The management and reduction of occupational stress are recognized as key factors in promoting employee well-being. Nursing is one of the many disciplines contributing to a huge body of research into the causes and effect of the ill-defined phenomenon of occupational stress. This literature review considers the ontological contribution of a number of disciplines to a growing body of knowledge on the subject of stress. The paper examines the complex issue of stress management, highlighting the impact of organizational culture and transformational leadership style on staff satisfaction levels.

This study describes the application of grounded theory to establish older, south Asian patient and carer views of service delivery in the UK. The purpose of the study was to inform the development of culturally sensitive services by defining the concept of cultural sensitivity from a user/carer perspective. The study took place in two community hospitals providing nurse-led intermediate care to a culturally diverse inner city population. Fifty-five per cent of the inner city population is of south Asian origin. Admissions to intermediate care, however, do not reflect the demography. Recent reports commissioned by the Department of Health highlight the failure of the National Health Service in England to provide culturally sensitive services to black and Asian patients. The Department of Health is trying to redress this inequality providing policy guidance for improving access and cultural sensitivity in the British health care system. There is little existing empirical evidence, however, to clarify the concept of culturally sensitive care. Patients and carers in this study described culturally appropriate care as that which respects individuality, creates mutual understanding, caters for spiritual need and maintains dignity. Older south Asian patients and their carers identified respect, understanding, spirituality and dignity as central to their conceptualization of cultural sensitivity. Their focus was on the nature of human relationships and their ability to interact in a positive way with staff. The findings of this small piece of empirical research are limited by the sample size (four patients and three carers), but illustrate that cultural sensitivity, although complex, can be defined. This then provides a basis for developing appropriate care strategies. One universal principle explicit in this research was that to be sensitive to culture staff must challenge their own assumptions and develop an understanding of the many layers of culture and subculture with which they are dealing. The starting point for any service is to understand the expectations of its users and to seek out and manage areas of conflict between organizational values and individuals' cultural requirements.

The satisfaction staff achieve from their work is in part determined by the style of management they work under. This article analyses the impact of a proactive leadership style on team performance and the quality of patient care.

Microbiological standards achieved by mothers when sterilizing babies' feeding utensils in the home were studied in the Slough area in England. Results indicated a marked improvement in this aspect of baby hygiene when compared to results of a similar survey conducted in the town of Reading, England, in 1970. Previously, 78% of bottles and 70% of the teats were recorded as being satisfactorily sterilized. During this study the number of sterile bottles had risen to 98.1%, sterile teats to 90.6%. These improved standards may be an indication of better education of mothers.

a b s t r a c tCommunity matrons, specialist nurses trained in the management of long-term conditions working alongside primary care teams and social service staff, have played an important role in the new enhanced approach to community services (care closer to home) in England. The underpinning proposition is that timely proactive care inputs might prevent some acute exacerbations or reduce the severity of the acute exacerbation, and proper community-based interventions are expected to reduce 5% of acute bed days. The community matrons intervention aims to increase patient and carer knowledge of their condition, increase patient confidence in their ability to manage their own health, and work with patients and carers to ensure they have an emergency plan that identifies impending deterioration and initiates a planned course of action or treatment to prevent a health crisis and thereby reduce emergency admissions to hospital. To encourage a systematic approach to case selection, the "Patient At Risk of Rehospitalization" or PARR tool has been developed and is recommended in national policy guidance. During 2003, the Department of Health in England established pilot sites in nine primary care organizations for the North American Evercare model, which showed no significant effect on rates of emergency admission, emergency bed days used or mortality, although patient experience of the service was positive and satisfaction levels high. Although the empirical evidence for the application of a case management approach to patients with long-term conditions is weak, the policy concept of strengthening community care for this large group of people has been compelling. The PARR tool may be fundamentally flawed because patients classified at risk of readmission may not necessarily benefit from case management. Further work is required to investigate the issue of optimum patient selection for case management, perhaps based on the potentially more clinically relevant construct of frailty.