Nursing education and regulation: international profiles and perspectives

This review of nurse education and regulation in selected OECD countries forms part of ongoing work on contemporary nursing careers and working lives, based at the National Nursing Research Unit, King’s College London. The review was commissioned by the Department of Health to inform their work in considering the UK’s position in relation to the Bologna declaration and changes that may emanate from the implementation of Modernising Nursing Careers (DH 2006). While much of the information in the review was obtained from publications and websites, we also contacted key personnel in most of the countries included for an up-to-date review of developments in their country and would like to thank them all for providing this information

Peer review: beyond the call of duty?

The number of manuscripts submitted to most scholarly journals has increased tremendously over the last few decades, and shows no sign of leveling off. Increasingly, a key challenge faced by editors of scientific journals like the International Journal of Nursing Studies (IJNS) is to secure peer reviews in a timely fashion for the manuscripts they handle. We hear from editors of some journals that it is not uncommon to have to issue 10–15 invitations before one can secure the peer reviews needed to assess a given manuscript and although the IJNS generally fares better than this it is certainly true that a high proportion, probably a majority, of review invitations are declined.\ud \ud Most often, researchers declining invitations to review invoke the fact that they are too busy to add yet another item to their already overcommitted schedule. Some reviewers respond that administrators at their university or research center are actively discouraging them from engaging in an activity that seems to bear no tangible benefits. Yet, however one looks at it, peer reviewing is a crucial component of the publishing process. Nobody has yet come up with a viable alternative. Therefore, we need to find a way to convince our colleagues to peer review manuscripts more often. This can be done with a stick or with various types of carrots.\ud \ud One “stick”, occasionally envisaged by editors (e.g., Anon., 2009), is straightforward, at least to explain. For the peer-reviewing enterprise to function well, each researcher should be reviewing every year as many manuscripts as the number of reviews he or she is getting for his/her own papers. So, someone submitting 10 manuscripts in a given year should be willing to review 20 or 30 manuscripts during the same timeframe (assuming that each manuscript is reviewed by 2 or 3 individuals, as is commonly the case). If this person does not meet the required quota of reviews, there would be some restrictions imposed on the submission of any new manuscript for publication. Boehlert et al. (2009) have advocated such a “stick” in the case of the submission of grant proposals.\ud \ud However, the implementation of such an automatic accounting of reviewing activities is fraught with difficulties. For one thing, it would not prevent reviewers from defeating the system by writing short, useless reviews just to make the number. To eliminate that loophole, someone would have to assess whether reviews meet minimal standards of quality before they can be counted in the annual or running total. There would need to be allowances, for example to allow young researchers to get established in their career. This raises the prospect of a complex and potentially expensive system somewhat akin to carbon trading where credits for reviewing are granted and then traded with a verification system to ensure that no one cheats.\ud \ud An alternative approach, instead of sanctioning bad reviewing practices, would be to reward good ones. Currently the IJNS publishes the names of all reviewers annually. Other journals go a step further for example by giving awards to outstanding reviewers (Baveye et al., 2009). The lucky few who are so singled out by such awards see their reviewing efforts validated. But fundamentally, these awards do not change the unsupportive atmosphere in which researchers review manuscripts. The problem has to be attacked at its root, in the current culture of universities and research centers, where administrators tend to equate research productivity with the number of articles published and the amount of extramural funding brought in. Annual activity reports occasionally require individuals to mention the number of manuscripts or grant proposals reviewed, but these data are currently unverifiable, and therefore, are generally assumed not to matter at all for promotions or salary adjustments.