Fathers' experiences of living with cancer: a phenomenological study

There is a paucity of knowledge about fathers' experiences of cancer. This study explored the experiences of fathers diagnosed and living with cancer while also having parental responsibility for children. A hermeneutic phenomenological approach guided the study. Data were generated through 22 in‐depth interviews with 10 fathers throughout Northern Ireland. The findings evidenced that fathers' identities are challenged and frequently re‐shaped by the cancer experience, in many cases leading to an improved lifestyle behaviour. Heightened engagement with their children can provide a protective effect from the illness. On the other hand a lack of involvement led to frustration and low mood. The findings also demonstrated that father/child relationships were adversely affected by the social complexities that exist in the variances and diversity of fathers parenting roles and status. This knowledge contributes to our understanding of the complex relationships of fathers in non‐traditional roles. It extends our understanding of how, when stereotyped gendered roles are ascribed to fathers it can impact on a fathers' ability to fulfil the traditional breadwinner's role. This is knowledge that will inform health care professionals and enable them to provide gendered‐sensitive care that takes account of the masculine psychological responses that can shape the cancer experience.     

Diabetic patients facing long-term complications: coping with uncertainty

A major problem of diabetes mellitus lies in its complications. Fourteen Type 1 diabetic patients with severe long-term complications were interviewed on two occasions with the aim of gaining a deeper understanding of their coping strategies. The study has a qualitative design and a grounded theory approach was used. The data-based categories 'Coming to terms', 'Keeping going' and 'Making sense' serve as a framework for the presentation of the substantive issues raised by the respondents. It was found that the problem of uncertainty featured prominently.     

A critical analysis of the failure of nurses to raise concerns about poor patient care

The occurrence of poor patient care is emerging as one of the most significant, challenging, and critical issues confronting contemporary nursing and those responsible for the provision of health care more generally. Indeed, as a consequence of the increased recognition of the manner in which nurses can be implicated in the occurrence of poor patient care, there has been sustained critical debate that seeks to understand how such healthcare failings can occur and, in particular, why nurses seemingly fail to intervene, raise concerns, and effectively respond to prevent the occurrence and continuation of such poor patient care. In seeking to contribute to this critical discussion, and in contrast to those “situational explanations” that maintain that the failure to raise concerns is a consequence of the contextual factors and challenging conditions to which nurses can be subject in the clinical setting, this paper will provide a resolutely philosophical analysis of that failure. In particular, it will draw upon the work of Jean‐Paul Sartre—the French philosopher generally regarded as one of the most influential thinkers of the twentieth century—in order to propose that his work can be productively recontextualized to provide a detailed, challenging, and provocative critical analysis of the occurrence and continuation of poor patient care and the role of individual nurse practitioners in such healthcare failings.     

A qualitative study exploring parental perspectives and involvement in health visiting services during the Health Visitor Implementation Plan in the South West of England

Internationally, there is a strong interest in engaging the public more widely in both the development and governance of public services. This study aimed to explore family perspectives on the introduction of a new policy initiative called the ‘Health Visitor Implementation Plan’ (Department of Health [2011] Health Visitor Implementation Plan 2011–15: A Call to Action) and their experiences of the new health visitor service provision. The policy aimed to increase the health visitor workforce by 4200 additional practitioners between 2011 and 2015, in parallel with introducing a new service model to provide comprehensive and accessible support for parents with children 0–5 years. Using a qualitative approach, data were collected via semi‐structured interviews and focus groups with 22 parents between March 2013 and March 2014. Questions focused around the extent to which the new service met parental expectation and need. Participants were recruited through Children's Centres and interviewed during established group sessions. Analysis was conducted using thematic analysis and constant comparative methods. The participants were asked to share their experiences of the health visiting service and their views on this national policy initiative. Although asked to comment on the policy at nation and local level, their responses were predominantly around personal experience. Parents welcomed the increase in workforce capacity and positive experiences centred on health visitors who were caring, knowledgeable, skilled and facilitated positive outcomes. Many of the negative experiences were seen to be due to poor relationships between the parent and the health visitor. Parents were influenced by the communication skills and personal attributes of the individual health visitors, including time to listen. The strength of parental opinion indicated that parents are willing to contribute to service development, consequently policy makers and health visitors themselves need to have clarity around the purpose and mechanism of parental involvement if meaningful partnership is to become a reality.     

Evaluation of health promotion activities in community nursing practice

The purpose of this research was to study the extent to which community nurses (CNs) were involved in health promotion activities and to investigate whether these activities were meeting the needs of their clients A cross-sectional survey by multiple methods was designed and carried out in four district health authorities (DHAs) in one regional health authority in England Two hundred and fifty-one (83 67%) completed questionnaires were returned by CNs working in primary health care (PHC) Sixty sessions with CNs were observed and 249 interviews were conducted with clients Additionally, as part of the observation 155 clinical records were examined CNs reported involvement in a wide range of opportunistic and organized health promotion activities Lifestyle advice and ill-health prevention were most frequently used by all groups Health visitors (HVs) were involved significantly more in group and community wide activities District nurses (DNs) were mainly involved in opportunistic health promotion Practice nurses (PNs) were found to be involved significantly more in health promotion activities organized on an individual basis Observation revealed that opportunistic health promotion was carried out in almost half of the consultations observed, of which lifestyle advice was the most frequent Records however showed that this information was rarely recorded The clients of PNs were mostly aware of other health promotion activities available within the general practice, while almost half of the HVs 'clients knew what other health promotion activities were available to them and few DNs' clients were aware of any     

Facilitation: a concept analysis

The term 'facilitation' appears to be open to a wide variety of definitions and interpretations. If teachers are to act as facilitators of learning they need a clearer understanding of facilitations as a strategy for nursing education. This concept analysis uses Walker and Avant's framework. Following a review of the literature related to facilitation, the paper postulates that there are four critical attributes for effective facilitation: genuine mutual respect; a partnership in learning; a dynamic, goal-orientated process; and critical reflection. The necessary antecedents and likely consequences are identified. Model and alternative cases are offered. A distinction is made between educational facilitation and facilitation in counselling. Recommendations are given regarding the future development of empirical referents. To enhance the reader's understanding of concept analysis, the paper incorporates a reflection on the process, together with a discussion of the way in which decisions regarding the attributes were reached.     

Clinical guidelines: an introduction to their development and implementation

There is a great deal of interest in the United Kingdom in clinical guidelines as a means of assisting practitioner and patient decision making about care options and in improving the quality of the care provided Confusion remains, however, over what is meant by a clinical guideline and how it differs from and relates to protocols and standards This paper was written under the auspices of the Royal College of Nursing Steering Group for the college's work on clinical guidelines, with the aim of clarifying some of the terminology used in the field and introducing ways in which clinical guidelines might be used by practitioners and patients to readers At the moment just how effective the use of clinical guidelines can be on care is poorly established What is known, however, is that crucial to their success are the strategies and methods used for their implementation Such strategies and methods raise questions about how a sense of ownership can be engendered in those using the clinical guidelines and how they may be best operationalized These questions are considered in this paper