From a ‘borderless world’ to a ‘world of borders’: ‘bringing history back in’

The first part of the paper explores some of the reasons why contemporary border studies understate the full significance of state borders and their global primacy. It is argued that this failing is rooted in a much wider lack of historical reflexivity-a reluctance to acknowledge the historical positioning (the 'where and when') of contemporary border studies themselves. This reluctance encourages a form of pseudohistory, or 'epochal thinking', which disfigures perspective on the present. Among the consequences are (a) exaggerated claims of the novelty of contemporary border change, propped up by poorly substantiated benchmarks in the past; (b) an incapacity to recognise the 'past in the present' as in the various historical deposits of state formation processes; and (c) a failure to recognise the distinctiveness of contemporary state borders and how they differ from other borders in their complexity and globality. The second part of the paper argues for a recalibration of border studies aimed at balancing their spatial emphases with a much greater, and more critical, historical sensitivity. It insists that 'boundedness', and state boundedness in particular, is a variable that must be understood historically. This is illustrated by arguing that a better analysis of contemporary border change means rethinking the crude periodisation which distinguishes the age of empire from the age of nation-states and, in turn, from some putative contemporary era 'beyond nation-states' and their borders.

A concept analysis of renal supportive care: the changing world of nephrology

Title. A concept analysis of renal supportive care: the changing world of nephrology

Aim. This paper is a report of a concept analysis of renal supportive care.

Background. Approximately 1.5 million people worldwide are kept alive by renal dialysis. As services are required to support patients who decide not to start or to withdraw from dialysis, the term renal supportive care is emerging. Being similar to the terms palliative care, end-of-life care, terminal care and conservative management, there is a need for conceptual clarity.

Method. Rodgers' evolutionary method was used as the organizing framework for this concept analysis. Data were collected from a review of CINAHL, Medline, PsycINFO, British Nursing Index, International Bibliography of the Social Sciences and ASSIA (1806-2006) using, 'renal' and 'supportive care' as keywords. All articles with an abstract were considered. The World Wide Web was also searched in English utilizing the phrase 'renal supportive care'.

Results. Five attributes of renal supportive care were identified: available from diagnosis to death with an emphasis on honesty regarding prognosis and impact of disease; interdisciplinary approach to care; restorative care; family and carer support and effective, lucid communication to ensure informed choice and clear lines of decision-making.

Conclusion. Renal supportive care is a dynamic and emerging concept relevant, but not limited to, the end phase of life. It suggests a central philosophy underpinning renal service development that allows patients, carers and the multidisciplinary team time to work together to realize complex goals. It has relevance for the renal community and is likely to be integrated increasingly into everyday nephrology practice.