A nursing care plan is a written, structured plan of action for patient care. There is strong evidence that care plans are viewed negatively by nurses and poorly implemented, with little evidence to suggest that they have any positive effect on quality of care or patient outcomes. The project reported in this paper aimed to investigate how nursing care plans were being used in five clinical areas, and to assess their influence on nursing practice. An exploratory, predominantly qualitative research design was selected utilizing participant observation, focus groups and diaries. In four of the five clinical areas, the 'activities of daily living' section of care plans had no apparent positive influence on nursing practice which was driven by other factors and sources of information. Care plans in the remaining ward were clinically led and locally owned, and in this setting they operated as an important guide to practice. It is concluded that a reinvention of the nursing care plan is needed without the constraint of a nursing model as its necessary foundation. New and imaginative plans of action for patient care should be encouraged, developed at ward level and tailored to the demands of the clinical area. These should contain a minimum of documentation and integrate with nursing practice.

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This paper suggests that the goal of nursing research in Northern Ireland should be to carry out rigorous, systematic inquiry designed to make significant contributions to knowledge. Such knowledge should impact positively on the physical, mental and social well-being of the population. There are, however, contrasting views about the content and direction of nursing research and how nursing can contribute to and influence the wider reasearch and development (R&D) agenda. These and other perspectives will be examined. It is the authors' contention that nursing has a series of key roles to play in health service research at strategic and operational levels. It will be argued that while research policy is framed by government, it should retain the flexibility to allow for projects that focus on issues and phenomena that are predominantly the concern of the nursing profession. In order to do this the profession should use the influence it has to make a worthwhile contribution to patient care.

This research builds on the findings of an ethnographic study of health inequalities in two small, rural communities in Northern Ireland. Through further analysis of existing data, this second study aimed to explore health professionals' perspectives on issues of service delivery relevant to government policy on primary care. Anthropological fieldwork was conducted for two consecutive 4-month periods during 1995 and 1996 in one predominantly Catholic and one predominantly Protestant town. To preserve confidentiality, the locations have been given the pseudonyms, respectively, of Ballymacross and Hunterstown. Research tools included fieldwork journals and a fieldwork diary, meetings with key informants, tape-recorded interviews, group discussions, participant observation and use of secondary material such as census data, local newspapers and community health profiles. Interviews with 15 health workers revealed that there was not a coherent approach to achieving health gain, little collaborative enterprise and minimal interaction between the different professional groups. The National Health Service (NHS)-employed primary care professionals, more than local community workers, appeared to be demoralized, exhausted and suspicious of the business-orientated health service. In this respect, the primary care-led NHS appeared not to be working. It is concluded that a shared health agenda should be developed by NHS-employed primary care professionals and local community workers to create a health-inducing environment at community level. This needs to be complemented by the establishment of formal mechanisms for inter-agency working at local, professional and government levels.

From March 2007 to April 2008 the Royal College of Nursing supported a project to improve services for people with alcohol-related problems by demonstrating and publicising the effectiveness of nursing interventions. The project team included representation from England, Northern Ireland, Wales and Scotland. This article presents a framework that can be adapted and used by nurses to promote the development of specialist nursing services by health and social care commissioners and policy makers to improve care for people who misuse alcohol.