The principles of promoting autonomy and independence underpin many approaches to improving the quality of nursing care for older people in whatever setting, and are in line with wider developments in health care such as the Patient's Charter. However, these concepts require careful definition if nursing practices which might promote autonomy and independence are to be identified. Although the generalizability of the research-based literature in this field is limited by a focus upon older people in continuing-care settings, a review of the literature found a number of indicators associated with attempts to promote patient autonomy and independence. These were grouped into the following categories: systems of care delivery which promote comprehensive individualized assessment and multidisciplinary care planning; attempts to encourage patients/clients to participate in decisions about their care; patterns of communication which avoid exerting power and control over patients/clients and attempts to modify the environment to promote independence and minimize risk. It is suggested that the review identifies a number of principles for nursing practice which can be applied in a range of care settings in order to promote the autonomy and independence of older people.

Although autonomy and independence are widely held to be important goals of care for older people, these terms lack precise definition and operationalization in the literature. This paper reports on observational data gathered as part of an evaluation of educational programmes in the nursing care of older people. Strategies which appear both to promote and inhibit autonomy and independence of older patients in a range of care settings are described. Recommendations are made for further research to explore the extent to which autonomy and independence are appropriate goals of care for older people with cognitive impairment.

The following paper reports on a survey of nursing homes in three health regions in England which formed part of a wider study to evaluate educational preparation for the nursing care of older people. The aims of the survey were to describe the educational preparation of staff employed within nursing homes and to explore relationships between educational preparation and one indicator of quality of care. A self-completion questionnaire was addressed to the senior nurse within a random sample of nursing homes. The instrument included a previously validated scale to measure resident autonomy. A total of 976 questionnaires were posted and 676 were returned, a response rate of 69%. The survey revealed wide variation in the educational preparation of staff in nursing homes and in the degree of contact with local centres providing nurse education. Statistically significant associations were found between resident autonomy and a composite measure of educational preparation, the proportion of qualified staff undertaking continuing professional education and the degree of contact with educational centres. The findings have implications for both purchasers and providers of education in this field.

Aim The aim of this study was to report a multifaceted knowledge translation intervention to facilitate use of the Malnutrition Universal Screening Tool and innovation in nutritional care for patients at risk of malnutrition. Background Malnutrition among hospitalized patients is a widespread problem leading to adverse health outcomes. Despite evidence of the benefits of malnutrition screening and recommendations for achieving good nutrition, shortfalls in practice continue. Design A mixed method integrated knowledge translation study. Methods The knowledge translation intervention comprised nutrition champions supported by knowledge translation facilitators and an action planning process. Data collection was undertaken over 18 months between 2011‐2012 in a hospital in England. Data comprised observation of mealtimes, audit of patient records, survey of nurses and semi‐structured interviews with nutrition champions, knowledge translation facilitators, senior ward nurses and nurse managers. Findings Statistically significant relationships (Chi Square) were observed between self‐reported confidence of nurses (a) to assess patients using the Malnutrition Universal Screening Tool, (b) to teach colleagues how to use the Malnutrition Universal Screening Tool and (c) to ensure that patients were assessed within 24 hours of admission. Ward‐based nutrition champions facilitated successful innovation in nutrition support. Contextual factors operating at micro (ward), meso (organization) and macro (healthcare system) levels acted as barriers and enablers for change. Conclusion Nutrition champions were successful in increasing the timely assessment of patients at risk of malnutrition and promoting innovation in nutritional care. Support from knowledge translation facilitators helped nutrition champions develop their role and work collaboratively with senior ward nurses to implement action plans for improving nutrition.

This is a repository copy of Development of the nursing associate role in community and primary care settings across England.