and parameters, and the practical dynamics of provision. This has been demonstrated by Sarvimaki (1988), Dunlop (1986), Benner and Wrubel (1989), Watson (1989) and Wild (1989). However, a new era of interest focuses on care not as a concern for nurses alone, but rather in the context of multiprofessional interaction (Fox and Forman, 1992) which includes those who engage in care activities but are not members of a registered health profession.

Late in 2009, a hospital I’d worked at years ago celebrated its centenary and this prompted me to reminisce. I recalled previous colleagues; those most vivid to me shared a number of characteristics. Generally they demonstrated high levels of professional skill and knowledge, provided high quality nursing and genuinely cared about their patients and colleagues. In other words they demonstrated what we now call ‘patient centredness’. Above all, they committed time and effort supporting and teaching colleagues, especially junior staff and those in training. They imparted their skills and knowledge and particularly their enthusiasm for nursing. Today we would talk about them as effective role models and mentors. Regardless of the labels used, they had a significant impact on my skills acquisition, but more importantly, on my willingness to undertake further learning and my views about what was important and valuable in caring for others. I know others were also influenced in very similar ways

This paper is based on, and summarises, papers read at the second annual international conference of Nurse Education Tomorrow held at the University of Durham (UK) September 1991. To this end this paper will offer: • Some Accreditation of Prior Learning (APL) definition and process as reflected in the literature available. A distinction will be made between APL and Accreditation of Prior Experiential Learning (APEL) although the procedures and processes for assessing them will be shown to be the same. • A brief outline of corporate strategy, as it applies to APL, will be given to form the basis for logical demonstration of how Derbyshire Institute of Health and Community Studies has employed such a corporate strategy. • Insights developed and gained from APL research currently being undertaken through the college of nursing and midwifery will be used to inform the development and nature of corporate strategy. A flowchart of the operationalisation of the corporate strategy is offered as an integrative summary of how all the APL ideas have had a positive cumulative effect. • The paper finishes by highlighting the possible strengths and limitations of APL corporate strategy.

Recently a family friend of many years was acutely ill in hospital, fortunately, she recovered and returned home. It was perhaps this incident that alerted me to the new guidelines released on 25 July 2007 by the National Institute for Health and Clinical Excellence (NICE, 2007) – Acutely Ill Patients in Hospital: Recognition of, and Response to, Acute Illness in Hospitalised Adults. The development of the guidelines were prompted by The National Patient Safety Agency (NPSA, 2007) publication, Safer Care for the Acutely Ill Patient: Learning From Serious Incidents, which is a comprehensive analysis of incident reports on 107 patients, whose deaths in acute hospitals were reported to the agency because of concerns about the safety of their care.

There are compelling reasons to suggest that nursing should be an all-graduate profession (RCN, 1997). Technological advancement, research-based education, clinical effectiveness, and evidence-based practice all provide the impetus for such change to take place. Nursing education has at last earned long overdue recognition. Infrastructures which can accommodate the implementation of an all-graduate nurse education programme in the UK are already in existence. These infrastructures developed as a result of Project 2000 and the recent integration of nurse education into the higher education sector.

Students frequently receive positive feedback and encouragement to develop an assignment for publication, but are unsure how best to proceed. Having a strategy that guides conversion of an assignment into an article can ease the task. Such a strategy can be informed by a few key questions and steps which are explored below.

The ethos of the internal market and devalued power to trusts has inevitably led to local pay and reward systems being put on the management agenda. A recently published survey (Industrial Relations Service (IRS), 1995) provides an interesting portrait of the achievement and presents plans for the introduction of local pay systems in 180 trusts.

The British Medical Journal of 29 April (1994) made grim reading for it highlighted, both in its editorial by Wilkinson and in five accompanying reports (Bissett et al; Morris et al; Phillimore et al; Power; Williams et al), the impact of current poverty upon mortality. Life expectancy for some groups is reported to be at its worst for 50 years, rising in absolute terms for men under 45 years and women aged 65-75 years.