The development of community psychiatric nursing: a professional project?

In this paper the author argues that the development of community psychiatric nursing can be understood as a professional project However, the case of community psychiatric nursing cannot be adequately understood from mainstream literature on the subject of professionalization within the health care division of labour The inadequacy of such literature is that it either concentrates upon the pre-eminent case of medicine or regards nursing's professionalization as being unitary The author posits that the professional projects of general nursing and community psychiatric nursing have different and even opposing interests To contextualize community psychiatric nurses'(CPNs') professional project the author examines the history of mental nursing, from which community psychiatric nursing evolved, the development of community mental health care, which allowed for the inception of community psychiatric nursing, CPNs'relationships with both psychiatrists, whose patronage assisted CPNs'initial growth as para-professionals, and general practitioners, who later assisted a more functionally autonomous role for CPNs in primary care, and social policy towards community care that enhanced CPNs'growth In conclusion the author argues that recent government-led changes in the management of community mental health care now impel CPNs to change the direction of their strategy for occupational survival and advancement     

Continuing care: developing a policy analysis for nursing

Many authors have commented on the invisibility of nursing in policy development, implementation and analysis. Some of this invisibility may be attributed to the lack of an easily accessible framework to assist analysis of policy from a nursing perspective. In this paper we offer a framework for nursing policy analysis based on the domain concepts of nursing. We use continuing care for older people, a topical policy issue and fundamental nursing speciality, as a case study to demonstrate the utility and potential of such a framework in action. The resulting analysis helps identify areas of potential policy interest to nurses, raises questions for further policy analysis and offers a coherent position statement for action.     

The application of decision making concepts by nurse practitioners in general practice

The application of decision making concepts by nurse practitioners in general practice ¶This paper is concerned with the conceptual frameworks which could be applied to nurse practitioners in general practice in reaching decisions during patient consultations. Four strategies of decision making are explained within a practice context: hypothetico-deductive method, decision analysis, pattern recognition and intuition. The study uses retrospective verbalization and observation of 20 nurse practitioners working alongside general practitioners to explore decision making issues. The results of the study show that important factors relating to decision making include: the ability to recognize patterns in clinical situations to fit with patterns previously seen; an appreciation of the consequences of inappropriate action; and the ability to concentrate simultaneously on complex and sometimes masked patient cues as well as multiple treatment options.     

Mandatory refreshment for nurses: an incentive to return?

The UKCC's proposal to introduce mandatory refreshment for nurses will affect all qualified nurses and those in training. This article reviews the advantages and disadvantages where similar changes have been effected. It discusses concerns to the individual and the profession and considers the implementation during a period of change.     

What changes in health behaviour might nurses logically expect from their health education work?

This paper examines nurses' health education work from a philosophical perspective Two key concepts, choice and autonomy, are explored by analysing examples of the health education work of the practice nurse and the health visitor As a result, the question,‘what changes in health behaviour might nurses logically expect from their health education work?’is considered The individualistic assumption within nurses' health education work, that individual patients and clients face certain choices and are able to exert some control over their health status, is reviewed Choices related to healthy eating, for example, are recognized to be constrained by issues such as finance, time and social circumstances The choice not to smoke is similarly constrained, for example, by social deprivation, cultural patterns and advertising The paper both rejects an overly determined conception of patients and clients where they are viewed as unable to make any choices, but also cautions against the danger of victim-blaming Constraints on patients' and clients' autonomy in health education by nurses are also considered These limitations on health education work include, for example, a lack of scientific knowledge related to an individual's propensity to develop disease In contrast, health education work within nursing may also be seen as enabling people to be more autonomous in relation to their health by imparting knowledge about health risks Health education work by nurses thus emerges from the analysis as a constrained but valuable activity     

A view of the phenomenon of caring in nursing practice

Care is regularly used as a suffix to nursing, in such well-known phrases as 'total nursing care' and 'holistic nursing care'. While most care is provided by lay persons, there is little nursing research which focuses on the meaning of care, particularly in relation to the United Kingdom. This small-scale study investigates the meaning of care from the experience of six practising staff nurses in a British hospital and leads to a view of this phenomenon. Phenomenology was the chosen methodology, which facilitated the emergence of an essential structure of caring which incorporated four major categories described as 'being supportive', 'communicating', 'pressure' and 'caring ability'. It is suggested that, through gaining perspectives to enhance our understanding of the meaning of care, it will ultimately develop our understanding of nursing itself.