Stigma, abortion, and disclosure--findings from a qualitative study.

INTRODUCTION: This study qualitatively explores perceptions of women who have experienced abortion care. It explores women's journey through abortion from confirmation of pregnancy to post-abortion. AIM: The study seeks to understand the implications of these perceptions for policy and practice. MAIN OUTCOME MEASURES: A qualitative study involving in-depth semi-structured interviews with 17 women, aged between 22 and 57 years, who had undergone legal induced abortion in the UK when they were 16 years or older. Participants were not recruited under the age of 16 because of the ethical and legal complexities of interviewing minors. Additionally, 16 years was deemed to be the most appropriate age as this is the legal age of consent in the UK. METHODS: Participants were recruited from 12 community contraception and sexual health clinics in two NHS trusts, one in England and one in Wales. Participant recruitment was set at a minimum of 12 and participants were recruited on a "first come first served basis" (i.e., the first 12 who contacted the researcher). The number of participants was raised to seventeen as this was the number deemed to be the most suitable for data saturation in this particular qualitative research. RESULTS: Women in this study understood abortion as highly taboo and a potentially personally stigmatizing event. These perceptions continued to affect disclosure to others, long after the abortion, and affected women's perceptions of the response of others, including society in general, significant others, and health professionals. CONCLUSIONS: Women's experiences of abortion may be influenced by perceived negative social attitudes. Health professionals and abortion service providers might combat the perceived isolation of women undergoing abortion by attending not only to clinical/technical aspects of the procedure but also to women's psychological/emotional sensitivities surrounding the event.

The nurse-patient relationship in the post-anaesthetic care unit.

AIM: To explore how post-anaesthetic care (PAC) nurses perceive their role, acknowledging the activities that they undertake routinely in their practice. METHOD: A generic qualitative research approach was used; eight PAC nurses were interviewed, with each interview lasting between 30 minutes and one hour. FINDINGS: A salient finding related to the psychosocial dimension of nursing, with much of the data referring to the nurse-patient relationship pre and post-operatively. Three themes were identified: communication, being an advocate and being remembered. CONCLUSION: The findings suggest that PAC nurses have the opportunity to develop relationships with patients both pre-operatively when the patients arrive in the operating department and post-operatively. The findings may help to challenge existing beliefs that when patients are in the care of PAC nurses, they are unconscious and therefore unable to engage in dialogue with the nurse. While the findings reflect the views of PAC nurses only, operating department practitioners might hold similar views. This study highlighted that there may be potential for development of the role of the PAC nurse, and as there is little documented about this role, further research is warranted.

A survey of school nursing provision in the UK.

AIM: This paper is a report of a study to map school nursing provision across the health and education sectors in Wales to identify the number, age, qualifications, terms of employment, location, functions and access to continuing professional development and clinical supervision of school nurses. BACKGROUND: School nurses are important in promoting the health of school-aged children. Increased demands have arisen from changes in patterns of health, illness and lifestyles. METHODS: An interview survey was conducted with a purposive sample of school nursing/health visiting managers from 13 healthcare sector providers, senior personnel officers from 22 Local Education Authorities and 45 head teachers/school nurses from independent schools. Data were collected between March and June 2004 and the overall response rate exceeded 80%. RESULTS: A total of 249 school nurses were identified: 90% employed by the healthcare sector and 10% by the education sector. An ageing, under-developed and under-resourced service was identified. Disparity in practice within and across the sectors was evident, resulting from lack of policy direction regarding the scope and content of school nursing services. Workforce size, age and educational profile pose challenges for service delivery. CONCLUSION: Investment in recruitment and education is required if school nurses are to meet increasing demands and fulfil their public health role. The low percentage of school nurses aged under 30 years may reflect lack of a career pathway and understanding of school nursing. The findings enable national and international comparisons in terms of numbers, size of caseload, age, qualifications, terms of employment and activities and functions.

Managerial perceptions of mentor, lecturer practitioner and link tutor roles.

