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.     

The emergency nurse practitioner role in major accident and emergency departments: professional issues and the research agenda

The emergency nurse practitioner (ENP) is a rapidly developing role within emergency health care provision in the United Kingdom (UK). This paper explores some of the available literature concerning the development of the role in the context of major accident and emergency departments. The professional and legal implications of this shift in role boundaries are discussed. The current inconsistencies in educational provision and the potential consequences for practice in this area, are highlighted. The relative plethora of rigorous evaluation studies of ENP role effectiveness in North America, is contrasted with the current paucity of empirical data available in the UK. A number of methodological issues concerning the evaluation of ENP services are identified. The need for research in this area, alongside a programme of continuing local audit to guide and inform evidence-based practice, is emphasized.     

Clinical supervision: a means of promoting reciprocity between practitioners and academics

This paper explores the potential of adopting an alternative approach to the facilitation of clinical supervision in a practice context by focusing on the experiences of academic staff of facilitating clinical supervision for clinical colleagues. The exploratory study, which forms the basis for ideas generated, was very small and hence it might be better conceptualized as an analysis of conversations about practice understandings rather than research per se , and certainly, we make no claims of any possibility of generalizability. Nonetheless, we anticipate that our findings will be of interest to a wide audience involved in clinical supervision given that the supervision by academic staff of colleagues in practice is an unusual and unconventional departure from the norm.
The experiences of six academic staff from one higher education institution who were brought together to form a focus group provide the basis for discussion. Analysis of the structured discussion led to emergence of four major themes which are presented in an order that moves from the individuals' experiences and perceptions of themselves in the process, to explore the relational nature of clinical supervision. The first theme highlights issues of professional identity or academics' sense of themselves as health professionals and/or academics. This leads to the second theme that explores the tangible benefits identified by participants of providing clinical supervision as academics. The third theme about the perceived contribution that academics make to supervision, links, finally, to the perceived reciprocity that springs from clinical supervision relationships between academics providing supervision in practice, and clinicians. Our findings, based on this modest inquiry, suggest that this model of clinical supervision has potential to prove highly fruitful for both academic staff and their clinical colleagues.     

Facilitating safe care: a qualitative study of Iranian nurse leaders

Aim The purpose of this study was to explore and describe how nurse leaders facilitate safe care from the perspectives of both nurses and nurse leaders. Background The health-care system’s success in improving patient safety pivots on nursing leadership. However, there is a lack of knowledge in the international literature about how nurse leaders facilitate provision of safe care and reaching the goal of a safe health-care system. Method A qualitative design using a content analysis approach was applied for data gathering and analysis. In this study, 20 nurses (16 nurses and four head nurses) working in a referral teaching hospital in Tehran, Iran, were recruited through purposive sampling. Semi-structured interviews and 10 hours of structured observations were conducted to collect data. Results The data analysis resulted in three main themes: ‘providing environmental prerequisites for safe nursing practice’, ‘uniting and integrating health-care providers’, and ‘creating an atmosphere of safe care’. Conclusion The results indicate that to facilitate providing safe care, nurse leaders should improve nurses’ working conditions, develop the nurses’ practical competencies, assign duties to nurses according to their skills and capabilities, administer appropriate supervision, improve health-care providers’ professional relationships and encourage their collaboration, empower nurses and reward their safe practice. Implications for nursing management Approaching the challenge of patient safety requires the health-care system to combine its efforts and strategies with nursing leadership in its vital role of facilitating safe care and improving patient safety.     

Working with vulnerable families: a health visiting perspective

The aim of this paper is to describe part of the findings of a research study which explored the health visitor's role in identifying and working with vulnerable families in relation to child protection One objective of the study was to describe and analyse the work which health visitors undertake with vulnerable families aimed at preventing crisis, ill-health and child abuse This paper outlines this aspect of the research and looks specifically at health visitors'perceptions of their work and interventions with vulnerable families and children Health visitors working m an inner city area and a suburban area were sampled and pilot work was undertaken in a third suburban area Stage one involved a postal survey of 102 health visitors, in which a response rate of 58 (57%) was obtained Stage two involved 12 in-depth interviews with health visitors One major finding of this study highlighted the fact that the health visitor's role when working with vulnerable families appears to be one of diversity and conflict In the light of the current National Health Service reforms it seems of paramount importance that health visitors illustrate to others, both managers and other health/social service professionals alike, the important function of their work with these vulnerable groups This is essential to ensure that health visitors'work with vulnerable families in relation to child protection is understood and valued and that the needs of vulnerable families continue to be identified This paper contributes to the knowledge base of health visiting and raises some important issues for professional health visiting practice     

The practitioner-teacher: a study in the introduction of mentors in the preregistration nurse education programme in Wales: part 1

This study focused on the introduction of mentors in the Common Foundation Programme of Project 2000 schemes of preregistration nurse education The research, which was commissioned by the Department of Health Research and Development Division on behalf of the Welsh Office Nursing Division, began in February 1992 and was undertaken on an all-Wales basis The completed report aims to provide policy makers with information relating to important issues which are central to the teaching and learning of nursing in clinical locations This first paper discusses some background issues and gives a brief conceptual framework for considering policy reform, summarizes the research questions which emerged and describes the methods used to address them The second paper (to appear in the next issue of the journal) will describe the key findings from the study and discuss some ensuing potential implications and considerations for all those involved in the preparation of future practitioners of nursing