The politics of sex research and constructions of female sexuality: what relevance to sexual health work with young women?

By examining the relationship between the cultural construction of female sexuality and the lack of potential for many young heterosexual women to be truly sexually healthy this paper submits that messages for women within HIV prevention programmes can be confused, confining and at times dangerous to women's health and well-being. It is suggested that these messages also reinforce a traditional, biologically determined medical understanding of female sexuality that does not take note of social or culturally based research or commentary on female experience or female desire, but rather confines many women to sexual restrictions, doing little to empower women to prevent sexual risk-taking. The ideological basis of the discussion within this paper is informed by the awareness that applications and understandings of 'sexuality'are diverse and contested within sex research traditions and will influence the choice of research concerns. The'deterministic'explanation of sexuality that 'sexuality'(the abstract noun referring to the quality of being 'sexual', Williams 1983) is your fate or destiny and that biology causes the patterns of sexual life, is abandoned in this paper in favour of a search for a definition of sexuality which brings together a host of different biological and mental possibilities which are given meaning only in social relations. This allows for a framework for the study of sexuality that relates it to other social phenomena, particularly economic, political and social structures (Foucault 1979); in other words, a study of the 'social construction'of sexuality. This paper suggests that health care professionals need to develop an awareness of the diversities within female sexuality and gain insight into their own values and assumptions about female sexuality if these are not to inhibit effective approaches and interventions in the areas of HIV and sexual health.     

Paying to participate: financial, social and personal costs to parents of involvement in their children's care in hospital

Parental participation now has become an accepted feature of the care of children in hospital. However, the costs to parents of their involvement in the care of their hospitalized children have received little attention. In this paper the financial, social and personal costs to a group of parents of children admitted to a surgical ward are described. Financial costs included loss of earnings, travel and subsistence. Parents'financial commitment was open-ended and the burden of financial costs was inequitable. The organization of alternative care for siblings carried social costs including loss of privacy and autonomy in family relationships. Participation in care could be distressing and so result in personal costs. Differences between the socialization of parents and health care professionals explain some of these personal costs. Implications for policy makers and practitioners are considered.     

A new paradigm for nursing: the potential of realism

Realism has been the dominant approach in the philosophy of science for the last 20 years. Realist philosophy has also been widely employed across a range of social sciences. Unfortunately, these powerful intellectual currents have not reached the shores of nursing which appears trapped in a time-warped debate about 'qualitative' (constructivist) and 'quantitative' (positivist) approaches. This paper argues that both positivism and constructionism are seriously flawed as philosophies of social and natural science. This is in marked contrast with realism which is a philosophy of both the natural and social sciences. I therefore propose that realism should be adopted as a radically different new paradigm for a unified biopsychosocial nursing.     

Outcome measures: problems and opportunities for public health nursing

Outcome measures: problems and opportunities for public health nursing
Increasingly, outcome measures are being used to evaluate the effectiveness of health care. There are particular difficulties in establishing outcome measures for public health nursing, especially those that would demonstrate health gain. These problems arise as a result of the role of public health nursing and the nature of outcome measures. Possible solutions are the use of caseload and community profiles or the aggregation of client-negotiated health objectives. These solutions would also provide small area health information and outcome measures which would be sensitive to health needs in local communities.     

Planning for continuity of carer in nursing

Planning for continuity of carer in nursing
The introduction of primary nursing and the named nurse reflects a growing recognition of the importance of continuity of carer in nursing rather than simply continuity of care. Continuity of carer is fundamental to the development of therapeutic inter-personal relationships with patients. Hospital nursing, however, provides a 24-hour service and therefore continuity of carer must be maintained within a system of nurse substitution. This paper identifies some of the organizational tensions experienced by nurses attempting to promote continuity of carer within a nursing development unit that is simultaneously striving to offer nurses personal development opportunities.     

Quality of care assessed: using the Senior Monitor index in three wards for the elderly before and after a change to primary nursing

Assessments of quality of care using Senior Monitor in three matched wards for elderly patients were carried out on three occasions. The first assessment was carried out in June 1987 as a trial of the measurement tool. The instrument allows for a maximum score of 100. All three wards scored above 60, with two wards scoring above 70. Primary nursing was introduced in one of the wards in January 1988 and the assessment was repeated in June 1988. All ward scores were above 70, with one ward, not the primary nursing ward, scoring above 80. A third assessment was carried out in June 1989. Again, all three wards scored above 70 but this time the primary nursing ward scored 86; the highest ward score of the series. The results for the sub-sections of the assessment are explored in the paper and issues about validity, reliability and inter-rater reliability are discussed. It is argued that Senior Monitor is a useful tool for assessing changes in the quality of care delivered to patients in wards for the elderly but that its full value only becomes apparent with repetition over an extended time period. It may be less appropriate for assessing the impact of a change in the organization of care, not because of any inherent fault in the test but because the very process of using it makes staff look at their practice more critically. It is this critical re-appraisal rather than the change in organization per se which stimulates the improvement in the quality of care.     

A review of nursing quality assurance

This paper presents an overview of frameworks used in nursing quality assurance, an outline of the quality assurance movement in nursing, and its current concerns. It is argued that quality assurance activity appears to be propelled by market forces, regulation, coercion and professionalism. The concern with measurement places quality assurance activity within the quantitative paradigm. The problems associated with measurement are discussed and the writer presents qualitative research as a complementary approach to quality assurance and improving care.     

Ethical health care management: is it possible?

Recent changes in the United Kingdom (UK) National Health Service (NHS) have resulted in the application of private sector management methods, in an attempt to improve the efficiency of service delivery. However, this has also led to concern regarding the appropriateness of such methods in a public service organization. This paper examines how the new 'business' culture of health care has led to conflict between the core values of nursing and management. It is argued that the central focus of the two roles is essentially different and this is at the heart of the conflict. Consideration is given to how the service may be managed in the future and the need for mutual understanding and collaboration is advocated as a means of reconciling these differences.     

Disseminating research evidence. A controlled trial in continence care

The dissemination of research evidence from which clinical practice should be based poses many well-documented problems for nurses. This study set out to overcome some of the common barriers to dissemination by providing a research-based clinical handbook for continence care. The impact of the handbook on nurses' knowledge of both urinary and faecal incontinence was tested using an experimental and control group. The experimental group received the handbook while the control group did not. Both groups completed an assessment questionnaire at week 1, prior to the intervention in the experimental group, followed by a second assessment at week 7 after the intervention in the experimental group. Data were collected using semistructured questionnaires. Statistically significant improvements in knowledge were found for those nurses who received a copy of the handbook, and nurses reported that they found the handbook useful and acceptable as a form of clinical updating. The dissemination of research findings is essential if evidence-based nursing is to become a reality, and this study clearly demonstrates one method by which this can be successfully achieved.