Administering questionnaires to older people: rigid adherence to protocol may deny and disacknowledge emotional expression.

This paper draws on data from a larger study conducted in care home facilities in: Seattle, USA; West Sussex and Surrey in the UK; and in the lower North Island in New Zealand. Two extracts from interactions between the researchers and an older person during the administration of The Philadelphia Geriatric Morale Scale in a care home facility in New Zealand were analysed following Houtkoop-Steenstra and using a Conversation Analysis (CA) approach. In the first extract the audio-recorded transcript was examined for events of institutional talk and rephrasing of questionnaire questions.

Creating an environment for caring using lean principles of the Virginia Mason Production System.

As healthcare leaders search for viable options to cut costs, increase efficiencies, and improve the product that they offer to customers, many are looking at different business models to adopt. At the same time, an aging workforce of nurses feel the pressure of being overworked and understaffed, resulting in both decreased job and patient satisfaction. Virginia Mason Medical Center in Seattle, Wash, has implemented the Virginia Mason Production System, using proven concepts adapted from the Toyota Production System that effectively eliminate "muda" or waste, in workplace processes.

Reflective practice in nursing ethics education: international collaboration.

Background: The Internet provides the opportunity for international comparative study and collaboration when learning about ethics in clinical nursing practice.

Aim: This paper aims to discuss Internet links developed between US and UK postregistration nursing students who were reflecting on clinical practice in order to explore how political and organizational structures of the health care system affect ethical decision-making.

Discussion: An analysis is presented of the stages in developing an exchange course for students from these countries, which involved various combinations of classroom-based teaching, on-line discussions and international visits by students and teachers during its evolution.

Assessing student critical thinking through online discussions.

Critical thinking is integral to nursing practice and education. The introduction of Internet-based and Internet-assisted instruction provides an opportunity to explore critical thinking with nursing students in a new format. The author reports on a hybrid or blended Internet-assisted course structure that incorporates online discussion and a new method for assessing student critical thinking.

The nature of long-term care nursing work.

Data from a pilot study on the nature of nursing work in long-term care (LTC) facilities are compared with data on nursing work in intensive care units (ICUs). The comparison suggests that the LTC nursing work environment is a complex, demanding, and interesting one that is different from, not less than, nursing work in acute care environments. The data also suggests that nursing educators and researchers should reconsider LTC nursing work environments.