Formal carers: attitudes to working with the dementing elderly and their informal carers

This paper presents a discussion of some of the results arising from a study into the inter-relationships between the dementing elderly in the community, and their informal and formal carers. The results from one phase of the study, which gathered data from informal carers, were used in the development of an attitudinal questionnaire. The questionnaire was distributed to a sample of 60 formal carers drawn from a wide variety of health, social and voluntary services. The questionnaire sought to gather data about the formal carers’ responses to their work with dementing people and their co-resident informal carers. The results of the questionnaire indicated that most of the formal carers believed that it was part of their job to maintain the dementing person in their own home and that they were effective in doing this. However, many of the respondents were uncertain whether homecare was best for the dementing person. The results also suggested that the majority of respondents felt that maintaining the dementing person at home was not detrimental to the informal carers welfare and that their intervention was effective in supporting the informal carer. These findings are discussed within the context of the informal carer phase of the study and demonstrate some variance between the formal and informal carer perspectives of care control and the significance of formal carer input.     

The rationale for the use of risk calculators in pressure sore prevention, and the evidence of the reliability and validity of published scales

Recent studies have shown an increase in pressure sore prevalence rates However, methodological inconsistencies and demographic considerations, which include an ageing population, make it difficult to interpret and compare results A multiplicity of intrinsic and extrinsic factors are thought to be associated with increased risk The development of risk calculators which incorporate these factors has been an attempt to identify which subjects are most at risk so that equipment and nursing interventions can be allocated appropriately Since the 1960s there has been a proliferation of risk assessment scales which have not been subjected to rigorous scrutiny of then- reliability and validity, and this is held to represent a failure of nursing research Recent evidence suggests that if critical cut-off points for'at-nsk'vs'no risk'are adjusted for particular patient populations the validity of existing scales can be improved Missing from the literature are research reports of studies earned out in the community As a result of demographic changes and community care policies, more'at-nsk'patients are likely to be nursed at home Future research needs to include community studies, and a more systematic approach in general, to the study of the predictive value of existing scales     

Paediatric day surgery: day-case unit admission compared with general paediatric ward admission

A small exploratory study ( n = 20) is described which compares the experience of children admitted to a day-case unit with that of children admitted to a general paediatric ward. Both samples received inadequate amounts of information, particularly prior to discharge. The care offered in the day-case unit was found to be woefully deficient in many areas and the wisdom of utilizing occasional sessions in an adult day-case unit is questioned. The crucial role of skilled nurses trained in the care of sick children is emphasized.     

The role of the health visitor in identifying and working with vulnerable families in relation to child protection: a review of the literature

This paper presents an overview of the research surrounding the role of the health visitor in identifying and working with vulnerable families in relation to child protection Only a limited number of empirical studies have been completed within the field of health visiting, so this review draws on most of the literature published over the last 15 years, which is mainly British in origin No previous reviews have focused on this specific area of health visiting Clearly with the recent increase in public and official recognition of child protection issues and the continuing debate of health visitor involvement within this area, this review takes a significant step forward in drawing together relevant research The review focuses on research within three main areas Firstly, the health visitor's role in working with vulnerable families in relation to child protection is explored The clients'perceptions of this role are also explored Secondly, the identification of vulnerable families by health visitors and non-health visitors is explored Within this area a number of studies by non-health visitors investigating screening approaches to child abuse have been reviewed, because they play such a major role in the literature and appear to have influenced subsequent health visitor research Thirdly, a review of health visitors'preventive work with vulnerable families is completed     

The measurement of nurse performance and its differentiation by course of preparation

This paper addresses the concept of nurse performance, its measurement and its differentiation by programme of preparation It is evident from the research conducted to date that a variety of methodologies have been used to explore and compare nurse performance The process of direct observation, however, has been selected to a lesser degree, and it is argued that its potential has yet to be realized Further, in recognition of the methodological challenges inherent within research of this nature it is suggested that nurse performance should be explored from a variety of perspectives, using a multi-method research design Significantly, educational preparation as a potential discriminator of performance has been explored only to a limited extent and studies carried out in the United States predominate In view of recent nurse education changes in the United Kingdom and the introduction of Project 2000, empirical work comparing outcomes of the different courses of pre-registration preparation is urgently required The authors are currently engaged in a comparative study of outcomes of pre-registration nurse education programmes funded by the English National Board for Nursing, Midwifery and Health Visiting This paper draws upon the literature reviewed to date     

Competence versus performance: which is more important?

The extensive literature in the field of competence and performance is reviewed in this paper, which argues that there is much confusion between these different constructs It concludes that since nurse pre-registration education is concerned with producing nurses who consistently provide care of a high quality, greater emphasis should be placed upon performance in the real-life clinical setting rather than upon competence     

Preparing for Trust status–an investigation into the morale of nurses undergoing change

The morale of nurses is a phenomenon often open to public comment without substantiated evidence. This study objectively explored the morale of nurses in a large district general hospital preparing for transition to National Health (NHS) Trust status. Information was sought using a 72-item questionnaire. The investigation was firmly centred around a structured theory which construes morale in terms of nine dimensions. The notion of morale being a construct synthesized of nine dimensions adds to the uniqueness of the study. Other studies fail to differentiate between the dynamic morale construct and the more complacent attitudes of job satisfaction.     

Processes in the creation and diffusion of nursing knowledge: an examination of the developing concept of family-centred care

The creation of a knowledge base to underpin and direct nursing practice has been the pursuit of nurse academics, educationists and practitioners over recent decades Much of this work has concerned the explication of major theories of nursing, whilst some has sought to elucidate specific areas of knowledge This paper outlines processes of creation and diffusion, considering the influence of factors from both within and without the nursing profession on the epistemology of its knowledge base An examination of the developing concept of family-centred care is utilized to illustrate the convolutionary process of knowledge creation     

Continuing professional education: identifying the characteristics of an effective system

The need for a functioning system of continuing professional education (CPE) in nursing, midwifery and health visiting has received increased attention in recent years However, whilst the literature describes a number of benefits, detailed empirical studies have been limited There is, in particular, a dearth of information on nurses' perceptions of the important components of a CPE programme Using the results of a recent evaluation of the Welsh National Board's Framework for Continuing Education, this paper highlights a number of key issues identified by practitioners, educators and managers throughout Wales Using a structure—process-outcome model, attention is focused on the outcomes of CPE and the structure and process variables which facilitate or inhibit success The results indicate a strong commitment to the principles of CPE and identify a complex range of perceived benefits Potential barriers inhibiting both the uptake of CPE and the achievement of subsequent change are discussed and the need to create an equitable, well-resourced system is stressed