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Background: Asthma and pregnancy are both sources of anxiety for women. Although there has been a focus on physiological management of asthma and pregnancy, there has been little research on the impact that personalised support can have on asthma care during pregnancy. This systematic review and narrative synthesis of the literature set out to answer the question 'What are women's experiences of asthma care, its management and education, during pregnancy?', Methods: This systematic review was carried out using accepted methodology from the York Centre for Reviews and Dissemination. Electronic database searches were conducted using PsycInfo, CINAHL, MedLine, Google Scholar and the Cochrane Library, using the combination search terms: 'Asthma' AND 'Pregnancy' AND 'Care' AND ('Education OR Information OR Experience'). Hand searching of journals and searches for grey literature were also undertaken. Independent quality appraisal by the three authors took place using the criteria detailed by Kmet et al. (Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields, 2004)., Results: All papers scoring in excess of 60% were deemed to be of adequate quality for inclusion, of which there were five: two qualitative designs and three quantitative designs. The designs were too methodologically heterogeneous to permit statistical meta-analysis so narrative review and synthesis was undertaken. Despite an embryonic evidence bases, it is reasonable to conclude that personalised care has beneficial outcomes for pregnant asthmatic women., Conclusions: Larger randomised controlled trials investigating personalised care are required to build an evidence base which can establish the efficacy of such interventions.

Patients who might benefit from genetic services may be denied access through failure to be referred. To investigate the evidence on barriers to referral to genetic services, we conducted a systematic review of empirical evidence on this topic. Nine studies were included in the review. Barriers related to non-genetic healthcare professionals were: lack of awareness of patient risk factors, failure to obtain adequate family history, lack of knowledge of genetics and genetic conditions, lack of awareness of genetic services, inadequate coordination of referral and lack of genetics workforce. Those related to individuals affected by or at risk of a genetic condition were: lack of awareness of personal risk, lack of knowledge and/or awareness of medical history of family members and lack of knowledge of genetic services. Research on access to genetic services is heterogeneous; stronger empirical evidence is needed on factors that are barriers, and further research is needed to develop 'targeted interventions' for equitable access to genetic services in a range of populations.

Purpose: The purpose of this paper is to discuss learning about service-user and carer involvement from an action research (AR) study into self-directed support implementation in one English mental health trust. The paper promotes appointing and supporting carers and people with experience as co-researchers to obtain authentic local perspectives when undertaking service implementation or redesign., Design/methodology/approach: The researchers used an AR spiral method incorporating carers and people with mental health experience as co-researchers. The co-researchers worked alongside the lead researcher gathering data from focus groups, training sessions and other meetings over four years and attending collaborative steering group meetings alongside professional workers throughout the study., Findings: The authors suggest that participation gave co-researchers a powerful and effective voice in this service redesign. This approach revealed more authentic research data and required professionals to be more accountable for their perceptions and to make explicit their understandings throughout the study, which enabled more effective working. Steering group participation was central to securing this participation., Originality/value: The paper illustrates how carer and service-user co-researchers can be supported to benefit both mental health organisations undergoing change and to co-researchers themselves. It also identifies AR's utility in uncovering learning as well as structuring change.

Background : Most asthmatic women have normal pregnancies and complications are infrequent when their asthma is well-controlled. Symptom control and medical treatment are concerning to pregnant asthma suffers, as is the impact that their illness and treatment might have on their unborn baby. The aim was to investigate in a qualitative study the thoughts and feelings of women's experiences of asthma in pregnancy. Twenty-two women with asthma who had a pregnancy within two years were asked to participate. Seven women were interviewed when data saturation was achieved. Interviews were transcribed and analysed using the 'Framework' Method, independently analysed by two researchers and consensus reached concerning the construction of themes. The key themes that emerged were Asthma and pregnancy; Pregnancy and post-natal experiences; and Health professionals. These findings are globally interesting because of the prevalence of maternal asthma and they illustrate participants' experiences concerning their asthma care and their views on its improvement. Pregnant asthmatic women have concerns about their care and treatment which might be alleviated by outreach, joint working between respiratory doctors and nurse specialists, midwives and General Practice nurses. Targeted educational activities could form a part of this care delivery.

