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The growing internationality of JAN is particularly well illustrated in this issue. There are papers from several European countries (England, Finland, Northern Ireland and Turkey) as well as three contributions from Australia, one from the USA and one paper which is co-authored between China and the USA. Importantly, all of the papers in this issue have relevance to issues and trends which are more global than local, thus demonstrating the importance of international dissemination of research in nursing beyond its particular country of origin.

The predominance in JAN of practice-orientated research is also well reflected in this issue. Five of the 10 papers fall into the category of Issues and innovations in nursing practice. Accordingly, that category leads this issue.

In that section, and across the remainder of the papers, there is the usual diversity in terms of the topics addressed in any one issue of JAN. At first glance there may well be only one or two papers that appear to relate directly to the particular interests of individual readers. But do look beyond the titles – and further even than the abstracts – because there are informative and interesting elements in every paper, not least with regard to methodological issues which underpin nursing research.

In my first ‘This issue of JAN’ column, I did indicate that I might not always adhere to the routine of commenting in turn on all of the papers in each issue. On this occasion I am going to be selective. This should not be interpreted as any slight to the authors of those papers I have not chosen to highlight. There are noteworthy points that could be made about all of the papers in this issue. However, I decided instead to focus on three papers which I particularly enjoyed for the simple reason that they struck me as ‘good news stories’ of the sort that might be worthy of the wider media publicity which nursing research now merits, yet rarely attracts.

Community nurses pioneer home-based cardiac rehabilitation for patients with special needs (pp. 121–129)

  1. Top of page
  2. Community nurses pioneer home-based cardiac rehabilitation for patients with special needs (pp. 121–129)
  3. ‘Computers are of value to my nursing practice’ says a majority of nurses (pp. 140–146)
  4. ‘We, us, together’: the creation of a new, shared midwifery curriculum (pp. 179–186)
  5. Postscript

Placed first in the issue, this paper by Warrington and colleagues from east-coast Australia reports on an evaluation of the delivery of a home-based cardiac rehabilitation programme by community nurses for patients with special needs. The benefits of structured rehabilitation after acute treatment of cardiac disease have been well documented. However, hospital-based rehabilitation programmes are both difficult for older patients to access and not generally designed to meet the special needs of individuals with co-existing chronic illness and disability.

Community nurses were given training before delivering the home-based programme which consisted of four contacts over a 9-week period designed to provide individual education as well as carer support. The idea of involving regular community nurses rather than introducing a specialist ‘outreach’ team to take cardiac rehabilitation into patients' homes particularly appeals to me. With the ever-increasing transfer of services from hospitals to the community, it simply is not sustainable to introduce specialist nurses for every conceivable condition. For community nurses to combine specialist input with routine home visits provides an a potentially sensible solution.

The majority of the patients involved in this pilot scheme were over the age of 65 years and, indeed, almost a third of the sample were older than 80. Only 40 of the 100 patients originally invited to participate, however, were included in the final analysis. There were various reasons for this but, notably, only six people elected to withdraw from the programme. But we are left with a small sample study, without a control group, and so this evaluation does have its limitations, as the authors acknowledge. Nevertheless, the findings were positive in terms of patients' knowledge of key symptoms and increased exercise tolerance and quality of life.

There is, as the authors say, a need for a larger replication study. This should be pursued. There are issues to be addressed in terms of method, measures and the scope of evaluation. However, the idea that community nurses have the potential to take cardiac rehabilitation into the homes of people who otherwise would not access this crucial, post-acute care is an idea well worth pursuing. It certainly is wholly in keeping with policy directives around the globe for development of more patient-centred, community-based services with tangible health improvement as their goal.

‘Computers are of value to my nursing practice’ says a majority of nurses (pp. 140–146)

  1. Top of page
  2. Community nurses pioneer home-based cardiac rehabilitation for patients with special needs (pp. 121–129)
  3. ‘Computers are of value to my nursing practice’ says a majority of nurses (pp. 140–146)
  4. ‘We, us, together’: the creation of a new, shared midwifery curriculum (pp. 179–186)
  5. Postscript

The age of the computer is with us now with a vengeance and woe betide any worker who resists engaging with the latest information technology (IT) brought into the workplace. Health services have not been the fastest of organizations to get themselves properly equipped with IT systems, at least in the UK, but that is rapidly changing. Thus it is vital that nurses and midwives, wherever they work, are confident about their ability to use and exploit information technology. So what could be more welcome than a survey of nurses that appears to show that the majority are already using computers and hold positive attitudes about the benefits of work-based computer systems?

