The aims of the study were to explore personal, professional and organisational factors that would affect future participation in the workforce of nurses aged 45 and over. The research was proposed against a background of concerns about a shortage of a skilled nursing workforce in London and ever increasing numbers of older nurses taking retirement. Data were collected with 37 mainly senior F grade nurses and health care assistants using a semi-structured interview schedule and biographical methods. There can be multiple expressions of commitment, which may differ at different levels of the organisation. Personal commitment (i.e., to family and children) was also very important. Expressions of commitment were not expressed in isolation, this means commitment is negotiated, contested and sustained across and within multiple situations.

This paper explores the use of storyline in grounded theory research and potentially other research methodologies that seek to explain phenomena. Storyline as a research strategy has had limited discussion in the literature. Although stories have been used as both a source of data and a means of reporting research findings, the use of storyline is underutilised and undeveloped as a method of constructing and conveying grounded theory. Construction of a theory that is grounded in the data and not influenced by external concepts is possible through the use of storyline. In presenting grounded theory in the form of a storyline, the nurse researcher is able to explain and describe the theoretical contribution in the context of nursing knowledge. Theoretical precedence, variation, limited gaps, the use of evidence and appropriate style are characteristics of an effective storyline. As both a means and an end in itself, storyline enhances the development, presentation and comprehension of the outcomes of grounded theory research in nursing.

Greater standardisation of assessments of older people with complex care needs is a requirement of UK policy. This study explores the practicability and validity of two assessment tools, Minimum Data Set Resident Assessment Instrument (MDS-RAI) and EASY-Care. Participants, aged 65 years or over, living in care homes or awaiting hospital discharge, were assessed using randomly allocated paired instruments. Client evaluation questionnaires on the practicability of the tools were completed. Short Form 12 (SF12) questionnaires were administered to assess participants’ health status. Registered nurses undertook data collection and participated in two focus groups designed to explore the practicability of the tools. Statistical tests were applied to quantitative data to assess practicability and validity. Thematic content analysis was used to analyse focus group transcripts. In all, 238 assessments were completed. Older people and assessors generally reported that both tools were practicable, with EASY-Care preferred to MDS-RAI for practicability measures including ease of use, usefulness and acceptability. Focus groups illustrated the significance of professional judgement when using structured tools. Both tools were reasonable indicators of activities of daily living, but there were shortcomings in measurements of cognitive performance and depression. Both instruments require development to fully capture the older person’s perspectives of needs and to test the validity of key measures.

The aim of this study is to explore the views of practice nurses’ recruiting into a primary care–based randomised controlled trial, and to investigate factors that influence the success of trial recruitment. It is known that time pressures, forgetfulness and lack of interest in the research topic negatively influence recruitment into research trials by General Practitioners (GPs), but no studies appear to have explored practice nurses’ experience of recruiting into trials. Semi-structured telephone interviews were conducted with a non-random purposive sample of 10 practice nurses who had participated in recruiting patients for the trial, and data were analysed using a thematic framework approach. Nurses who had been asked to take part in the study found it a positive experience, and had decided to take part because the area of research was of interest and could potentially benefit patients. Nurses who had been delegated the role of recruitment by the GP felt put upon and recruited less well. None of the nurses reported difficulties remembering to recruit patients and developed useful strategies to aid memory. Nurses often acted as gatekeepers, selecting which patients they offered the intervention to. Nurses with dedicated time for research recruited more successfully. For nurses who recruited during routine consultation, it was often the patient’s lack of interest in taking part in the trial, rather than time limitations that hindered recruitment. Overall, nurses were positive about recruiting into the trial, particularly if the research area could benefit patients and if directly asked to take part.

Nursing schools are committed to improving the passing rate of the National Council Licensure Examination for Registered Nurses (NCLEX-RN) and to remain above acceptable levels. Therefore, the National League for Nursing (NLN) readiness exam taken before graduation can be used as a diagnostic test. The NLN scores are used to investigate which clinical course grade has the highest correlation with the readiness exam and ultimately with the NCLEX. With that knowledge, educators could strengthen particular courses in order to ultimately enhance a higher NCLEX-RN passing rate. To investigate the relationship among nursing clinical course grades, foundational science courses, and NCLEX-RN readiness exam scores, the initial study in 2004 on BSN performance was compared to a follow-up study on ADN students in 2007 in another college within the same university. Stepwise regression and Pearson moment correlation analysed the data. The first nursing course, adult health nursing and maternal child health nursing, truly appears foundational for the NCLEX readiness exam. These results were consistent in both BSN and ADN programs. As adult learning theory suggests, the first nursing course may provide an overview into which the facts and skills of later courses are integrated.

