The cyclical impact of the United Kingdom Research Assessment Exercise (UK RAE) on manuscript submissions was one of the issues referred to last December (36:6, p. 716) when looking back on JAN's development over 2001. As a result, we decided to limit issues in 2002 to ten articles, exclusive of editorials, JAN fora, etc. By June, submissions had not only returned to their pre-RAE levels, but were also higher than at any time in the past. Manuscript acceptances are also up and beginning with issue 40:1, JAN will have 12 articles in each issue. This will maintain JAN's valued time period of 4–5 months between an article's acceptance and publication, making a total of a year or less between submission and publication. The achievement of this target is heavily dependent on the speed with which authors return a manuscript with revisions completed to the reviewers' satisfaction.

Further improvement in the impact factor for the year 2001 can also be reported (Table 1). Also pleasing is the fact that JAN received a total of 3734 citations in 2001, showing the influence that the journal must have upon readership. Our closest competitor was Nursing Research with 1704 total citations (impact factor 1.2).

Table 1.  The position of JAN in the SCCI citation listing 2001
JAN 's impact factor:  0·619  0·581  0·637  0·638  0·769  0·797
Category and rating:1112  9131210
No. of nursing journals  on SCCI citation listing264041424342

This issue begins with two articles on Issues and innovations in nursing education. The findings from a survey of pharmacology teaching on undergraduate nursing courses are reported first, and make salutary reading. They will no doubt prompt questions by teachers of pharmacology to nurses in other countries as to their own comparability. The low response rate makes the findings even more disturbing; were recipients of the questionnaires sent to all university campuses (13) in Victoria, Australia, not interested in sharing their experiences? The second article concerns baccalaureate student nurses' smoking behaviours in one Canadian province. A greater proportion of the 62% non-smokers who responded showed positive health promotional attitudes and behaviours than in the group who were smokers. The findings have implications beyond the danger to individual smokers' health, especially as the authors report that the respondents showed similar demographic characteristics to those of the general population of under-25 year olds. The findings are of concern both to policy-makers in general and to employers of nurses.

A number of inter-related articles follow on the topics of caring and phenomenology. First, a tour de force by John Paley introduces some of Nietzsche's philosophical ideas in an analysis of caring as a slave morality. I found Paley's arguments to be both intriguing and convincing having long researched the contentious relationships between nursing and medicine myself. I was less certain about the extrapolation of his critique to nursing's use of phenomenology as a research method. An author whose own Selected Annotated Bibliography of Phenomenological Sources (Maggs-Rapport 2001) will be reviewed in a forthcoming issue of JAN, therefore responded at my request in JAN Forum. She pays homage to Paley's rare ability and intellectual dexterity in presenting his arguments and contends that he raises several questions that may be ‘some of the most important to have emerged from the nursing literature for some time’. Nevertheless, Maggs-Rapport takes issue with his arguments on phenomenology, showing that it is the incorrect use of the method, rather than the use of the method at all that should be of concern to nurses. I suspect that Paley himself might agree with this line of reasoning. The next article returns to an earlier debate on Benner & Wrubel on caring initiated by Edwards (33, pp. 167–171). Here, the author argues that Benner & Wrubel (1989) fail to distinguish between what Edwards calls ‘ontological’ and ‘intentional’ caring and that this misleads ‘readers who are unaware of these subtleties’. Benner and Wrubel respond themselves in a second JAN Forum contribution that argues philosophically to ‘set the record straight’ on Heidegger. However uncomfortable some readers may be with the arguments put forward in these and other recent debates in JAN, they are clearly not going to go away. In my view, they are to be welcomed as they signify the emergence of a maturing research profession.

The first methodological article critiques the contribution of qualitative palliative care research reported in nursing, compared with a group of similar studies from anthropology and sociology journals. Nursing articles compared unfavourably in respect of their theoretical and conceptual content, and their contribution to understanding. The negative aspects of both groups were, however, remarkably similar, and the findings were also apparently similar to an earlier study of medical journals. These findings confirm broader issues that have been debated extensively in JAN; namely how good is nurses' familiarity with, and application of theories drawn from the subject disciplines that inform health care research? My somewhat pessimistic conclusion is that these difficulties will never be fully resolved to the satisfaction of the subject disciplines, unless nurses were to study them completely separately (as a postgraduate in anthropology or biology, sociology or chemistry, etc., being recruited as a student nurse). This would be impossible except for a select few (and these may not necessarily be experts in their specialist subject). Yet we have to recognise that the problem lies at the heart of much current criticism of nursing research. We are taken back to the unresolved philosophical and practical questions of eclecticism in nursing curricula design (see Fealy, 37, pp. 558–565). I hope that the many issues raised by these searching articles will promote active, informed discussion.

