"Surviving out of the Ashes" - An exploration of young adult service users' perspectives of mental health recovery.

WHAT IS KNOWN ON THE SUBJECT?: The conceptual components of mental health recovery have been proposed, however, the barriers to their sustainability within the context of internal and external stressors require further exploration. Within their emerging adult role, young people will experience the personal challenges that will directly impact their understanding of their recovery, which will be different from other age groups. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Findings revealed recovery is understood as an uncharted, timely and personal process of engaging and transcending pain. Perceived barriers to mental health recovery and the internal dynamics experienced within the process have been explored. Recovery in young adulthood involved the reclaiming of their active and purposeful life force. It acquires real-life relevance when applied to the social and cultural factors that provide meaning in life for young adults. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This research will impact how mental health nurses understand the catalytic effects of personal, social and cultural meaning of suffering in young adults' actualization of mental health recovery. Findings have significance for practice as the process of mental health recovery must not be presented as a clinical pathway, but understood as a personalized strategy of individual wellness in young adulthood. ABSTRACT: INTRODUCTION: Within their emerging adult role, young people will embark on employment, form intimate relationships and live independently. This indicates that how recovery is experienced and actualized in young adulthood may be different from other age groups. AIM/QUESTION: To explore young adult service user's perspectives of mental health recovery in Northern Ireland. METHOD: Semi-structured individual qualitative interviews were analysed using a Gadamerian-based hermeneutic method and interpreted using a novel theoretical framework. The sample comprised 25 participants with an average age of 28 years. FINDINGS: Five key themes evolved: Services: A Losing Battle Straight Away; From your Foundations to a Step in the Dark; Let Go of the Pain not the Experience; Surviving Out of the Ashes Recovery; and Needs to be More than a Word. DISCUSSION: The main findings were that recovery involved the reclaiming of their active and purposeful life force. It is suggested that young adults have developed an explanatory model of "use that stuff you wanna bury" to transform an illness narrative to a wellness strategy. IMPLICATIONS FOR PRACTICE: This research has implications for mental health nursing so the process of mental health recovery is not presented as a clinical pathway, but a personalized strategy of individual wellness.

Service user engagement: A co-created interview schedule exploring mental health recovery in young adults.

AIM: The aim of this study was to co-create of an interview schedule exploring mental health recovery in collaboration with young adult service users. BACKGROUND: Service user involvement in research has been increasingly recognized as providing a vital authentic insight into mental health recovery. Engagement and collaboration with service users have facilitated the exploration of inaccessible or under-investigated aspects of the lived experience of mental health recovery, not only directing the trajectory of research, but making it relevant to their own contextual experience. DESIGN: A qualitative content analysis framework was employed in the co-creation of a semi-structured interview schedule through an engagement process with service users. METHODS: Two separate engagement groups took place at the premises of the service user organizations, between January - February 2014. Miles and Huberman's analysis framework was chosen for this phase as it enabled the visual presentation of factors, concepts or variables and the established relationship between them. RESULTS: The lived experience of mental ill health in young adulthood and how this was understood by others was a particularly relevant theme for participants. Further themes were identified between the impact of painful experiences at this developmental life stage leading to a deeper understanding of others through finding meaning in their own mental health recovery journey. CONCLUSION: Our findings identified that suffering painful experiences is an integral aspect in the process of mental health recovery. This understanding has particular relevance to mental health nursing practice, ensuring the care delivered is cognizant of the suffering or painful experiences that young adults are encountering.

Tokenistic or genuinely effective? Exploring the views of voluntary sector staff regarding the emerging peer support worker role in mental health.

