This issue of JAN

Two literature reviews begin this issue. The management of comorbidities is a subject rarely explored in the literature; yet the care of people with a variety of concurrent chronic illnesses is becoming an increasingly important subject for nursing and medical care. In the United Kingdom (UK) there is little co-ordination of care for people living with different medical conditions, beyond what general practice can offer. Most patients with comorbidities are cared for in the secondary care sector by several consultants simultaneously, each of who is responsible for the management of different symptoms and the subsequent treatments rarely appear to consider the patient as a whole. The first article from Australia explores the literature on the care of comorbities in acute settings and helps to raise the profile of this important aspect of medical and nursing practice. As the authors state ‘People with comorbidities have additional needs as a result of their combined illnesses that increase the complexity of care required…and (they) are at risk of being neglected in acute care, predominantly because the current…environment has not recognized adequately the special needs of these patients’. As a carer for someone currently living with multiple pathologies (comorbidities), I can only agree with the arguments presented in this article. I hope that it will stimulate all health care practitioners to take seriously the needs of such people, and to consider the question of what these mean in terms of multidisciplinary co-operation. The second literature review from an author in the United States of America (USA) is on a very different topic – poetry as an aesthetic expression for nursing. A module on literature in relation to nursing and health care was included on the health-visiting course that I followed in the early 1970s, and I was deeply impressed by the relevance of its contents. I remember reading there for the first time Dylan Thomas's (1999) Do Not Go Gentle Into That Good Night, written on the death of his father, and the power of the refrain ‘Rage, rage against the dying of the light.’ The current review is therefore welcome for extending our view of poetry as a ‘rich textual medium’ in helping to illuminate nursing for its practitioners. One article on the conceptual analysis of ‘partnership’ follows in the nursing theory category, and offers a paradigm case for neophyte conceptual analysts. The Canadian authors explicate all aspects of the process, from philosophical perspectives to the practical considerations of the setting and sample for data collection and management. As a result, we are provided with a historical trajectory of the evolution of the context of democratic partnership, from the International Declaration of Human Rights in 1948 through the various socio-political and economic factors that have led to current thinking on health promotion. This article is essential reading for students interested in the history of ideas in nursing, not only for its content but also for its style. It is followed by a single contribution to JAN Forum, a response to Draper & McSherry's editorial on spiritual assessment (39, 1–2). The authors challenge the original critique with many examples of research on spirituality, and thereby contribute to this ongoing debate. Articles from authors in Taiwan, USA, Hong Kong, Jordan and Finland may be found in the section on nursing practice. The sleep positioning of infants has been the subject of much recent discussion and public education in the attempt to reduce the possibility of sudden infant death, and mothers of full-term infants are strongly advised to put them to sleep in the supine position. The first practice article is therefore somewhat controversial as it addresses the same subject for the care of mechanically ventilated, pre-term infants at the chronological age of 7 days or less. The findings from this cross over design study that prone infants had improved sleep quality and decreased stress when compared with their supine state, flies in the face of this current received wisdom for older infants. This is a subject that should be taken up in further research. The pre-term infants were, of course, mechanically ventilated and any possibility of sleep apnoea was monitored. Nevertheless, parents may ask nurses questions about different practices for infants of different ages and health status, and we need to know the answers. The next article reports on a telephone study of relatives who were recently bereaved when a family member died in an Accident and Emergency (A & E) department in Hong Kong. A socially appropriate period of 50 or more days was left before the 76 respondents were contacted. The literature review for this study referred to earlier studies that showed the limited preparedness that nurses had received in order to deal with these distressing situations (also see JAN35, 562–570). It appears that in the current study the relatives were able to comment on many helpful nursing actions that had been offered, and this suggests that A & E nurses may now be better prepared in making culturally appropriate responses to sudden death. We welcome the next article from members of nursing faculty at the University of Science and Technology at Irbid in northern Jordan. We know that great strides have been made over the past decade in establishing the academic department of nursing at Irbid, and the emergence of research related to a major demographic concern in Jordan demonstrates this progress. Stress after myocardial infarction is regularly reviewed in nursing studies, but patients' experiences vary according to the local context. The authors are to be congratulated for identifying local social and cultural factors that contribute to their patients' stress. We look forward to further developments in their research programme in this important area of nursing care. The final practice article concerns the analysis of story-telling as a means of evaluating patient participation at co-operative team meetings in acute psychiatric care. The analysis of the discourses adopted in the meetings shows that the different interactive styles used by professional experts may promote either active or passive participation on the part of the patient and/or significant others. An unthinking conversational style can thus have profound effects on the ability of respondents to participate. Three articles follow on Experience before and throughout the nursing career. The first presents an important analysis of career trends of UK graduate nurses (GNs). Setting a small group of contemporary interviews with GNs against a background of historical documentary evidence on graduates and their careers, the author presents ‘a critical assessment of this earlier work’. The findings are important not only for their historical insights into the poorly developed debates on UK graduate nurses, but also for their contribution to contemporary arguments on the place of graduate nurses in the labour force, and their eventual career destinations. The author of the second careers' article addresses another topical issue by developing a theoretical framework with which to explore voluntary nurse learner wastage. Drawing again on previous work, in this study the interaction between the learner and the educational institution was examined in relation to learners' decisions to stay or leave. Like the previous article, this one also raises many important issues to be addressed in relation to the retention and motivation of nurses in their careers. The third careers article on predictors of job satisfaction and absenteeism in two samples of Hong Kong nurses also focuses on organizational climate, and psychological distress. Although very different in method, similar themes to those in the second article are identified. It seems that we are not short of evidence on what motivates nurses to stay, leave or take time off from work. The next step must be to ensure that systems are in place to identify these problems and to take the necessary remedial action. If the previous three articles present analyses and problem clarification in relation to what makes different groups of nurses ‘tick’, the single education article (also from Hong Kong) reports on a deliberate strategy adopted to manage change. It presents the ways in which action inquiry was constructed in the light of student feedback on curriculum change, and this report conveys the openness and collaboration that are so frequently missing from such accounts. Nevertheless, the authors are not complacent and conclude by observing that ‘continuing effort is required to sustain this engaged and engaging paradigm’. Since the introduction of categories for articles in July 1998, those in the section on Methodological issues in nursing research have consistently represented one eighth of all published articles. The final article in the methods section follows in this tradition and would have fitted well into issue 40:1 had there been room, concerned as it is with the value of combining qualitative and quantitative approaches in research by means of method triangulation. The authors, from the University of Oslo in Norway, emphasize not only the vital importance of epistemological issues in methods triangulation, but also that understanding the complexity of health services demands the use of multiple methods and perspectives. We concur, and would say that methodological complexity is one important aspect of JAN's traditional eclecticism; others being the diversity of nursing situations that are covered in the journal, together with their different international contexts. Issue 40:2 is typical of this rich variety of subject matter.

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