Search

Aim. This paper explores the sexual health interview from a critical perspective, and to demonstrate how the confession ritual involved in this interview is implicated in the construction of subjectivities (meaning identities) as well as in fostering self-surveillance (self-regulation). Background. The concept of public health depends primarily on several surveillance tools that monitor both the incidence and prevalence rates of certain diseases. Within the subgroup of infectious diseases, sexually transmitted infections comprise a group that is closely monitored. As a result, surveillance techniques, including policing sexual practices, are part of the public health worker's mandate. Method. Using a Foucauldian perspective, we demonstrate that confession is a political technology in the sexual health domain. Findings. As one group of frontline workers in the field of sexual health, nurses are responsible for data collection through methods such as interviewing clients. Nurses play an integral role in the sexual health experience of clients as well as in the construction of the client's subjectivity. We strongly believe that a Foucauldian perspective could be useful in explaining certain current client behavioural trends (for example, an avoidance by at-risk groups of interactions with nurses in sexual health clinics) being observed in sexual health clinics across the Western hemisphere. Conclusion. Clinicians need to be aware of the confessional nature of their questions and provide requested services rather than impose services that they determine to be important and relevant. By appreciating that the sexual health interview is an invasive and embarrassing sexual confession, healthcare providers and policy-makers may be better able to design and implement more user-oriented, population-sensitive sexual health services. [ABSTRACT FROM AUTHOR]

BACKGROUND: The paper is based on a case study, which was part of a Department of Health commissioned research study covering 10 National Health Service (NHS) trusts in England that had adopted a range of approaches to the employment terms and conditions of nurses, midwives, and other non-medical staff, as the precursor to evaluating Agenda for Change, the modernized pay system for the NHS. AIM: The aim of this paper is to discuss a case study of the effects of changing nurses' pay progression. METHODS: Fieldwork took place in 2000, and included interviews with managers, union representatives and other staff, and analysis of internal documents. FINDINGS: Findings discussed include the constraints on managers when devising a new pay system, the time and detailed work needed and the challenges of assessing their effects (particularly in relation to patient care). Although the latter are difficult to assess, staff involved in the scheme reported benefits from the closer focus on competences which resulted from the scheme. CONCLUSIONS: The effects of changes to pay schemes are difficult to assess, and the evaluation of the proposed national scheme (Agenda for Change) will be challenging. [ABSTRACT FROM AUTHOR]

BACKGROUND: Considerable financial and philosophical effort has been expended on the evidence-based practice agenda. Whilst few would disagree with the notion of delivering care based on information about what works, there remain significant challenges about what evidence is, and thus how practitioners use it in decision-making in the reality of clinical practice. AIM: This paper continues the debate about the nature of evidence and argues for the use of a broader evidence base in the implementation of patient-centred care. DISCUSSION: Against a background of financial constraints, risk reduction, increased managerialism research evidence, and more specifically research about effectiveness, have assumed pre-eminence. However, the practice of effective nursing, which is mediated through the contact and relationship between individual practitioner and patient, can only be achieved by using several sources of evidence. This paper outlines the potential contribution of four types of evidence in the delivery of care, namely research, clinical experience, patient experience and information from the local context. Fundamentally, drawing on these four sources of evidence will require the bringing together of two approaches to care: the external, scientific and the internal, intuitive. CONCLUSION: Having described the characteristics of a broader evidence base for practice, the challenge remains to ensure that each is as robust as possible, and that they are melded coherently and sensibly in the real time of practice. Some of the ideas presented in this paper challenge more traditional approaches to evidence-based practice. The delivery of effective, evidence-based patient-centred care will only be realized when a broader definition of what counts as evidence is embraced. [ABSTRACT FROM AUTHOR]

This paper examines the phenomenon of family 'interference' in the health care of a sick member from a new angle. The `interfering' behaviours are located within the context of the family's evolving relationships with health care providers. The authors argue that the behaviours are an understandable product of the family's disillusionment and dissatisfaction with their health care relationships. As such, these interfering behaviours represent the family's most productive means of positively influencing their sick member's experience with illness. In addition, they set the stage for negotiation to take place between the family and health care providers which leads to mutually satisfying care a When interference is appreciated within the context of health care relationships, it becomes obvious that some of our traditional nursing responses are counterproductive. This paper offers suggestions for making interference work, as well as theoretical questions to the nursing practitioner. [ABSTRACT FROM AUTHOR]

