Power in interactions between nurses and patients, as mediated through language, is examined in this paper. The findings from an observational study confirm much previous research in that the majority of nurse-patient interactions were superficial, routinized and related to tasks. It was found that nurses exert a lot of control over interactions and the linguistic devices used to achieve this are explored. Links are established between macro-level factors, such as the institution, and the micro-level of nurse-patient encounters, to demonstrate how wider forces affect and are reflected in interactions. Examination of the interactions also reveals issues of conflict arising from the caring and controlling functions that nurses perform. It is suggested that the power dimension inherent in the relationship constitutes a barrier to open and meaningful communication between nurses and patients.

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The Gold Standards Framework in Care Homes programme aims to improve the quality of end-of-life care for residents. The impact of introducing phase 2 of the programme to homes in England was evaluated. A pre-post survey design was adopted, focusing on indicators identified as markers of good end-of-life care. The 95 homes in phase 2 of the programme were invited to participate in the evaluation. Homes completed a baseline survey of care provision and an audit of the five most recent resident deaths. The survey and audit were repeated post programme completion. Forty-nine homes returned completed pre- and post-surveys, 44 returned pre- and post-data on deaths. Although some staff found completion of the programme challenging, homes that returned pre- and post-data demonstrated improvements in aspects of end-of-life care. There were statistically significant increases in the proportion of residents who died in the care homes and those who had an advanced care plan. Crisis admissions to hospital were significantly reduced. This evaluation indicates that appropriately funded structured programmes have the potential to assist nursing homes improve the provision of end-of-life care to older adults, in line with government health policy.

Leadership development is seen as central to the modernisation agenda of the NHS. It has been identified in key policy documents and a range of leadership development programmes have been developed to meet this need This paper reviews the evidence concerning leadership development in nursing. The conclusion reached is that leadership is only one element in the changes that need to occur in health care. Too much emphasis on leadership without an equal concern for transforming the organisations nurses and other health personnel work in may result in leadership being added to the list of transient management "fads" which have characterised health care in recent years.

The existence of a theory-practice gap in nursing in the United Kingdom has been an issue of concern for many years. However recent events have resulted in a new dimension of the theory-practice gap emerging. This paper explores the origins of the contrasting values attributed to nurses and health care managers and identifies areas of conflict. It is argued that the theory-practice gap in nursing is being compounded by a more fundamental divergence of approaches to the delivery of health care and that this represents a major challenge to nurse educators. Nursing is at a crossroads in its development, and if it is to survive it must incorporate some elements of the new managerialism whilst demonstrating to managers the importance of recognizing professional values. The future of nursing can be secured, but it will involve partnership and cooperation with the new managers.