This article aims to give insight into the experience of an intensive course of radiation therapy and relate the findings to the nurses working with individuals receiving radiation therapy. The purpose of this article is to describe and interpret the experiences of individuals undergoing radiation therapy in the cancer center of a large teaching hospital. The philosophic basis of this study was hermeneutic phenomenology and draws on the experiences described by 20 individuals undergoing radiation therapy through a series of unstructured interviews. The findings indicate that there are deficits in the care delivered in some radiation therapy departments. Information and preparation for radiation therapy are often inadequate or do not meet the needs of the individuals in this study. Participants continue to adopt a "sick" or "patient" role even though they attend treatments on an outpatient basis and are required to manage their own care, which results in a feeling of not being in control. Moreover, the coping styles of the participants vary and are not clearly identified and assisted by relevant health professionals. Care is not always well coordinated between the various health professionals, resulting in the patient receiving mixed or confusing messages about their treatments.

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In this Clinical Practice Development (CPD) project we set out to identify and describe current approaches to the management and delivery of nursing care in an Australian Metropolitan Teaching Hospital. Using a simple descriptive design, data were collected to elicit patterns of care provided by nursing teams. We sought to demonstrate patterns described by nursing teams (interviews) and actual patterns of care (observation). As expected there was a degree of incongruence between the espoused and actual patterns of care. Interview data revealed that most study wards had a view of nursing that emphasizes meeting the total care needs of patients and their families through offering biopsychosocial and educative care. The observational data revealed that a relatively large proportion of time was expended on activities that were not regarded as important by staff when interviewed (e.g. documentation) while relatively small amounts of time were observed to be spent educating patients or communicating with relatives of patients. The identification of this type of gap creates a dissonance in clinicians that can be used to stimulate change through CPD. Clinicians used the information to stimulate discussion and to rewrite team value statements.

Objectives  The objective of this review was to appraise and synthesise the best available evidence on the feasibility, meaningfulness and effectiveness of nursing leadership attributes that contribute to the development and sustainability of nursing leadership to foster a healthy work environment. Inclusion criteria  This review considered quantitative and qualitative research papers that addressed the feasibility, meaningfulness and effectiveness of developing and sustaining nursing leadership to foster a healthy work environment in healthcare. Papers of the highest level of evidence ratings were given priority. Participants of interest were leaders and those who were affected by leadership, specifically staff and patients. Interventions of interest including positive leadership attributes, as well as system and policy constructs, that impact on the development and sustainability of nursing leadership within the healthcare environment were considered in the review. Search strategy  The search strategy sought to find both published and unpublished studies and papers, limited to the English language. An initial limited search of MEDLINE and CINAHL was undertaken followed by an analysis of the text words contained in the title and abstract, and of the index terms used to describe the paper. A second extensive search was then undertaken using all identified key words and index terms. Methodological quality  Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using an appropriate critical appraisal instrument from the System for the Unified Management, Assessment and Review of Information (SUMARI) package. Results  A total of 48 papers, experimental, qualitative and textual in nature, were included in the review. The majority of papers were descriptive and examined the relationships between leadership styles and characteristics and particular outcomes, such as satisfaction. Because of the diverse nature of these papers meta-analysis of the results was not possible. For this reason, this section of the review was presented in narrative form. The qualitative and textual papers were analysed using The Joanna Briggs Institute-Qualitative Assessment and Review Instrument and The Joanna Briggs Institute-Narrative, Opinion and Text Assessment and Review Instrument. The process of meta-synthesis embodied in these programs involves the aggregation or synthesis of findings or conclusions. Eight syntheses were derived with key themes related to collaboration, education, emotional intelligence, organisational climate, professional development, positive behaviours and qualities and the need for a supportive environment. Conclusion  A combination of leadership styles and characteristics was found to contribute to the development and sustainability of a healthy work environment. The current work conducted in this area provides a solid foundation for future directions in research.