This paper reviews new theoretical and practical developments in working with partners of people with aphasia and describes the development of a clinician's resource entitled 'SPPARC: Supporting Partners of People with Aphasia in Relationships and Conversation'. It focuses particularly on one part of that resource: the SPPARC Conversation Training Programme, which adapts conversation analysis for clinical use. The paper describes the stages involved in assessing and working on conversation in everyday life.

Background

Purpose -This paper aims to briefly review leadership within the contemporary UK National Health Services (NHS) including Department of Health and Royal College of Nursing (RCN) initiatives. Design/methodology/approach -It is argued that the concept of clinical leadership is a viable and important one, and is theoretically consistent with the contemporary social psychological literature on the importance of "local" leadership to effective organizational functioning. Field theory proposes that local influences (e.g. local management) on attitudes and behaviour will to a large extent mediate the impact of the organization (e.g. organisational structure and values) on (in this instance) health care delivery. Findings -The reality of clinical leadership must involve a judicious blend effective management in the conventional sense with skill in transformational change in order to make real difference to the care delivery process. Practical implications -For leadership initiatives to become truly culturally embedded into the "way we do things around here", they require more than just individual training and development. Originality/value -A view is offered for the practical interpretation of the clinical leadership concept in relationship terms. This will involve management of the relationship between health care professionals, between health care professionals and the "organizations" to which they are accountable and between health care professionals and service users.

This exploratory study investigates relatives' overall experiences of the critical care environment and how staff perceived these experiences. Traditionally, research in Critical Care concentrated on patients' psychological well-being or relatives' immediate needs. There is little research that addresses the relative's overall experience of events. Critical Care Units are possibly the most daunting units in hospitals. Having a family member admitted to a Critical Care Unit could qualify as a traumatic-enough stressor to induce post-traumatic stress symptoms in relatives. A convenience sample of eight relatives and five staff participated in the study. The study used qualitative methods and drew on techniques of grounded theory. While staff perceived relatives' experiences accurately; issues arose, from both staff and relatives perspective, with regard to accurate dissemination of information. Further research into the communication processes used within Critical Care Units is required in addition to developing best practice in this area.

Staff need to be aware that communicating in a way that conveys empathy and responds to the individual as a valued person is an important factor in maintaining dignity. Nurses on hospital wards particularly need to take measures to safeguard the dignity of older people with cognitive problems who have difficulty in making their needs known.

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Patient and carer experiences of delayed or premature discharge. Quality and equity of access to intermediate care for older people.

It was confirmed that high levels of speech, language and communication difficulties are found among the young offender population. The implications for the management of young offenders, the limitations of the study and indications for further research are discussed.