Introduction: There is international concern about retention of student nurses on undergraduate programmes. United Kingdom Higher Education Institutions are monitored on their attrition statistics and can be penalised financially, so they have an incentive to help students remain on their programmes beyond their moral duty to ensure students receive the best possible educational experience., Aims: to understand students' and staff concerns about programmes and placements as part of developing our retention strategies., Design: This study reports qualitative data on retention and attrition collected as part of an action research study., Setting: One University School of Nursing and Midwifery in the South West of England., Participants: Staff, current third year and ex-student nurses from the adult field., Methods: Data were collected in focus groups, both face-to face and virtual, and individual telephone interviews. These were transcribed and subjected to qualitative content analysis., Results: FOUR THEMES EMERGED: Academic support, Placements and mentors, Stresses and the reality of nursing life, and Dreams for a better programme., Conclusions: The themes Academic support, Placements and mentors and Stresses and the reality of nursing life, resonate with international literature. Dreams for a better programme included smaller group learning. Vocation, friendship and resilience seem instrumental in retaining students, and Higher Education Institutions should work to facilitate these. 'Vocation' has been overlooked in the retention discussions, and working more actively to foster vocation and belongingness could be important.

Aims: To reports a study in which action research approach was utilised to introduce a new system of risk assessment, based on traffic lights, into a community mental health team., Background: Risk management is a serious concern in community mental healthcare where there is less direct, real-time supervision of clients than in other settings, and because inadequate management of risk can have fatal consequences when service users are a risk to themselves and/or others., Design: An action research design was undertaken, using three phases of Look, Think and Act., Methods: Data were collected between January and March of 2012. In the action research phases, qualitative data were collected in focus groups with the team's multi-disciplinary mental health professionals. Data were transcribed verbatim and analysed thematically, which involved agreement of themes and interpretations by two researchers. The Look, Think and Act phases guided the development of the project; team members worked collaboratively on the traffic light system, implemented and evaluated it., Findings: Themes were constructed that were discussed across the focus groups. These themes were: Ease of use; Risk identification and management; Legal status; Different teams' views of risk; Post-implementation evaluation., Conclusion: Action research has been used to implement change in mental health risk management. Others internationally would benefit from considering a Traffic Light System, and in using action research to implement it.

Background: Attrition in nurse education is a worldwide issue. Clinical placements form a major part of nurse education and have an important role in students' perceptions of nursing. Student nurses cite unsatisfactory placement experiences as a reason for leaving nursing education., Objective: To conduct a systematic review to establish nursing students' placement-related reasons for leaving their programme., Data Sources: Major health literature databases were searched, including studies from 1995 to 2011., Review Methods: This review considered quantitative and qualitative research investigating student nurse attrition, with an emphasis on placement-related issues. After a systematic selection process, included studies were quality assessed by three researchers., Results: Eighteen studies were included in the review. The studies investigated personal reasons for leaving, demographic and other factors, and students' attributes. As for all student attrition, there was no single reason (related to placements) why students chose to leave, however, being a young or a male student were major factors, along with being exposed to unpleasant placement experiences, the attitudes of placement staff, and lack of support. Perceptions of the nursing profession and practice assessments were also factors in placement-related attrition., Conclusions: There is a need for more high quality reporting in the area of attrition in student nursing, whether this is due to placement issues or other reasons. Prior work experience in healthcare settings is important in enabling students to complete their programmes and recruitment and retention strategies should consider this. When students are recruited with limited or no healthcare experience, targeting retention strategies and support on these students may be useful., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: Professionals are interested in using e-health but implementation of new methods is slow. Barriers to implementation include the need for training and limited awareness or experience. Research may not always convince mental health professionals (MHPs). Adding the 'voice' of mental health service users (MHSUs) in collaborative learning may help. Involving MHSUs in face-face education can be difficult. We had previously been unable to engage MHPs in online discussion with MHSUs. Here we assessed the feasibility of short online courses involving MHSUs and MHPs., Methods: We ran three e-health courses, comprising live interactive webcast, week's access to a discussion forum, and final live interactive webcast. We recruited MHPs via posters, newsletters, and telephone from a local NHS trust, and online via mailing lists and personal contacts from NHS trusts and higher education. We recruited MHSUs via a previous project and an independent user involvement service. Participants were presented with research evidence about e-health and asked to discuss topics using professional and lived experience. Feasibility was assessed through recruitment and attrition, participation, and researcher workloads. Outcomes of self-esteem and general self-efficacy (MHSUs), and Internet self-efficacy and confidence (MHPs) were piloted., Results: Online recruiting was effective. We lost 15/41 from registration to follow-up but only 5/31 that participated in the course failed to complete follow-up. Nineteen MHPs and 12 MHSUs took part and engaged with each other in online discussion. Feedback was positive; three-quarters of MHPs indicated future plans to use the Internet for practice, and 80% of MHSUs felt the course should be continued. Running three courses for 31 participants took between 200 to 250 hours. Before and after outcome measures were completed by 26/31 that participated. MHP Internet self-efficacy and general Internet confidence, MHSU self-esteem and general self-efficacy, all seemed reliable and seemed to show some increase., Conclusions: Collaborative learning between MHSUs and MHPs in a structured online anonymous environment over a one-week course is feasible, may be more practical and less costly than face-face methods, and is worthy of further study.

