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For over a decade, the need to develop a robust evidence base for nursing, midwifery and health visiting through research has been part of the UK government's R&D strategy. Progress has been slow and little is known about the organisational reality of the most recent strategies. This study aimed to investigate the nature of posts with named responsibilities to lead and develop nursing and midwifery research activity, based in acute NHS hospital trusts. Data were obtained through telephone interviews with directors of nursing services, and a postal survey of relevant staff. Fifty two people responsible for nursing and midwifery R&D were invited to complete the questionnaire, of whom 34 responded. The majority of trusts were able to name an individual responsible for leading nursing R&D, although the remit of the role varied considerably. The effectiveness of implementing any national research strategy is likely to be constrained by the lack of consistency regarding nursing research roles, a factor that may also be implicated in the lack of progress in securing a meaningful contribution to NHS research from nursing R&D.

Interprofessional teamwork is seen in healthcare policy and practice as a key strategy for providing safe, efficient and holistic healthcare and is an accepted part of evidence-based stroke care. The impact of interprofessional teamwork on patient and carer experience(s) of care is unknown, although some research suggests a relationship might exist. This study aimed to explore patient and carer perceptions of good and poor teamwork and its impact on experiences of care. Critical incident interviews were conducted with 50 patients and 33 carers in acute, inpatient rehabilitation and community phases of care within two UK stroke care pathways. An analytical framework, derived from a realist synthesis of 13 'mechanisms' (processes) of interprofessional teamwork, was used to identify positive and negative 'indicators' of teamwork. Participants identified several mechanisms of teamwork, but it was not a subject most talked about readily. This suggests that interprofessional teamwork is not a concept that is particularly important to stroke patients and carers; they do not readily perceive any impacts of teamwork on their experiences. These findings are a salient reminder that what might be expected by healthcare professionals to be important influences on experience may not be perceived to be so by patients and carers.

Interprofessional teamwork has become an integral feature of healthcare delivery in a wide range of conditions and services in many countries. Many assumptions are made in healthcare literature and policy about how interprofessional teams function and about the outcomes of interprofessional teamwork. Realist synthesis is an approach to reviewing research evidence on complex interventions which seeks to explore these assumptions. It does this by unpacking the mechanisms of an intervention, exploring the contexts which trigger or deactivate them and connecting these contexts and mechanisms to their subsequent outcomes. This is the second in a series of four papers reporting a realist synthesis of interprofessional teamworking. The paper discusses four of the 13 mechanisms identified in the synthesis: collaboration and coordination; pooling of resources; individual learning; and role blurring. These mechanisms together capture the day-to-day functioning of teams and the dependence of that on members' understanding each others' skills and knowledge and learning from them. This synthesis found empirical evidence to support all four mechanisms, which tentatively suggests that collaboration, pooling, learning, and role blurring are all underlying processes of interprofessional teamwork. However, the supporting evidence for individual learning was relatively weak, therefore there may be assumptions made about learning within healthcare literature and policy that are not founded upon strong empirical evidence. There is a need for more robust research on individual learning to further understand its relationship with interprofessional teamworking in healthcare.

OBJECTIVES: To provide a comprehensive scoping review of evidence of the impact and effectiveness of 12h shifts in the international nursing literature, supplemented by a review of evidence in other, non-nursing related industries. DATA SOURCES: A search of the academic literature was undertaken in electronic databases (AMED, MEDLINE, CINAHL, PsychInfo, Scopus, HMIC, the Cochrane Library, Business Source Premier, Econ Lit, ASSIA and Social Policy and Practice). REVIEW METHODS: A total of 158 potentially relevant nursing research papers and reviews were published between 1973 and 2014. Two reviewers independently reviewed the articles, leaving 85 primary research studies and 10 review papers in the nursing field to be included in the scoping review. Thirty-one relevant primary research papers and reviews were also identified in the non-nursing related industries literature. RESULTS: Research into 12h nursing shifts fell within five broad themes: 'risks to patients', 'patient experience', 'risks to staff', 'staff experience' and 'impact on the organisation of work'. There was inconclusive evidence of the effects of 12h shift patterns in all five themes, with some studies demonstrating positive impacts and others negative or no impacts. This also mirrors the evidence in other, non-nursing related industries. The quality of research reviewed is generally weak and most studies focus on the risks, experience and work/life balance for staff, with few addressing the impact on patient outcomes and experience of care or work productivity. CONCLUSIONS: There is insufficient evidence to justify the widespread implementation or withdrawal of 12h shifts in nursing. It is not clearly understood where there are real benefits and where there are real and unacceptable risks to patients and staff. More research focusing on the impact of 12h nursing shifts on patient safety and experience of care and on the long term impact on staff and work organisation is required.

