We conducted a three-month pilot study of a home monitoring service for patients with chronic obstructive pulmonary disease. Fifty-five patients were recruited. They transmitted physiological data to a monitoring centre once a day. During the period of the study, 36 escalations were reported to have occurred. Of these, 29 (81%) were managed at home; the other 7 (19%) resulted in acute admission after emergency telephone calls. Although only a small number of patients were involved for a relatively short period of time, there was evidence of a substantial (approximately 50%) decrease in rates of hospital admission. The service was highly acceptable to the patients.

Before sunrise one spring morning in 1815, twenty-four-year-old Susan Davis Nye left her family's farm in Amenia, New York. “After a most affecting parting from my beloved brothers, sisters and friends, I kissed my little sleeping babes and before the sun shone upon my dear native hills, bade them farewell, perhaps forever!” Thus begins the first entry in her journal dated April 22nd, the day she undertook the initial leg of a long voyage south to teach in North Carolina.

Use of simulation is well established as a way of learning and assessing skills in vocational disciplines. In many institutions the use of simulation with student nurses is being tested as a way of helping them learn clinical skills, problemsolving, clinical assessment and decision-making. This paper explores the value of simulation as a learning tool through the presentation of findings from an evaluative research project into the use of simulation in nursing education. The focus of this paper is how students perceive that simulations help them learn and suggests that simulation may play a part in how students perceive learning that is meaningful to them. A literature review on the use of simulation is presented together with literature related to the learning theory that underpins simulation. The methodology, data collection and findings of the evaluative study are then presented followed by a discussion of the findings. Although the original research did not set out to examine how students perceived that simulations influenced their learning, the analysis indicated that this was a significant issue for them. Conclusions are drawn about how learning theory and simulation can be brought together to enhance student learning.Keywords: VET and development; learning in the professions; learning theory; pedagogy; vocational education and training IntroductionToday's complex health care environment demands that nurses are able to make accurate assessments, to solve problems and to make sound clinical decisions. Simulations provide realistic learning opportunities to enable students to practise their assessment, problem-solving and clinical decision-making skills in a relatively safe environment. Kingston University/St George's University of London (KU/SGUL) define simulation as the creation of a safe and supportive practice setting using role players, which reflects or mimics real practice environments. Role players can offer a greater sense of reality in many clinical situations than manikins, which often have limited realistic human interaction. However, in order for learning through simulations to be maximised, it needs to be carefully planned so that its use is based on understanding of learning appropriate for a professional/vocational programme.Two literature reviews are presented; one related to the use of simulation in teaching and the second related to the learning theory underpinning simulation. This

Dickoff & James assert that theory comes from practice for practice. This paper will explore the reality of this statement in nursing today. The nature of nursing knowledge from an historical perspective facilitates an understanding of where nursing theory development is today. The purpose of theory is debated and the motivation for its development considered. Practice theory, theory which is developed from practice for practice, is analysed, and this is advocated as one method to reduce the theory-practice gap in nursing. Whether practitioners are able to undertake the development of practice theory is discussed and some obstacles identified. Reflection and action research have been offered as methods to facilitate the development of practice theory by practitioners.