\ud \ud There may be ways out of this difficulty. All the major publishers have information on who reviews what, how long reviewers take to respond to invitations, how long it takes them to send in their reviews. All it would take, in addition, would be for editors or associate editors who receive reviews to assess and record their usefulness, and one would have a very rich data set, which, if it were made available to universities and research centers in a way that preserves the anonymity of the peer-review process, could be used fruitfully to evaluate individuals’ reviewing performance and impact. Of course, one would have to agree on what constitutes a “useful” review. Pointing out typos and syntax errors in a manuscript is useful, but not hugely so. Identifying problems and offering ways to overcome them, proposing advice on how to analyze data better, or editing the text to increase its readability are all ways to make more substantial contributions. Generally, one might consider that there is a usefulness gradation from reviews focused on finding flaws in a manuscript to those focused on helping authors improve their text. Debate among scientists could result in a reliable set of guidelines on how to evaluate peer reviews.\ud \ud Beyond making statistics available to decision makers, other options are also available to raise the level of visibility and recognition of peer reviews (Baveye, 2010). Right or wrong, universities and research centers worldwide now rely more and more on some type of scientometric index, like the h-index (Hirsch, 2005), to evaluate the “impact” of their researchers. In other cases, such as the UK, the basis on which institutions are funded is linked to schemes which have measures such as the impact factor at their core (Nolan et al., 2008 M. Nolan, C. Ingleton and M. Hayter, The research excellence framework (REF): a major impediment to free and informed debate?, International Journal of Nursing Studies 45 (4) (2008), pp. 487–488. Article | PDF (202 K) | View Record in Scopus | Cited By in Scopus (4)Nolan et al., 2008). While many researchers see bibliometric analysis as a legitimate tool to explore discipline's activities and knowledge sources (see for example [Beckstead and Beckstead, 2006], [Oermann et al., 2008] and [Urquhart, 2006]), previous editorials in the IJNS have noted this trend and expressed disquiet at the distorting effect it could have on academic practice when used to pass judgments on quality ([Ketefian and Freda, 2009] and [Nolan et al., 2008]).\ud \ud Many of these indices implicitly encourage researchers to publish more articles, which in turn may detract researchers from engaging in peer reviewing. Certainly, none of the current indices encompass in any way the significant impact individuals can have on a discipline via their peer reviewing. But one could conceive of scientometric indexes that would include some measure of peer-reviewing impact, calculated on the basis of some of the data mentioned earlier. Clearly, such developments will not happen overnight. Before any of them can materialize, a necessary first step is for researchers to discuss with their campus administration, or the managers of their research institution, the crucial importance of peer reviewing and the need to have this activity valued in the same way that research, teaching, and outreach are. A debate along these lines is long overdue.\ud \ud Academic peer review is a necessary part of the publication process but while publication is recognised and valued, peer review is not. Even without the pressures of reward based on publication-based measures there is a potential for those less civic-minded authors to benefit from, but not contribute to, the peer-review system. Current scientometrics actively encourage and reward such behavior in a way that is, ultimately, not sustainable. Once administrators perceive that there is a need in this respect, are convinced that it will not cost a fortune to give peer reviewing more attention, and formulate a clear demand to librarians and publishers to help move things forward, there is hope that this perverse incentive in the current system can be removed. Otherwise the future of the current model of peer review looks bleak and we may indeed have to look forward to a complex bureaucratic system in which review credits are traded.\ud \ud For now, although the IJNS can count itself lucky because the problem affects this journal less than many others, in common with other journals we must thank our peer reviewers who are acting above and beyond the call of duty as it is perceived by many institutions. Without their efforts, journals like this cannot maintain their high standards. It is time for us to lend our weight to calls for a wide-ranging debate in order to ensure that these efforts are properly acknowledged and rewarded when judging the extent and quality of an academic's scientific contribution