Formative assessment policies and self-regulation theories argue that student selfassessment of their own work and processes are useful for raising academic performance and self-regulatory skills. However, research into student self-evaluation raises serious doubts about the quality of self-assessment as an assessment process and identifies conditions which must be met if students’ judgments are to be useful, valid, and reliable. This paper recommends that student self-assessment should no longer be treated as an assessment, but instead as an essential competence for self-regulation. As such, we describe a potential curriculum approach that could guide teachers to appropriate use of self-assessment tools.

BACKGROUND: A growing number of countries legislate for nurses to have medication prescribing authority although it is a contested issue. The UK is one of these countries, giving authority to nurses with additional qualifications since 1992 and incrementally widened the scope of nurse prescribing, most recently in 2006. The policy intention for primary care was to improve efficiency in service delivery through flexibility between medical and nursing roles. The extent to which this has occurred is uncertain. This study investigated nurses prescribing activities, over time, in English primary care settings.\ud \ud METHODS: A secondary data analysis of a national primary care prescription database 2006-2010 and National Health Service workforce database 2010 was undertaken.\ud \ud RESULTS: The numbers of nurses issuing more than one prescription annually in primary care rose from 13,391 in 2006 to 15,841 in 2010. This represented forty three percent of those with prescribing qualifications and authorisation from their employers. The number of items prescribed by nurses rose from 1.1% to 1.5% of total items prescribed in primary care. The greatest volume of items prescribed by independent nurse prescribers was in the category of penicillins, followed by dressings. However, the category where independent nurse prescribers contributed the largest proportion of all primary care prescriptions was emergency contraception (9.1%). In contrast, community practitioner nurse prescribers' greatest volume and contribution was in the category of gel and colloid dressings (27%), medicated stockings (14.5%) and incontinence appliances (4.2%). There were slightly higher rates of nurse prescribing in areas with higher levels of socio-economic deprivation and fewer physicians per capita, but the correlations were weak and warrant further investigation.\ud \ud CONCLUSIONS: The percentage of prescriptions written by nurses in primary care in England is very small in comparison to physicians. Our findings suggest that nurse prescribing is used where it is seen to have relative advantage by all stakeholders, in particular when it supports efficiency in nursing practice and also health promotion activities by nurses in general practice. It is in these areas that there appears to be flexibility in the prescribing role between nurses and general practitioners.

OBJECTIVES: to evaluate the outcome and cost of transfer to a nursing-led inpatient unit for ‘intermediate care’. The unit was designed to replace a period of care in acute hospital wards and promote recovery before discharge to the community. DESIGN: randomized controlled trial comparing outcomes of care on a nursing-led inpatient unit with the system of consultant-managed care on a range of acute hospital wards. SETTING: hospital wards in an acute inner-London National Health Service trust. SUBJECTS: 175 patients assessed to be medically stable but requiring further inpatient care, referred to the unit from acute wards. INTERVENTION: 89 patients were randomly allocated to care on the unit (nursing-led care with no routine medical intervention) and 86 to usual hospital care. MAIN OUTCOME MEASURES: length of hospital stay, discharge destination, functional dependence (Barthel index) and direct healthcare costs. RESULTS: care in the unit had no significant impact on discharge destination or dependence. Length of inpatient stay was significantly increased for the treatment group (P=0.036; 95% confidence interval 1.1–20.7 days). The daily cost of care was lower on the unit, but the mean total cost was £1044 higher—although the difference from the control was not significant (P=0.150; 95% confidence interval -£382 to £2471). CONCLUSIONS: the nursing-led inpatient unit led to longer hospital stays. Since length of stay is the main driver of costs, this model of care—at least as implemented here—may be more costly. However, since the unit may substitute for both secondary and primary care, longer-term follow-up is needed to determine whether patients are better prepared for discharge under this model of care, resulting in reduced primary-care costs.

Originally published in 1991 as part of the Tavistock Classics in the History of Psychiatry series, this re-edition of J-M. Charcot’s Clinical Lectures on Diseases of the Nervous System provides a unique opportunity to examine the work of one of the last century’s most controversial and admired physicians. Widely esteemed for his work in neuropathology, Charcot was also an innovator in the study of hysteria, making important contributions to its study in both women and men. The Clinical Lectures reproduced here are especially important for two key reasons. First, they provide insight into Charcot’s often neglected study of male hysteria, especially traumatic shock, as well as, hysteria among children. Secondly, they give an opportunity to examine his clinical method and style. His presentations and scholarly compilations greatly influenced an entire generation of French and other physicians interested in the study of the ‘unconscious’ during the turn of the century. The introduction, which precedes the work, places the volume in its social, political and historical context. It highlights the key features of the historiographical debate surrounding Charcot, which ranges in scope from the social and intellectual history of the Third Republic through that of early psychoanalysis. It then proceeds with an examination of the key themes – both substantive and methodological – underlying Charcot’s researches, providing both a general entree into the history of medicine and society in this period, as well as an explication du texte which carefully analyses the lectures themselves.

