This paper relates a common problem in community practice. A client chose to share information with a support worker who was unsure of her competence to deal with the disclosure. An innovative and reflective approach to finding evidence for potential benefit or harm is described, together with an interpretation of this evidence, and finally recommendations for clinical practice based on ‘best available evidence’.

This paper describes how new insight into community nursing know-how or professional artistry was produced through qualitative analysis of 30 transcripts of audio-recorded simulation data. The data were generated by simulated patient assessments of two cases. These simulated assessments were undertaken by a heterogeneous sample of district nurses drawn from a large conurbation in central Scotland in 1995. The existence of multiple sets of rich, dynamic and interactive data about each case provided a sound basis for exploring important and poorly understood aspects of nursing knowledge which are generally regarded as implicit. These aspects of nursing knowledge are particularly challenging for empirical research. The findings described are believed to be of particular interest in their articulation of collaborative approaches to patient assessment. Illustrations from the data are provided, and it is argued that the validity of the findings is enhanced by the unusual nature of the database, as well as the analytical procedures described. The limitations and significance of the findings are also addressed. The empirical analysis is linked to a preliminary discussion of procedural knowledge in nursing practice. The findings are discussed with reference to certain aspects of Foucault's view of power.

To clarify how nursing practice influences programme outcomes, the purpose of the research reported here was to examine the relationship that exists between client factors, system characteristics, provider actions and client outcomes in a postpartum programme. The programme is a community-based service primarily delivered by public health nurses in a large urban city in Western Canada. Relationships between structure, process and outcome dimensions in the programme were examined from both an explicit programme theory (normative programme) grounded in primary health care principles and philosophy, and an implicit programme condition (implemented programme) reflecting actual programme delivery. Elements of the McGill model of nursing were used as the basis from which to develop the normative programme theory that guided the research. One finding from this descriptive study was that nursing practice in the programme is still very much rooted in a ‘traditional’ model of health service delivery. There was little evidence of practice consistent with generally accepted health promotion standards.

This paper begins by identifying the context and extent of grade-mix changes in the district nursing service, drawing attention to significant dilution in grade mix at a time of considerable organizational change. The paper goes on to argue that there is no easy formula for providing sound evidence on which policy and management decisions about grade mix can be based. It suggests that the focus on tasks in much of the research on district nursing does not offer a sufficient basis for making grade-mix decisions, because nursing skills are not made explicit. The paper then makes reference to one ethnographic research study in order to illustrate and explore some of the methodological difficulties associated with trying to provide evidence of the use of district nursing skills, focusing in particular on the invisible work undertaken by team members. The paper concludes that if differences in the use of skills by different grades of nurse can be identified, then further increases in grade dilution will have consequences for patient care and must therefore address issues of quality in order to comply with the principles of clinical governance.

Interviewing can provide unique opportunities for professionals to gain some understanding of the child's subjective experience, where other means of data collection are inappropriate and other sources of data are less valid. This article is concerned with the principles and practicalities of interviewing children for the purposes of health-related research. It draws on the knowledge gained from three decades of research involving interviewing young people in many contexts, including health care, social welfare and child protection. A conceptual framework is presented to illustrate the interactive and iterative processes that occur between interviewer and interviewee, and the pivotal importance of context in shaping any interaction. The influences of the young person's linguistic, cognitive and social skills are discussed. The effects of the gender and ethnicity of both the researcher and the researched are considered in relation to the conduct of the interview, and the influence of adult biases and perspectives on the evaluation and interpretation of data is explored.