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This issue begins with three papers under the category heading Issues and innovations in nursing education. First, a paper from the United States of America (USA) presents an important critique of contemporary approaches to cultural education in nursing. The author argues that despite careful and rigorous curricular attention to culture, nursing students are currently taught about cultures as monoliths, and are expected to learn the alleged unique, distinguishing characteristics of each. She gives good reasons why this approach should be challenged, not least the impact of globalization in producing so many multicultural societies where there is a failure to care adequately for members of those groups who differ from the dominant culture. Theoretically, it is the anthropological notion of the other that is challenged with great erudition in this article and which, on reading, I felt presented nurse educators with a paradigm shift for teaching practice. For those who wish to pursue this subject further theoretically, and in a non-nursing context, I would recommend an article on anthropology, culture and the cinema that appeared coincidentally just as this important paper was undergoing editorial revision (Henley 2001).

The second education paper reports on a study of self-directed learning (SDL). Groups of both teachers and students from eight United Kingdom (UK) paediatric intensive care nursing (ICU) courses identified SDL as one method to be used alongside others, and related SDL to observable events rather than to cognitive processes. The author concludes that issues of control and autonomy within the learning environment need further exploration if the concept of SDL is to be advanced. It seems that at present, the cognitive goals of SDL are not well understood, at least in UK paediatric ICU nursing. The third article in this section concerns undergraduate students’ perceptions of clinical mentors. Some might identify this as a well-worn theme. However, in this Hong Kong study, the authors designed and used a culturally appropriate tool in a before and after evaluation of a newly implemented mentoring scheme. Statistically significant differences were found following strategies designed to improve the preparation of mentors. The authors suggest that the questionnaire used could be adopted as an instrument to evaluate the effectiveness of mentoring programmes for other nursing courses. Given the frequent problems reported with all forms of clinical teaching, this would appear to be a useful suggestion that might be taken up elsewhere.

Two papers follow in the category Nursing theory or concept development or analysis. The first is reflective of several papers published earlier in issue 36:2, particularly Gilbert’s ‘Reflective practice and clinical supervision: meticulous rituals of the confessional’. Here, Foucauldian concepts of power, knowledge and discourse are used in the analysis of reflection and reflective practice in nursing. Although not focused specifically on the British preoccupation with clinical supervision, the Australian author interrogates the contemporary literature and challenges the hegemonic discourse on reflection in contemporary nursing. The second paper in the category is a fascinating concept analysis of the Near Death Experience (NDE). The author confirms that a phenomenal number of people have claimed to have had an NDE, and that many feel insecure in talking to others about their experience. She summarizes the stages of an NDE and outlines the positive and negative consequences that may follow, together with the implications for nursing staff.

Eight articles follow under the category heading Issues and innovations in nursing practice. In the first paper the urgent need for education for nurse prescribing in mental health nursing is one important finding to emerge from a study of mental health nurses’ perceptions of the subject. Authors Hicks and Tyler (also from the University of Birmingham, UK) highlighted in their study of family planning nurses (issue 35:5), how nurses’ educational preparation has lagged behind the UK governments’ policy initiatives in the area of nurse prescribing. All the more worrying therefore that despite mental health nurses’ perceptions that nurses prescribing would significantly improve their clients’ access to medication, compliance, relapse prevention and cost-effectiveness, respondents in this second Birmingham study did not feel at present that they had the necessary knowledge and skills to assume this responsibility. The second paper, from Canada, also concerns the relationship between nurses’ knowledge and their practice, this time in the management of pain in postoperative cardiac patients. The fact that patients reported moderate to severe pain but received only 47% of their prescribed analgesia took me back to my third year student nurse days when one dynamic ward sister would chase up every due dose for the chest surgery patients in her care, and we recognized then that she was a rare exception to the general rule. The authors report further worrying findings that include significant variation between hospitals in analgesics and pain education for nurses. If postoperative pain management is such an enduring historical problem in nursing, is it possible that an organizational systems approach would achieve more in future than simply recording the proportion of individual failures in analgesia administration?