AIM: To explore nurses' archived accounts of Matron Muriel Powell's management and leadership style and the impact of this on the implementation and sustainability of innovation in the workplace. BACKGROUND: In popular discourse, the matron has become an emblem of leadership. Although the title disappeared in the UK in the late 1960s as part of the re-organization recommended by the Salmon Report, it re-appeared in 2002 in an attempt to improve care standards by reasserting a strong nursing presence and clinical leadership role. DESIGN: Secondary data analysis using qualitative thematic analysis. METHODS: This paper draws on interview data held in the 'Nurses Voices' archive. The interview transcripts of 132 nurses who trained or worked at St George's hospital in 1920-1980 were analysed in depth between March 2011-January 2012 and themes were generated inductively by grouping together emergent codes in the data with similar meaning. RESULTS: Looking back, the nurses recalled strong memories of the leadership of Matron Powell. Her presence emerged as a significant influence throughout the interviews. Two resonant themes were identified: innovation and open communication. CONCLUSIONS: Through her visibility and direct access with patients and staff, Dame Muriel Powell showed what we would now call transformative leadership qualities. Her leadership created a culture of open communication and innovation that initiated change in the organization and the nursing workforce. Looking back and learning from historical figures can deepen understanding and provide pointers for the nurse leaders of today.

In 1857, a series of psychic torments and bodily seizures erupted in Morzine, a Savoyard commune of some two thousand migrant masons and seasonal workers in the high country of the Chablais. The crisis began when young and adolescent girls claimed to see the Virgin Mary, but this transitory interaction with the Mother of God had neither the beatific nor the awesome qualities normally associated with contemporary visionary experience. Rather than heavenly smiles and bodily rapture, they instead had alarming convulsive attacks, had no message to relay, and relished blaspheming the Eucharist during their seizures. The women believed themselves possessed as a result of a mal donne, a witch's curse, and they sought to counterattack through magic, magnetism, and pilgrimage, going far from their village world in search of relief. Their errant life began when they felt abandoned by their parish priest: Abbe Pinguet and his minions had willingly exorcised them beginning in 1857, convinced such expedients would rid the community of the "devils," but the situation changed dramatically in 1860 when France annexed Savoy and the authorities pressured the priest to stop his "superstitious" practices. He retracted both his belief in their possession and his willingness to exorcise, and from that moment the intensity of the mal grew rapidly.' The degree of attention lavished on the girls and women-numbering around two hundred at the end of 1861 -is evidenced by the physicians whom

Pulmonary drug delivery routes present several advantages compared to conventional drug administration, such as fewer systemic side effects than oral or parenteral administration. Many studies show drug delivery systems that are intended for pulmonary administration. However, the time that these systems stay at the mucose surfaces is limited. Mucoadhesive polymers are needed to increase residence time of drugs and therefore to promote absorption through the mucose. Chitosan, a polysaccharide obtained by chitin deacetylation, is used in drug release systems and has mucoadhesion and absorption-promoting properties. There are numerous studies on the use of chitosan drug delivery systems to increase the bioavailability of drugs at the lung mucose. This chapter is a review of literature reports detailing chitosan-based drug delivery systems intended for use in inhalers. The effect of different types of chitosan particulate systems on aerosolization properties will be compared.

Acyclovir (ACV) is one of the drugs of choice for the treatment of epidermal, ocular or systemic herpetic infections. Nevertheless, its trans-mucosal limited absorption and the scarce contact time of the formulation with the mucosal surface – especially in the ocular mucosa – constitute a big limitation of the antiviral efficiency. The most effective way to solve these problems is to increase the quantity and the residence time of the drug over the ocular surface. In order to cope with all these requirements, micro-particles (MPs) and nano-particles (NPs) containing ACV have been developed using cross-linked chitosan with tripolyphosphate (TPP) due to the biocompatibility, bio-adhesion ability and the potential power as penetration enhancer of this polymer. Particles were characterized by Fourier-transformed infrared (FTIR) spectroscopy, X-ray diffraction, SEM, Zeta potential and particle size. Encapsulation efficiency and release profiles in flow through diffusion cells were also determined. Besides the Slug Mucosal Irritation (SMI) assay has been applied as an alternative to the Draize test to predict the mucosal irritation of the selected formulation. FTIR and X-ray results suggested an electrostatic interaction ACV-Chitosan that made ACV be molecularly dispersed within the polymer matrix. Encapsulation efficiency was 75% for MP and 16% for NP. Release profiles in flow through diffusion cells were also determined. From the diffusion profiles, it was found that the amounts of ACV effectively diffused in 24 h were 30, 430 and 80 μg for the ACV solution, MP and NP respectively. SMI results showed that chitosan-based particles induced moderate irritation and mild tissue damage, what supposes that ACV-MP constitute a promising alternative for further development of an antiviral formulation.

