In 2010, the chief nursing officer and nurse director for Wales commissioned a study to identify attitudes and behaviours associated with professionalism for nurses and midwives in Wales. The study was part of an exploration project of professionalism in nursing and midwifery. A Delphi study design was used to generate a consensus on the question 'What does "professionalism" mean in terms of attitudes and behaviours for nurses and midwives in Wales?' The question was put to an expert panel, comprising 27 members of the Consultant Nurse, Midwives and Health Professionals Forum and eight directors of nursing, using electronic questionnaires. The descriptors generated were subsumed into categories that were ranked, statistically tested and attributed a Likert-type score before consensus was achieved. The resultant categories and themes defined acceptable and unacceptable attitudes and behaviours, and enabled the development of an overarching short definition of professionalism. This carves a unique niche in the evidence base on professionalism and provides a tool for replicating the study in other countries and for other professional groups such as healthcare support workers, nursing and midwifery students and allied health professionals.

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Aim Breathlessness is one the most common problems experienced in cancer; evidence suggests that up to 79% will encounter this distressing symptom, which can undermine functional ability and compromise independence. Evidence suggests that while there are breathlessness management programmes, few exist specifically for cancer and none provided care and advice cross the eight domains which are physical, psychological, practical, nutritional, social, spiritual, financial and information. Method A survey of breathlessness programmes for people with cancer across South East Wales revealed inadequate provision, with current services unable to meet the demand. Additionally, they did not cover the eight domains of care necessary for the provision of holistic care. An evidence based non-pharmacological breathlessness management programme was developed as well as a workforce education programme to ensure the right level of skills and competence of those delivering the pathway. Results Fourty people were referred and 22 were seen. The most common presenting tumour sites were breast (N=12), lung (N=9), pancreas (N=3) and ovary (N=3). Of the patients who entered the pathway, 19 (83%) self-managed successfully and 3 (17%) required referral for specialist care such as nutrition, occupational therapy and physiotherapy. Conclusions and discussion While dyspnoea is not routinely assessed and is an expected burden for many people with cancer, simple self-management techniques used as this pathway can empower such people to cope a little better with the distress and life limiting effects of their dyspnoea. As this is a patient led intervention, they determine what level of advice and information they want and thus they are able to control this as well as the level of professional intervention accessed. Finally, though the pathway was developed primarily for people with cancer, it has been shown that it can be effortlessly transferred to other conditions where breathing may be compromised.