The first line nurse managers’ opportunities to lead nursing care seem to be diminishing. The aim of this study was, therefore, to gain an understanding of the first line nurse managers in their experiences in the development of nursing care as part of a wider research programme. Finnish nurse managers wrote narratives at the beginning of five different leadership courses in this grounded theory study. ‘Preparing the Air for Nursing Care’ emerged as a core category. It was formed by two major categories. ‘Being Concerned about Nursing Care’ describes the nurse managers’ focus on the development of nursing care, the nursing caregivers’ health and knowledge and a concern for the whole organisation. The second major category ‘Creating the Direction and Content of Nursing Care’ describes the nurse manager working together with the staff to create individual and family-centred best practice, initiating relationships and dialogues for nursing care, and a culture of caring. A typology was created that explained the four main modalities to emerge from the data: ‘the Active Developer’, ‘the Passive Thinker’, ‘the Impulsive Creator’ and ‘the Routine Manager’.

Given that the majority of frail older people living at home are cared for by family members, ensuring appropriate and sensitive support services for family carers is a major policy priority globally. Such assessment of the needs and situation of individual carers is a crucial first step towards ensuring that they receive flexible, quality support services. However, existing assessment practice is still inadequate in many countries. This paper describes a negotiated approach to carer assessment, the Carers Outcome Agreement Tool (COAT) and briefly considers its development with carers and practitioners in an Anglo-Swedish development project (2003–2005) and subsequent implementation within five municipalities in Sweden (2006–2008). A participatory research design was adopted in both projects building on the ÄldreVäst Sjuhärad model, which is a user-focused approach to research and development. This paper provides a short summary of the COAT development before presenting the qualitative findings from the Swedish implementation project (2006–2008), which emerged from focus group interviews with COAT practitioners and telephone follow-up interviews with carers who had a first and second COAT assessment. The findings clearly highlight the value of COAT in enabling partnerships to be developed between carers and practitioners, which recognise the expertise of both parties. They also challenge providers to invest sufficient time and ‘ear-marked' resources for family care support so that COAT becomes an integral part of a comprehensive long-term carer strategy, which feeds directly into local developments in service delivery and organisation.

The care of frail older people and their family carers present significant challenges for welfare systems throughout the world. In order to address their needs, policy initiatives are promoting partnership working between service users, family carers and providers, whereby the former are increasingly involved in the design and evaluation of services. However, participatory models of working raise fundamental issues about power relations and pose important questions about what constitutes ‘evidence’. Several authors identify tensions between movements such as evidencebased practice and initiatives designed to increase the active participation of service users suggesting that there is a need for a new approach to research that reconciles potentially conflicting goals. This paper describes the evolution of a model of participatory research resulting from a collaboration between Sweden and the United Kingdom, which actively involved older people, family carers, service providers and voluntary organisations. The model is underpinned by constructivist principles that have been adapted by the authors so as to be more intellectually accessible to a nonacademic audience. The conceptual basis for the model is described and a case study illustrates how it is applied in practice. It is argued that the approach could be adopted widely as a means of more fully engaging older people, their families and a range of service providers in important debates about future health and social care provision.