WHAT IS KNOWN ON THE SUBJECT: The introduction of PSWs within mental health services has grown substantially both internationally and locally; however, no recognized studies have focused on the evolvement of this role within a Northern Ireland (NI) context. Research is increasingly focusing on service users' and PSWs perspectives on mental health service provision. Despite this, few studies exist which exclusively report staff views in relation to the PSW role. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Results of the current study identified varying perspectives on the peer role. Some participants believed that the PSW role was tokenistic; others opposed these views, highlighting the value of this role. Clearly defined job descriptions and the importance of ensuring the PSW is a cohesive part of the team and not an "add on," was identified as imperative to avoid tokenistic practice. Provision of a flexible working environment, both sensitive and responsive to the peers' own mental health needs, was identified as significant in order for the peer to fulfil their role successfully. IMPLICATIONS FOR PRACTICE: Services introducing PSWs within teams should engage with nursing staff at all organizational levels in the role development process to minimize the risk of tokenism, for example, the PSW role not integrated or valued within teams. Clearly defined job/role specifications for PSWs should be devised to ensure that both the PSW and the mental health nursing team have a shared understanding regarding this role. ABSTRACT: Aim Peer support worker (PSW) roles are gaining recognition internationally as a valuable component in mental health service delivery. The aim of this study was to explore the views of mental health voluntary sector staff regarding the emergence of this role. Method A qualitative research design was used. A purposive sample was employed. Semi-structured interviews were undertaken with 10 staff members in various positions in two voluntary mental health organizations. Interview transcripts were analysed thematically. Results Views varied on the PSW role with some participants stating that it was tokenistic, whereas others highlighted the value of its contribution. Participants' expressed concerns regarding professional boundaries and organizational cultural challenges that PSWs may encounter in their role. The provision of reasonable adjustments was recommended as an integral support mechanism. Conclusion Successful integration of the PSW requires careful consideration of the role, the workplace environment and the unique needs of the peer, to prevent the role becoming constrained and diluted. Implications for practice The PSW role may impact the traditional delivery of mental health nursing services. It is therefore essential that nurses are cognizant of these potential challenges to successfully facilitate the integration of PSWs in practice.

Developing a research agenda for nursing and midwifery: a modified Delphi study.

AIM: We sought to ascertain the nursing and midwifery research priorities at a large private tertiary hospital in Australia. DESIGN: A modified Delphi technique with two rounds of questionnaires. METHODS: The first round survey was distributed to 448 nurses and midwives with a 19.2% (n=86) response rate. Due to a low response rate in some specialties, the second round of the Delphi was only sent to nurses in the Learning and Organisational Development speciality who were asked to rank 10 identified topics specific to Learning and Organisational Development using a five point Likert-type scale. RESULTS: Two hundred and fifty seven topics were identified in Round One and were condensed to 181 topics. Each topic was assigned to one of four categories: clinical audit; existing evidence base; research; or other topics which fell beyond the bounds of nursing or midwifery research. Twenty three research topics were identified with priorities focusing on learning and development and workforce issues. CONCLUSION: Priorities were congruent with the organisation's strategic workforce focus. Topics identified in this study will ensure that the nursing and midwifery research conducted at the study setting is relevant and reflects priorities as determined by clinical nurses and midwives.

Quality of nursing doctoral education in seven countries: survey of faculty and students/graduates.

AIMS: This study aimed to compare the findings of the quality of nursing doctoral education survey across seven countries and discuss the strategic directions for improving quality. BACKGROUND: No comparative evaluation of global quality of nursing doctoral education has been reported to date despite the rapid increase in the number of nursing doctoral programmes. DESIGN: A descriptive, cross-country, comparative design was employed. METHODS: Data were collected from 2007-2010 from nursing schools in seven countries: Australia, Japan, Korea, South Africa, Thailand, UK and USA. An online questionnaire was used to evaluate quality of nursing doctoral education except for Japan, where a paper version was used. Korea and South Africa used e-mails quality of nursing doctoral education was evaluated using four domains: Programme, Faculty (referring to academic staff), Resource and Evaluation. Descriptive statistics, correlational and ordinal logistic regression were employed. RESULTS: A total of 105 deans/schools, 414 faculty and 1149 students/graduates participated. The perceptions of faculty and students/graduates about the quality of nursing doctoral education across the seven countries were mostly favourable on all four domains. The faculty domain score had the largest estimated coefficient for relative importance. As the overall quality level of doctoral education rose from fair to good, the resource domain showed an increased effect. CONCLUSIONS: Both faculty and students/graduates groups rated the overall quality of nursing doctoral education favourably. The faculty domain had the greatest importance for quality, followed by the programme domain. However, the importance of the resource domain gained significance as the overall quality of nursing doctoral education increased, indicating the needs for more attention to resources if the quality of nursing doctoral education is to improve.

An exploration of the choices of patients with chronic kidney disease.

