The development of a model to manage change: reflection on a critical incident in a focus group setting. An innovative approach

Aim This paper describes the development of a model to manage and evaluate the management of change. The Change Management Model may provide nurse managers or change agents with a structured and measurable model for managing and evaluating the change process. A measurement constructs tools to further assist the evaluation process is also described. Background The author argues that certain key variables can be identified which contribute to the successful implementation of change. These variables include critical success factors for change, communication issues, change dynamics that include resistance or acceptance of change, and the variables related to the management of the implementation and evaluation stages of the change process. Key issues Change is a constant in the health care field. Nurse managers must learn to accept change as a normal process and to develop coping and managing strategies for the successful management of change. This acceptance of change as a dynamic process will create opportunities and challenges for nurses. Conclusion The Change Model was developed through reflection on critical incidents related to change by students at a University School of Nursing and Midwifery in the Republic of Ireland, in a focus group setting. The Measurement Construct Tool was developed through a review of the tools currently in use and from ideas generated in a matrix related to change presented by Clarke & Garside (1997) . Students who were involved in the initial focus group discussions agreed that the Change Model was highly effective in describing how the change was managed; that the Change Management Measurement Constructs Tool facilitated the evaluation of a change process; and permitted the inherent subjectivity related to the change process to be replaced by an objective measurement tool. Both the model and the Measurement Construct Tool are in the process of being tested for validity and reliability.     

Some surprising similarities in the clinical reasoning of'expert' and 'novice' orthopaedic nurses: report of a study using verbal protocols and protocol analyses

This paper reports on an Australian study of 'expert' and 'novice' orthopaedic nursing practitioners' clinical reasoning Concurrent and retrospective verbal reports of patient assessment and care planning in real 'everyday' practice situations were collected from nine pairs of 'expert' and 'novice' orthopaedic nurses Verbal protocol analyses revealed that the experts used the same level of concepts as novices, that their clinical reasoning was as physically orientated as that of novices, and that the implicit constructions of nursing in the reasonings of both experts and novices were consistent with a 'medical model' of health care The research design, limitations and findings are discussed     

Delta + 27 homozygosis in a Sicilian family.

During a screening program to identify at risk couples for beta-thalassemia first-trimester prenatal diagnosis, we were able to detect, by polymerase chain reaction (PCR) and direct genomic sequencing of the PCR product, a homozygosis for the G-T substitution at the first nucleotide of codon 27 of the delta-globin gene in a pregnant Sicilian woman. The possibility of showing an interaction between delta and beta thalassemia is relevant for a thalassemia prevention program because it may hide a beta-thal carrier state.     

Developing a promotion plan for health care marketing

Promotion of a health care provider's services is essential for communication with its customers and consumers. It is relevant to an organization's marketing strategy and is an element of what is described as the marketing mix. This paper considers the relationship of promotion to the marketing of services and proposes a plan for the promotion of the organization as a whole which can also be applied to an individual service or specialty. Whilst specific reference is made to an National Health Service (NHS) Trust it is also relevant to a Directly Managed Unit.     

A family nursing approach to the care of a child with a chronic illness

Chronic illness in childhood affects family functioning, and professional support is required when the child is being cared for at home. The focus of concern for this study is the nursing contribution to the support of the family. A longitudinal ethnographic study of the experience of four families caring for a child with cystic fibrosis provided data. Analysis of the four case studies provides insight to the effect of cystic fibrosis on family interaction. The genetic aspects and the life-threatening nature of the illness are seen to have a profound effect on the parents' lives. The experience of crisis and the chronic burden of care are described. The context of long-term care requires the nurse to share the illness trajectory with the families and to help family members to travel it together. This is seen to require a high level of interpersonal skill and considerable emotional investment. The issues for nursing are examined. The research arose from practice, and it contributes to theoretical explanation of nursing interaction, and the relationship of systems thinking to understanding of the nursing situation. The case for the development of family nursing practice to meet contemporary health care needs is argued.     

A partnership approach to leadership development for Directors of Nursing in Older People's services in Ireland – articulating the impact

This paper outlines the approach undertaken by the Royal College of Nursing to design, deliver and evaluate a programme of leadership development for Directors of Nursing in Older People's services commissioned by the Nursing and Midwifery Planning Development Unit Dublin, Kildare and Wicklow. The programme was developed to support Nurse Directors of these services to enhance their leadership capabilities at a time of significant health service reform and investment. The programme was underpinned by the Office of Health Management's Nursing Competency Framework ( Rush et al. 2000 ). The key influences for the programme were the significant contemporary policy and organizational developments directly experienced by Directors of Nursing. This paper will focus on the benefits for participants, commissioners and service users alike in adopting this kind of partnership approach to the design, delivery and evaluation of a bespoke RCN leadership development programme which combined the experience of RCN Gerontology alongside Leadership. Specifically, the paper focuses on the context of the commissioned work and the ways of working between the members of the delivery team and the commissioners, their roles and responsibilities and the importance of these interrelationships in the delivery of a development programme which would meet the specific needs of this key group of nurse leaders. The key learning and experiences of the Directors of Nursing are highlighted.