Reflective journal writing has frequently been used in nursing and other health care fields as an educational strategy to promote reflection and learning. Although reflective journal writing is recognised as a valuable tool to promote students' learning, very little research has been undertaken to evaluate its use. The overall aim of this study is to examine the use of reflective journals in the promotion of reflection and learning in post-registration nursing students. In order to achieve that aim a qualitative descriptive case study design was utilised to examine four objectives. The first was to analyse reflective journals completed by students during a period of learning in order to determine the extent and level of reflection achieved. The second, to examine the use of reflective journals as an educational strategy for facilitating learning in the practice setting. Thirdly, there was the intention to examine the nature and content of guidelines given to students with regard to the use of a reflective journal, and fourthly, to examine the support given to students by preceptors in relation to completing a reflective journal during their practice experience.A purposive homogenous sample of eighty one part-time post-registration nursing students undertaking one of four modules, either as part of the Diploma in Professional Studies in Palliative Care Nursing or the Diploma in Breast Care Nursing during one semester constituted the total sample. Forty-two students agreed to participate in the research.Data were collected from reflective journals completed during one module and by interviews with fifteen students, two teachers and three preceptors.Forty-two journals were analysed to determine the extent and level of reflection using a model devised by Boud et al. [1985] and adapted by Wong et al. [1995]. A model devised by Mezirow [1990] was used to identify the non-reflectors, reflectors, and critical reflectors.The findings suggest that student writing can be used as evidence for the presence or absence of reflective thinking. Allocating students to the three categories of non-reflector, reflector and critical reflector was possible. However, identifying textual elements within the journals and allocating them to the finer levels of reflection was more difficult and less reliable. Evidence suggests overall that journals are a useful tool for promoting reflection and learning. However, some students appear to benefit more from journals than others. Approximately two thirds of the respondents were able to demonstrate varying levels of reflection and were classified as either reflectors or critical reflectors. The remaining one third of the respondents were unable to demonstrate any levels of reflection. Overall respondents expressed positive views, regarding the use of reflective journals. However, a small number found writing challenging and some questioned their use. Some respondents preferred to talk about their reflections rather than write them in a journal. The importance of receiving clear guidance...

Aims and objectives To explore parental involvement in the child's acute pain care and establish ways in which parental preferences for involvement in their child's care can be identified, facilitated and enhanced by nurses. Background Despite growing evidence supporting effective acute pain management in children and the availability of national and international practice guidelines, children still experience acute pain. Involving parents in their child's pain care has been identified as being a central tenet of pain management in children. Design and methods A qualitative study using an ethnographical approach with nonparticipant observation and follow‐up semi‐structured interviews was undertaken. Nurses (n = 14), parents (n = 41), grandparents (n = 2), other relative (n = 1) and children (n = 30) participated. The framework approach underpinned data analysis. Consolidated criteria for reporting qualitative research (COREQ) enabled comprehensive reporting of the study. Results Three concepts emerged from the data: “parents as advocates for their child,” “nurses promoting involvement and partnership” and “nurses unintentionally preventing involvement and partnership.” Variations in the way parents were involved in their child's pain care were identified. Despite family‐centred care being the dominant model of involving families in their child's care, evidence of this being implemented was limited. Parents attempted to advocate effective pain care for their child, whether or not they were supported by nurses. Conclusions Parental involvement in their child's acute pain care can improve the child's pain experience, reduce parental anxiety and increase parents’ satisfaction in care. Nurses aspired to involve parents in pain care, but did not always enact this in practice. Relevance for practice Children deserve optimum pain care, which includes parental involvement. Parental involvement underpinned by the principles of family‐centred care was poorly implemented. Parents attempted to be involved and advocate for their child's pain care whether or not they were supported by nurses. An alternative approach for supporting parents to advocate in their child's acute pain care is offered, the “Partnership in Pain Care Model.”

Accessible Summary What is known on the subject? Addressing spiritual issues to maintain a sense of hope, meaning and purpose can be an important aspect of mental health care which goes beyond simply providing facilities for religious observance. Expressions of spiritual need from service users can potentially be confused with symptoms of mental ill health. Little is known about how mental health nurses understand or provide this aspect of care for service users. What the paper adds to existing knowledge? An understanding from the mental health nurse perspective of how mental health nurses understand and care for service users’ spiritual needs, and what influences their practice in this area. Ideas about how education and opportunities for good practice in this area might be advanced. What are the implications for practice? Nurses need more education and guidance as well as supportive team and management cultures so that they feel comfortable and able to deliver this important aspect of care. AbstractIntroductionMental health nurses have a professional obligation to attend to service users’ spiritual needs, but little is known about specific issues related to provision of care for spiritual need faced by mental health nurses or how nurses understand this aspect of care and deliver it in practice.Aim/QuestionTo explore mental health nurses’ ́understandings of spiritual need and their experiences of delivering this care for service users.MethodA qualitative study was conducted in one NHS mental health service. Interviews were undertaken with seventeen mental health nurses practising in a variety of areas.ResultsFour themes were generated from thematic analysis of data in the template style: Expressing personal perspectives on spirituality; Expressing perspectives on spirituality as a nursing professional; Nursing spiritually; and Permeating anxiety (integrative).DiscussionParticipants had complex understandings of spiritual need and evident anxieties in relation to this area of care. Two different approaches to nursing spiritually are characterised as (a) pragmatic (concerned with procedural aspects of care) and (b) spiritually empathetic. Mental health nurses were uncertain about the acceptability of attention to spiritual issues as part of care and anxious about distinguishing between symptoms of mental ill health and spiritual needs.Implications for practiceEducational experiences need to emphasise both pragmatic and empathetic approaches, and work needs to be organised to support good practice.

Purpose and BackgroundIn the UK, family-centred care (FCC) is espoused as being firmly embedded within the approach to care delivery when working with children and families (Smith and Coleman, 2010). Whilst the Royal College of Nursing (2009) advocates family involvement in pain care, research suggests parents and children are not actively involved in care decisions. The study explored the extent to which parents/main carers are involved and partners in their child’s pain care and the factors that influence parental involvement. The “Family-Centred Care continuum” was the conceptual framework used to examine parental involvement.MethodsA qualitative ethnographical approach was adopted. Data were collected using non-participant observation and follow up interviews with a purposive sample of nurses, parents and children on the children’s wards of a district general hospital. Framework approach underpinned data analysis.ResultsPartnership between nurses and parents was not overtly evident in relation to pain care. Involvement appeared to be “unspoken”, with neither party (nurse or parent) being clear about the extent to which parents can be, or are involved in care. Few examples of explicit negotiation related to pain care were observed. However, parents attempted to be involved and act as advocates for their child, particularly when pain care was perceived as sub-optimal. Parents used a number of strategies to be advocates for their child whether supported by nurses or not, including; being determined to be involved by persistence; speaking up for their child; having or gaining knowledge about their child’s care and knowing their child. Nurse’s actions either promoted involvement and parent advocacy or hindered it. Providing information, planning care with parents, valuing parent contributions and supporting parent choices were facilitating factors. Hindering factors were identified as; making decisions without involving parents; lack of communication and variations in understanding of the principles and subsequent implementation of FCC.Conclusions and implicationsNurses require knowledge and confidence to implement collaboration with parents, by empowering parents and overtly negotiating roles. Further research is necessary to identify how nurses can support parents to be partners in care.

The 'Pillars of Partnership in Pain Care' model offers an alternative approach to involving parents.