This month in JAN


Changes to the presentation of the Journal of Advanced Nursing from January 2001 have been described in both October and November 2000 This month in JAN editorials. In anticipation of these changes, new Guidelines for Authors have already been introduced. Authors wishing to submit papers are requested to consult these new Guidelines carefully. From January 2001, whilst continuing regularly with This issue in JAN, main editorials will be included only as an occasional feature. Current issues and forthcoming events (replacing the former News) and Media Reviews sections will continue as before. This, therefore, is the last This month in JAN before the changes are introduced in the New Year. We hope that readers will let us know how they like the new format. The editors always welcome feedback on any aspect of the Journal of Advanced Nursing and we hope that Janforum will be used increasingly by readers for issues for debate.

Seventeen (58.6%) of this month’s 29 papers are concerned with Issues and Innovations in Nursing Practice, and a further five (17%) with Issues and Innovations in Nurse Education. The December 2000 issue differs then quite considerably from that of November, which was concerned with several conceptual analyses. Nevertheless, the concept of hope that was also discussed last month recurs in a paper by a North American author who has published widely on this subject (this time in people with a first recurrence of cancer). I still wait hopefully for a dedicated author to carry out a systematic review of all the diverse nursing research work on hope.

Seventeen papers on Issues and innovations in nursing practice cover material from many different countries. Papers this month range from aspects of mental health care in South Africa to myocardial infarction in women in Australia, from diabetes adjustment in the USA to nursing home care in The Netherlands, from grief in older people in England to a health education programme for pregnant women in Thailand. Highlights this month include How we live: participatory research with six people with learning difficulties, a paper that represents an in depth inquiry with clients living in nurse-managed community homes, and lasting more than 18 months. Research in the area of learning difficulties has proliferated since the mid-1980s, reflecting perhaps the concern of health and social care professionals to ensure that life for their clients is as meaningful and as autonomous as possible. The study reported here adds to this body of knowledge and demonstrates the sensitivity with which the research was carried out, and the findings interpreted.

Three further papers in the Issues and innovations in nursing practice category represent relatively rare subjects for nurses to report, and all add important dimensions to our knowledge. The first, A qualitative study of stress factors in the early stage of acute traumatic hand injury, finds ubiquitous factors common to the majority of the twenty patients studied. Practical problems with daily activities were reported by all participants, whilst uncertainty about future function, pain, and being dependent on the help of others, occurred in a substantial number. These findings may seem obvious, yet it is rare to see hand injury featuring in nursing research and the patients so affected are highly dependent on nursing care. The second paper, Journey to recovery following physical trauma, confirms that research on recovery from illness principally concentrates on the integration of chronic illness into one’s life. The authors describe their research findings under three main themes, and argue that the accounts of seriously injured survivors do not necessarily correspond with those of most trauma clinicians. These two papers on the experience of trauma certainly confirm an editorial impression that this is a neglected area for nursing research.

The third paper on a rare topic reports on five Women’s experience of suffering repeated severe attacks of acute intermittent porphyria. For the majority of British readers this condition will be associated with Alan Bennett’s popular play and film The Madness of King George, but few will have encountered this distressing condition in professional practice. The importance of epidemiological knowledge is highlighted in this paper for, the authors explain, acute intermittent porphyria is rare but found all around the world, with the highest prevalence in northern Sweden.

Two papers focus on aspects of direct clinical practice. The first is a literature review on the Oral health care needs of dependent older people: responsibilities of nurses and care staff. As someone who has recently observed in a personal capacity the need for this crucial aspect of nursing care, I can only endorse the authors’ conclusions that this is a relatively neglected area in practice, education and research. The second paper concerns yet another neglected area for nursing practice research, patients’ perspectives on the experience of urodynamics investigation. The potential for discomfort and embarrassment to accompany this procedure has, surprisingly, not been the subject of previous studies. The authors identify patients’ extent of satisfaction with the investigation, and include several recommendations for practice.

Another relatively rare report, from the USA, on laboratory investigations into the Effects of pressure support ventilation and continuous positive airway pressure on diaphragm performance has implications for nurses working in intensive care when weaning patients from dependency on mechanical ventilation. The authors note that further research on diaphragm condition and functioning are recommended.

Two papers under the Philosophical and ethical issues category include some considerations on healing, nursing and caring within Islam, and findings on the ethical decision-making process of accident victims with neurosurgical trauma. The first paper adds to a growing body of knowledge on cultural aspects of nursing care, whilst the second raises serious ethical issues, including the role of nurses in ethical decision-making.

A paper under the Health and nursing policy issues category on the British health visitor’s potential role in the management of acute childhood illness is topical. Here is a practical example of the increasing medicalization of the role, an innovation that need not necessarily be resisted, but should at least be considered within the wider context of the systematic review discussed in this month’s main editorial.

Three methodological papers reinforce a growing impression of nurses’ increasing interest in research design issues. This month these include an account of the development of an instrument to measure compliance, the use of focus groups to develop a culturally sensitive video, and a means of enhancing rigour in the analysis of data from semi-structured research diaries.

Finally, the five papers within the category Issues and innovations in nursing education cover new material on familiar subjects. These include a British paper on the biological sciences in nurse education, which dispels the idea that their influence is diminishing in modern curricula. The authors do find, however, that staff nurses notably lacked confidence in this area. Other papers include a study of the development of nurse–patient relationships amongst students, the role of the nurse teacher in addressing the theory–practice gap, a longitudinal study of the qualities of an effective mentor, and the development of reflective skills in a post-registration course on palliative care.

Together, these 29 papers include subjects of specialist and general interest for nurses everywhere. We commend them to our readers.