This issue of JAN


An occasional editorial from authors at the University of Hull, England begins this issue. They comment on the difficulties of assessing the spiritual needs of patients, indeed the lack of necessity for nurses to engage in this form of assessment at all. No doubt their argument will arouse debate especially as a forthcoming article (Tanyi, JAN39:5, 2002) seeks to clarify the meaning of spirituality, something that the authors of this editorial suggest is also fraught with difficulty. We welcome further commentary on an issue that seems to run and run.

An article under the category Issues and innovations in nursing education concerns the practice of complementary alternative treatments by practice nurses in Oregon, United States of America (USA). Eighty-three per cent of the sample of 151 nurses recommended these to their patients yet only 24% reported that their formal nurse practitioner education prepared them to make these recommendations, whilst 60% relied on personal sources. These findings make an interesting comparison with a larger study reported from Israel (JAN36, 41–48) where a much smaller proportion of the 279 staff nurses responding reported using complementary alternatives, but a majority would have liked to know more and like their American counterparts in this article, received little formal training in their use.

The single literature review in this issue addresses the question of cardiac symptoms in women in comparison with those reported for men. The authors suggest that their findings have important implications for nursing practice as women can have vague or non-classic symptoms even in acute myocardial infarction. The gendered nature of cardiac disease is gaining increased recognition and two forthcoming articles (Rhodes & Bowles, Lockyer & Bury, JAN39:5) will address other aspects of the same issue.

Seven articles feature in the category Issues and innovations in nursing practice. The first, also from the USA, continues the theme of critical cardiovascular nursing and clinical nursing diagnostic expertise. After reading five written simulations of different aspects of cardiac dysfunction, 23 expert and 23 novice nurses were asked to state a predominant problem and give a diagnostic explanation. Diagnostic accuracy was greater with experts than with novices, and the major variable was the recalled proportion of highly relevant cues to total cues. The authors suggest that their study supports the idea that expertise is associated with an ability to focus on highly relevant cues. The second article, from England, also concerns nurses' expertise, this time in the provision of competent care for patients with tracheostomy tubes in situ. Non-participant observation using a structured observation schedule was used to observe 28 nurses, and each was interviewed and completed a questionnaire on their knowledge of tracheal suctioning practices. The findings were disappointing; a low level of knowledge was identified and poor practice observed, the latter sometimes being potentially unsafe. Yet on interview, participants offered rationales not based on current research for specific parts of their practice. The authors observe that this study raises concern about all aspects of tracheal suctioning. No generalization is claimed for their findings however, these must be of sufficient concern for nurses everywhere involved in this form of care to consider their own practice.

If the first two practice articles report on empirical studies related to nurses' expertise, the third explores the barriers that acute nurses perceive to prevent them from using research in their decision-making. Derived from a large study of nurse decision-making carried out in the Centre for Evidence Based Nursing at the University of York, England, this article reports on four perspectives related to the individual, organization, the nature of the research information itself, and the environment, which respondents associated with barriers to research use. That respondents saw research as too ‘academic’ and complex speaks volumes for the educational preparation that the nurses in this sample had received. Coupled with another finding that researchers and their research products ‘lack clinical credibility’, these perspectives may reflect the prevailing cultural milieu into which British nurses are currently socialized. In their editorial ‘Academic nursing – what is happening to it and where is it going?’ (JAN36, 1–2) Thompson and Watson observed that ‘there is currently an anti-intellectual ethos pervading nursing and anything perceived to be intellectual is criticized as elitist’. The findings of this study appear to confirm their view. Bearing in mind the disappointing findings of the previous article in this issue, educational policy-makers need to consider very seriously the effects on practice that their ‘dumbing down’ of nurse education in the UK may produce. There is, after all, little point in the Secretary of State for Health promising a revolutionized National Health Service if its practitioners are unable to comprehend the research reports that are so necessary an adjunct to excellence in their clinical practice.

The next article from Taiwan reports on a small study of 12 registered nurses' perceptions of the introduction of computerized care plans. In the UK, nurses mainly had to cope with this innovation in the late 1980s and early 1990s, so it is interesting to see that these Taiwanese nurses produced similar reactions in wanting tools that help to save time on paperwork and to target patient problems. Whether the care plans live up to these expectations could perhaps be the subject of a later study. An intriguing article follows on vertical equity in Irish public health nursing; taking forward the operationalization of this elusive concept in an extremely challenging way. Commenting in ‘This issue of JAN’ (37, 499–500) on an article on ‘An analysis of the concept of equity and its application to health visiting’ (pp. 598–606) I observed that ‘One of the great difficulties with the concept of equity is that it is much discussed theoretically, but there is little guidance on how the principle(s) should be applied in practice.’ In this article, the author from the Republic of Ireland has thrown down the gauntlet to policy-makers over the need for public health practitioners to assess local health needs and to provide appropriate services in response. How different from the ‘checklist’ approach to health visiting that seems to have evolved at management's behest in many areas in the UK. Will this study make any difference? Or will changing entrenched attitudes and beliefs about the ‘right’ way to provide services prove too difficult a task? A follow-up study of the consequences of this research would be invaluable.

An article from Sweden reports on an investigation in one surgical ward of nurses' perceptions of the need for care and support for women with newly diagnosed breast cancer and their relatives. Here the authors report that the respondents relied too heavily on theoretical explanations of need and too little on their own experiences in practice. This must surely be the other side of the coin to that explored in the article above on tracheal suctioning? A balance must be struck between sole reliance on empirical research and that expertise that comes from identifying highly relevant cues in a specific situation, as shown by the American authors of the study of cardiovascular nursing. An interesting subsidiary finding in this Swedish study was that the nurses' own needs were often unsatisfactorily met. The final article, also from Sweden, reports on a phenomenological study of eight women with Parkinson's disease. The findings from this sensitive study will be of value to nurses caring for the increasing numbers of people who survive with heavily disabling neurological diseases. That the disease affects the quality of life not only for the sufferer but also for those providing care should come as no surprise. Yet, despite the rhetoric of policy-makers to ‘care for the carers’ how many nurses really take this message to heart?

The final article in the category Philosophical and ethical issues was submitted in response to ‘An archaeology of caring knowledge’ (JAN36, 188–198). This is one of only two strong responses received against the original paper, and readers should consider both sides of the argument and draw their own conclusions. In doing so, they may like to consider Paley's own response to the current article, which follows in the first of three readers' contributions to JAN Forum.