These were the findings of a survey of nurses that Webster and colleagues conducted in connection with the introduction to their hospital in Brisbane, Australia, of a comprehensive, computerized information retrieval system for the use of all health care staff. The system, they argue, provides an excellent opportunity for nurses to access information in pursuit of evidence-based practice but, of course, only if they have the skills to exploit computer-held information. I was surprised by the very positive findings of this survey. Three-quarters of the nurses who returned the questionnaire stated that they used a computer at home and 45% of these indicated that their use was on a daily basis. A high proportion (76%) had used a computer to undertake a literature review; almost all respondents (99%) had used a computer at work; nearly 70% had already accessed the hospital's new information system; and over 80% agreed or strongly agreed with the statement that: ‘Computers are of value to my nursing practice’. What could be better than that? Well, without wanting to detract from this ‘good news story’, it has to be said that the response to the survey was low (590 of 1708, 34·5%). As far as we can tell, say the authors, ‘the sample was reasonably representative of the hospital population.’ Maybe so. But non-respondents surely were more likely to be those with less interest in computers and perhaps fearful of the new system being introduced. If so, then the findings are positively biased. If I were a member of this research team, I would want to re-survey the non-respondents, and would suggest an incentive even more enticing than the original prize draw of a Gold Class cinema pass for two!

Aside from its possibly over-inflated findings, this survey gives encouragement to other hospitals to assess systematically the readiness of nursing staff to exploit the use of computers in aiding the development of evidence-based practice. Interestingly, the survey in Brisbane was based on a questionnaire developed in Scotland for purposes of assessing computer literacy among midwives. That original study also was published in JAN (Hillen et al. 1998, 27, 24–29). Notably, Hillen et al. uncovered very much lower levels of interest in and use of computers, only 23% of the midwives surveyed having used a computer at home. Webster et al. note the time difference between the two studies but, in fact, home ownership of computers is still in the minority in the UK. There has been a substantial rise over the past 15 years from 13% of UK households owning a PC in 1985 to just over two-fifths in 2001 (http://www.national-statistics.gov.uk). But, when compared with the sample of Australian nurses, the UK is certainly lagging behind.

Aside from its positive findings, this paper is also cheering because its authors do not see their survey as an end in itself. Strategies for improving levels of computer use are under development and, even more importantly, effort is being invested to ensure that better IT provision actually results in better patient care. I am not convinced myself that every single nurse needs to become highly skilled at retrieving and synthesizing ‘the evidence’ because a collective approach to that task seems far more sensible. More needs to be known about time-efficient ways of transferring new knowledge into practice but, for the moment at least, it certainly is good news to have evidence from this JAN paper that nurses appear to be keeping apace with computers in this increasingly challenging ‘information age’.

‘We, us, together’: the creation of a new, shared midwifery curriculum (pp. 179–186)

  1. Top of page
  2. Community nurses pioneer home-based cardiac rehabilitation for patients with special needs (pp. 121–129)
  3. ‘Computers are of value to my nursing practice’ says a majority of nurses (pp. 140–146)
  4. ‘We, us, together’: the creation of a new, shared midwifery curriculum (pp. 179–186)
  5. Postscript

The metaphor of a journey is used by Cutts and colleagues to tell their story of the development of a new, shared Bachelor of Midwifery curriculum by a consortium of three universities in Victoria, Australia, with teachers, service providers and service users all pulling together. With permission from the indigenous Ganai Elders Language Reference Group, they named their project ‘Werna Naloo’ which, when translated, means ‘we, us, together’. There is soul in that title – and in this paper.

I am not a midwife. I engage in the usual banter of rivalry which goes on between nurses and midwives. You do not have to be a midwife to enjoy this paper and see it as offering a model for replacing isolation and competition in our education system with co-operation and collaboration across institutional (and ideological) boundaries. This project depicts an imaginative enterprise with the outcome of an imaginative, yet grounded, midwifery curriculum designed to meet the needs and expectations of childbearing women in the 21st century.

There is also a more general debate at the heart of this paper around the question of whether or not midwives should first be educated as nurses. Given the growing shortage of nurses and midwives alike, it does seem wasteful to be preparing nurses who become midwives and taking longer to prepare midwives than may be absolutely necessary. Cutts et al. contend that there is now a body of evidence that suggests outcomes for women are better when midwifery is not predicated either on nursing or obstetrics. If the case for ‘direct-entry midwifery education’ is clear, then the question now needs to focus on the best form and approach of that preparation. The Australian curriculum described in this paper would seem to be one contender. The authors promise us a ‘Postcard’ in 2004 when the first graduates emerge from the programme. JAN will look forward to receiving that update.

Postscript

  1. Top of page
  2. Community nurses pioneer home-based cardiac rehabilitation for patients with special needs (pp. 121–129)
  3. ‘Computers are of value to my nursing practice’ says a majority of nurses (pp. 140–146)
  4. ‘We, us, together’: the creation of a new, shared midwifery curriculum (pp. 179–186)
  5. Postscript

It was only after I had drafted this column that I realized all three of the papers I had chosen to highlight have come from Australia. This should not be interpreted as anything other than happenstance! I also should reiterate that, by choosing to focus only on three papers in this ‘This issue of JAN’ column, this should not detract from due attention to all other papers. You will find, as I did, that some papers stand out for you for particular reasons but all, for different reasons, are well worth reading.