BACKGROUND: Chronic kidney disease (CKD) is a progressive loss of renal function over a period of time. It is common, often unrecognized, and frequently coexists with other conditions, including diabetes and cardiovascular disease. There has been little research undertaken into treatment options and decision-making processes of CKD patients in general. OBJECTIVES: To determine the treatment options that CKD patients are offered and their views and experiences with regard to these choices. DESIGN: A survey design was adopted. PARTICIPANTS: Participants included patients who had CKD at the time of the study and who were on renal dialysis. RESULTS: A wide range of findings emerged from the study. Key findings showed that the majority of patients felt that written information was the main source of information, but that almost one-quarter of patients felt that they did not receive enough information about dialysis to allow them to make an informed choice. Almost one-fifth of participants did not consider that they had been strongly encouraged by health professionals to be independent with regard to their choice of dialysis. CONCLUSION: While the majority of patients feel fully informed and involved in the decision-making processes around treatment and management of their CKD, not all patients receive sufficient information to make an informed choice about their treatment and that treatment options are not always presented to patients and their families to enable them to make a fully informed choice.

Research priorities for the therapy professions in Northern Ireland and the Republic of Ireland: a comparison of findings from a Delphi consultation.

BACKGROUND: Allied health professions constitute a large and growing proportion of the healthcare workforce. As a collective they are involved in complex care interventions often within multidisciplinary teams and increasingly in community settings. Even though reliable information is lacking, some professions do appear to have developed an active research culture, whereas others are more limited in terms of research. PURPOSE: This paper reports on the comparative findings of two Delphi studies, one in Northern Ireland and one in the Republic of Ireland, undertaken between 2008 and 2011. The aim of both studies was to identify research priorities for six of the therapy professions. METHOD: A classic Delphi approach was used involving expert panels from the therapy disciplines, service users, and key stakeholders. RESULTS: Both studies provided rich sources of data. Areas of commonality included the evaluation of practice generally and specific interventions common to each of the professions. More effective service management and health promotion research were also identified as important in both countries. CONCLUSIONS: As the global number of allied health professionals increases, along with the need for them to support their practice with sound evidence, the findings from this paper have international implications.

Quality of doctoral nursing education in the United Kingdom: exploring the views of doctoral students and staff based on a cross-sectional questionnaire survey.

AIM: To evaluate the quality of doctoral education in nursing in the United Kingdom. BACKGROUND: In recent decades, doctoral education programmes in nursing are increasing worldwide. There are many reasons for this and concerns have been raised regarding the quality of provision in and across countries. To date, the quality of doctoral education on a global level has not been reported in the literature. This United Kingdom study is part of a seven country investigation into the quality of doctoral education in nursing (Australia, Japan, Korea, South Africa, Thailand, United Kingdom and United States of America). DESIGN: A quantitative study using a cross-sectional comparative survey design. METHOD: An online survey was administered to collect the views of doctoral students and staff members on four domains: programme, faculty/staff, resource and evaluation. The study was carried out between 2010-2012. RESULTS: In most cases, staff perceived these more positively than students and the differences in perception were often statistically significant. Interestingly, many students rated the quality of supervision as excellent, whereas no staff member rated supervision this highly. The crucial importance of resources was confirmed in the path analysis of the four Quality of Doctoral Nursing Education domains. This demonstrates that investment in resources is much more cost-effective than investment in the other domains in relation to improving the overall quality of doctoral education in nursing. CONCLUSION: This study has wide-ranging implications for how the quality of doctoral education is monitored and enhanced.

Investigating the role of the general practitioner in cancer prevention: a mixed methods study.

BACKGROUND: Despite evidence of the effectiveness of cancer preventive services and the increasing development of guidelines, actual rates of delivery of cancer prevention activities remain low. Due to their frequent front-line contact with the public, family physicians (GPs) have the potential to play an important role in the primary prevention of cancer. However, there is a lack of information about their actual role in cancer prevention. The aim of this study was to investigate the actual and potential roles of general practitioners (GP) in the prevention of cancer. METHODS: A sequential exploratory mixed methods approach was used. The sample included all the General Practice (GP) practices in a region in the UK (n=345). Postal questionnaires were administered to GPs (n=1249); following 290 returns (response rate 23%), semi-structured interviews were undertaken with GPs (n=14). RESULTS: The majority of the GP respondents (66.4%, n=184) considered that they routinely provided cancer prevention information. This was specifically focusing on smoking cessation as almost all GPs (96.8%, n=270) enquired about a patient's smoking status. Overall, 47.2% (n=128) of GP respondents indicated that they felt they did not have time to perform a cancer prevention role; however, 88.3% (n=242) still felt that they had the 'opportunity' to do so. Over half the sample (61.3%, n=168) indicated that imposed health priorities and targets militated against providing cancer prevention activities. Almost all the GP respondents (98.9%, n=273) agreed with empowering individuals to take responsibility for their health issues. The GPs identified the need for alternative models for cancer prevention beyond current face to face patient care, including other health and non-health professionals. Whilst lack of time was identified as a critical factor, the GPs indicated that significant efforts were made to encourage patients to take personal responsibility for lifestyle choices. CONCLUSIONS: The GPs indicated a need for training around behavioural change and theories of motivation and action. This has implications for primary care and family physicians worldwide. While doctor-patient consultations and the physicians' credibility offer great potential for cancer prevention, time pressures and imposed government targets often mean that their actual cancer prevention role is reduced.