This paper argues that the rhetoric of multidisciplinary teamwork is central to the provision of health care generally and geriatric care in particular. Yet the notion of teamwork is poorly defined, and the supposed benefits for patients are not always readily apparent. Looking at teamwork in practice, examples from research are used to illustrate how multidisciplinary decision making and work with patients can, under particular circumstances, take on the appearance of collaboration amongst a team of expert colleagues, which co-opts patients and relatives to the status of team members. But very often, multidisciphnary work with patients is coordinated not by mutual collaboration amongst a team of equals, but by means of established work routines which are broadly applied to whole categories of patients, and by the operation of the traditional hierarchy of social relations in health care. For long stay patients, the pervasiveness of the teamwork mythology and the frequent concurrent withdrawal of other professionals can, at worst, leave the nurses in the invidious position of having responsibility, but no formal or legal authority for caring for their patients: work which no other professional is anxious to do. This leads to negative outcomes for patients as well as for nurses. Finally, it is stressed that analysis of multidisciplinary teamwork both in theory and in practice is vital if we are to understand the conditions under which multidisciplinary teamwork both flourishes, and can be demonstrated to be a necessary condition for the creation of positive care outcomes for geriatric patients in hospital. This paper seeks to raise some of the issues which must be confronted in this endeavour. [ABSTRACT FROM AUTHOR]

In this paper the technological, demographic, social and disease-pattern changes in British society are considered and their implications for the nursing and health services discussed. The influences of major nursing reports as well as the consequences of the growth of professionalism in nursing and the potential outcome of the spread of political consciousness among nurses are also highlighted. Nurses are admonished to come to terms with the 'real' diseases of today, those resulting from affluence and senescence. Although conceding that nurses have unique and professional roles, a plea is made for the importance of good team work in health care. The paper ends with the recognition that by building up the body of knowledge of nursing, not only will the planning of nursing care be enhanced but also the ability to change as the needs of society change. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a study of the perspectives of homeless individuals on their health and healthcare needs. BACKGROUND: Many studies show the high incidence and severity of diseases, physical and mental, amongst the homeless populations. However, the views of homeless people themselves are usually omitted. In order to provide appropriate care, healthcare professionals need to be aware of these perspectives. METHOD: A descriptive, exploratory design, using semi-structured interviews and observational field notes, was chosen for this qualitative study. A convenience sample of 24 participants experiencing homelessness was recruited in one Canadian city in 2005. FINDINGS: Participants described their health and healthcare needs in a holistic sense. They reported concerns about physical illnesses, mental health, addictions and stress. Shelter life promoted spread of diseases and lacked privacy. Violence was rampant in shelters and on the streets, leading to constant fear. There was emotional distress over social exclusion and depersonalization. Participants wanted to work and to be housed, yet felt trapped in a dehumanizing system. CONCLUSION: The recommendations are (a) elimination or mitigation of most health problems of the homeless through safe, affordable housing; (b) reintegration into the community through job counselling, treatment of addictions and employment. Negative societal attitudes towards these clients need to change. Healthcare professionals, particularly community nurses, have opportunities to collaborate respectfully with these clients and work for changes in public policies, such as national housing and addiction treatment policies, and for streamlined, humanized services to smooth the processes of social reintegration. [ABSTRACT FROM AUTHOR]

