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A review of the literature suggests people with learning disabilities are viewed negatively by others in society. Such negative views have also been found among many health care professionals, including nurses. This study measured the attitudes of a randomly selected sample of nurses in a general hospital (n = 31) towards people with learning disabilities. The study involved a triangulation approach utilizing a Likert scale attitude measurement questionnaire. Two comparisons between subjects in the study were undertaken-a comparison of the attitudes of graduate nurses and those who were non-graduates; a comparison between nurses who had most contact, and those who had least contact with people who have learning disabilities. From the sample of 31 nurses, 10 subjects were selected for more in-depth interviews which were tape recorded, transcribed and, using the process of 'content analysis', quantified. Findings suggest the attitudes held by the total sample towards people with learning disabilities were more negative than would be expected from those in a caring profession. The graduate nurses were found to be more positive in their perceived attitudes towards people with learning disabilities than non-graduate nurses. Nurses in the sample who had high contact were found to have more positive attitudes than nurses who had lower amounts of contact with people who had learning disabilities.

Aim. This paper presents the findings of one aspect of a larger study aiming to build a substantive grounded theory of the process of initial assessment at triage. Background. Prioritisation at triage within emergency departments centres primarily on assessing the threat to physiological function of people presenting with health-care problems. This approach presumes that clinical reasoning strategies reside exclusively within the health-care practitioner, with the patient playing no active part in the process. Design. A grounded theory/symbolic interactionist methodology. Methods. Thirty-eight recordings were made of live triage encounters involving 14 emergency nurses from two demographically distinct emergency departments. At the end of the relevant shift, those encounters in which the nurses were involved were replayed to them. The recording was stopped after each question or comment by the nurse who was then asked to say what they were thinking at the time. The nurses' thoughts were recorded, transcribed and analysed using the constant comparative method, in which hypotheses are generated and continually modified in the light of incoming data until a conceptual story line, or theory, is produced. Results. The findings suggest that the outward clinical signs of problems presenting to the emergency department were not viewed by nurses as neutral manifestations of the pathology itself but as a conscious or unconscious portrayal of patients' physical discomfort and their perception of the nature of the problem. The way in which patients and carers depict their problems is used by triage nurses to determine the credibility of the clinical information they provide. Conclusion. Triage can be regarded as a process in which nurses act as an adjudicating panel, judging the clinical data before them through the appraisal of the way patients act out their problems and narrate their stories. Relevance to clinical practice. Nursing practice and research need to account for the patient's contribution to the decision-making process at triage.

This paper explores the role of contemporary mental health nursing and challenges practitioners to acknowledge the influence that power relationships have on therapeutic practice and client outcomes. It is argued that empowerment and advocacy remain central concepts for nursing and that the art of accurate empathy is a pre-requisite for contemporary mental health care.