Delegating and supervising unregistered professionals: the student nurse experience.

BACKGROUND: Changing models of healthcare have resulted in the need for registered nurses to be competent in delegating and supervising the unregistered health care assistant. However research evidence suggests nurse education does not prepare students for the practicalities of this role. OBJECTIVES: This paper reports on undergraduate student nurses' level of preparation when working with health care assistants (HCA). It is part of a large scale project, undertaken between 2005 and 2011, which explored pre-registration student nurses' perceptions of the role of the HCA and how this affects their clinical learning. DESIGN: A sequential transformative mixed method research design was adopted. SETTING: One higher educational institution in the United Kingdom. PARTICIPANTS: Forty-five pre-registration nursing students took part in phase one and 662 participated in phase two. METHODS: Phase one used focus groups (n=32) and interviews (n=13) and phase two used a semi-structured questionnaire. RESULTS: Whilst most students reported that they were familiar with the role of the health care assistant, findings showed that nurse training did not initially prepare students for the realities of clinical practice, however as students progressed they became more aware of such issues. For some such skills were learnt on the job and they identified a number of barriers they faced when delegating tasks such as fear of causing conflict. Overall the lack of initial preparation was perceived by participants to be a hindrance to meeting the goals of clinical learning and to understanding the dynamics within the nursing hierarchy. CONCLUSIONS: Students in this study highlighted gaps in their educational programme and clinical experiences regarding their preparation for a delegatory and/or supervisory role. Given the importance of such skills, it is imperative that universities provide pre-registration student nurses with the education necessary to develop delegation strategies and to adapt to their evolving professional role.

A qualitative study exploring the impact of student nurses working part time as a health care assistant.

BACKGROUND: National and international evidence indicates that university students engage in employment whilst studying. Research has suggested that nursing students either enter training with previous care experience or tend to work part time in a health related area whilst undertaking higher education. The impact of this on the socialisation process remains unclear. OBJECTIVES: Based on the symbolic interactionist framework, this paper reports on a theme from a large mixed methods study - the extent and implications of student nurses' work experience on learning and training. DESIGN: One qualitative stage from a sequential exploratory mixed methods design. SETTINGS: One higher education institution in the United Kingdom. PARTICIPANTS: Forty-five pre-registration nursing students. METHODS: Thirty-two students took part in four focus groups and 13 took part in individual interviews. RESULTS: Findings revealed that 27 (60%) of students were in paid nursing related employment. This was reported to be advantageous by most participants with regards to enhancing confidence, skills and time spent in the clinical setting. However, it was also perceived by a small number of participants as being detrimental to subsequent learning resulting in role confusion, influencing placement behaviour, and preferences for future nursing practice. Student participants with no prior work experience believed this placed them at a disadvantage, negatively influencing their learning, ability to fit in, and adjustment on placement. Findings have suggested that student participants desire more recognition of the experience and skills they have gained from their employment. CONCLUSIONS: Whilst care experience among the student nursing population is advocated, the results of this study show that it is perceived to impinged on their learning and educational journey. Policy makers, educationalists and health service providers need to be aware of the students who operate within the dual roles of student and health care worker so as to provide guidance and appropriate direction.

Perceptions of the unregistered healthcare worker's role in pre-registration student nurses' clinical training.

