The causes of falls: views of older people with visual impairment.

BACKGROUND: Sight impairment increases with age and, compared with the general older population, older people with sight impairment are more likely to fall. There is a growing body of evidence on the views and perceptions of older people about falls, but little is published on the views of older people with sight impairment. OBJECTIVE: To explore what older people with sight impairment believe to be the causes of falls. DESIGN: A qualitative design was used, incorporating focus groups and interviews in which participants discussed falls and falls prevention. Framework analysis was employed to identify themes arising from participants' discussions of the causes of falls. SETTING AND PARTICIPANTS: Fifty-four community dwelling men and women with sight impairment, aged 65 and over, were recruited from across Greater Manchester, UK. RESULTS: Five types of factors were identified that were believed to cause falls: (i) health issues and changes in balance caused by ageing; (ii) cognitive and behavioural factors; (iii) the impact of sight impairment on getting around the home; (iv) the impact of sight impairment on negotiating the environment away from home; and (v) unexplained falls. DISCUSSION AND CONCLUSIONS: Older people with sight impairment reported many researched risk factors previously identified by older people without sight impairment but also described many perceived risks unique to people with sight impairment. There are few interventions to prevent falls aimed at older people with sight impairment, and the results of this study allow further tailoring of such interventions based on views of older people with sight impairment.

Atrophy and anarchy: Third national survey of nursing skill-mix and advanced nursing practice in ophthalmology.

AIMS AND OBJECTIVES: The aims of the study were to investigate the advanced nursing practice and the skill-mix of nurses working in ophthalmology. BACKGROUND: The expansion of new nursing roles in the United Kingdom in the past decade is set against the background of a nursing shortage. The plan to modernize the National Health Service and improve the efficiency and delivery of healthcare services as well as to reduce junior doctors' hours contributes towards a profusion of new and more specialized and advanced nursing roles in various areas of nursing including ophthalmology. DESIGN: A self-reporting quantitative questionnaire was employed. The study used comparative and descriptive statistical tests. METHOD: The questionnaires were distributed to all ophthalmic hospitals and units in the United Kingdom. Hospital and unit managers were responsible for completing the questionnaires. RESULTS: Out of a total 181 questionnaires 117 were returned. There is a downward trend in the total number of nurses working in ophthalmology. The results demonstrate more nurses working at an advanced level. However, there is a general confusion regarding role interpretation at the advanced level of practice, evident through the wide range of job titles being used. There was inconsistency in the qualifications expected of these nurses. CONCLUSION: Whilst there are more nurses working at an advanced level this is set against an ageing workforce and an overall decline in the number of nurses in ophthalmology. There is inconsistency in job titles, grades, roles and qualifications for nurses who work at an advanced or higher level of practice. The Agenda for Change with its new structure for grading jobs in the United Kingdom may offer protection and consistency in job titles, pay and qualifications for National Health Service nurse specialists. The Nursing and Midwifery Council needs to provide clear guidelines to the practitioners on educational and professional requirements, to protect patients and nurses. RELEVANCE TO CLINICAL PRACTICE: The findings indicate that there is a need for better regulations for nurses working at advanced nursing practice.

Trends in the nature of provision in ophthalmology services and resources and barriers to education in ophthalmic nursing: 3rd National UK survey.

Over the last decade in the United Kingdom (UK), the roles of nurses have become increasingly specialised to support a more efficient and effective health service. In ophthalmology, the changes are most visible in the growing number of patients being treated as day case and the greater nursing contribution to patient outcomes. To support this change there is a continuing need for educational institutions to create opportunities to meet the training needs of nurses working in both specialised areas and at the advance level of practice. This article reports on a 3rd national survey the aims of which were to investigate trends in the nature and provision of ophthalmic services and the resources and barriers to education in ophthalmic nursing. The results demonstrate that over the three surveys there has been a significant increase of pre-operative assessment units and a significant decrease of designated ophthalmic wards. Between the second and third survey, the results indicate fewer difficulties with funding but there has been an increase of respondents stating a lack of training institutions offering ophthalmic courses. The survey shows that at a time when nurses need to acquire ophthalmic nursing skills and knowledge there appear to be fewer opportunities for them to access ophthalmic courses.

Praiseworthy pragmatism? Validity and action research.

BACKGROUND: Action research has been promoted as a suitable methodology for nursing, but is located in a discourse that challenges its claims of validity. This discourse, influenced by positivism, is similar to that which qualitative researchers have faced. AIM: This article contributes to theoretical discussion of the validity of action research. FINDINGS: Because of similarities, the emergent debates around the reconceptualization of validity in qualitative research are outlined, prior to a consideration of the relative arguments in relation to action research. Three avenues of thought are discerned: that no criteria are required; that parallels with other schools are appropriate; and that new concepts specific to one school of thought should be developed. CONCLUSIONS: Because of its ethical and action-oriented principles, action research offers the potential to address validity issues that remain problematic to 'pure' qualitative researchers, and it can be claimed that its pragmatic approach is validity-enhancing. We argue for the rejection of naïve rule-based formulae and for recognition of the impact of contextual and pragmatic concerns, so that the potential for the added value of action research might be realized.