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There is increasing evidence in the literature that patient outcome is strongly linked to the quality of nursing care. In practice, the process of measuring the quality of nursing care is complex and multifaceted as it is dependent not only on the skills and practices of the individual nurse, but also on the professional and organisational structure that is practised within. The expert panel concept was developed to address clinical standards and practice at The Royal Melbourne Hospital. The Nursing Expert Panel's purpose was to evaluate nursing practice, identify practice deficits, highlight areas of clinical innovation and excellence, and make recommendations where appropriate to improve patient outcome. The aim of this paper is to investigate this.

A pilot programme to evaluate eight clinical areas was developed and implemented. The key areas of evaluation included clinical care as well as the managerial and professional practices that support patient care. The Expert Panel, consisting of predominantly nursing staff, was recruited from within the organisation. During the evaluation, the panel collected qualitative and quantitative data using a variety of data collection tools. Data were then analysed and recommendations developed.

Five common themes of practice deficit were identified during the pilot period and the development of strategies for practice improvement is in progress.

Following successful implementation of the pilot phase, the Nursing Expert Panel process is now being implemented across the organisation. With ongoing evaluation and improvement of the Expert Panel Process, this quality initiative will become the foundation of nursing standards and practice evaluation at this organisation.

The purpose of this paper is to report on ethnographic research that investigated how self-employed nurses perceive the contemporary healthcare field, what attributes they possess that facilitate their roles as change agents, what strategies they use to influence change, and what consequences they face for their actions, thus contributing to what is known about organizational change in institutionalized settings such as healthcare.

Focussed ethnography was used to explore self-employed nurses’ work experiences and elucidate the cultural elements of their social contexts, including customs, ideologies, beliefs, and knowledge and the ways that these impact upon the possibilities for change in the system.

These self-employed nurses reflected on the shortcomings in the healthcare system and took entrepreneurial risks that would allow them to practice nursing according to their professional values. They used a number of strategies to influence change such as capitalizing on opportunities, preparing themselves for innovative work, managing and expanding the scope of nursing practice, and building new ideas on foundational nursing knowledge and experience. They had high job satisfaction and a strong sense of contribution but they faced significant resistance because of their non-traditional approach to nursing practice.

Despite dramatic restructuring in the Canadian healthcare system, the system remains physician-centered and hospital-based. Nursing ' s professional potential has been largely untapped in any change efforts. Self-employed nurses have positioned themselves to deliver care based on nursing values and to promote alternative conceptions of health and healthcare. This study offers a rare exploration of this unique form of nursing practice and its potential to influence health system reform.

This paper reports on a study undertaken in one mental health NHS foundation trust in the UK, which sought to examine to what extent advanced practice nursing could contribute to advancing new ways of working in the future. The literature on advanced nursing in the UK is critically discussed and where availability permits, reference is made to international literature. The findings of a survey of nurses with a Masters degree or acting at advanced level are reported and discussed. Though the data reported here are largely confirmed by similar studies, nevertheless the insights provided should alert organisations to the complexity of introducing new roles during a time of radical change in the health care system. Despite the efforts of a highly motivated trust, respondents identified barriers and obstacles that were of such significance that some were forced to rethink their readiness to embrace the role. It is hoped that the recommendations derived from this study may assist other organisations at a similar stage of implementing advanced nursing practice roles.

This paper presents a research study that demonstrates the inadequacy of the traditional biomedical approach to caring for older people and shows the benefits of using a more holistic, bio‐psychosocial approach. An ethnographic inductive approach was taken. Non‐participant observation was performed on complete episodes of nursing practice, followed by semi‐structured interviews to explore and ratify theories in use. Phase one of the data analysis used qualitative inductive analysis to generate main categories and themes. Phase two was a process of factor isolation, which identified factors of practice theories in use. The themes identified were: nursing therapeutics; preventative nursing; communication; nurse‐patient relationships; collaborative nursing; nursing assessment; decision making; and management of patient care. Further analysis identified that important theoretical factors included: encouraging; responding; comforting; explaining; maintaining ability; judgement in action; and collaborating. This knowledge is embedded in the practice theories of practitioners but it is only by exploring and critiquing these that we can hope to understand the complex nature of nursing practice as it relates to the care of older people.