The second methods article, from Norwegian authors, raises further issues concerning empirical research that uses phenomenology as a theoretical underpinning in the study of women suffering from stroke. Gender as well as differences in social class, education and social status are fundamental in constituting the research subject's world, and the authors argue for two forms of openness (the informant's and the researcher's) in gaining access to this personal reality. Gender also lies at the heart of the single article in the Nursing theory and concept development or analysis category. In her analysis, the author sees gender sensitivity as ‘involving an awareness of the socio-political context in which definitions of ethical practice take place’. The case is argued for exploration of gender sensitive care to understand all the processes of power in social relations, especially as they affect the provision of nursing care.

Five practice articles conclude the issue; the first two on very different aspects of pain management. The findings from a small English study obtained by interviews with a matched group of parents and nurses, show that nurses' poor communication and knowledge deficits created obstacles to good postoperative pain management in children. This observation reinforces the situation reported extensively in the literature. The authors recognise that the problem is not just one of poorly informed nurses, as well-informed parents may constitute a considerable threat to nursing staff. If behavioural changes are to be brought about, solutions must be implemented across a broad front by developing the knowledge and confidence of both parents and nurses. The second article also concerns pain, but of a very different kind. The authors researched the experiences of 14 Swedish men with fibromyalgia-type pain. Respondents were anxious not to be known as ‘whingers’, and they hoped that investigations by specialists in the field would result in actions for the relief of their pain. But they were also aware that being a sufferer from chronic pain meant that they were likely to be seen as uninteresting patients. The stoicism of these men in the face of chronic pain for which there is no cure, and the help that engaged and interested staff could provide despite the unlikelihood of a cure, was revealing. The study findings remind us that health professionals generally still prefer to work with clients for whom recovery is a possibility, and also that skilled and attentive care can promote well-being amongst chronically ill patients, even in the absence of other possible interventions.

The rationale for an assessment of the unmet nursing care needs of 322 physically disabled patients is the subject of the next article. The majority of disabled people in central Taiwan live at home with care provided by family members, many of whom have no particular training for the tasks that they perform. In the Taiwanese culture the needs of family members are placed above one's own. Hence, meeting the considerable number of unmet needs that were identified also requires attention to the needs and education of caregivers. As in the study of children'spostoperative pain above, a two-pronged solution is required in order to promote high quality family care; in this case, appropriate assessment together with counselling support and training for the caregivers.

Thirty years ago, community nurses in the UK were obliged to join ‘primary health care teams’ in the mistaken belief that teams inevitably improved cost-effectiveness. Policy makers ignored protests to the contrary, which was regrettable as attention to teams' internal dynamics might have resulted in better delivery of care to patients. In the next article, petty jealousies and role boundaries are recognised as important attitudinal barriers to interprofessional team care. Researchers from the north west of England carried out a ‘before and after’ study in four different sites with dedicated stroke units (recognized to produce the best patient outcomes) using recent policy initiatives as interventions that require whole team collaboration. Little change was observed as a result of their introduction. The authors conclude that teams do need support in the formative phases, but they also need time to establish a team identity, which may be quite different in different settings. The introduction of methods to improve team co-ordination had no apparent effect and some members were ambivalent about team working. The final article, from Norway, reports on a small study of 10 women's experiences of living with newly diagnosed breast cancer. Although no generalization is claimed, the findings are important for nurses providing care to this group of patients. The authors provide insightful comments on the implications for nursing practice; notably the women's expectation of competence, and the nurses' need to provide support by focusing on personal resources and coping ability rather than on the limitations imposed by the illness. Once again, a small qualitative study provides much food for thought in developing good practice.


  1. Top of page
  2. References
  • Benner P. & Wrubel J. (1989) The Primacy of Caring, Stress and Coping in Health and Illness. Addison-Wesley, Menlo Park, CA.
  • Maggs-Rapport F.L. (2001) Selected Annotated Bibliography of Phenomenological Sources. Mary Seacole Research Paper 3, de Montfort University, Leicester (to be reviewed in a forthcoming issue of JAN).