With the increasing focus on collaborative, interprofessional models of service delivery in many parts of the world, it is crucial that nurses be able to demonstrate confidence in the value they add to the health system. As the largest group of health professionals, nurses must serve as change agents in strengthening health systems and influencing the development of appropriate health policy. This requires that nurses have a solid understanding of what is their unique role in contributing to attainment of desired health outcomes in the populations they serve. In this article, the role of nurses in health care is reviewed, with commentary on some areas in which nurses are currently underutilized in health care delivery, whether employed in community or institutional settings. Data from research conducted in Canada suggest that nurses have a tendency to define themselves by the tasks or activities they perform and seem unable to clearly articulate their special role in health care. Strong leadership and a willingness by nurses to re-orient their practice will be required to ensure that the potential for harnessing the knowledge, experience, capabilities and commitment of nurses in advancing health care reform shifts from rhetoric to reality.

The purpose of this article is to explore the processes that enable home care nursing services to provide good quality care. The focus is on how quality care is defined by nurses, patients and carers, and palliative care provision is used as an exemplar. The international policy scene is one of escalating costs and shortage of qualified nurses, which has resulted in a variety of forms of skill mix. In addition there has been an emphasis on partnership working with patients and carers, who are encouraged to participate in care giving. The article draws upon data generated in studies conducted by the author and colleagues over a 10-year period. The main conclusions of the article are that nurses, patients and carers were able to articulate the essential components of high quality care and that these elements fitted the structure, process and outcome framework first described by Donabedian (1969). In addition, forming a good relationship and rapport with the patient and family is viewed as a critical pre-requisite to quality care. It is noteworthy that the awareness contexts first described by Glaser and Strauss (1965) are still a relevant framework for analysing nurse patient and carer interactions. Finally it is suggested that the quality indicators identified in this article could be used as a useful starting point to develop criteria for judging quality of provision in palliative and supportive care services.

There is wide recognition that patient and client assessment by community nurses is central to the provision of high quality care. It is also acknowledged that assessment in the home setting is a complex process requiring a wide range of knowledge and skills. This article identifies two distinct approaches to assessment that have emerged in different contexts around the world. These approaches comprise the formal, structured questionnaire-based assessment that has been developed particularly in response to the requirement to determine service eligibility and the informal, conversation-based assessment that draws on nursing concepts and theories. The article briefly traces the professional and policy influences that have shaped the development of these two approaches before turning to a critical analysis of selected empirical work that has examined their effectiveness. Research undertaken on the structured form of assessment has focused largely on issues of reliability. While the majority of studies indicate that this form of assessment is reliable in identifying patient need, some research highlights its failure to take account of patient and client perspectives. This raises questions about the appropriateness of the nursing interventions that are planned in response to a structured assessment. Less research attention has been devoted to exploring the conversation-based approach to assessment, but this body of work has drawn attention to the potential for practitioners to adopt a controlling influence over the assessment process. Reference is made to research in which the author has collaborated that illuminates the way in which two styles of conversation-based assessment impact differently on patients and clients. The article concludes by identifying the need for further research and argues that a key focus should be the ways in which assessment contributes to care planning and patient outcomes.

This paper presents developments in evidence-based nursing practice in Botswana, Africa. Issues pertaining to evidence-based practice in community health such as the role of research, the digital divide between African countries and developing countries, and evidenced-based nursing curricula are discussed. The role of globalization in capacity building in evidence-based practice is emphasized. Recommendations for addressing challenges faced by some African countries, including Botswana in implementing evidence-based nursing practice are made.

This article reports on the implementation of community-based prevention of dementia among older adults in Japan. It is expected that the incidence of dementia will continue to increase as the population ages and thus care of those at risk of and with dementia is an important issue for nursing practice in the community. Community-based prevention of dementia comprises a comprehensive range of activities such as obtaining an understanding of community residents, early detection of dementia, fostering of volunteers, implementation of dementia prevention activities, provision of nursing care for older adults with dementia, as well as collaboration with local administrative institutions. We are working with a Japanese community (population of 65 years or more: about 2480 out of a total population of 10800) and in this article our activities are described. Among our activities we focus on itemizing the signs of dementia for early detection of the disease and on fostering volunteers. For early detection of dementia it is important to itemize the signs of dementia that close family members would notice in daily life. For fostering of volunteers it is necessary to enable them to develop skills to provide activities/clubs to interest the older adults and which are effective for prevention of dementia. We have started with clubs including a personal computer club, children's songs club and a picture mail club. Such activities are important strategies for a community-based intervention. The article concludes with reference to the need for verification studies to evaluate the impact of the community-based approach to the prevention of dementia outlined here which includes anticipatory education of the population concerning dementia, development of a method of early detection of dementia using a check-list and a means of secondary prevention via the activities of a group of volunteers (Ichigo Kai).

For the last 4 years we have implemented a model to mobilize rural health workers as leaders for HIV prevention in Malawi. We use a conceptual framework that integrates the World Health Organization's (WHO) primary health care (PHC) model, the social–cognitive model of behavioural change, and contextual tailoring of the intervention. Health workers are potential rural HIV prevention leaders because they have community trust and respect. However, their leadership potential has been limited by both health system barriers such as inadequate workers, supplies, and training and personal barriers such as risky occupational and personal behaviours. In the first phase of the project, we developed collaborative relationships and conducted qualitative research to adapt a peer group intervention for rural health workers and community members. In the ongoing second phase, we trained the health workers, who then volunteered and provided the intervention to adults in the communities their health centres serve. The intervention was adapted for young people through a community participatory process. Currently the adapted intervention is being offered to young people. As a guide to replication, we discuss barriers encountered in implementing this collaborative project and how we overcame them. This project demonstrates that health workers can be effective leaders for community AIDS prevention in African countries. The primary health care model offers a feasible, cost-effective and sustainable approach to maximizing health worker-community collaboration to reduce the spread of HIV.

In 1999 Hockey postulated the hypothesis that some older people experience a continual accumulation of small, individually minor events or difficulties that degrade their resilience until they ‘cannot cope with another thing’. She referred to this accumulation as cumulative trivia. The essence of cumulative trivia lies in their everyday nature, where regular occurrence and variety of challenge stack up to form perceived threats to an older person's ability to function independently. There is a strong overlap between this concept of cumulative trivia and an established concept in the health psychology literature called daily hassles. Consistent with the mainstream psychology approach, the vast majority of research into daily hassles has been quantitative. In the present article we adopt a critical stance to the knowledge produced from this research, questioning its foundations in the positivist epistemology. In particular the research is criticized for absenting the social context from our understanding of daily hassles, and for focusing too strongly upon the individual. The considerable lack of research into daily hassles in the lives of older people is also highlighted, indicating the need for work in this area. Using a social constructionist framework, we attempt to develop a holistic conceptualization of cumulative trivia, through which some key differences between the cumulative trivia and daily hassles concepts are indicated. We argue that cumulative trivia could be seen within the framework of the daily hassles literature but that this framework would require to be developed further and refined to accommodate the specific characteristics associated with Hockey's concept. We suggest that the social construction of ageing may serve to normalize experiences in ageing such that they become trivialized. Finally we examine how the social construction of independence as an ideal state may create or exacerbate the effects of cumulative trivia, and argue for its reconstruction to legitimize older people's experiences of minor difficulties. Through these arguments we relocate responsibility for cumulative trivia toward the social context.