Aim. The aim of this paper is to clarify and refine the concept of patient advocacy through synthesizing the advocacy literature in nursing and to establish a theoretical basis for future studies on patient advocacy in nursing. Background. Patient advocacy is an essential component of the Registered Nurse professional role. During the past 30 years, the patient advocacy role has become more important, but the concept of patient advocacy lacks a consistent definition and research into nurses' patient advocacy roles is limited. There have been few quantitative empirical studies on patient advocacy in nursing. Method. Walker and Avant's method of concept analysis was used as a guideline in examining the concept of patient advocacy through synthesizing the advocacy literature in English (1974-2006). Findings. A mid-range theory of patient advocacy emerges during the process of synthesizing and analysing the advocacy literature. Three core attributes of the concept of patient advocacy are identified: (1) safeguarding patients' autonomy; (2) acting on behalf of patients; and (3) championing social justice in the provision of health care. They reflect nurses' patient advocacy roles at both macro- and microsocial levels. Antecedents of patient advocacy occur at both macro- and micro-social levels and call for nurses' advocacy roles in the healthcare system. Consequences produced by nurses' patient advocacy behaviours are contextual. Nurses' patient advocacy behaviours not only can positively influence the patients, other nurses and the nursing profession, but also can cause negative consequences for nurses who take action to advocate for patients. Conclusion. The proposed mid-range theory may be useful in guiding advocacy practice in nursing and in guiding research in the advocacy area. The proposed theory needs to be furthered refined and tested in the future. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a study investigating health visitors’ and practice nurses’ attitudes, beliefs and practice associated with routinely advising patients about physical activity. Background. There is worldwide concern about increasing rates of obesity and decreasing population levels of physical activity, and it has been argued that primary healthcare professionals are ideally placed to promote physical activity within local communities. In recent years, the public health role of primary care-based nurses in the United Kingdom has been considerably expanded to include playing a key role in improving the health of their local practice populations. A systematic literature search revealed that very few studies investigating nurses’ views and experiences of this type work have been published. The limited amount of research that has been conducted is generally small-scale and primarily concerned with general medical practitioners’ practice and attitudes, and not those of nurses. Methods. A questionnaire survey ( n = 630) and 20 in-depth interviews were conducted with health visitors and practice nurses in four health regions in Scotland between March and April 2004. The response rate was 63% overall. Results. Ninety per cent ( n = 149) of health visitors and 88% ( n = 186) of practice nurses said that they were very likely or likely to recommend all apparently healthy adult patients to take moderate exercise. Health visitors were more likely to discuss psychological benefits than practice nurses. However, only 9% ( n = 15) of practice nurses and 11% ( n = 15) of health visitors correctly described the current recommendations – an accumulation of 30 minutes of moderate physical activity five times a week. Interview data suggested that most nurses gave physical activity advice based on their beliefs about the patient's willingness to change and their impressions of the patient's presenting condition, underlying physical condition and life circumstances. No measure of underlying physical fitness was used. There was a lack of agreement between the questionnaire and interview data associated with levels of physical activity advising. Conclusion. There were high levels of enthusiasm for physical activity promotion amongst health visitors and practice nurses. However, nursing leaders and opinion-makers should challenge practitioners’ current beliefs and assumptions about physical activity promotion in the general population. [ABSTRACT FROM AUTHOR]

AIM: This paper reports a study to define a nurse-led clinic by exploring the domains of structure, process and outcome. BACKGROUND: Nurse clinics have been introduced as a measure to support intermediate care after the acute phase of disease. Previous studies have been mainly descriptive, or have only addressed a particular aspect of clinic service. METHODS: This exploratory study was conducted in two phases. In the first phase, nurses from 34 clinics were interviewed. In the second phase, 162 clinic sessions were observed, and 162 patients and 16 physicians were interviewed. The data were collected in 2001-2003. RESULTS: The nurses who ran the clinics were very experienced, and resources were available to support their work. Over 80% of their work was independent or interdependent, involving skills such as adjusting medications, and initiating therapies and diagnostic tests according to protocols. The principal interventions were assessments and evaluations, and health counselling. The nurses rated 'management of symptoms', 'prevention of complications', and 'client satisfaction' as the top three key indicators of their success. All patients studied showed improvement after the nurse clinic consultation, but the best rates were found in wound and continence clinics. Satisfaction scores for both nurses and clients were high. Physicians valued their partnership in care with the nurses, but were concerned about possible legal liability resulting from the advanced roles assumed by these nurses. CONCLUSIONS: A nurse clinic is an effective alternative model of ambulatory healthcare delivery that uses a holistic framework. [ABSTRACT FROM AUTHOR]

BACKGROUND: In the UK, school nursing has recently been at the forefront of policy change, with school nurses being considered pivotal to child-centred public health practice. There is very little literature on this topic and, in particular, little that is written from a practitioner perspective. AIM: This paper reports a survey that examines the work of school nurses compared with the expectations of their first line managers and policy-makers in government, in order to discover any potential practical or ideological areas of conflict. METHODS: We first applied a theoretical framework of sensitizing concepts to the historical, political, cultural and contextual background of school nursing. Following this, 46 school nurses in the West Midlands region of the UK were randomly selected and asked to complete a questionnaire about their personal characteristics, experience, training and working practices. The 38 nurses who completed this were then interviewed. Job descriptions for school nurses and governmental job expectations were obtained from various official sources and compared with the self-reported practices of school nurses. FINDINGS: All the nurses met the work criteria of their local employers, except in respect of health needs assessment activities, which two nurses had not yet attempted. All 38 also carried out a range of additional work activities, including providing sexual health services and parental support clinics. They also had a diverse range of skills and qualifications relevant to supporting the needs of their local communities. Qualitative data from interviews provided a useful insight into nurses' feelings of being valued by their clients and by local and national employers, and feelings of professional undervaluing by their peers. They felt positive about role changes in the last few years, and that they supported the child-centred public health role advocated by public policy. CONCLUSIONS: The practice of the school nurses in this study covered what employers and policy-makers required, with the notable exception of health needs assessment, which nurses were uncomfortable and unconfident about. The theoretical framework used provides a useful starting point for examining how school nursing has developed into its current role. [ABSTRACT FROM AUTHOR]