Aims and Objectives: The aim was to investigate the impact of a new structure for supporting students and mentors in practice placements (Placement Development Teams) in fostering interprofessional education from the perspective of non-medical health care students and staff., Background: Interprofessional education is an important international issue which received significant impetus in the UK as a result of many high-profile cases where uni-professional boundaries and cultures have contributed to adverse patient and client outcomes., Design: This study was part of a longitudinal qualitative evaluation of Placement Development Teams. The design for this stage was cross-sectional., Methods: Data were collected using telephone interviews with key educational stakeholders in trusts and Strategic Health Authorities and focus groups with third-year non-medical health care students working in the south-west peninsula of England., Results: Students' focus group data indicated that interprofessional support and learning was key. Students had mixed views on how much they valued support gained from staff and students from other professions. Staff data indicated that they facilitated communication. Staff discussed their practical activities which made a difference and helped change the organisational culture in favour of interprofessional education., Conclusion: If interprofessional education in clinical practice is to be effective, it needs local facilitation and structures that support it. Placement Development Teams can provide this. The 'best' means of 'doing interprofessional education' in clinical practice and its impact on patient outcomes requires further large-scale research work with rigorous methodologies at a national level., Relevance to Clinical Practice: To embed interprofessional education in practice-based professions' curricula and clinical placements requires active, supportive structures and local facilitation. Structures such as Placement Development Teams can help to achieve this where organisational cultures are influenced by committed staff. Students require persuasion concerning the benefits of interprofessional education., (© 2011 Blackwell Publishing Ltd.)

Background: Use of the Internet for people with Long Term Conditions (LTCs) can have a positive effect on knowledge, social support, behavioural and clinical outcomes, yet there is concern that a 'digital divide' prevents some patients from benefitting. While some patients do not have access to the Internet, others that do may still lack expertise or the confidence to make full use of it. The aim of this pilot study was to develop an intervention and test methods for a definitive randomised controlled trial (RCT) of anonymous personal online email support for patients in this latter group., Methods: Recruitment success was evaluated by the number and appropriateness of participants recruited. A personalised e-health support intervention was developed. The provisional primary outcome was the extent to which the Internet affected the participants' confidence in dealing with their LTC. Primary outcome, seven process measures and two secondary outcomes measures were evaluated for completeness of data and sensitivity to detect changes., Results: Thirty nine participants were recruited, 29 after personally receiving a leaflet, seven via email advertising, and three via leaflets left in waiting areas. Most participants (61%) were aged over 60. The majority (21/38) rated themselves as experienced Internet users although only 5/38 had used discussion forums for their LTC. Piloting the intervention identified support needed as: (i) technical help with some websites, (ii) advice about issues such as anonymity, (iii) help in judging information quality, (iv) identification of relevant information (via 'Information Prescriptions'), (v) motivational support to try new sites. Attrition was fairly high: 20/39 completed follow up questionnaires. Three process measures showed ceiling effects and two had too many missing values to be useable., Conclusion: E-health support is a promising way of addressing the problems faced by older generation e-health seekers. Face-to-face leaflet distribution recruited sufficient numbers but additional locations other than hospital should be tried to recruit Internet novices with LTCs. An RCT is feasible and necessary to evaluate the potential benefits of anonymous email support. Our methods could be used by other researchers studying Internet use by people with LTCs.