BACKGROUND: Securing employment after qualification is of utmost importance to newly qualified nurses to consolidate knowledge and skills. The factors that influence success in gaining this first post are not known. OBJECTIVES: The study aimed to describe the first post gained after qualification in terms of setting, nature of employment contract and geographical distribution and explore the relationship between a range of factors (including ethnicity) and employment at the point of qualification. DESIGN: An exploratory study using structured questionnaires and secondary analysis of data routinely collected by the universities about students and their progress during their course. SETTINGS: The study was conducted in eight universities within a large, multicultural city in the UK as part of the 'Readiness for Work' research programme. PARTICIPANTS: Eight hundred and four newly qualified nurses who had successfully completed a diploma or degree from one of the universities; a response rate of 77% representing 49% of all graduating students in the study population. METHODS: Data were collected by self-completed semi-structured questionnaires administered to students at the time of qualification and at three months post-qualification. Routinely collected data from the universities were also collected. RESULTS: Fifty two percent of participants had been offered a job at the point of qualification (85% of those who had applied and been interviewed). Of these, 99% had been offered a nursing post, 88% in the city studied, 67% in the healthcare setting where they had completed a course placement. 44% felt "confident" and 32% "very confident" about their employment prospects. Predictors of employment success included ethnicity, specialty of nursing and university attended. Predictors of confidence and preparedness for job seeking included ethnicity, nursing specialty, gender and grade of degree. Newly qualified nurses from non-White/British ethnic groups were less likely to get a job and feel confident about and prepared for job seeking. CONCLUSIONS: This study has demonstrated that ethnicity does lead to employment disadvantage for newly qualified nurses. This is an important contribution towards recognizing and describing the evidence so that appropriate responses and interventions can be developed. It is important that universities and healthcare institutions work closely together to support students at this important time in their nursing career.

Implementing quality management techniques, such as statistical process control (SPC), is a competitive necessity for today's integrated steel producers in North America. We compared successful and unsuccessful SPC project implementations at 12 integrated steel companies to determine the differences in key factors. Successful implementations had larger teams and more middle management support than unsuccessful implementations.

The students we deal with in Colleges of technology often show strong tendencies towards passiveness in their attitude to learning a foreign language. It would appear that this is due largely to bad habits acquired during their secondary school studies. The problem which we as lecturers face is to take a close look at their past learning experience, pointing out to the students the weaknesses in their language competence and to motivate them to acquire active language competence instead. Our students will need above all communicative language competence if they are to be useful to their future employers, and this has to be borne in mind when deciding on a language teaching strategy., Les étudiants à qui nous avons affaire dans le contexte d’un IUT présentent souvent des symptômes de passivité dans leur apprentissage d’une langue étrangère. Ceci serait dû à de mauvaises habitudes acquises pendant leurs études secondaires. Le problème qui se pose est donc de rectifier la situation en analysant leur vécu linguistique, en montrant aux étudiants les lacunes qui existent dans leurs compétences linguistiques et en les motivant à acquérir des compétences actives. Tout cela dans un contexte professionnel où l’étudiant aura surtout besoin de compétences communicatives pour être utile à son employeur. Ceci doit être considéré comme primordial lors de l’élaboration d’une stratégie d’enseignement de langue., Harris Ruth. D’un apprentissage passif à un apprentissage actif. In: Cahiers de l'APLIUT, volume 13, numéro 4, 1994. Les Langues de spécialité dans l’enseignement supérieur technologique des pays de la Communauté européenne (II) pp. 20-30.

Background Safe and timely access to effective and appropriate medication through primary care settings is a major concern for all countries addressing both acute and chronic disease burdens. Legislation for nurses and other professionals allied to medicine to prescribe exists in a minority of countries, with more considering introducing legislation. Although there is variation in the range of medicines permitted to be prescribed, questions remain as to the contribution prescribing by nurses and professionals allied to medicine makes to the care of patients in primary care and what is the evidence on which clinicians, commissioners of services and policy makers can consider this innovation. Methods A integrative review of literature on non-medical prescribing in primary care was undertaken guided by dimensions of health care quality: effectiveness, acceptability, efficiency and access. Results 19 papers of 17 empirical studies were identified which provided evidence of patient outcome of non medical prescribing in primary care settings. The majority were undertaken in the UK with only one each from the USA, Canada, Botswana and Zimbabwe. Only two studies investigated clinical outcomes of non-medical prescribing. Seven papers reported on qualitative designs and four of these had fewer than ten participants. Most studies reported that non medical prescribing was widely accepted and viewed positively by patients and professionals. Conclusions Primary health care is the setting where timely access to safe and appropriate medicines is most critical for the well-being of any population. The gradual growth over time of legislative authority and in the numbers of non-medical prescribers, particularly nurses, in some countries suggests that the acceptability of non-medical prescribing is based on the perceived value to the health care system as a whole. Our review suggests that there are substantial gaps in the knowledge base to help evidence based policy making in this arena. We suggest that future studies of non-medical prescribing in primary care focus on the broad range of patient and health service outcomes and include economic dimensions.