Educating pre-registration nurses in clinical practice is a global issue. Within different countries problems exist in educating and supervising students in clinical practice and various models of clinical education are employed. In Wales, United Kingdom, this responsibility is divided between mentors, lecturer practitioners and link tutors. This paper reports on the third phase of a three-phase study in Wales to explore differences between mentors, lecturer practitioners and link tutors, and how they work together to assist students to integrate theory and practice. Four focus group interviews of National Health Service managers and Higher Education managers (n=22) were conducted. Qualitative content analysis revealed four themes: role characteristics and competencies, role differences, role conflict, and future options. The findings suggest a theory-practice continuum along which mentors, lecturer practitioners and link tutors occupy different positions. The article explores these different positions and offers suggestions for future role development.

A literature review of the public health roles of health visitors and school nurses.

This paper describes a two-stage review relating to the family-centred public health role of health visitors and the child-centred public health role of school nurses. During the first stage, literature was searched using CINAHL and Medline databases and two models were used to frame the literature analysis. The findings of this analysis were, however, disappointing. Although many policy documents advocate development of the family-centred public health role of health visitors and the child-centred public health role of school nurses, there was no overwhelming evidence of reports of these approaches in health visiting and school nursing practice. The second stage of the review comprised a content analysis of West Midlands community trusts' strategic development plans. Seventeen plans were analysed. Of these, only two were 'formal' plans, the remainder being fragmented documentation related to plans for the development of health visiting and school nursing services. It may be concluded from the analysis that NHS trusts are beginning to adopt ideas from the rhetoric of national policy documents. Additionally, public health practice initiatives form an integrated part of most of the trust strategic development plans that the researchers examined.

Advanced nursing practitioners in primary care settings: an exploration of the developing roles.

Recent health care policies have resulted in patients having access to an integrated system of care that is quick and reliable. In concert with these changes, opportunities for professional development in nursing have increased, together with a reduction in the numbers of doctors. Advanced Nurse Practitioners (ANPs) have, therefore, developed to meet the complex demands of health care systems. This paper reports on a study that aimed to explore the current role of ANPs in primary care in the West Midlands region of the UK and how ANPs within three different nursing disciplines in primary care developed their roles over time. The study utilized a qualitative exploratory design incorporating a longitudinal element. Twenty-one ANPs were interviewed during phase one, 15 of whom were interviewed again during phase two, approximately 15 months later. Their managers (where appropriate) were also interviewed during phase one. The findings reveal that the nature and focus of practice varies between disciplines. At the extreme practice end of the practice-strategic continuum, Practice Nurse ANPs' expertise lies in their advanced practical assessment and diagnosis of individual patients, with little opportunity for strategic development. Health Visitor and District Nurse ANPs operate at the strategic end of the practice-strategic continuum, but operate differently at this level. Health Visitors, being community and public health focused are involved in multi-agency work, practice development and policy formulation. District Nurses work with individual patients/carers and the nursing team, thus their involvement in strategic developments tends to focus at the patient care level, such as protocol and practice developments, although their work also involves work in all three other domains. Overall, the findings reveal a unique role for all three with a potential career pathway for ANPs to become Nurse Consultants in the future.

Nursing roles and levels of practice: a framework for differentiating between elementary, specialist and advancing nursing practice.

The recent profusion of new nursing roles in the UK has led to much confusion in the minds of health care consumers, employers, nursing practitioners and educationalists regarding the meaning, scope of practice, preparation for, and expectations of such roles. Titles such as Clinical Nurse Specialist (CNS), Nurse Practitioner (NP), Advanced Nurse Practitioner (ANP), Higher Level Practitioner (HLP) and more recently Nurse Consultant (NC) are being adopted in a variety of care settings with little understanding or consensus as to the nature of or differences between such roles. Further, the former United Kingdom Central Council for Nursing, Midwifery and Health Visiting (1992) initiative for extending the scope of professional practice allows for the prospect that nurses can adopt additional clinical tasks or alter the nature of service provision provided that they acquire the appropriate education or training, levels of competence and are prepared to be accountable for their new practices. Consequently, nursing practice is becoming more diverse than ever before and the boundaries of inter- and intraprofessional practices are becoming increasingly blurred. The UKCC (1999a) has recently contributed to an understanding of the levels of clinical practice undertaken at the specialist level but the situation at advanced or consultant levels remains unclear.