Aims and Objectives: To explore the experience of student support prior to the implementation of a new structure for supporting students and mentors in practice placements (Placement Development Teams) for health care professionals. This study reports findings relating to acute sector adult nursing students and staff., Background: Clinical practice is essential in pre-registration health care professional education programmes. The English Model National Partnership Agreement for health care education gives a new impetus to Strategic Health Authorities, Higher Education Institutions and National Health Service Trusts to evaluate and redesign their strategies for student support., Design: This study was phase one of a large longitudinal qualitative evaluation of Placement Development Teams' introduction. The design for this phase was cross-sectional., Methods: Data were collected using telephone interviews with key educational stakeholders in trusts and Strategic Health Authorities and focus groups with third-year adult nursing students working in six acute sector trusts., Results: Five themes emerged from the nursing students' focus group data. These were (1) Supportive and unsupportive behaviour of staff. (2) Mentor allocation. (3) Placement allocation. (4) Benefits of students to the placement area. (5) Perceived control over the learning experience. Four themes emerged from data analysis of the staff telephone interview data. These were (1) Vision of support services. (2) Proactive versus reactive support. (3) Barriers to achieving proactive support. (4) Bridging the gap between education and the trusts., Conclusion: Supporting students in practice is multifaceted and interpersonal and structural factors are important. This study illustrates how student support activity can be redesigned to meet the needs of the Model National Partnership Agreement., Relevance to Clinical Practice: Good mentoring is particularly important for student support. Where there are high student numbers in placement, this can adversely affect students' placement learning., (© 2010 Blackwell Publishing Ltd.)

Aims: To investigate the impact of a new structure for supporting healthcare students and mentors in practice placements (Placement Development Teams)., Introduction: The English Model National Partnership Agreement for healthcare education required Strategic Health Authorities, Higher Education Institutions and National Health Service Trusts to redesign strategies for student support. Placement Development Teams are one English University's response to this., Materials and Methodology: This study was phase 2 of a longitudinal qualitative evaluation of Placement Development Teams. Data were collected after establishment of Placement Development Teams, and compared and contrasted with those collected prior to their implementation. Telephone interviews were conducted with key educational stakeholders in Trusts and Strategic Health Authorities. Focus groups were conducted with third year non-medical healthcare students and first year paramedics working in 16 NHS Trusts in the south west peninsula of England., Results: Pre-Placement Development Teams, themes from the students' data were: Supportive and unsupportive behaviour of staff; Mentor allocation; Placement allocation; Benefits of students to the placement area and Perceived control over the learning experience. Post-Placement Development Teams, the themes were Communication; Supportive and unsupportive behaviour of staff; The effect of peers on the placement experience; Knowledge and perceptions of the work of the PDTs. Form the staff data, pre-Placement Development Teams the themes were: Vision for improving student support. Post-Placement Development Teams themes from the staff data were how they provided a central point of contact for student and mentor support; and how they supported students and mentors., Conclusion: Support of students and mentors is particularly important following the introduction of The English Model National Partnership Agreement for healthcare education. Placement Development Teams can facilitate partnership working between higher education institutions and placement providers for student support.

Purpose: The purpose of this paper is to describe learning gained from involving service users and carers as researchers in an action research study. The researchers aimed to introduce self-directed support in mental health services--part of the government's personalisation agenda, which requires a move from current social care commissioning, where a person is matched to available services, to one where a person self-assesses, has an agreed support plan and then with appropriate help, purchases his or her own services to lead as independent a life as possible. This development is allied closely with the mental health service recovery approach., Design/methodology/approach: Three service users and two carers were recruited to work alongside the lead researcher. Service users were fully involved in the steering group - part of participatory action research project. Data were collected from: debriefing meetings with co-researchers between April and December 2007; a group interview held by the lead researcher; and participants' journal comments and self-reflections., Findings: The main areas in which service users and carers found involvement difficult were: overcoming professional language barriers; emotional impact; and power imbalances between themselves and professionals. Findings suggest that considerable improvement is required by mental health professionals and managers if service users and carers are successfully involved in projects., Research Limitations/implications: This is a small study within a larger action research project. Findings are not generalisable owing to the small sample; however, findings are supported by the service-user involvement literature., Originality/value: Few studies explore participation effects on service users and carers from their perspective. This research provides insights into what needs to be addressed to improve service user and carer involvement to improve mental health services.