Background Informal carers frequently suffer adverse consequences from caring. General practice teams are well positioned to support them. However, what carers of stroke survivors want and expect from general practice, and the practical support measures they might like, remain largely unexplored. The aims of this study are twofold. Firstly it explores both the support stroke carers would like from general practice and their reactions to the community based support proposed in the New Deal. Secondly, perceptions of a general practice team are investigated covering similar topics to carer interviews but from their perspective. Methods Semi-structured interviews were conducted with 13 stroke carers and 10 members of a general practice team. Carers' experiences and expectations of general practice and opinions of support measures from recent government policy were explored. General practice professionals were asked about their perceived role and their perceptions of carers' support needs. Interviews were content analysed. Results Carers' expectations of support from general practice were low and they neither received nor expected much support for themselves. General practice was seen as reactive primarily because of time constraints. Some carers would appreciate emotional support but others did not want additional services. Responses to recent policy initiatives were mixed with carers saying these might benefit other carers but not themselves. General practice professionals' opinions were broadly similar. They recognise carers' support needs but see their role as reactive, focussed on stroke survivors, rather than carers. Caring was recognised as challenging. Providing emotional support and referral were seen as important but identification of carers was considered difficult. Time constraints limit their support. Responses to recent policy initiatives were positive. Conclusions Carers' expectations of support from general practice for themselves are low and teams are seen as reactive and time constrained. Both the carers and the general practice team participants emphasised the valuable role of general practice team in supporting stroke survivors. Research is needed to determine general practice teams' awareness and identification of carers and of the difficulties they encounter supporting stroke carers. Carer policy initiatives need greater specificity with greater attention to diversity in carer needs.

A colorimetric method previously described for the determination of chitosan has been evaluated because lack of linearity had been observed at certain concentrations. Calibration curves of varied-characteristic chitosans, recovery studies and chitosan quantification in seven commercial dietary supplements have been performed. Some analysis conditions including the solvent of the samples have been studied and optimised. Different data combinations have been checked in order to select the widest range of concentrations where no serial correlation was found. With the selected conditions the method is linear, reproducible and provides reliable results in the analysis of the chitosan content in capsules. Its selectivity has been proved by the lack of interference with other compounds present in the dietary supplements. But in the case of tablet products, the presence of cellulose and magnesium stearate may produce an underestimation of the chitosan content. © 2010 Elsevier Ltd. All rights reserved., This work received financial support from the Spanish Ministry of Education (Project MAT2004-03982). M.M. was the recipient of a fellowship from this Ministry.

This presents a theoretical approach to talent development in emerging nations, with focus on curricular intervention derived from qualitative research. Elements of culturally appropriate curricular design are discussed in connection with practical educational application and viable options in the light of the special problems of developing countries. The implementation of qualitatively derived curricular intervention in Ebeye, Marshall Islands, an economically and educationally disadvantaged population in the throes of conflict and change, is utilized to illustrate the technique. An account of evalution processes incorporating qualitative and quantitative assessment is discussed, along with initial preliminary results of a follow-up investigation. The article concludes with suggested adaptations of the approach to a wide spectrum of cultures with similar economic constraints and political conflicts. Guidelines to qualitatively derived intervention are outlined along with implications of broader concomitant educational problems, issues and related research.

This article highlights findings from three studies into nurse-led inpatient units. The results are not the same in each case, particularly with regard to length of stay, and the authors discuss the possible reasons for this. Further work is needed to develop NLIUs and identify cost savings.

Chitosan is a natural polymer composed of randomly distributed -(1-4)-linked D-glucosamine (deacetylated unit) and Nacetyl-D-glucosamine (acetylated unit). It has been described as a non-toxic, biodegradable and biocompatible polymer with very interesting biological properties, such as permeation-enhancing and mucoadhesive properties, anticoagulant and antimicrobial activity and so on. Chitosan has been used in several areas such as biomedical, pharmaceutical and biotechnological fields as well as in the food industry. Recently, there has been a growing interest in the modification of chitosan to improve its solubility in physiological conditions, to introduce new applications or to improve chitosan biological properties. Research and development on a variety of amphiphilic copolymers containing hydrophobic and hydrophilic segments, have been very active due to their spontaneous self-assembly behaviour in aqueous media These smart transitions often lead to diverse functional compartment structures like micelles, vesicles and gels, which represent promising applications in the field of biotechnology and pharmaceutics. The aim of the present paper is to review the latest advances in the synthesis of chitosan amphiphilic derivatives with a special emphasis in their applications.