This paper explores philosophical and methodological issues involved in determining 'What counts as making a meaningful difference?'--the fundamental question in health outcomes research and evidence-based practice. Eight diverse stakeholders are identified along with the competing agendas they bring to the debate. The power to define what counts as meaningful change in health status is typically rooted in disciplinary socialization, linguistic traditions and an orthodox consensus that circumscribes acceptable research foci and methods. The various implicit assumptions and sites of definitional authority have consequences both for health researchers and for the public being served. For researchers, their designs may be driven by available instrumentation, short political time lines, and statistical rather than clinical significance. Because methods to capture salient health outcomes are still being developed, failure to capture significant outcomes may be methodological in origin. The public may experience the consequences of subsequent programmatic funding decisions and the exclusionary potential of different categorization schemes. Despite this, the public seldom has a voice in deciding what constitutes a meaningful health outcome. Researchers are urged to involve their target population in designing studies to help rebalance relative stakeholder power, and to consider the consequences of their methodological decisions. [ABSTRACT FROM AUTHOR]

Recent government proposals have underlined the importance of ascertaining users' views of health care. Traditionally these have been obtained through satisfaction surveys. However, researchers argue that the focus of attention should now shift to exploring dissatisfaction because it highlights more clearly any problems in lay-practitioner relationships. Research has shown that dissatisfaction is a complex social construct which is underpinned by a range of values, beliefs, attitudes and experiences. The aim of this paper is to provide insights into the meaning of dissatisfaction by exploring how dissatisfied users attribute cause, responsibility and blame for their untoward experiences. Forty-one people were identified from a household survey of user views as experiencing problems with their health care. They were interviewed in depth, and a grounded theory approach was used to construct a framework inductively from their accounts. This identified a number of normative expectations through which health work was routinely criticized; these included respondents casting aspersions on the professional integrity of health care practitioners and preserving their own moral identity through demonstrating competence, knowledge, rationality, reasonableness and concern for others. Moreover, it is argued that these patterns help practitioners to understand how dissatisfied users' perceive subsequent health care encounters. [ABSTRACT FROM AUTHOR]

This paper attempts to explain some general issues in evaluation and evaluative research in the health care field with specific reference to nursing. The evaluation process and nursing process are contrasted and methods used in evaluative research discussed. The case is made for more emphasis to be placed on the evaluation phase of the nursing process and process-outcome evaluation is advocated as a means of encouraging progress in the hitherto neglected area of evaluative research in nursing. [ABSTRACT FROM AUTHOR]

This paper presents a proposed model for continuing nursing education based on Imogene King's conceptual framework. The rationale for using King's conceptual framework as the foundation underlying this proposed model is three-fold: the concepts--social systems, health, perception, and interpersonal relationships--are relevant in every nursing situation; the interacting levels of operation--individuals, groups, and society-depict a reciprocal relationship between human behaviour and the environment; and the triad of elements-continuing nursing education, nursing practice, and nursing research-are interrelated in the nursing profession. The authors contend that this approach to continuing nursing education is beneficial to participating nurses, the health care consumer, and to the advancement of the nursing profession. Based on its simplicity and flexibility, the proposed intra-systems model described in this article is useful as a systematic guide for continuing nursing education. The authors believe that this proposed model provides an approach for stimulating continued learning, for establishing innovative foundations for nursing practice, and for generating inquiry through research. Utilizing this approach in maintaining the educational standards for professional practice will promote change for the advancement of the nursing profession. [ABSTRACT FROM AUTHOR]

The organization of the way in which hospitals and hospital staff provide a service to patients is obviously of critical importance to their effectiveness, yet it is clear that rigidities and inappropriate and ineffective procedures frequently intrude. It is commonly held that changing hospitals as organizations is difficult to accomplish, and indeed, reported attempts at such change reflect this. The project reported here was a successful attempt at changing a number of different aspects of the culture of a psychiatric hospital which included managerial practices and structure, aspects of patient care, multidisciplinary team work, and staff development. The present paper concentrates on some specific outcomes at ward level. The general pattern for bringing about change involves the collection of (valid) data and then feeding this back to the staff involved so that they can take appropriate action. The data discussed here concerned ward nursing staff's attitude to the 'climate' of the hospital, their job satisfaction and aspects of patient care. This was fed back to nursing, managerial and medical staff, and action plans were agreed to overcome the difficulties highlighted. Outcomes have included the production of ward and unit objectives and changes in treatment programs and aspects of patient care on the wards. [ABSTRACT FROM AUTHOR]