Aims and Objectives: To explore influences on decision-making concerning placement capacity planning for supporting nursing students in clinical placements. The research questions were: * How are decisions relating to capacity planning and management of the learning environment made within the practice areas? * What factors were or are perceived as important to take into consideration when making these decisions?, Background: It is already known that clinical placements are pivotal to pre-registration nurse education. The recent large expansion of nurse education places means that more students require clinical placements than previously. This study explored decision-making about placement capacity amongst mentors in one central English county., Design: A qualitative design using focus groups. STUDY AND METHODS: Collecting data allowed researchers to engage mentors in discussions concerning their decisions about how many students they could support in practice and the learning environment they could provide. Twenty-nine active nursing student mentors participated, representing three branches (Adult, Mental Health and Child Health Nursing) from various acute and community settings and professional roles., Results: Three themes emerged relating to capacity management issues in clinical placements: * Capacity issues: how decisions are made in relation to capacity planning, by whom they are made and what influences them? * Supporting learners and enhancing support in practice. * Issues impacting on learning in practice., Conclusions: This study adds further understanding of the need for robust information to support allocation decisions, coupled with greater clinical staff and mentors' involvement in decisions about student support. The forthcoming Skills for Health Ensuring Quality in Partnership requirements may add authority and structure to student support activities., Relevance to Clinical Practice: Strategic practice and placement development links and joint appointments between UK NHS trusts and higher education institutions should be considered if placement capacity issues are to be addressed successfully and the quality of students' placements are to be safeguarded.

English stakeholder collaboration has resulted in a new quality assurance process for non-medical health and social care placement providers and higher education institutions. This study aimed to discover the impact on student support that taking part in a pilot had on participating placement areas. Using a questionnaire survey with longitudinal follow-up one year later, we found that placement staff valued the opportunity to review and improve student support practices. This was still in evidence a year later where the pilot was described as giving the opportunity to provide evidence of aspects of student support practice; communicating and changing or developing aspects of that practice. Benefits accrued from interdisciplinary working in sharing and collaborating with other professions and organisations. Such activity could enhance clinical support staff activities and facilitate strategic partnerships between placement providers and higher education institutions.

Aims and Objectives: The aim was to interview new entrants to a Master's level programme of educational preparation for advanced healthcare practice roles. The objectives were to gain an understanding of their issues and concerns as they looked ahead to their future development and to illuminate issues concerning their experiences as students and as employees., Background: As advanced practice roles become more widespread in the United Kingdom and abroad, nurses and other healthcare professionals are becoming more involved in innovation and service development and experiencing greater autonomy in many areas, particularly in regard to clinical examination and diagnosis., Design: A qualitative design was employed to illuminate issues and concerns of new students on a Master's degree programme of educational preparation for advanced healthcare practitioners., Methods: Two focus group interviews were conducted in 2004. Sixteen students from two programme cohorts participated in the two groups., Findings: Two main themes were outlined. These were: 'opportunities for development' and 'time pressures'. Subcategories within these two themes are also discussed., Conclusions: Students undertaking Master's level preparation for advanced healthcare practitioner roles perceive personal and professional benefits and opportunities to develop innovative services to improve patient care as accruing from the programme. These opportunities and benefits were related to the United Kingdom national health policy agenda. Some role difficulties were experienced. The additional burdens that the programme of study provided were an issue for some, but these were perceived as a temporary problem, worth undergoing for the likely long-term benefits., Relevance to Clinical Practice: Students undertaking educational preparation for advanced practice roles see themselves as innovators, specifically aiming to develop and improve aspects of service provision. Education for advanced practice roles should not be undertaken lightly, but can equip students with various skills, particularly regarding clinical assessment, and these skills should underpin practitioners' autonomy.