Conventional political history is notorious for the ‘maleness’ of its exposition, and standard accounts of the Dreyfus Affair all too readily conform to this stereotype. As an espionage tale, the Affair falls within the masculine arenas of diplomatic and military history, while as a story of political crisis, its main characters remain ministers, jurists, and polemicists.1 The history of the struggle between ‘intellectuals’ and ‘anti-intellectuals,’ moreover, focuses attention on the leading lights of French academia and literature, almost all men, who tussled over the primary values of French politics and society.2

A series of televised public service announcements (PSAs) about acquired immune deficiency syndrome (AIDS) was evaluated with 100 black participants attending a Sexually Transmitted Diseases Clinic in Atlanta, Georgia. Since the literacy level of the participants was suspected to be low, questions were administered orally and an electronic data collection technique was used which permitted the participants to push buttons, as opposed to speaking or writing responses. In this way, data were collected regarding: (i) the participants’ demographics; (ii) their self‐perceived AIDS knowledge and awareness; and (iii) their second‐by‐second continuous responses to the video presentation. Participants who perceived themselves to be at high risk of contracting human immunodeficiency virus (HIV) infection gave more positive continuous responses to the PSA sequence than did self‐perceived low‐risk participants. Men gave more approving responses than women. The results were considered in relation to previous ...

Title. Work sampling: a quantitative analysis of nursing activity in a neuro-rehabilitation setting. Aim. The aim of this investigation was to establish the distribution and proportion of nursing activity represented by patient-related care activities (direct and indirect), and other nursing activities (unit-related and personal) within one inpatient neurological rehabilitation unit. Background. A set of tools has been developed for estimating the care/nursing hours required for direct hands-on patient care in hospital rehabilitation settings. However, to apply this information to estimate the actual staffing requirements in relation to a given caseload, it is necessary to know the proportion of nursing workload assigned to other activities and how this may vary throughout the day. Method. A work sampling study was conducted during 2004. A snapshot of nursing activity was recorded at 5-minute intervals from 06·00 to 23·55 spread over 2 weeks, with one session from 06·00 to 15·25 and the second from 15·30 to 23·55. Results. A total of 8883 nursing activities were observed and recorded over 126 hours and categorized as follows: 4060 (46%) direct patient care, 2218 (25%) indirect patient care, 874 (10%) unit-related and 1731 (19%) personal time. The proportions of direct care fluctuated throughout the day, with direct care activities mainly concentrated in early mornings and to a lesser extent evenings. Conclusion. Direct patient care accounted for less than half of the nursing activity in a rehabilitation setting. Estimates of staffing requirement must also take account of the time required for indirect care and non-patient related activity.

BACKGROUND: With the changing demographic profile of the nursing workforce, retaining the skill and experience of nurses in mid-life is very important. Work-life balance is a concept that is gaining increasing prominence in today's society. However, little is known about older nurses' experience of family friendly policies and flexible working. OBJECTIVES: This study explored the organisational, professional and personal factors that influence perceptions of commitment and participation in the workforce for nurses working in mid-life (aged 45 and over). DESIGN: A qualitative study using a range of methods including biographical methods, semi-structured face-to-face interviews, focus groups and telephone interviews. Data were analysed using constant comparative method. SETTINGS: A large inner city acute teaching hospital and an inner city mental health and social care trust providing both community and inpatient health and social care. PARTICIPANTS: 34 nurses and 3 health care assistants participated in individual interviews, 10 nurses participated in two focus groups and 17 managers participated in individual telephone interviews. RESULTS: Four themes emerged: the nature of nursing poses a challenge to the implementation of flexible working, differences in perceptions of the availability of flexible working, ward managers have a crucial role in the implementation of flexible working policies and the implementation of flexible working may be creating an inflexible workforce. CONCLUSIONS: The findings suggest that there are limits to the implementation of flexible working for nurses. In some areas there is evidence that the implementation of flexible working may be producing an inflexible workforce as older nurses are required to compensate for the flexible working patterns of their colleagues. Ward managers have a key role in the implementation of family friendly policies and require support to fulfil this role. There is a need for creative solutions to address implementation of flexible working for all nurses to ensure that workforce policy addresses the need to retain nurses in the workforce in a fair and equitable way.