The difficulties of basing healthcare on literary warrant have been explained in different ways: busy practitioners have no time to read extensively, physical access is difficult, and adequate surrogates for texts like indexes, abstracts, systematic reviews are partial in their coverage. The author suggests that a deeper problem of domain conflict must be addressed. This paper reviews problems identified in previous research on evidence‐based nursing practice, which indicates that there are conflicts between medical and nursing domains. EBM (evidence‐based medicine, or “text”) poses challenges for nurses (proponents of “caritas”). An additional surrogate for the medical corpus, the clinical guideline, is discussed. When based on inclusive consultation, this may prove to be a hospitable epistemological bridge for groups whose domains are in conflict. Drawing on “social studies of science” literature, the author explores the provenance and status of the clinical guideline as a “translation artefact” or bridging mechanism, and presents a “snapshot” case study of the Scottish Intercollegiate Guidelines Network in 1998. She suggests that the clinical guideline is a powerful documentary genre, which links several strands of information science: information retrieval, literary warrant and the politics of classification.

The forensic nursing role is complex, creates tensions within itself and is underpinned by core values, knowledge, skills and personal attributes; often referred to as ‘good nurse’ characteristics (Smith & Godfrey, 2002). Forensic nurses perform unique, multifaceted roles; they are viewed by patients as ‘a source of treatment, comfort and advice’, but also as ‘part of the system that deprives them of their liberty’ (United Kingdom Central Council for Nursing, Midwifery and Health Visiting & University of Central Lancashire (UKCC & UCLAN), 1999: 42). This is problematic both for nurses and patients. Although appearing as opposites, security and therapeutic characteristics of nurses can and do co‐exist in forensic nursing (Peternelji‐Taylor & Johnson, 1996). Through critical analysis of dialogue from interviews and focus groups, this paper depicts forensic practice with people with a learning disability through a study that explores apparent ‘truths’ about such people detained in forensic settings (here referred to as ‘the men’) and the staff who work with them. Beliefs about nursing characteristics were exposed through discourses present in dialogue between the men and the staff. General research questions included: (1) What are the discourses related to learning disability and forensic practice? (2) What ideologies underpin and justify forensic practice? (3) What in particular are the positive discourses? Related discussion is primarily concerned with the way that staff and men share relationships and with characteristics of the nursing staff. Findings generally suggest that the staff may be viewed as prison wardens, leading to relationships of mistrust. Paradoxically, there are also positive discourses identifying warm and therapeutic relationships and good nurse characteristics of the staff. This may have practice implications, such as enabling staff to hear positive views expressed by the men and begin to develop metrics of ‘good’ forensic nurse characteristics that may positively affect treatment.

The purpose of this paper is to assess the contribution of scenario-based learning aimed at raising awareness of sustainability in health-care practitioners. The Lancet Countdown on Climate Change calls for urgent action on health and climate change; this requires appropriate knowledge, skills and competencies that can be gained through undergraduate education. The International Council of Nurses calls for leadership in nursing for sustainability; however, climate change and health are given little attention in nursing and health-care curricula.

A cohort of nursing and midwifery students was introduced to sustainability and climate change in the context of health care through scenario-based learning sessions in each of their three years of undergraduate education. Questionnaires were used to collect data on participant’s attitudes toward sustainability and climate change, how useful the educational sessions were and the extent to which their clinical practice had changed.

Significant differences were found between scores in Years 1 and 2 suggesting greater awareness of the importance of sustainability in nursing education and practice. Comparison of Years 2 and 3 scores found participants more likely to apply sustainability principles in clinical practice and challenge unsustainable practices in the work environment.

