This issue begins with an occasional editorial by Professor Roger Watson, Media Reviews Editor, on the subject of elder abuse, neglect and restraint. Although we publish relatively frequent articles on elder restraint, research on the national prevalence of elder abuse is much less common. As Professor Watson points out nurses are the most likely to observe abuse in institutional and possibly domestic settings and research is needed urgently. Nevertheless, it is a difficult area of study that requires leadership from policy makers and managers in healthcare in the setting up of mandatory reporting systems so that data can be collected over time for comparative purposes.
In contrast to recent issues of JAN, we focus in this issue on several theoretical articles beginning with two under the heading Nursing theory and concept development from the United States of America (USA) and Canada, respectively. In the first, a study is described in which staff nurse work behaviours were correlated with perspectives identified previously in two theories that were developed to take account of the lived experience of female nurses. Statistically significant relationships were identified between workplace behaviours, family behaviours, and silencing behaviours as measured by the research instruments. The authors argue that complex and abstract processes were made evident through empirical measurement, and that the lessons learnt should be applied to the accurate study of nurses at a time of institutional shortages and negative morale. In the second theoretical article, a different slant is taken to nurses and power through the study of nursing and Foucault's concept of governmentality. The authors conclude that rather than seeing nurses as powerless, their interpretation shows them to be a powerful group who exercise power in many different ways, through the governance of populations and of individuals.
In a single article under Philosophical and ethical issues a United Kingdom (UK) philosopher who is a relatively frequent contributor to JAN, takes issue with some of Patricia Benner's theoretical interpretations. The JAN editorial team welcomes debates of this nature as they are seen as a beneficial product of nursing in the academy where nurses rub shoulders with non-nursing theorists and have the opportunity to enter into dialogue over theoretical interpretations for practice. Nevertheless, we are aware that some nurses are uncomfortable with this form of eclecticism, seeing it as unnecessarily assertive and potentially damaging to nursing's own theoretical development. There is no simple mediating answer to these two opposing positions, although I would caution the critics lest we lose nursing's hard won place in higher education. There are many who would happily see nursing return to monotechnic educational environments. At JAN we shall continue therefore to welcome contributions from non-nursing authors in the belief that they have much to offer a sometimes introspective profession, whilst at the same time acknowledging that not everyone will agree with our position.
A second paper from Canada in the section on Methodological issues in nursing research reviews the literature on the use of narrative in nursing research and provides examples on the perspectives of individuals with chronic obstructive pulmonary disease (COPD), family caregivers and nurses. The authors point out that most of our knowledge of living with COPD is derived from biophysical information whereas the narratives of participants telling their stories about COPD convey meanings rather than objective truth. For nurses trying to provide appropriate care these personal truths are vitally important as a context to what the illness experience means for each individual. Personal truths are not however, statistically generalizable and their value lies in what they tell us about the need to listen and to hear what we are told.
A third Canadian paper reports on a study of hardiness, work support and psychological distress among nursing assistants (NAs) and registered nurses (RNs) in Quebec. The findings from this study would bear replication amongst other populations as countries worldwide use support staff to relieve scarce registered nurses of many tasks. In this study, levels of psychological distress were similar between NAs and RNs, but NAs reported significantly less hardiness, which was found to be a significant mediator between work support and distress. The authors' conclusion that their results support theoretical propositions linking personal and contextual resources to health-related outcomes may also be related to the findings of the first USA paper in this issue. Readers may also be interested to see the use of a Toolbox in this paper that Professor Webb wrote about in her editorial for issue 38(3).
The first of three papers on Issues and innovations in nursing practice concerns ethnicity in pressure ulcer risk assessment with relation to a specific Pakistani ethnic minority in England. The authors bring a range of diverse research skills to the subject and in this study they attempted to replace anecdotal evidence with systematic investigation. They found that whilst age is predictive of pressure ulcer formation, ethnicity in the studied population is not. The second practice article comes from a Taiwanese author who has carried out substantial amounts of research into parental psychological distress and the coping patterns of parents with a child with cancer. In the study reported here she investigated gender differences between mothers and fathers. Whilst mothers averaged significantly higher levels of all forms of distress, the first two months following diagnosis were particularly distressing for both parents in terms of depression, anxiety, and global stress. Marital dissatisfaction was also greater in this group than in comparative populations. The author concludes that her findings indicate a need for thorough psychiatric consultation at the time of diagnosis for children who have cancer and their families. The third practice paper reports on the auditing of surgical wound infection rates in a 3-year prospective study of 2241 patients in a Scottish NHS Trust. The provision of information apparently did reduce the infection rate, although the result was not statistically significant. The authors point out however, that the result was clinically significant as fewer patients were suffering from infections. Amongst several staged interventions, the most notable change was achieved after guidelines for best practice were introduced using a normative re-education strategy, however, the authors caution that continued surveillance and feedback are necessary in order to maintain the reduced rates.
An article on factors influencing the effectiveness of nursing leadership in Hong Kong follows in the section on Health and nursing policy issues. A case study approach was used to study the effectiveness of nursing leadership in relation to the changing socio-economic-political context of Hong Kong during a 15-year period of education reform. The findings from interviews with 27 informants identified three major barriers and three facilitators. That medical dominance and nurse socialization were major barriers to educational reform will not surprise many readers. Nevertheless it was found that nurses could exercise effective leadership if they took advantage of facilitating factors in the environment.
The final article in this issue reports on a study in the Republic of Ireland in which 16 staff nurses described their perceptions of facilitating clinical learning for diploma students. The findings confirm those of earlier studies of Project 2000 students in England. It is salutary to find that uncertainty about supernumerary status for students still persists, with all the attendant doubts about clinical competence and the ability to work as a team member. Perhaps these difficulties will only ever be resolved fully when the majority of staff nurses are themselves diploma- or degree-educated.