‘Can the transfer of (medical) tasks from an internist to a nurse specialist be justified for the care of stable (type 2) diabetic patients?’ This question is answered affirmatively in an article reporting a nonequivalent control group design study from The Netherlands. Equal outcomes for a number of variables were found for traditional and nurse specialist care, and somewhat better glycaemic control in the nurse specialist model. In addition to detailed reporting of this study, the paper also demonstrates the methodological problems inherent in research that ideally should involve randomization, but which in practice is constrained by the structure of health service provision. The next paper also reports on an evaluation of nurse/physician substitution, this time for acute minor illnesses in an English general practice. High levels of patient satisfaction were found for all professionals, with patients seeing health visitors reporting higher levels of satisfaction than for either general practitioners (GPs) or practice nurses. Consultation outcomes were similar for all three groups except that GPs were more likely to initiate further investigations. The authors conclude that substitution can reduce GP workload, but do not comment on what aspects of the nurses’ roles may have to be sacrificed in order to become GP substitutes. This is currently a particularly salient issue in the case of British health visiting.

Another study of considerable methodological complexity is reported in ‘Eating as both coping and stressor in overweight control’. Obesity is now a developed world major health problem (see Holm et al., issue 36:2), and coping with weight control is a major source of distress to many individuals. Yet, incredibly, stress-induced eating and lapses in dieting have not been studied together before as integrated parts of a larger model of stress and nutritional behaviour. The author begins here to redress this imbalance in research, with some corroboration of the initial hypotheses, but not of others. Clearly, this important paper must represent the beginning of further refined inquiry of the interrelated variables.

Two papers follow on aspects of dementia; the first is from the USA, the second from the UK. Both could be read usefully in conjunction with Graneheim et al.’s Swedish observational study of a woman with dementia and behavioural disturbance (issue 36:2). The first article focuses on the relationship between problematic behaviour and caregivers. Female caregivers were more affected than men in two respects, and caregiver reaction was more highly associated with the impact of care giving than the actual frequency of the problem behaviours. The second paper is concerned with the importance of relationships in providing care for persons with dementia. Both papers recommend education and training of carers (and, in the second paper, care recipients) on important aspects of symptom alleviation in the care of dementia sufferers.

The final two papers in this issue relate to the care of sick children, although the last is included in the literature review category. First, from the UK, a disturbing paper reports on a comparative phenomenological study of nurses’ and parents’ perceptions of parent involvement in their child’s pain management. Twenty nurses and 20 parents in one large urban hospital were interviewed, and no claims to generalization are made. Nevertheless, children’s nurses everywhere should read the findings with concern, and question local paediatric pain control practice. Parental involvement in their child’s pain management was found to be superficial and limited, whilst nurses perceived that parental involvement and the child’s management were adequate. Twycross (issue 34:1) has already questioned the lack of consensus over pain content in the child branch of the Project 2000 Diploma nurse education programme, and these findings reinforce the need to scrutinize the management of children’s pain and their parents’ involvement in both children’s nursing education and practice. The final paper, also from the UK, is a critical literature review of eight research studies carried out between 1987 and 1997 on the needs or experiences of both parents with at least one chronically ill child. The author found three themes emerging: the needs for normality, information and partnership. She points out that the burdens placed on these parents acts as a reminder for the need for empathetic care delivery. Quite so!

This issue of JAN is not intended to be merely an expansion of the table of contents. In this issue, I have tried even more than usual to make connections between articles published not only in this issue, but also in recent ones. Some readers have suggested that the category headings we now use are helpful to teachers and students as a ‘map’ to find their way around the contents. By picking up related themes in This issue of JAN I hope also that familiarity with recent JAN contents helps teachers, students, practitioners and policy-makers in making some of the necessary connections between articles in order to meet their various needs. Feedback on this, or any other aspect of JAN is always welcomed, and acted upon.

References

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  2. References
  • 1
    Henley P. (2001) Fly in the soup (commentary on Anthropologie et cinéma: passage à l’image, passage par l’image, M.H. Piault, 2000 & Transcultural cinema, D. MacDougall, 1998). London Review of Books23(12), 3537.