A hermeneutic analysis of the lived experiences of associate nurses

• ? In order to understand better the role of associate nurse in the primary nursing model, narratives from associate nurses were analysed using hermeneutic approach.
• ? Major themes in the narratives included: connecting with patients, collaborating with other nurses, and making decisions.
• ? Associate nurses were found to define their practice as ‘primary’ in terms of their contributions to patient care and being a responsible professional.
• ? A better understanding of the associate role in clinical practice can enhance patient care and professional relationships.
• ? Further research into the philosophical nature of primary nursing is suggested.

     

Better late than never? An evaluation of community nursing services for children in the UK

• ? The development of community nursing services for children in the UK was first suggested by Platt in 1959; until recently, however, such services have been rare and children have spent many unnecessary and potentially traumatic days in hospital.
• ? This paper considers the development of community nursing services for children in the UK.
• ? It identifies factors which have promoted the growth of these schemes, and examines the effectiveness of services from professional, managerial and economic perspectives.
• ? The viewpoint of the consumer – the child and family themselves – is also considered.

     

Advanced clinical practice—how do we promote it?

Summary This paper aims to examine the promotion of advanced clinical practice. It addresses questions such as:

• ? what is advanced clinical practice?
• ? what is the relevance of knowledge to clinical practice?
• ? what is the relevance of research to clinical practice?
• ? what is the relevance of the culture to clinical practice?
• ? what is the role of the clinical nurse? It does not present ready answers. Rather, it attempts to highlight difficulties and ambiguities originating from the contradictory goals and requirements of nursing education, research and practice.

     

Nursing staff's perceptions and experiences of primary nursing practice in intensive care 4 years on

• ? This study explores the perceptions of staff who have been practising primary nursing for more than 4 years in intensive care.
• ? It considers what primary nursing is, what its benefits, disadvantages, and role impact are and other issues within an intensive care setting from the staff's perceptions and experiences.
• ? Although many of the perceived advantages and disadvantages are similar to experiences from other areas of nursing, there are some differences.
• ? The differences seem to relate to the way primary nursing is practised within the research setting – each primary nurse works with the same small team of associates, which is perceived as providing added benefits in terms of personal support and development of junior staff.
• ? The changes in role are seen to reflect other models in the literature which focus on becoming more patient centred and on working therapeutically.
• ? A number of future issues are addressed.

     

Caring: fitting the concept to nursing practice

• ? This paper explores the concept of caring when used to define the nature of nursing.
• ? It is suggested that explorations of caring in nursing fail to acknowledge the real world of work in nursing, which is influenced by personal career choice and the organization of the health-care systems in which nurses work.
• ? In some situations nurses delegate the caring role to others thus giving ‘care by proxy’, a factor that is not clearly acknowledged in the literature on caring.
• ? It is suggested that if caring in nursing practice was denned as ‘formalized caring’ it would offer a framework for the analysis of caring more conducive to the reality of nursing practice today.

     

The effectiveness of nursing: a review

• ? This paper describes the findings of a literature review of the effectiveness of nursing. Three journals were selected in which this type of study was most likely to be published. A diversity of attempts to measure nursing effectiveness with various types of patient was found. Generally, however, there was a lack of rigour in study design and sample sixes were too small to be able to draw conclusions. No studies were found which undertook a cost-effectiveness analysis of nursing interventions.
• ? Suggestions for the way forward in measuring nursing effectiveness are given, together with questions to be addressed by nursing research.

     

A model of clinical supervision for nurses undertaking short placements in mental health care settings

• ? This paper presents a model of supervision developed from the experience of supervising undergraduate general nursing students undertaking clinical experience in psychiatric wards.
• ? Supervision structures and methods are presented and the theoretical underpinnings of the supervision model are discussed.
• ? Our experience of using the model over the past 5 years suggests that it has the potential to allow students to gain a good understanding of individual patients within a short time span and to engage with them as active collaborators in care.
• ? The supervision model can also assist students to develop the knowledge and insights needed to gain the respect of senior colleagues, and the confidence to challenge the professional conservatism that often characterizes psychiatric wards.