AIM: To explore the unregistered healthcare worker's role and influence on student nurses' clinical learning experience. BACKGROUND: Across the developed world, the role of the unregistered worker is exceeding its traditional boundaries. Evidence suggests that this includes the day-to-day mentoring of pre-registration student nurses. However, no research to date has explored reasons as to why this is occurring, what types of tasks are taught, and the consequence of this. DESIGN: A sequential exploratory mixed method research design was adopted. METHOD: Reporting on the final qualitative phase of a mixed method sequential research study, semi-structured interviews were undertaken with 59 unregistered healthcare workers across four hospitals in Northern Ireland. Transcriptions were analysed using a content analysis approach; all data were collected in 2010. RESULTS: Findings show the diversity of the unregistered healthcare workers' roles and confirm that they play a major part in the education of student nurses with regards to basic, clinical, and non-clinical tasks, with and without the approval of registered staff. However, their involvement did not reflect their levels of expertise as evidenced by certified training. Their participation was justified based on mentor unavailability, their closeness to the student and the patient. While some did raise concerns, they recommended that these workers be formally involved in nurse education. CONCLUSION: Mechanisms of workforce planning need to pay particular attention to the expanding role of unregistered healthcare workers as 'role drift' has the potential to alter patterns of work and affect current educational approaches impacting on the acquisition of clinical skills. Further research is recommended in this domain.

Providing meaningful care: learning from the experiences of suicidal young men.

Little is known about young suicidal men's preferences for care. Using a broad interpretive approach, we interviewed 36 formerly suicidal young men in a study addressing the development and provision of mental health services. Our analysis yielded three core categories: widening access and bolstering proactive outreach, on becoming a man, and equipping young men for future challenges. Collectively, these categories suggest key features and processes of appropriate service configuration and clinical care: (a) services that reach out proactively serve to encourage young men's initial and ongoing engagement; (b) care delivered over the long term ensures a necessary focus on a meaningful future life; (c) mental health professionals (MHPs) are centrally involved alongside significant others, including those with personal experience of suicide; and (d) the development of a vital interpersonal connection is based on MHPs actively communicating their empathy, open-mindedness, and interest in a young man's unique biography.

Analysis of international content of ranked nursing journals in 2005 using ex post facto design.

AIM: The purpose of this study was to examine articles in ISI-ranked nursing journals and to analyse the articles and journals, using definitions of international and article content. BACKGROUND: Growing emphasis on global health includes attention on international nursing literature. Contributions from Latin America and Africa have been reported. Attention to ranked nursing journals to support scholarship in global health is needed. METHOD: Using an ex post facto design, characteristics of 2827 articles, authors and journals of 32 ranked nursing journals for the year 2005 were analysed between June 2006 and June 2007. Using definitions of international and of article content, research questions were analysed statistically. FINDINGS: (a) 928 (32·8%) articles were international; (b) 2016 (71·3%) articles were empirical or scholarly; (c) 826 (89·3%) articles reflecting international content were scholarly or empirical; (d) among international articles more were empirical (66·3 % vs. 32·8 %; χ(2) ((1)) = 283·6, P < 0·001); (e) among non-international articles more were scholarly (29·2 % vs. 22·7 %; χ(2) ((1)) = 15·85, P < 0·001; 22·7 %); (f) 1004 (78·0 %) articles were international, based on author characteristics; (f) 20 (62·5 %) journals were led by an international editorial team; and (g) international journals had more international articles (3·6 % vs. 29·2 %; χ(2) ((1)) = 175·75, P < 0·001) and higher impact factors than non-international journals (t = -14·43, P < 0·001). CONCLUSION: Articles with empirical content appear more frequently in international journals. Results indicate the need to examine the international relevance of the nursing literature.

An exploration of public knowledge of warning signs for cancer.

BACKGROUND: Warning signs of cancer have long been used as an effective way to summarise and communicate early indications of cancer to the public. Given the increasing global burden of cancer, the communication of these warning signs to the public is more important than ever before. AIM: This paper presents part of a larger study which explored the attitudes, knowledge and behaviours of people in mid-life towards cancer prevention. The focus of this paper is on the assessment of the knowledge of members of the public aged between 35 and 54 years of age. METHOD: A questionnaire was administered to a representative sample of the population listing 17 warning signs of cancer. These included the correct warning signs and distracter signs. Respondents were asked to correctly identify the seven warning signs. RESULTS: Findings show that respondents could identify 4.8 cancer warning signs correctly. Analysis by demographics shows that being female, being older, having a higher level of educational attainment and being in a higher socio-economic group are predictors of better level of knowledge of cancer warning signs. RECOMMENDATIONS: Recommendations are proffered with regard to better targeting, clarification and communication of cancer warning signs.

Benchmarks for effective primary care-based nursing services for adults with depression: a Delphi study.