The hypothesis that patients hospitalized for long periods and receiving psychotrophic drugs increase in weight is tested, and it was discovered that women patients were somewhat heavier than their 'standard' weights. This, however, was not due to hospitalization or drug effects. Contrary to expectation, the ratio of observed/'standard' weight decreased in men suffering from chronic schizophrenia. In view of the loss of weight frequently observed in affective disorder patients, we discovered puzzling higher mean ratios in men with this illness. This paper shows that small research projects can be carried out by nurses who are actively involved in patient care. It also demonstrates that small scale investigations, replicating locally some other research, testing its validity in a different setting are eminently worthwhile. [ABSTRACT FROM AUTHOR]

There is widespread discussion at the present time of participation--allowing members of an organization to exert an influence on the processes of decision-making. The National Health Service is not isolated from this debate and already a number of experiments have been carried out at various levels of the service to allow a wider range of opinion to influence decisions than hitherto. This paper reports on a study the author carried out into one such exercise, designed to assist a Health Board reach decisions about the long-term pattern of health care in its area. Nurses, paramedical staff and local authority staff, as well as doctors, were appointed to a series of programme planning committees to advise the Health Board on issues of long-term policy. After 2 years of operation, a study was carried out into the operation of the committees and the lessons drawn from the experience should be relevant to actual and potential members of any consultative or decision-making body. [ABSTRACT FROM AUTHOR]

There is considerable evidence to suggest that despite the availability of free medical services under the British National Health Service, there remains a clear social class bias in accessibility to a wide range of health care services. The literature on social class and the use of health services is examined and it is suggested that the greatest inequalities are to be found in the uses of preventive services. In the second half of the paper, some tentative proposals, which might have to reduce existing patterns of inequality, are examined. [ABSTRACT FROM AUTHOR]

This paper is based on the nursing lecture delivered on the occasion of the Royal College of Nursing's Diamond Jubilee Year Annual General Meeting, 24 November 1976. The history of the first sixty years of the college is recorded and discussed and its national and international contributions to the nursing profession and the art and science of nursing are documented. The College's pioneering role in nursing research and post-basic nursing education are also considered as are its influences on the development of the National Health Service and its significant role in representing nurses. [ABSTRACT FROM AUTHOR]

In this paper the author, who is a member of the Royal College of Nursing of the United Kingdom (Ren) Council, discusses the functional and dysfunctional aspects of organizational behaviour and applies this discussion to the organizational problems of the Ren, the main professional organization of nurses in the United Kingdom. In particular, three concepts are considered in some detail: the concepts of oligarchy, elitism and plurality of goals. It is argued that problems which are ignored do not disappear and that dysfunctions which are by definition latent must be made manifest before they can be remedied. The existence of opposition, it is further argued, is essential to keep democracy alive, to buffer oligarchy and to promote change essential for the organization's survival. [ABSTRACT FROM AUTHOR]

This paper has endeavoured to describe a longitudinal learning experience required in the post-basic baccalaureate nursing programme at Tel-Aviv University, Israel. It grew out of the need to help students internalize and integrate studies, apply theory in practice and to function as change agents. An evaluation of the programme as perceived by students and graduates brought to light problems and suggestions for improvement and to a large degree confirmed the value of this programme. [ABSTRACT FROM AUTHOR]

Although literature on community health nursing identifies a nursing role at the community level, there is a lack of clarity about the elements and expected outcomes of this role. In this paper three models of community health practice are presented and discussed in terms of their effectiveness as a basis for nursing practice at the community level. These models are (1) the public health model, (2) community participation model, and (3) community change model. Factors that affect the effectiveness of nursing to work at the community level are also discussed and questions for reflection and debate raised. [ABSTRACT FROM AUTHOR]

Reflects on the 50th anniversary of the creation of the British National Health Service (NHS) in July 1998. Thoughts on changes in nursing care from the 1940's to the 1990's; The author's experience as a nurse treating tuberculosis patients in the 1950's; Progress in nursing scholarship; Quality of papers submitted to the 'Journal of Advanced Nursing.'