Janet Nolan

Developing the nurse's role in patient education: rehabilitation as a case example

Over the past decade considerable emphasis has been placed on the nurses role in patient education. Despite this numerous studies have suggested that this aspect of nursing practice is under-developed. Using rehabilitation as a case example this paper explores the nursing contribution to patient education in five conditions: multiple sclerosis; arthritis; myocardial infarction; spinal injury and stroke. Although the literature identifies considerable potential for nurses to take a lead role in patient education this is rarely achieved in practice. Analyses of printed curricula from a range of courses indicate that nurses are not adequately prepared for patient education and that a reorientation of nurse education is required.

Swedish experiences of a negotiated approach to carer assessment: the Carers Outcome Agreement Tool:

Abstract Given that the majority of frail older people living at home are cared for by family members, ensuring appropriate and sensitive support services for family carers is a major policy priority globally. Such assessment of the needs and situation of individual carers is a crucial first step towards ensuring that they receive flexible, quality support services. However, existing assessment practice is still inadequate in many countries. This paper describes a negotiated approach to carer assessment, the Carers Outcome Agreement Tool (COAT) and briefly considers its development with carers and practitioners in an Anglo-Swedish development project (2003–2005) and subsequent implementation within five municipalities in Sweden (2006–2008). A participatory research design was adopted in both projects building on the ÄldreVäst Sjuhärad model, which is a user-focused approach to research and development. This paper provides a short summary of the COAT development before presenting the qualitative findings from the Swedish implementation project (2006–2008), which emerged from focus group interviews with COAT practitioners and telephone follow-up interviews with carers who had a first and second COAT assessment. The findings clearly highlight the value of COAT in enabling partnerships to be developed between carers and practitioners, which recognise the expertise of both parties. They also challenge providers to invest sufficient time and ‘ear-marked’ resources for family care support so that COAT becomes an integral part of a comprehensive long-term carer strategy, which feeds directly into local developments in service delivery and organisation.

Developing a model of participatory research involving researchers, practitioners, older people and their family carers - an international collaboration

The care of frail older people and their family carers present significant challenges for welfare systems throughout the world. In order to address their needs, policy initiatives are promoting partnership working between service users, family carers and providers, whereby the former are increasingly involved in the design and evaluation of services. However, participatory models of working raise fundamental issues about power relations and pose important questions about what constitutes ‘evidence’. Several authors identify tensions between movements such as evidence-based practice and initiatives designed to increase the active participation of service users suggesting that there is a need for a new approach to research that reconciles potentially conflicting goals. This paper describes the evolution of a model of participatory research resulting from a collaboration between Sweden and the United Kingdom, which actively involved older people, family carers, service providers and voluntary organisations. The model is underpinned by constructivist principles that have been adapted by the authors so as to be more intellectually accessible to a non-academic audience. The conceptual basis for the model is described and a case study illustrates how it is applied in practice. It is argued that the approach could be adopted widely as a means of more fully engaging older people, their families and a range of service providers in important debates about future health and social care provision