This research studied the differences of hospitals’ organisational climates and nurses’ intent to stay at different types of Jordanian hospitals and investigated the relationship between the two concepts, from the point views of nurses. In 2005, using convenience sampling technique, a survey was used to collect the data. A total of 361 nurses were recruited; 190 nurses from governmental hospitals, 107 nurses from teaching hospitals and 64 nurses from private hospitals. Comparisons were performed using the total scores and the individual items of scales. Farley’s Nursing Practice Environment Scale (NPES) was used to assess the organisational climates (Farly, MJ, Nyberg, J (1990) Nurs Health Care 11: 532–535). McCain’s Behavioral Commitment Scale (1990) was used to measure nurses’ intent to stay (McCloskey, JC (1990) Image J Nurs Sch 22: 140–143). Nurses ‘somewhat disagree’ about the organisational climates of their hospitals. Quality of care and professionalism were the most important variables that influence hospitals’ organisational climates. There were some significant differences between nurses at different types of hospitals in their perceptions about hospitals’ organisational climates. Nurses were neutral in reporting their intent to stay; but there were no statistically significant differences. Although, nurses plan to stay at their jobs for at least 2–3 years and as long as possible, some nurse reported that they will not stay at their jobs to the end of their careers. Nurse administrators have to create supportive organisational climates that would encourage nurses to stay at their jobs to the end of their careers. This would influence positively the quality of patient care and nurses’ professionalism. These outcomes could be achieved if nurse administrators use supportive leadership styles in organisations that are adaptive to change and professionals’ needs.

Caring has long been affirmed as the essence in nursing. A caring protocol was developed to enhance professional caring and served as a tool to establish a caring culture within a cluster of hospitals. The protocol encompasses three essential elements of professional caring: image, attitude and behaviour. It aims to assess the effectiveness of the protocol in two convalescent hospitals with the objectives to: (1) gain the responses from patients and relatives and (2) explore the feedback from nursing and supporting staff. A mixed method was adopted: a pre- and post-test design and focus group interviews. Nursing and supporting staff from 18 wards were recruited for the study using the caring protocol in two convalescent hospitals. A positive response was obtained from patients and relatives after the implementation of the protocol. Nursing and supporting staff appreciated the implementation process, which could enhance caring. Valuable suggestions were also gathered to maintain the caring culture in wards. The caring protocol is an effective way in enhancing professional caring in hospitals shown by the positive responses from patients and relatives. The protocol was also well accepted by nursing and supporting staff and had a significant impact demonstrated on supporting staff.

In the current healthcare arena, clinical errors are receiving much attention. Unintentionally, nurses commit errors, which require guiding ethical principles. This replicated study aimed to assess Jordanian Registered Nurses’ (RNs) perceptions of clinical errors they had committed over the past year: assess nurses’ perceptions of clinical errors committed by other nurses’ detect if these errors were related to the nursing shortage and assess whether or not nurses felt any moral distress. The studied phenomena were compared across different hospitals as well as in various units and wards. A survey was used to collect data from 420 nurses from 13 hospitals. A considerable percentage of RNs reported that they omitted to give medication/treatment or gave medication/treatment at the wrong time, and also indicated that other nurses gave incorrect medication or incorrectly administered treatments; practice issues which were related to the nursing shortage and causing moral distress. RNs perceived that clinical errors/untoward clinical incidents that they and other nurses experienced occurred largely because of the nursing shortage and resulted in moral distress. Moreover, a considerable percentage of RNs perceived that other nurses made clinical errors and/or experienced untoward clinical incidents related to the nursing shortage more frequently than the RNs themselves. Across different types of hospitals, nurses were not different in regard to clinical errors and their treatments, and the resultant moral distress. Nurses in units were slightly higher than nurses in wards in reporting clinical errors, treating them when they occurred, relating these errors to the nursing shortage, and thus were experiencing more moral distress. Aggravated by the nursing shortage, moral distress that occurs as a result of clinical errors is increasing, thus nurse managers should assess the contributing factors of moral distress and find ways to eliminate them.

Through qualitative in-depth interviews, we collected the views of persons with Parkinson’s disease (pwPD) and their close relatives in care homes to establish their collective views of the effectiveness of care. We also reviewed the corresponding care plans. Drawing on these two forms of data collection, we compared similarities and differences between the qualitative interview data and the care plan analysis to elaborate on the experience of residential care for pwPD. Close relatives of care home residents can be a fruitful source of information for care home staff, throughout the care planning process, especially in relation to the specific needs of a pwPD. Although health and social policy advocate active collaboration between people with long-term conditions, their families, and their formal carers, there is limited evidence of such collaboration in the data examined here. There is an apparent shortfall in the knowledge and understanding of PD among care home staff. There are important pragmatic (e.g. drug administration) as well as psycho-social reasons for flexibility in routine care provision to meet the dynamic needs of pwPD. The findings here support the need for further, larger scale research into the quality of care for pwPD who are care home residents.