This project illustrates how benefits to patients, carers, staff and NHS trusts can result from service redesign that is targeted at improving services for patients with chronic obstructive pulmonary disease. Using a Continuous Quality Improvement methodology and 'plan-do-study-act' cycles, this project established key local measures for service redesign based on the national Ideal Design of Emergency Care project. These were to improve patients' experiences of care, by: decreasing patient journey time, improving patient, carer and staff experiences and reducing process variability. The result was a reduction in the average length of stay for patients and an increase in the numbers of patients admitted directly to the emergency medical unit and transferred to the respiratory department. Service users were actively involved in developing the changes. Although not generalizable, this project provides useful insights for consideration by others facing similar issues in their own organisations: we conclude that the methodology used in this study has been instrumental in improving key aspects of patient care, and that a similar methodological approach could be effective for other organisations.

Background: In 2003, the National Health Service in England and Wales, despite its large investment in information and communication technology, had not set a national research agenda. The National Health Service has three main research and development programs: one is the Service Delivery and Organisation program, commissioned in 2003, and the others are two parallel "scoping exercises" to help set a research agenda. This paper reports on one of those projects. A parallel literature review was carried out by others and has been reported elsewhere., Objective: The objective was to explore the concerns of stakeholders and to review relevant policy in order to produce recommendations and a conceptual map of eHealth research., Methods: There were two parallel strands. For the stakeholder consultation, 37 professionals representing 12 "stakeholder" groups participated in focus groups or interviews. Discussion was prompted by eHealth "scenarios" and analyzed using thematic content analysis. Subsequently, 17 lay participants, in three focus groups, discussed and prioritized these themes. For the policy review, 26 policy makers were interviewed, and 95 policy documents were reviewed. Recommendations were subsequently reviewed in a conference workshop. Recommendations for research from both strands were combined into a conceptual map., Results: Themes from stakeholder consultation and policy review were combined as 43 recommendations under six headings. Four of these headings (using, processing, sharing, and controlling information) describe the scope of eHealth research. The other two relate to how research should be carried out (ensuring best practice is first identified and disseminated) and to the values considered important by stakeholders (in particular, measuring improvement in health)., Conclusions: The scope of eHealth research (using, processing, sharing, controlling information) derived empirically from this study corresponds with "textbook" descriptions of informatics. Stakeholders would like eHealth research to include outcomes such as improved health or quality of life, but such research may be long term while changes in information technology are rapid. Longer-term research questions need to be concerned with human behavior and our use of information, rather than particular technologies. In some cases, "modelling" longer-term costs and benefits (in terms of health) may be desirable.

Aim: The aim of this paper is to report a study exploring, from the perspective of key stakeholders (mentors of nurses, managers of nurses, and modern matrons) in one English acute sector hospital, how decisions are made on how many learner nurses can be supported in clinical practice. The objective was to identify what factors are taken into consideration in making these decisions., Background: Supporting increasing numbers of students is a demand of current service provision in the English National Health Service, as part of an expansion in the numbers of all healthcare professionals. This is particularly the case in nursing, where the government announced a required increase in numbers of qualified nurses of 20 000. This expansion of numbers has implications for the quality of placement learning in clinical placements., Methods: Data were collected using three focus group interviews with a total of 12 participants in 2003/04. Recruitment was on a purposive basis. Subsequent analysis identified themes, which were compared across groups. A short questionnaire was also used to establish participants' biographical details prior to the focus groups., Findings: Three key themes were identified: 'capacity issues', 'enhancing support in practice' and 'issues impacting on learning in practice'. 'Capacity issues' identified factors that impact on the capacity of placements to support learners. 'Enhancing support in practice' identified necessary roles and strategies to enhance learning in practice. Finally, 'issues impacting on learning in practice' identified learner groups where support could be enhanced through structured management of the placement experience., Conclusions: Decisions on learner numbers to be supported at any one time are complex, with a multitude of dimensions. These include identification of types of learners and numbers of mentors available to support them and other operational issues. 'Educational staff' are needed at operational and strategic levels to support learning in practice. Timely and appropriate audit information to support allocation decisions and identify strategies to enhance the quality and support of learning in practice, are also required., Relevance to Clinical Practice: Increases in learner numbers and National Health Service modernization have had an impact on clinical placements' capacity to support learning, and potentially, on learners' achievements in practice. Findings from this study are thus important in evaluating the impact of these policy initiatives.

