• Jane Robinson Editor


Four papers on elder care in the section on Issues and innovations in nursing practice begin this month’s issue. First, an observational study of qualified and unqualified nurses’ interaction within the context of handovers in elderly care wards is reported. This found, amongst other identifiers, that interaction was cryptic, given at high speed, prioritized biomedical accounts and emphasized physical aspects of care. The patients’ resuscitation status was highly salient to all grades of nurse at the handover. This fact may be significant given recent press attention in the UK to the unsolicited ‘Do not resuscitate’ instructions for many patients considered to be terminally ill. The authors comment that socialized knowledge was required in order to interpret these nurses’ accounts of events. A further paper on the nurses’ use of informal documentation in preference to formal records will be published in a later issue.

Of the three papers on stroke patients, one raises the issue of the rehabilitation role of the hospital nurse when (and if) adjusting the stroke patient’s position in bed. In 380 hours of patient observation, the deliberate adjustment of patients was found to be a rare event and the need for a more carefully considered and consistent approach to this aspect of the nurse’s role is advocated.

Aspects of discharge planning and long term follow-up feature in a number of papers. A Dutch study presents an evaluation of the introduction of the liaison nurse role to improve discharge planning for stroke patients in two hospitals. Hospital nurses were reported to be satisfied with the innovation, and patients with the discussion of their needs both before and after discharge. However, on two important indicators, services were either the same, or worse than before the innovation. The duration of hospital stay for both a before and after study group remained unchanged, while the number of patients for whom medication arrived at home on time had decreased following the introduction of the new role. The authors observe that further research on the liaison role is required. We would concur. For example, the precise, proposed benefits and responsibilities need to be described very accurately before such a role is introduced. Also, just how the liaison nurse’s interventions can make a difference to outcome measures over which she may, or may not, exert an influence need to be assessed carefully. A third paper also describes a follow-up study of six patients for at least 12 months after stroke, and highlights the very different perceptions of long-term recovery held by health professionals and the patients themselves. For the informants, the social context of recovery with engagement in the social world was emphasized over improvement in discrete physical function. They identified no end-point to their recovery, and no common path between participants was found. The author recommends that stroke services should be structured to take account of stroke families’ differential long-term needs within the home environment.

The remaining papers in the section on Issues and innovations in nursing practice include two on aspects of the care of cardiac patients. One describes the possible use of an algorithm to assess chest pain patients’ suitability for early transfer from a cardiac care unit, but recommends further work. A second UK paper describes the perceptions of patients and carers up to 6 weeks following hospital discharge after a myocardial infarction, a relatively rare perspective to be studied outside the USA. A further paper on long-term follow-up concerns the experiences of 12 Swedish patients a year after they had received a liver transplant. This section concludes with a paper on the crucial role of the practitioner in increasing the uptake of cervical screening in Hong Kong, and a report from the UK 25-year follow-up survey of British nurses in behavioural psychotherapy.

The concept of autonomy is explored in a single paper included under Philosophical and ethical issues. The author concludes that nurses interpret the term in different ways. This, it is argued, is unsatisfactory and nurses need to agree a definition for practical use that is central to respect for patient choice and independence. There is much here to stimulate debate on the meanings of the term, and whether a single definition would actually work for nurses.

Five papers on very different aspects of Methodological issues in nursing research feature this month. The first proposes that serum albumin may be a useful predictor of pressure sores in the over 64 year age group, particularly when used in conjunction with one of the pre-existing tools such as the Waterlow score. A second paper explores the use of the Miller Behavioural Style Scale with adult daughters of women with early breast cancer, and concludes that the psychometric properties of the monitoring subscale justify its use in future studies with this group. The measurement of quality of life is the subject of the third paper. The relative strengths and weaknesses of two leading respondent-generated instruments are appraised, although the author concludes that doubts about various aspects of their use persist. He argues that nurse researchers are well placed to investigate the validity of the conceptual assumptions underlying the use of these tools. The fourth paper reports on the experience of conducting multiple case studies in the context of policy-oriented research, and explores the methodological, practical and ethical issues in case study research design. The final paper in this section calls for reflexivity on the part of nurse researchers working in the field of disability research. The crucial importance of considering the definitions of disability used, and the possible collusion of the researcher in a system that may serve to perpetuate the oppression of the disabled are discussed, as are strategies for promoting reflexivity.

Randomized control trials feature in a literature review on the methodological issues involved in exploring complementary therapies. As nurses increasingly use a variety of alternative therapies in the delivery of their care, this is clearly an important topic for review. A second literature review on minimizing postpartum pain explores a range of issues of particular importance for midwives, and identifies that many aspects of this important area remain unresearched.

Three papers on Issues and innovations in nursing education cover a range of topics. From Nigeria comes an important report on the provision, and results, of an educational programme on HIV and AIDS to undergraduate degree nurses. From Spain a randomized control study of the teaching of techniques of self-control and communication skills with severely ill patients, is reported. Finally from the UK, a paper that provides evidence on the costs of ward-based and community-based educational placements will answer many of the queries, charges and counter-charges, that have been made since nursing students in the UK became super-numerary. The paper also explores the policy implications of the findings.

Policy issues are explored further in two papers in the section on Health and nursing policy issues. A national survey from the UK on suicide and self-harm in in-patient psychiatric units reports some disturbing findings on, and variations in, observation policies. The second paper, in a study that examined domestic and child care responsibilities in relation to English qualified nurses’ involvement in continuing education, found that the impact of course participation on home and family life was invariably negative. Many students participated in their own time and several were self-funding; those with children compared with those without, were less likely to view continuing education in a positive light.

A paper under Nursing and health care management issues reports on a quasi-experimental study of the introduction of two care pathways. The results were mixed, although staff identified many positive features associated with using the care pathway tool.

Four papers report on various aspects of Experience before and throughout the nursing career. A paper from Germany and the Netherlands describes the development of a model of burnout and life satisfaction amongst nurses. Two conceptually different categories are distinguished — exhaustion that arises from excessive job demands, and disengagement that arises from poor job resources. The paper contributes to a deeper understanding of the concept of occupational burnout. The study of job satisfaction and stress in nursing is thus producing findings that may contribute to the development of interventions to counteract their effects. Many of these ideas can also be found in a second, descriptive, study of midwives’ support needs within the changing context of childbirth in Britain.

Of the last two papers to be mentioned in This month in JAN for August 2000, the first argues for strategies of empowerment for nurses. This, it is suggested, may be achieved by recognizing that subordination features in the cultural narratives of nursing and that this results in feelings of horizontal violence between nurses. Reflective practice, it is argued, can help nurses to deal with feelings of oppression and to develop emancipatory action. Finally, a follow-up study is reported that compares perceptions of the transition to qualified status of nurses qualifying in 1985, with those of 1998. Although ‘fumbling along’ may still describe some newly qualified nurses’ experiences, the development of a more active style of learning suggests that changes in nurse education in the UK have brought about a greater degree of self confidence. When this is combined with the support of preceptors, the newly qualified nurse of 1998 appears to feel a greater degree of competence than her colleagues who qualified in 1985. This is a positive note on which to end. It is to be hoped that all our readers will find material in this issue that is of interest, and of use in their practice.