The first line nurse managers’ opportunities to lead nursing care seem to be diminishing. The aim of this study was, therefore, to gain an understanding of the first line nurse managers in their experiences in the development of nursing care as part of a wider research programme. Finnish nurse managers wrote narratives at the beginning of five different leadership courses in this grounded theory study. ‘Preparing the Air for Nursing Care’ emerged as a core category. It was formed by two major categories. ‘Being Concerned about Nursing Care’ describes the nurse managers’ focus on the development of nursing care, the nursing caregivers’ health and knowledge and a concern for the whole organisation. The second major category ‘Creating the Direction and Content of Nursing Care’ describes the nurse manager working together with the staff to create individual and family-centred best practice, initiating relationships and dialogues for nursing care, and a culture of caring. A typology was created that explained the four main modalities to emerge from the data: ‘the Active Developer’, ‘the Passive Thinker’, ‘the Impulsive Creator’ and ‘the Routine Manager’.

Cardiac rehabilitation is an integral component of comprehensive cardiac care and is effective in reducing morbidity and mortality and improving quality of life. However, despite a 50-year-history and extensive evidence base attesting to its clinical and cost-effectiveness, including adding years to life and life to years, and exhortations that its implementation should be a key priority, the majority of cardiac patients do not receive rehabilitation. There is a comparative dearth of funding and wide variation in service provision, with a health care system that often fails to address issues such as sub-optimal referral, enrolment and completion, particularly amongst certain potential user groups that could benefit. This paper reviews these issues and suggests ways of overcoming the obstacles identified. It also highlights some of the knowledge gaps and areas that warrant further research.

Cardiac rehabilitation and secondary prevention can promote recovery, reduce coronary events and improve quality of life in many people with heart disease. Traditionally provided for people with coronary heart disease, there is scope to have provision for a range of people, both young and old, and including those with heart failure, valve disease or with an internal cardiac defibrillator. At its best, cardiac rehabilitation spans the whole pathway of care, beginning before admission to hospital and continuing long after, with ongoing management of lifestyle changes. Guidelines are available based on best evidence, and programmes focus on the whole person and address physical, psychological and social well-being. They incorporate health education, risk factor modification, social support and exercise. Programmes can be run in the community, home or hospital. To ensure effective cardiac rehabilitation for each patient, members of the multi-disciplinary team are challenged to work together to meet the individual needs of patients and their family. The standard of care should be monitored through audit so that improvements can be made.

Nurse teacherhood is composed of many factors. It includes nurse teachers’ tasks and different multidimensional roles and also nurse teachers’ individual experiences of being a nurse teacher. Nurse teachers’ experiences of nurse teacherhood depend on the meanings they give to the different factors. In other words, there are not only one but also several interpretations of what nurse teacherhood is. These interpretations affect what is important for each nurse teacher in their own nurse teacherhood and how satisfied they are with their profession. This paper is part of a larger study examining how Finnish nurse teachers experience their nurse teacherhood in polytechnics. The purpose of this paper was to describe nurse teacherhood during the years 2003 and 2004, when polytechnics and thus also nurse education were actively being developed in Finland. Nurse teachers (N = 34) were interviewed and the data were analysed using the grounded theory method. The categories describing nurse teacherhood were: process of change in the organisation, operating culture of the health care working community, professional self-esteem, focus of competence, relationship with students, the future in one’s profession and requirements for staying in the profession. The core category was commitment to nurse teacherhood. Nurse teachers’ individual experiences of the significance of the categories describing teacherhood were reflected by their level of commitment to teacherhood. Nurse teachers, whose commitment to nurse teacherhood was weak, were especially unsatisfied with changes related to their teacherhood. Nurse teachers’ conceptions of their future as nurse teachers were significant in terms of the direction in which they were developing their own teacherhood. Some nurse teachers who were weakly committed to nurse teacherhood considered it unlikely that they would continue in the profession in the future.

Several national and state-based inquiry documents have reported long-standing and major concerns about mental health service provision in Australia. In particular, accounts of the difficult circumstances that surround the recruitment and retention of high-quality mental health nurses have clearly emerged, independent of jurisdiction. However, the privately experienced cost of working and coping in contemporary mental health settings, especially when the resilience of nursing staff is tested remains poorly understood. Clinical supervision (CS), a structured staff support arrangement, has shown promise as a positive contribution to the clinical governance agenda and is now found reflected in central policy themes elsewhere in the world. However, the concept of CS remains underdeveloped in Australia. The background to a unique randomised controlled trial (RCT), currently in progress in Queensland, Australia, has been described in this study. The efficacy of the most widely adopted model of CS that may address the promotion of standards and clinical audit issues, the development of skills and knowledge and the personal well-being of the supervisee will be tested. This study, funded by the Queensland Treasury/Golden Casket Foundation, will focus not only on the outcomes for individual mental health nurses but also examine the quality of care they provide and the effects of both on patient outcomes. This study will seek to establish a sustainable, strategically significant contribution to the knowledge base both for the mental health nursing workforce in Queensland (and beyond) and the patients they seek to serve.