There is evidence that adequate numbers of well-educated nurses working in acute care areas can reduce the risk of patient mortality, although the evidence for this is confined to studies in high income countries and the evidence is not sufficiently robust to draw up definitive nurse: patient ratios. There is also moderate evidence that well trained nurses can produce health outcomes that are equivalent to those of doctors for patients with a range of chronic health problems, particularly for those patients managed in primary care, and that nurse-led care may be more effective than medical care in promoting patient adherence to treatment and patient satisfaction. There is low to moderate evidence for the benefits of parenting support programmes delivered by nurses on a range of health outcomes; and for the impact of home visiting on improving function and other health service outcomes for older people. The wider societal benefits of home visiting by nurses and the impact of this on long term outcomes and related cost-effectiveness of home visiting has not been established. There is limited available information regarding the wider global impact of increasing the numbers of nurses and their contribution to healthcare through improved education. Moreover there is very little evidence for the cost-effectiveness of changing care providers from doctors to nurses and as the majority of cost data available has tended to come from studies based in higher income countries, their external validity in terms of applicability to settings in low and middle income countries is questionable. In addition to effectiveness, cost and safety, future research needs to address how implementing expanded nursing roles and task shifting impacts on the morale, retention, and professional development of nurses and the other workforces, and the longer term implications of these developments both locally and internationally.

Service user involvement has become a common feature of education programmes for mental health students. However, little is known about the effects of this type of education on the interpersonal skills of students taking part. This paper reports findings from a systematic review that formed part of a wider investigation into service user involvement in teaching interpersonal skills. The review aimed to locate and assess the quality of the published evidence relating to the effects of service user involvement on mental health students interpersonal skills and to synthesize results, using a definition of interpersonal skill that includes attitudes, empathy and skills as its key components. Results from this study indicate that the quality of evidence in this area is poor. However, sufficient synthesis of the evidence base was possible to allow conclusions and recommendations for both research and practice. Conclusions were that the involvement of service users in this area is both acceptable and valuable for students and had specific impacts on attitudes, empathy and skills. Some difficulties and reservations about the style of involvement are discussed. Recommendations for the conduct of future research are also made.

To date, a number of studies evaluating service developments, education, expert practice and leadership have been carried out. However although a number of studies have assessed perceived impact of the consultant role, no measure of actual benefit has been published to date. Studies that evaluate the cost benefit/outcomes of these roles in relation to both activity and quality of service are required.

This article discusses the report of the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) Commission that was published in 1999. Problems identified with the previous Project 2000 model of diploma-level nursing programmes are identified, including student criticisms of placement arrangements and the existence of both theory-practice and practice-theory gaps. The UKCC Commission's recommendations for curricular revision are discussed, particularly in relation to clinical competence and how this should be defined and measured. The implications for who should supervise and assess students in clinical practice are also explored. The importance of preparing and assessing students for holistic individualized care which respects patients' own beliefs, values and culture is emphasized.

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