Further research is required to explore sustainability practice in postgraduate nurses/midwives. However, this study supports the need for sustainability education to be embedded within health-care professional degrees through applied and participatory pedagogical approaches.

To the best of the authors’ knowledge, this is the first study to evaluate sustainability education and its impact on nursing attitudes towards practice.

The purpose of this paper is to explore the applicability of the process of identifying a conceptual framework of practice to areas of nursing without a current clearly identified scope of practice. Worldwide, nursing is a diverse profession with many recognised sub-specialties, some of which are under threat. Nurses with specialised knowledge, experience and education are needed to provide specific care in nursing sub-specialties. However, some of these characteristics are implicit and not clear to the wider nursing community. This paper presents an overview of research to identify the parameters of practice for a sub-specialty of nursing.

The methodology was interpretive enquiry as it allowed for the interpretation of multiple realities which resulted in a rich description of the work of a sub-specialty. The research used document analysis, focus group interviews and individual interviews as the methods of collecting data. Documents were analysed using iterative and thematic analysis The focus group and individual interview data were analysed using an adaptation of a six-phase thematic analysis process.

This paper presents the findings of the entire analysis and the resultant holistic conceptual framework for the work of the child and adolescent mental health nurse in the inpatient unit. The findings have contributed new knowledge to mental health nursing, specifically child and adolescent mental health nursing making the parameters of practice more explicit. Research is currently being undertaken in Australia to further develop the framework for other sub-specialties of nursing such as community health and orthopaedics. These sub-specialties have been identified as potentially at risk.

This paper discussed the applicability of a broader use of a qualitative research methodology used to identify scope of practice in child and adolescent mental health nursing, for other nursing specialties.

This paper aims to explore how dispositions of nursing habitus carry shift handover into practice in acute care.

Handover (the exchange of information by nurses between shifts) is more recently purported to be a procedure that transfers the responsibility of and accountability for care to maintain patient safety. Using Bourdieu's theory of practice as lens, this paper examines data from an ethnographic study of nurses' work in acute care to reveal what happens in and around nurses' practices of handover.

Exploring handover as a practice enables identification of nurses' responsibilities of work as professional, clinician and employee. These responsibilities are not practised separately, rather, as braided identities they are embodied into nurses' practices of work. Nurses' clinician and employee identities address the clinical and organisationally relevant material contained in handover, but it is in the ways that nurses embody their responses that their professional identity becomes evident.

Viewing handover as a procedure suggests that nurses are rule followers and/or sole players and conceptualises nurses as individualised professionals only. This received knowledge as doxa misrecognises the centrality of connectedness between nurses in their work in the acute care setting.

Recognising nurses' braided workplace identities as being professional, clinician and employee upends the doxa of nurses work as tasks and roles in the delivery of healthcare in the acute care setting.

The purpose of this paper is to consider how meaning may be made of nursing practices by contrasting the rationalistic approach commonly used in the nursing literature with Bourdieu’s theory of practice.

The data under consideration is an account of ten to 15 minutes of a larger ethnographic study of nursing practices which asks the question: how do nurses accomplish nursing within and between patients’ needs for care in the acute hospital setting? The five main sources of data were: observations of and conversations with nurse participants, as well as hospital documentation (including facility protocols and patients’ notes) and the observer’s field diary. These were woven together to provide an account of one nurse with one patient for a few moments of her day.

Although this paper makes no attempt to speak to the rest of her workload, in these few minutes the nurse accomplishes multiple moments of nursing practice. Further, while the rationalistic approach presents the nurse as a highly skilled practitioner, Bourdieu’s theory of practice not only illuminates the nurse’s role as pivotal in the acute hospital setting but is also able to address the dialectical nature of the relationship between nurses’ practices and the dynamics of the context.

The use of Bourdieu’s theory of practice makes possible the study of how nurses nurse “within and between” to illuminate the everyday practices of nurses.