The recovery alliance theory (RAT) is a mid-range theory of mental health nursing based on humanistic philosophy. The conception of the RAT was the outcome of collaboration among service users, practising mental health nurses, educationalists and managers and was developed in the context of a number of political and social changes as well as changes in the mental health field. The theory is composed of six constructs: humanistic philosophy, recovery, partnership relation, strengths focus, empowerment and common humanity. The derivation of three concepts from these constructs, namely coping, self-responsibility/control and working alliance, forms the basis for the translation of the constructs into a system of mental health nursing practice [Partnership in Coping system (PinC)]. The constructs underpinning the RAT were clearly demonstrated in a preliminary trial of the PinC system.

Treatment under the traditional medical model has largely ignored the family's knowledge, expertise and potential therapeutic effects on hospitalized mentally ill people. This paper reviews the family's role as caregiver. It reports on an evaluation of services by caregivers. Its findings reflect views stated in other surveys in identifying the need for improvement in education and social support for families, greater family involvement in the patient's care and improvement in staff attitudes towards families. The study concludes by describing the development of a family support project in a Nursing Practice Development Unit in a secure ward and offers a blueprint for mental health nurses in facilitating the more active involvement of families in the recovery of their family members.

The paper identifies shortcomings of approaches used in organizing and delivering mental health nursing. It provides a rationale for the development of a new system of mental health nursing namely the Partnership in Coping system (PinC). This system has been developed by service users, clinical mental health nurses and an academic mental health nurse. Currently, it is undergoing trials in Western Australia. The PinC focuses on the strengths of clients. It uses the positive aspects of mental health nursing namely its holistic perspective, the length and nature of the informal contacts, the 'ordinariness' of relationships with clients and the nurse's knowledge of the clients' social and physical environments. It is a versatile system that can also be used across different mental health settings (community and inpatient facilities). The paper describes the philosophy behind the system, the concept of coping, the nature of the partnership between the client and nurse and their respective roles.

Heart transplantation confronts the patient with major physical, psychological and social demands. Psychological adjustment to these stressors requires effective coping abilities. The purpose of this study was to investigate the coping mechanisms used by heart transplant recipients. A group of 42 heart transplant recipients completed the questionnaire. The instrument, F-COPES (Family Crisis Oriented Personal Evaluation Scales), was used to measure coping behaviours, thereby producing scores on five coping subscales: Acquiring social support; Reframing; Seeking spiritual support; Mobilizing family to accept help; and Passive appraisal. The results indicated that subjects in the present study (Scottish patients) scored slightly higher than normative subjects (American patients) on the Reframing subscale, slightly lower on the two subscales Acquiring social support and Mobilizing family to accept help, and much lower on Spiritual support. These results also indicated that the coping strategies used by this sample appeared to be largely independent of the time elapsed since transplantation, and the age of the subject. The major finding was that subjects scored much higher on the Passive appraisal coping subscale (almost double the score of the normative subjects).

The development of the extended role in nursing has been seen by some as primarily a means for nurses taking on tasks that have traditionally been the work of junior doctors. Others object to this view and ascribe to the 'new nursing' perspective of Salvage. She sees the extended role as moving towards increasing autonomy and operating in a professional rather than a bureaucratic occupational model. This view militates against the development of nurses as mini-doctors. This paper discusses the controversy surrounding the development of the extended role, focusing particularly on the use of complementary therapies as a legitimate component of the 'new nurses' role.