We listen but do we hear? The importance of patient stories.

Patients' perspectives on their illness and care are increasingly recognized as the focus for the organization of health care, yet patient stories are rarely examined on their own. Mostly, they are dissected for data, and so the impact is lost. This article presents a number of story tellers, all patients with leg wounds attending a social clinic. Reading their stories helps us understand the experience of being a patient and living with difficult and painful leg wounds. They also show how nurses can play a critical role in optimizing the power of the story in the patient's journey towards physical and psychological healing.

The therapeutic relationship: dead or merely impeded by technology?

The ways in which current nurse education is delivered, combined with rapid increases in technological advances in health care, are having a major impact on the delivery of care to patients. This article focuses on one aspect of that care: the establishment, development and maintenance of the therapeutic relationship. The authors argue that the changes in education delivery and the rapid introduction of technologies are contributing to the possible demise of the contemporary nurse-patient relationship and, therefore, the loss of that essence of nursing which is essential to the patients' well-being and the nurses' professional satisfaction. The article explores the requisite knowledge and skills competences essential for the formation of the therapeutic relationship and asks whether these are being impeded by simulated educational activities and the advent of ubiquitous computing. The authors acknowledge the difficulties associated with the assessment of an effective therapeutic relationship and suggest a possible framework in which a performance of understanding of the formation of a therapeutic relationship can be established.

Care study: the Leg Club Model and the sharing of knowledge.

The empowerment of patients can be considered an important part of the nurses' role in the management of chronic venous leg ulcers. This article describes how one individual's healing rate improved when she was given greater control over her own care by a partnership formed with her nursing team. The negative impact of a subsequent change to a more autocratic care regime is discussed. The authors investigate how nurse education, reflection and sharing best practice could overcome barriers to patients becoming more involved in their own individualized wound management and treatment. The role of the Leg Club Model (a clinic held in a social environment as opposed to a medical setting) in promoting an environment of collaborative working, open communication and knowledge sharing is examined.

From task to talking in wound care.

The author outlines a model that can be used to separate nursing tasks from talking to patients. It is hoped that the model will promote effective use of time and improve the quality of nurse-patient interactions in wound care and other clinical settings.

Living theory: enhancing the psychological support of patients.

This article explores how nurses, involved in a research project incorporating teaching psychological theories and counselling skills to enhance the psychological support of patients with wounds, had, one year on, changed their professional practice. This inquiry was framed by living theory, a concept previously only used in education, which is based on the integration of known knowledge, newly taught knowledge and increased self-awareness. The major principle of living theory is that one's values are questioned, modified, clarified and sometimes changed completely in striving to improve one's professional practice. This research showed nurses creating their own living theories, aspiring to really care for the whole person by developing strong, meaningful relationships with patients. The steps that participants took from first using the enhanced way of working with patients with wounds, to using it to support all patients psychologically, are demonstrated.

Teaching nurses psychological support of patients with wounds.

Concerns about lack of professional empathy with psychological aspects of wound care provided the springboard for this study. Forty-three qualified nurses who regularly care for patients with wounds recorded in research diaries how they supported patients holistically before and after attending a counselling skills workshop. Thirty-nine nurses then attended focus groups to share their experiences. Participants represented varied practice settings, with 581 patient situations recorded in the diaries. Data analysis identified four themes: reflection sharpens the focus on practice; complex situations; emotional labour; and knowing the patient. While patients' feelings were identified in the first diary period, and reflection sharpened the focus on practice, patients' psychological needs were not attended to fully. Following the workshop there was a major shift in the understanding and provision of psychological support for patients with wounds by some of the nurses. Others were unable or unwilling to embrace counselling skills into care. This highlights the need to address nurses' attitudes and beliefs that might interfere with psychological support for patients with wounds.