AIM: This paper is a report of a study conducted to identify and gain consensus on appropriate benchmarks for effective primary care-based nursing services for adults with depression. BACKGROUND: Worldwide evidence suggests that between 5% and 16% of the population have a diagnosis of depression. Most of their care and treatment takes place in primary care. In recent years, primary care nurses, including community mental health nurses, have become more involved in the identification and management of patients with depression; however, there are no appropriate benchmarks to guide, develop and support their practice. METHOD: In 2006, a three-round electronic Delphi survey was completed by a United Kingdom multi-professional expert panel (n = 67). FINDINGS: Round 1 generated 1216 statements relating to structures (such as training and protocols), processes (such as access and screening) and outcomes (such as patient satisfaction and treatments). Content analysis was used to collapse statements into 140 benchmarks. Seventy-three benchmarks achieved consensus during subsequent rounds. Of these, 45 (61%) were related to structures, 18 (25%) to processes and 10 (14%) to outcomes. CONCLUSION: Multi-professional primary care staff have similar views about the appropriate benchmarks for care of adults with depression. These benchmarks could serve as a foundation for depression improvement initiatives in primary care and ongoing research into depression management by nurses.

Health care managers' perspectives on new nursing and midwifery roles: perceived impact on patient care and cost effectiveness.

AIMS: The aim of this study was to explore new nursing and midwifery roles and associated levels of practice from the health care providers' perspective. This paper will present findings relating to the perceived cost effectiveness of these roles and their impact on patient care. BACKGROUND: Profound changes in the way the health care systems are organized, managed and financed have resulted in the proliferation of new nursing and midwifery roles. However, the evidence base for these workforce developments is limited, especially with regard to health care providers' perspectives on cost effectiveness and patient outcomes. METHOD: Qualitative interviews were carried out with all Directors of Nursing in the 18 Health and Social Services (HSS) Trusts and the Chief Nurses and Directors of Primary Care in the four HSS Boards in Northern Ireland. RESULTS: Key findings were as follows: there was widespread support for the development of these roles, they are perceived to have a positive impact on patient care; however, the need for support was recognized to ensure the continuation of such roles. Securing funding was problematic and this was influential on the kind of new roles that were developed. IMPLICATIONS FOR NURSING MANAGEMENT: Issues relating to effective implementation and the need for further research into the efficacy and effectives of such initiatives is required.

Identifying the core components of cultural competence: findings from a Delphi study.

AIM: To identify the core components of cultural competence from a Swedish perspective. Background. The cultural diversity of Swedish society raises challenges for nursing practice. Nurses need to be culturally competent, i.e. demonstrate the effective application of knowledge, skills and attitudes to practice safely and effectively in a multicultural society. Existing frameworks of cultural competence reflect the socio-cultural, historical and political context they were developed in. To date, there has been no research examining cultural competence within a Swedish context. DESIGN: A Delphi survey. METHODS: A purposeful sample of 24 experts (eight nurses, eight researchers and eight lecturers) knowledgeable in multicultural issues was recruited. Interviews were undertaken to identify the knowledge, skills and attitudes that formed the components of cultural competence. Content analysis yielded statements which were developed into a questionnaire. Respondents scored questionnaire items in terms of perceived importance. Statements which reached consensus were removed from questionnaires used in subsequent rounds. Three rounds of questionnaires were distributed during 2006. RESULTS: A total of 118 out of 137 components reached a consensus level of 75%. The components were categorised into five areas, cultural sensitivity, cultural understanding, cultural encounters, understanding of health, ill-health and healthcare and social and cultural contexts with 17 associated subcategories. CONCLUSIONS: There are some similarities between the issues raised in the current study and existing frameworks of cultural competence from the USA and the UK. However, Swedish experts placed less emphasis on ethnohistory and on developing skills to challenge discrimination and racism. RELEVANCE TO CLINICAL PRACTICE: This study identified the core components of cultural competence important to nurses practising within a multicultural society such as Sweden. Acquisition of the knowledge, skills and attitudes identified should enable nurses to meet the needs of patients from different cultural backgrounds. The components of cultural competence can form the basis of nursing curricula.

Attitudes, knowledge and behaviours with regard to skin cancer: a literature review.

In recent years there has been a dramatic increase in the prevalence of skin cancer worldwide. There has been a huge amount of research literature on skin cancer especially in the last 10-15 years. There is no doubt that this is in direct relation to the increases in prevalence of the disease on a worldwide basis. Australian and American research has led in the field and again it is probable that this has been due to the increase in rates of skin cancer in those countries. This paper provides a comprehensive review of the existing international literature in the area.