Graham R Williamson discusses the concept of triangulation in data collection and analysis in mixed-methods research, and reflects upon how this contributed to a deeper understanding when he used it in his work

Background: Lecturer practitioner roles have been widely established in the UK, and are seen as having the ability to overcome the theory-practice gap in nursing, as well as offering other benefits including functioning as a link between education and practice., Aims and Objectives: This article systematically reviews the research literature on UK lecturer practitioner roles in nursing and midwifery, in order to construct a picture of the themes that emerge from their national implementation., Conclusions: Only eight published research studies meeting the inclusion criteria were identified in journals, and five more included from the 'grey literature', totalling 13 suitable research reports. Of these 13 papers, six involved nurses and midwives. Key themes from the literature are outlined and discussed. There is an overwhelming preference for qualitative methodologies, although there is a strong argument for quantitative work in mixed-methods studies., Relevance to Clinical Practice: Lecturer practitioner roles can make an important contribution to nursing and midwifery education, but this is problematic. It is essential that managers clarify the purpose, responsibilities, support and review of lecturer practitioner roles if they are to be successful., (Copyright 2004 Blackwell Publishing Ltd)

Background: Lecturer Practitioner roles are well established in the United Kingdom. The national literature demonstrates that these staff are valuable to National Health Service trusts and universities however, their roles are busy and demanding, with conflicting expectations from the two employers. In addition, their role in addressing the theory-practice gap - a major reason for their establishment - is at best unclear. Although a number of qualitative studies have explored the topic, there have been no systematic attempts to develop the role or to quantify the effects on postholders., Aim: This paper reports a study that aimed to develop aspects of Lecturer Practitioners' work roles, examine the effects of this on individuals at one English university, and to quantify Lecturer Practitioners' occupational stress and burnout., Methods: A flexible, 'spiral' action research framework and 'collaborative group approach' were used, with mixed methods of data collection. Data were collected through focus groups, meetings and participant feedback, and participants' reflective diaries. A questionnaire using previously validated psychological attitude rating scales was also used to measure occupational stress and burnout, the extent to which the project influenced these, and the influence of Lecturer Practitioners' experience and qualifications. Six null hypotheses were constructed to measure these ideas. Findings from qualitative and quantitative perspectives were triangulated to give depth to the analysis., Findings: Five themes emerged from the focus groups: personal motivation, workload pressures, role clarity, preparation and support, and gains from the role. Specific policies and documentation were developed as a result of this initial project planning work. The findings from the questionnaire indicated that Lecturer Practitioners were no more stressed or burnt out than comparable workers. Synthesis of findings indicated, broadly speaking, that these LPs were 'thriving rather than just surviving'., Conclusion: Action research was an effective methodology for uncovering new knowledge, and bringing about organizational change in this project.

Aim: This paper contributes to an understanding of the political and ethical aspects of action research (AR)., Background: Action research is growing in popularity in nursing and health care as a means of changing practice and generating new knowledge. As a methodology, AR relies on a close collaborative working relationship between researcher and participants, but this close relationship is also the source of political and ethical problems faced by researchers and participants., Content: We argue that action researchers and participants working in their own organizations should be clear about the extent to which they are engaged in a political activity, and that AR does not offer the same ethical guarantees concerning confidentiality and anonymity, informed consent, and protection from harm as other research methodologies (both quantitative and qualitative). This argument is illustrated by our experiences of participation in an AR study., Conclusion: We outline three areas where AR is implicitly political, and three areas where it is ethically problematic. We recommend that researchers and participants recognize, discuss and negotiate these problematic areas before starting their work.

Graham Williamson and Sue Prosser discuss the ethical dimensions of action research, informed by their experiences of participation in an action research project in the workplace.