There has been substantial research on children's empathic responsiveness towards distressed people, and on the limited responsiveness of children with autism. To date, however, there have not been experimental studies to test how far children show concern towards someone who might be expected to feel badly, when that person has not (yet) expressed any negative feelings. We tested matched groups of children with autism and learning disability, and typically developing children of similar verbal mental age (approximately 6 years), with a novel procedure in which participants witnessed one person (E1) tearing the drawing of another (E2). In a comparison condition, a blank card was torn. In the torn-drawing condition, as predicted, fewer participants with autism orientated towards E2 with an immediate look, and as a group, they were rated as showing less concern for, and fewer concerned looks towards, E2. We discuss possible implications for theoretical perspectives on the early development of empathy in typically as well as atypically developing children.

Title. Northwick Park Care Needs Assessment: adaptation for inpatient neurological rehabilitation settings Aim. This paper is a report of a study to establish which timings and assumptions of the Northwick Park Dependency Scale and Care Needs Assessment are appropriate to the inpatient rehabilitation setting and which, if any, require adjustment. Background. Cost-effective provision of nursing care relies on being able to adjust staffing levels in accordance with patient dependency. The Northwick Park Dependency Scale and Care Needs Assessment enables direct assessment of nursing care needs in community settings. Method. An observational study was conducted in 2004 to record the time taken to complete direct nursing care interventions in a rehabilitation ward and to compare these times with simultaneously recorded time-estimates provided by the Care Needs Assessment. A total of 1168 nursing interactions were timed for 50 care episodes. Results. There was considerable variation in the time taken for each nursing intervention, depending on overall patient dependency and the number of nurses required. Although there was good correlation between observed care times and those estimated by the Care Needs Assessment, observation confirmed that most interventions took substantially less time than the estimates. There was also a very different pattern of care in hospital compared with the community, with shorter, more frequent interactions as nurses distribute their time between different patients, and activities other than direct patient care. Conclusion. The Northwick Park Care Needs Assessment tool already has widespread application in other countries and its continued use for estimating community care needs remains relevant. The tool, once fully developed, will have the potential to contribute to international rehabilitation nursing workforce planning and research.

BACKGROUND: The Nursing led inpatient Unit (NLU) is one of a range of services that have been considered in order to manage more successfully the transition between hospital and home for patients with extended recovery times. This is an update of an earlier review published in The Cochrane Library in Issue 3, 2004. OBJECTIVES: To determine whether nursing‐led inpatient units are effective in preparing patients for discharge from hospital compared to usual inpatient care. SEARCH METHODS: We searched The Cochrane Library, the Specialized Register of the Cochrane Effective Practice and Organisation of Care (EPOC) group, MEDLINE, CINAHL, EMBASE, BNI and HMIC databases. Citation searches were undertaken on the science and social science citation indices. Authors were contacted to identify additional data. The initial search was done in January 2001. The register search was updated in October 2006, the other database searches were updated in November 2006 and the citation search was run in January 2007. SELECTION CRITERIA: Controlled trials and interrupted time series designs that compared the NLU to usual inpatient care managed by doctors. Patients over 18 years of age following an acute hospital admission for a physical health condition. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Ten random or quasi‐random controlled trials reported on a total of 1896 patients. There was no statistically significant effect on inpatient mortality (OR 1.10, 95% CI 0.56 to 2.16) or mortality to longest follow up (OR 0.92, 95% CI 0.65 to 1.29) but higher quality studies showed a larger non‐significant increase in inpatient mortality (OR 1.52, 95% CI 0.86 to 2.68). Discharge to institutional care was reduced for the NLU (OR 0.44 95% CI 0.22 to 0.89) and functional status at discharge increased (SMD 0.37, 95% CI 0.20 to 0.54) but there was a near significant increase in inpatient stay (WMD 5.13 days 95% CI ‐0.5 days to 10.76 days). Early readmissions were reduced (OR 0.52 95% CI 0.34 to 0.80). One study compared a NLU for the chronically critically ill with ICU care. Mortality (OR 0.62 95% CI 0.35 to 1.10) and length of inpatient stay differ did not differ (WMD 2 days, 95% CI 10.96 to ‐6.96 days). Early readmissions were reduced (OR 0.33 95% CI 0.12 to 0.94). Costs of care on the NLU were higher for UK studies but lower for US based studies. AUTHORS' CONCLUSIONS: There is some evidence that patients discharged from a NLU are better prepared for discharge but it is unclear if this is simply a product of an increased length of inpatient stay. No statistically significant adverse effects were noted but the possibility of increased early mortality cannot be discounted. More research is needed.

In recent years, there has been an increasing policy focus on the role of interprofessional education in healthcare. However, the literature emphasizes process rather than outcomes, with little that specifically relates interprofessional educational interventions to the care of people with long-term conditions. This article questions what we know about interprofessional interventions in the care of people with chronic disease, examines the evidence for and potential of interprofessional education in changing practice, and makes suggestions for further research.

