Findings from a Delphi exercise regarding conflicts of interests, general practitioners and safeguarding children: 'Listen carefully, judge slowly'.

General practitioners (GPs) have to negotiate a range of challenges when they suspect child abuse or neglect. This article details findings from a Delphi exercise that was part of a larger study exploring the conflicts of interest that arise for UK GPs in safeguarding children. The specific objectives of the Delphi exercise were to understand how these conflicts of interest are seen from the perspectives of an expert panel, and to identify best practice for GPs.

Eleven themes of patient-centred professionalism in community pharmacy: innovative approaches to consulting.

Objectives: The study aimed to clarify patient-centred professionalism within and across community pharmacy settings; position that knowledge in a modern-day environment, accessing the opinions and experiences of patients and professionals; inform the literature on the value of consultation workshops within this context; and develop a template of positive and challenging exemplars of patient-centred professionalism within these contexts.

Methods: Thirty-nine study participants contributed to extended consultation workshops. Sessions were supported by bio-photographic data of healthcare practices across a range of different settings, and a final forum event.

The use of vignettes within a Delphi exercise: a useful approach in empirical ethics?

There has been an increase in recent years in the use of empirical methods in healthcare ethics. Appeals to empirical data cannot answer moral questions, but insights into the knowledge, attitudes, experience, preferences and practice of interested parties can play an important part in the development of healthcare ethics. In particular, while we may establish a general ethical principle to provide explanatory and normative guidance for healthcare professionals, the interpretation and application of such general principles to actual practice still requires interpretation and judgement.

Obtaining consensus regarding patient-centred professionalism in community pharmacy: nominal group work activity with professionals, stakeholders and members of the public.

Objectives: The aim of this study was to develop a ranked thematic list encompassing the positive and negative exemplars of patient-centred professionalism in community pharmacy.

Methods: An adapted Nominal Group Work (NGW) method was used in six individual consultation workshops (two with established pharmacists, one with newly qualified pharmacists, one with pharmacy staff, one with stakeholders and one with members of the public) followed by a mixed-group forum event.

Key Findings: Each of the six workshops resulted in the production of approximately 10 positive and 10 negative exemplars of patient-centred professionalism.

Understanding general practitioners' conflicts of interests and the paramountcy principle in safeguarding children.

As family physicians, general practitioners play a key role in safeguarding children. Should they suspect child abuse or neglect they may experience a conflict between responding to the needs and interests of the child and those of an adult patient. English law insists on the paramountcy of the interests of the child, but in family practice many other interests may be at stake.

Is the 2008 NMC Code ethical?

In 2008 the United Kingdom Nursing and Midwifery Council (NMC) published the latest version of its code of conduct (The code: standards of conduct, performance and ethics for nurses and midwives). The new version marked a significant change of style in the Code compared with previous versions. There has been considerable controversy and the accrual of an extensive body of literature over the years in the UK and Europe criticizing nursing codes of ethics and questioning their ethical standing and their usefulness.

Understanding student nurse attrition: learning from the literature.

Student attrition in nursing causes concern, but is not a new phenomenon. Challenges in defining and understanding attrition, changes in the commissioning of nurse education and developments within the United Kingdom National Health Service (UKNHS) and the profession contribute more generally to making this a complex topic for managers and for research. In this paper we discuss findings from an integrative review of the UK literature and discuss three levels of possible contributory factors identified from the literature (micro/individual; meso/institutional; and macro/political and professional).

Nurses' views on dignity in care.

Aim: The aim of the RCN dignity survey was to gain the perspectives of nurses, healthcare assistants and nursing students regarding the maintenance and promotion of dignity in everyday practice. This article presents survey respondents' experiences of providing dignified care for older people.

Method: A survey questionnaire was developed including fixed response and free text questions.

The RCN dignity survey: implications for leaders.

In response to concerns about a lack of dignity in care raised in the media and several studies, the RCN launched last year its dignity campaign, Dignity: At the heart of everything we do. A major part of this campaign was a dignity survey of more than 2000 nurses, nursing students and healthcare assistants, making it the largest dignity survey of the U.K.

Dignified care for children and young people: nurses' perspectives.

Aim: To explore the perspectives of nurses working with children and young people on dignified care and the challenges of providing such care.

Methods: A questionnaire was developed including fixed response and free text questions. A survey link was emailed to RCN members.

Demonstrating dignity.

The concept of dignity is commonly used by nurses, but not widely understood. Here the concept is unravelled and its importance to good nursing care is explained.

Dignity in the care of older people - a review of the theoretical and empirical literature.

Background: Dignity has become a central concern in UK health policy in relation to older and vulnerable people. The empirical and theoretical literature relating to dignity is extensive and as likely to confound and confuse as to clarify the meaning of dignity for nurses in practice. The aim of this paper is critically to examine the literature and to address the following questions: What does dignity mean? What promotes and diminishes dignity? And how might dignity be operationalised in the care of older people?This paper critically reviews the theoretical and empirical literature relating to dignity and clarifies the meaning and implications of dignity in relation to the care of older people.

Real nursing? The development of telenursing.

Aim: This paper is a report of a study to understand the impact of telenursing from the perspective of nurses involved in its provision, and in more traditional roles.

Background: Nurse-led telephone helplines have recently been introduced across the United Kingdom, a major step in the development of nursing practice.

Method: A structured questionnaire was sent to all nurses working in the NHS Direct (National Health Service Direct) Wales telephone service (n = 111).

On different types of dignity in nursing care: a critique of Nordenfelt.

Dignity appears to be an important concept in nursing philosophy and more widely in health care policy and provision. Recent events in the UK have generated much interest in the subject. However, there appears to be some confusion about the precise meaning and application of the concept.

Ethical aspects of withdrawing and withholding treatment.

Decisions about withdrawing and withholding treatment are common in health care. During almost every encounter between health professionals and patients a decision needs to be made about treatment options. In most cases these choices do not pose any difficulty, for example, starting antibiotics when a patient has an infection.

Phenomenology as a paradigm of movement.

Phenomenology is a well-founded qualitative methodology that is frequently used by nurse researchers and considered of value when addressing research questions in nursing practice and nurse education. However, at present, nurse researchers using phenomenology tend to divide phenomenological methodology into the descriptive and interpretive formats. The nursing literature suggests that there is a deep divide between researchers following the methodological underpinnings and basic precepts pertaining to these two camps.

The ethical divide.

Ethics is an area of growing interest in nursing and is a compulsory part of nurse education. Yet record numbers of nurses care being removed from the register and media stories of poor practice are rife. This article explores the issues.

Risk, Helsinki 2000 and the use of placebo in medical research.

There has been vigorous debate over the use of placebo controls in clinical trials in human subjects where active treatments are already in widespread use. The debate has extended from the use of placebo controls in trials of products for AIDS in developing countries to the use of placebos in trials in conditions such as mild hypertension, asthma, depression, chronic stable angina etc. Some have argued that placebos can never be justified where an active treatment exists.

Design and performance of a multi-centre randomised controlled trial and economic evaluation of joint tele-consultations [ISRCTN54264250].

Background: Appropriate information flow is crucial to the care of patients, particularly at the interface between primary and secondary care. Communication problems can result from inadequate organisation and training, There is a major expectation that information and communication technologies may offer solutions, but little reliable evidence. This paper reports the design and performance of a multi-centre randomised controlled trial (RCT), unparalleled in telemedicine research in either scale or range of outcomes.