An assessment of failure to rescue derived from routine NHS data as a nursing sensitive patient safety indicator (report to Policy Research Programme)

Objectives: This study aims to assess the potential for deriving 2 mortality based failure to rescue indicators and a proxy measure, based on exceptionally long length of stay, from English hospital administrative data by exploring change in coding practice over time and measuring associations between failure to rescue and factors which would suggest indicators derived from these data are valid.Design: Cross sectional observational study of routinely collected administrative data.Setting: 146 general acute hospital trusts in England.Participants: Discharge data from 66,100,672 surgical admissions (1997 to 2009).Results: Median percentage of surgical admissions with at least one secondary diagnosis recorded increased from 26% in 1997/8 to 40% in 2008/9. The failure to rescue rate for a hospital appears to be relatively stable over time: inter-year correlations between 2007/8 and 2008/9 were r=0.92 to r=0.94. No failure to rescue indicator was significantly correlated with average number of secondary diagnoses coded per hospital. Regression analyses showed that failure to rescue was significantly associated (p<0.05) with several hospital characteristics previously associated with quality including staffing levels. Higher medical staffing (doctors + nurses) per bed and more doctors relative to the number of nurses were associated with lower failure to rescue. Conclusion: Coding practice has improved, and failure to rescue can be derived from English administrative data. The suggestion that it is particularly sensitive to nursing is not clearly supported. Although the patient population is more homogenous than for other mortality measures, risk adjustment is still required

Infection prevention as "a show": a qualitative study of nurses' infection prevention behaviours

Background: Control of infection and prevention of healthcare associated infections is an ongoing issue worldwide. Yet despite initiatives and strategies to reduce the burden that these infections cause, healthcare workers' practice is still reported as suboptimal and these infections persist. Much of the research to date has primarily focused on predicting infection prevention behaviours and factors associated with guideline compliance. While this has given valuable insight, an investigation aiming to understand and explain behaviours that occur in everyday practice from the perspective of the actors themselves may hold the key to the challenges of effecting behaviour change. This study questioned "How can nurses' infection prevention behaviour be explained?" This paper presents one of three identified themes 'Rationalising dirt-related behaviour'. Design: This interpretative qualitative study uses vignettes, developed from nurses' accounts of practice, to explore nurses' reported infection prevention behaviours. Participants: Registered nurses working in an acute hospital setting and had been qualified for over a year. They were recruited while studying part-time at a London University. Methods: Twenty semi-structured interviews were undertaken using a topic guide and vignettes. Interviews were transcribed verbatim and analysed using the framework method. Results: The findings demonstrate that participants were keen to give a good impression and present themselves as knowledgeable practitioners, although it was evident that they did not always follow procedure and policy. They rationalised their own behaviour and logically justified any deviations from policy. Deviations in others were criticised as irrational and explained as superficial and part of a 'show' or display. However, participants also gave a presentation of themselves: a show or display that was influenced by the desire to protect self and satisfy patient scrutiny. Conclusions: This study contributes to the identification and explanation of nurses' infection prevention behaviours which are considered inappropriate or harmful. Behaviour is multifaceted and complex, stemming from a response to factors that are outside a purely 'scientific' understanding of infection and not simply understood as a deficit in knowledge. This calls for educational interventions that consider beliefs, values and social understanding of dirt and infection. © 2013 Elsevier Ltd

Theoretical development and social capital measurement

Chapter 4, by Sarah Hean and colleagues, highlights the importance of theory development in making the concept useful to the practice of public health. The authors present an innovative way of thinking about the different facets of social capital, describe the development of a survey instrument that attempts to make explicit the inputs and outputs of social capital and describe how these can be operationalised in a practice setting. The survey tool takes account of the dynamic nature of social capital and offers a useful way of evaluating community projects

Residential densities in world cities: how London compares

London may have passed its historical 1939 peak population just under a year ago, but despite being Europe’s largest city (depending on where both regional and municipal boundaries are drawn) it has relatively low residential density. New York City crams the same amount of people into roughly half the space, and suburbanisation and Victorian slum clearance mean that many inner London Boroughs are less dense today than they were in 1939

Equality in language aspects of the theory of linguistic equality

This dissertation is an essay about the assumptions that make the systematic study of language possible. It attempts to refine and make explicit ill-defined ideas which underpin the most fruitful developments in modern linguistics. It charts the evolution of the concept of linguistic equality and its significance in many branches of study; and it tries to elaborate and sophisticate an analysis of the implications of the idea. It attempts to test several hypotheses: that, at some point in the first quarter of the twentieth century, linguistic equality became "an idea whose time had come"; that the idea became a covert hegemonic concept and a necessary if insufficient precondition for all thinking and research about language. There is no pretence that definitive answers have been given; only a hope that interesting and worthwhile questions have been asked