     

Assessment,prevention and monitoring of chronic leg ulcers in the community: report of a survey

Summary

• ? A questionnaire was completed by 146 community nurses which requested information on the types of leg ulcers they managed, along with details of their nursing assessment, monitoring and prevention strategies.
• ? Important differences in their reported clinical practice related to when they qualified as a community nurse.
• ? It is imperative that patients with chronic leg ulcers be given the benefit of a medical diagnosis, and an in-depth nursing assessment so that an appropriate and effective plan of management may be developed.
• ? Community nurses could benefit from further information on the aetiology and research-based management of patients with leg ulcers.
• ? A creative approach to the dissemination of research evidence for the management of leg ulcers, as part of continuing education initiatives, is required.

     

Changes in practice nursing: professionalism,segmentation and sponsorship

• ? In the wake of recent government policies and legislation, practice nursing has undergone major changes. Not least of these has been the rapid growth in the number of practice nurses.
• ? In addition, their work role has grown greatly over recent years.
• ? This has given rise to the question of whether their professional development now justifies their status as autonomous nurse practitioners.
• ? This and related issues are explored in the empirical part of this paper, which focuses on the changes in the work and responsibilities of practice nurses in two industrial towns in the English Midlands.

     

Promoting leadership and management in Australian general practice nursing: what will it take?

Aim This paper outlines the current state of Australian practice nursing, describes the context of general practice and establishes the importance of promoting leadership and management in this setting. Background Australian general practice nurses have emerged as key stakeholders in primary health care. However, their role in leadership and management has been largely invisible. The reasons for this are multifactorial, including the delay to establish a strong professional organization, their negative power relationships with general medical practitioners, limited nursing leadership and poorly defined roles. To date, the impetus for practice nurse growth has been largely external to the nursing profession. Growth has been driven by the increasing burden of chronic disease and workforce shortages. This has further weakened the control of nurse leaders over the development of the specialty. Conclusions The Australian practice nurse role is at a crossroads. While the practice nurse role is a viable force to improve health outcomes, the growing strength of the practice nurse challenges traditional professional roles and practice patterns. Implications for nursing management There is an urgent need to develop practice nurse leaders and managers to not only embrace the challenges of Australian general practice from an operational perspective, but also undertake a clinical leadership role. As clinical leaders, these nurses will need to develop a culture that not only optimizes health outcomes but also advances the status of the nursing profession.     

The value of reflective practice for nursing

• ? This paper notes the dawning of reflective practice on the horizon of nursing practice and sets out to explore its value for nursing.
• ? Central to this value is the potential of reflective practice to enable practitioners to develop clinical expertise towards achieving desirable and effective practice and, through collaborative research, the development of a valid disciplinary knowledge grounded in practitioners' personal knowledge.

     

‘It's the little things that count’: the hidden complexity of everyday clinical nursing practice

• ? This article reports on one aspect of a phenomenological study of everyday experience in nursing and how it contributes to the development of nursing expertise.
• ? The study was carried out with 10 ‘excellent, experienced’ surgical ward sisters in two Scottish teaching hospitals.
• ? The ward sisters were found to help individual patients towards recovery by making the ward work for all.
• ? When moment-by-moment nursing practice, the context of nursing experience, is examined, it is found to be patient-centred and complex, geared towards multi-layered goals.
• ? Three distinct yet inextricably intertwined processes–noticing, understanding and acting–characterize how nurses practise nursing. The quality of these processes contributes to the effectiveness of nurses' caring practices.
• ? The ‘little things’ of nursing practice make a difference to patients because they are imbued with nursing knowledge and skill.

