Articulating the role of the clinical nurse specialist in New Brunswick.

The clinical nurse specialist (CNS) role is often misunderstood and underutilized. Through partnership with the CNS Advisory Committee in the Horizon Health Network and the Masters of Nursing Program at the University of New Brunswick, the authors developed a clear articulation and visual representation of the CNS role in New Brunswick. This paper synthesizes information gleaned from interviews with the clinical nurse specialists working within Horizon Health Network and integrates this information with the published literature and the position statement of the Canadian Nurses Association (CNA). Vision, voice and value emerged as key considerations, as did barriers to, and successes of, the CNS role. This paper contributes to the acquisition of knowledge regarding the role of the CNS according to the CNA and current published literature. It further promotes an understanding of the important role of the CNS in the healthcare system in New Brunswick, and introduces strategies that can be utilized by clinical nurse specialists to demonstrate value and support the continuation of the role.

Getting through ethics: the fit between research ethics board assessments and qualitative research.

In this paper, we draw on the authors' collective experiences as qualitative researchers undergoing research ethics reviews. We highlight specific areas within our standard national guidelines that support qualitative research. Using case examples, we illustrate how diverse interpretations of these guidelines can be inconsistent and problematic for qualitative researchers. We outline recommendations for transparency, reciprocity, and streamlining of the review process. It is our hope that adoption of these recommendations will lead to a more collegial evaluative process, thereby contributing to the advancement of knowledge.

A partnership model evolves from a living inventory of engagement.

This university-community partnership developed when practitioners at a community health centre within a regional health authority collaborated with nursing faculty at the University of New Brunswick in Saint John, New Brunswick, Canada. A philosophical match and work context facilitated this collaboration. Partners acknowledged that continued maintenance of the partnership, or its termination, was dependent on the acceptance of principles of partnership engagement. Even though the common philosophy of primary healthcare brought these partners together and reciprocal capacity building was the glue that nurtured their partnership, the tensions that arose fuelled its continued growth and development. Roles and responsibilities of members were discerned and space was created to acknowledge and integrate the lessons learned when tensions were examined. Within this environmental context, a model of partnership emerged. Tensions within this model were accepted as opportunities that resulted in beliefs being challenged, relevant questions generated and partnership alliances strengthened. In this spiral process, new relevant knowledge was constructed and new norms for best practice and policy were developed. The utility of this inter-professional Partnership Model: Living Inventory of Engagement is demonstrated through case examples.

Nursing theory-directed healthcare: modifying Kolcaba's comfort theory as an institution-wide approach.

The tradition of the nursing discipline borrowing theory from other disciplines is examined, and the idea of other healthcare disciplines borrowing nursing theory is proposed. A brief literature review of borrowed theory sets the stage to examine how a modification in the theoretical framework of Kolcaba's theory of comfort can guide the thinking and work of other healthcare disciplines. This change positions Kolcaba's theory as an acceptable blueprint to guide the activities of all health disciplines within an institution, transposing this theory from a theory for nursing to a theory for healthcare. In a healthcare climate that embraces interprofessional collaboration, a single theoretical framework has the potential to facilitate greater understanding between disciplines and greater continuity of care for healthcare recipients and their families. To clearly demonstrate this assertion, a hypothetical case example is presented.

Theoretical, psychometric, and pragmatic issues in pain measurement.

Measurement is essential to nursing practice and research, and adequate tool selection is crucial for both. The present paper seeks to provide an overview of key issues to consider in tool development, selection, and psychometric testing using the concept of pain. Both the classic and the contemporary approaches to validity are described and compared. Although sharing similar features, the contemporary approach seems more encompassing, because it considers measurement purposes, participants' characteristics, and conditions under which instruments are used. Strategies pertaining to reliability and validity testing are discussed and illustrated with specific pain assessment measures, including pain intensity scales, multidimensional questionnaires, and other behavioral tools. Depending on measurement purposes, the more appropriate strategies are highlighted. Cultural issues in pain measurement as well as pragmatic criteria for measure selection also are discussed.

An examination of the self-care concept uncovers a new direction for healthcare reform.

The concept of self-care is multidimensional, with many defining elements. This paper describes the origin of this comprehensive concept. It examines the response of the nursing discipline to citizen self-care initiatives and the subsequent effects this response has had on the development of nursing knowledge. The evolution of self-care as a core concept within Canadian health policy is presented; the potential readiness fo citizens to accept self-care as an aspect of healthcare delivery is explored, identifying potential benefits and obstacles. The paper concludes with a proposed self-care approach to healthcare reform in Canada and the subsequent influence this approach may have on the discipline of nursing. The congruency between a self-care healthcare delivery system and the theoretical foundations and perspective of healthcare delivery held by the nursing discipline is discussed. The role nurses might assume in shaping a self-care healthcare delivery system is delineated.

Primary health care: a framework for policy development.

Primary health care has utility for policy development at all levels of organization in any nation, including policies influencing the health of persons living with severe and persistent mental illnesses. Using the primary health care framework, policies to improve health and housing for this population evolve from intersectoral collaboration. Active participation by those persons whose essential health is compromised by housing that is not acceptable, adequate, suitable, and affordable is required. Appropriate and affordable methods that address health challenges are identified. Access to services meeting essential health care needs of citizens has potential for healthy outcomes.