Aims The nursing-led inpatient unit is designed to substitute for a period of care in acute hospital wards and to improve patient outcome prior to discharge to the community. This paper aims to evaluate the cost, from the UK National Health Service perspective, of transfer to a nursing-led inpatient unit for intermediate care and to discuss the impact of these findings to the future development and sustainability of the nursing-led inpatient unit. Background Recent economic analyses have showed that nursing-led inpatient units are associated with increased costs of care with length of stay as the main driver of inpatient costs. Method The cost-effectiveness analysis was part of a randomized-controlled trial with a sample size of 175, of which 89 were in the nursing-led inpatient unit arm and 86 in the control arm. Resource use data included length of stay, investigations performed, multiprofessional input and nursing input. Clinical outcome was measured using Barthel Index, a functional status measure. Results Cost per day was lower on the nursing-led inpatient unit although cost per hospital stay was higher due to significantly increased length of stay. Postdischarge community care costs were lower. The incremental cost-effectiveness ratio of the treatment was £1044 per point improvement of the Barthel Index. Conclusions The nursing-led inpatient unit was associated with higher costs however, the question of whether the nursing-led inpatient unit is cost-effective has not been clearly answered because of the limited follow-up period of the study. The increased cost of care on the nursing-led inpatient unit was not a major factor in local management decisions about the future of the unit. The changes in the context of service provision within which the nursing-led inpatient unit operated as a result of substantial investment in intermediate care did have a major impact.

BACKGROUND Little is known about the frequency with which information from the Internet is presented by patients within primary care consultations or the subsequent impact that it may have on those consultations. OBJECTIVES The aims of this study were to describe the frequency with which Internet information was presented within primary care consultations in one inner-city health authority and to describe the characteristics of the subsequent consultation from the perspective of the health professionals involved. METHODS A postal survey was used to estimate the frequency of Internet information presentation and eight in-depth interviews were used to obtain health professionals' perceptions of the consultations that followed. RESULTS Presentation of information from the Internet was relatively infrequent within primary care at the time of the survey (November 2000 to March 2001), but frequencies of presentation were higher for GPs than for any other health professional group. Health professionals have stereotypical views of Internet users and fear for their own professional status in relation to the Internet-informed patient or client. CONCLUSIONS Although presentation of information from the Internet to date remains relatively infrequent, health professionals appear to feel threatened by it and adopt strategies that minimize its impact on the subsequent consultation.

Recruitment of frail older people to research: lessons learnt through experience Background. With the emphasis on the need for clinical governance and evidence-based practice in the healthcare industry there is increasing pressure on researchers to provide tangible research evidence of the effectiveness of new treatments, interventions and services. Recruiting an adequate size of sample is an important factor in the success or otherwise of a study to answer the research question. Difficulty in the recruitment of older people to research is widely acknowledged. However, much can be achieved to maximize the success of this process. Aims of the paper. This paper describes and explores our experience of recruiting frail, older people to research, with particular emphasis on ensuring quality in the process of research related to ethical practice. Conclusions. Recruitment of frail older people to research can be a complex process in which the awareness and integrity of the researcher is key in upholding the principle of nonexploitation. It is important not to underestimate this difficulty and to ensure that the data collection period is sufficient to recruit adequate numbers. There is a need to continue to develop and refine recruitment skills and strategies to maximize the involvement of frail older people to research while protecting their right to refuse.

In order to assess the potential for a nursing-led in-patient unit (NLIU) to substitute for a period of care in the acute hospital environment and promote recovery before discharge, a randomised controlled trial was conducted. The setting was an acute inner London hospital trust, part of the UK's national health service. Of patients referred to a NLIU from acute wards, 80 were randomly assigned to usual care (remain in normal hospital system) and 97 to the NLIU (nursing-led care with no routine medical involvement). Patients were identified as medically stable but in need of additional nursing intervention by referring medical staff prior to full nursing assessment of suitability. Outcomes compared included functional dependence (Barthel Index), discharge destination and length of hospital stay. Inputs from nursing, paramedical and medical staff were measured. There was no significant difference in functional independence at discharge (p0.05). Patients undergoing usual care stayed in hospital for less time (mean difference 18 days, p0.01) but the same number of patients were in hospital 90 days after recruitment (23% NLIU, 24% usual care p0.05) due to re-admissions. The model of care implemented differed considerably from that described in the literature with the NLIU having significantly fewer qualified nurses (RNs). Although the anticipated benefits of the NLIU were not demonstrated, the study does not conclude that the model should be rejected. Factors driving length of stay need to be further investigated, as does the possibility of post-discharge benefits. The NLIU does offer some potential to substitute for acute care but also appears to substitute for a period of primary care.