     

Bonding theory–tying mothers in knots? A critical review of the application of a theory to nursing

• ? In recent times, nursing has witnessed a growing support for the notion of theory as being instrumental in enhancing nursing practice and ultimately patient care (Marriner, 1986). Whether generated from nursing practice, or ‘borrowed’ from other fields, the use of theory is viewed by some as the key to the ultimate recognition of nursing as a scientific, professional discipline in its own right (Stevens, 1984). Parallel to this view, there is a research perspective that questions the ultimate contribution of certain theories to health-care practice, particularly those emanating from other disciplines, urging caution in their practical utility. This paper enlarges upon this theme, focusing specifically upon the psychological theory of bonding, attempting to explore critically the degree to which it can be used in nursing practice, and to which it contributes towards our understanding of the attachment behaviour between a mother and her infant.
• ? A brief outline is given of the theory and its impact on health-care practice, and possible limitations discussed with reference to the conceptual origins of bonding theory, the validity of its research methodology, and its use within the wider health-care setting.
• ? A feminist sociological perspective is used in a brief attempt to explore the wider implications of the bonding theory in relation to the position of women.

     

Caring research and concepts: a selected review of the literature

• ? A selected review of the literature on caring in nursing is presented. The review relies on the work of the major theorists in this area.
• ? The major conceptualizations of caring are compared and contrasted, along with some of the research approaches which have been applied to investigate the phenomenon of caring in nursing.
• ? The outcome of quantitative and qualitative research on caring is described and the justification for an extension of the quantitative work, through the development of an appropriate inventory and the application of multivariate statistical analysis, is discussed.

     

An analysis of the changes involved in the introduction of the nursing process and primary nursing using a theoretical framework of loss and attachment

• ? The nursing process is an innovation which has had a great effect on nursing practice.
• ? Primary nursing is an innovation currently having profound effects on the delivery of nursing care.
• ? In this article a theoretical framework of loss and attachment (Marris, 1985) is used to analyse these innovations.
• ? Data from studies of the nursing process (Bryar, 1985) and primary nursing (Mead, 1991a) are used to argue that changes in working practices may result in a period of loss and mourning. Nurses must have time to work through this period of mourning if change is to be successfully implemented.

     

Creating consensus about nursing outcomes. I. An exploration of focus group methodology

• ? The aim of this study is to explore a method for achieving consensus about nursing outcomes between patients, nurses and health professionals.
• ? Focus group work as a research tool is described and reviewed.
• ? Problems of recruiting and facilitating such groups are highlighted.
• ? The relationship between focus groups and consensus is discussed.
• ? It is concluded that focus group work is not without problems, yet means of incorporating patient views into health services need to be developed.

     

Eating despite severe difficulties: assessment of poststroke eating

• ? A programme for the assessment and nursing diagnoses of eating difficulties among stroke patients was tested. The patients' experiences regarding eating were expressed in interviews and dialogues. Eating was observed during both a test meal and regular meals.
• ? The assessments included the prerequisites for eating as well as oral, pharyngeal and oesophageal functions.
• ? General and specific nursing diagnoses as well as life consequences (handicap) were established, based on assessment of disabilities and impairments, and interviewing the patients and their families, respectively. The general nursing diagnoses were formulated on admission after the test meal and these were reformulated to form specific nursing diagnoses after assessments of the functions.
• ? The programme presented proved to be useful in clinical practice. It is emphasized that many assessments must be co-ordinated for each individual.

     

A review of primary health-care organization

• ? A contract for the provision of community nursing and associated services was drawn up between the Plymouth Community Unit and general practitioners associated with a fundholding practice at a health centre in Devon in October 1991.
• ? This project, which aimed at applying purchaser/provider principles, contained some novel features and was subject to evaluation and review after 6 months.
• ? An evaluation which had four main aspects was carried out, consisting of interviews and questionnaire assessment of staff attitudes, patients' views of the effectiveness of aspects of the practice health-promotion activity, an analysis of staff activity data before and during the pilot phase and an examination of the documentation concerned with critical issues which had arisen.
• ? Questionnaire data indicated that staff motivation and enthusiasm for the project was high and that patients' views on the practice facilities were generally positive.
• ? The role of the Macmillan nursing service at this practice was greatly enhanced during the pilot project with a fourfold increase in the number of visits carried out.
• ? Over 120 h were spent by health visiting and district nursing staff on issues surrounding the pilot project including attending additional meetings.
• ? The results are discussed in relation to service benefits to patients, the effect on the cohesion of the primary health-care team and issues of fundholding and are considered in the context of models put forward for the future development of community-based nursing care.