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.     

Evaluation of a nurse-led continence service in the south-west of Glasgow, Scotland

This paper reports the results of a pilot study of a nurse-led continence promotion service in both the community and a local nursing home. Telephone and written referrals were made to the service from 28 primary care teams in Glasgow, Scotland. In the nursing home all patients were assessed and an appropriate management plan implemented. A full assessment was carried out in all community patients, including an appraisal of contributory factors, urinalysis and diaries of food and drink intake. A management plan suited to the patient was then implemented. Patients' levels of incontinence in both arms of the study were assessed objectively using the Lagro-Janssen method. The cost incurred in both arms of the study were measured. There was a 69% improvement in the level of incontinence in the community group compared with 30% in the residents wing and 13% in the hospital wing. The savings in the nursing home amounted to pound;4152 in the residents' wing and £1959 in the hospital wing. In summary, a nurse dedicated to urinary incontinence in the community allows improved management, a greater level of awareness and results in resource savings, whilst increasing patient accessibility to a service.     

The emerging role of the British nurse teacher in Project 2000 programmes: a Delphi survey

The findings of a three-round Delphi survey, conducted to explore the role of the British nurse teacher as it emerges within Project 2000 programmes, are discussed The panel of experts comprising 201 grade 2 nurse teachers was drawn from the 25 of the 28 colleges in England who had implemented Project 2000 between September 1989 and April 1991 The findings highlight the complex and multifaceted role of the nurse teacher and the changes which are occurring in the role Currently, the main changes are related to teaching and learning activities These emphasize the depth, level and specialist nature of the teaching, and teaching on a variety of courses at diploma and degree level Assessment activities are given the highest overall rating as important, and recruitment activities the lowest, in both the current and future roles Educational management and administrative activities are found to be numerous and currently do not appear to be declining The few changes that have occurred to the administrative areas have been replaced with similar activities Another important area for the future was perceived to be research activity In view of the developing partnership with higher education in the United Kingdom, this is not a surprising finding     

New paradigm research in practice: the trials and tribulations of action research

This methodological paper reflects on the way in which nursing research has developed along similar lines to research in education It focuses on the emergence of action research as an example of collaborative research within the practice discipline of nursing Action research is placed in the framework of new paradigm research and questions concerning its scientific merit are addressed along with its idealistic value to nursing Drawing on issues raised during the collection of data for a PhD study which examined a changing ward culture, I hope to share some methodological concerns about the use of action research as a means of changing practice     

Academic validation of prior and experiential learning: evaluation of the process

This report is a summary of an AP(E)L evaluative research project conducted at the University of Southampton School of Nursing and Midwifery. The project aimed to shed light on the perceptions of candidates and teachers in conjunction with the effectiveness of the accreditation process. Through initial semi-structured interviews with teachers ( n = 6) and candidates ( n = 6) offering their perceptions and experiences, an emergent questionnaire was sent to the remaining active accreditation candidates ( n = 60, response n = 39) and advisers/assessors ( n = 36), response n = 32). The effectiveness of candidate preparation for beginning an accreditation claim, the comprehensiveness of the types of credit available to capture learning through experience, the styles of advising and feedback from assessment are all reported on. Interestingly, the data highlight how preparing an accreditation claim can affect both adviser and candidate, in terms of being more self-critical and reflective in their areas of practice.     

How accurately do nurses perceive patients' needs? A comparison of general and psychiatric settings

This paper examines to what extent nurses' perceptions of patients' needs correspond to the patients' views of their own needs. A questionnaire was designed to assess patients' emotional and physical needs in general medical wards and in acute psychiatric wards. Sixty patients, 30 psychiatric and 30 general, together with their 'key' nurses, took part in the study. Results indicate that, despite there being no evidence of appreciable disagreement between the 'average' psychiatric nurse and the 'average' psychiatric patient, there is little evidence that individual nurses and their patients, whether psychiatric or general, agree. The nurses' inability to perceive patients' needs on an individual basis is consistent with other studies which suggest that nurses use stereotypes when perceiving patients' needs. Implications for nursing care are discussed.     

Mental disorder among a homeless population in Belfast: an exploratory survey

Mental disorder among a homeless population in Belfast: an exploratory survey
This study aimed to identify the prevalence of mental disorder in hostels for the homeless in Belfast, Northern Ireland. In addition, it attempted to assess the facilities and support offered from both the hostels and the Health Service to homeless people who have a mental disorder. Lastly it sought to determine whether or not psychiatric hospital bed closure had any influence on the prevalence of homelessness among these persons in Belfast. An exploratory approach was adopted, using semi-structured interviews as the method of data collection. The sample consisted of 12 hostels for the homeless with a total occupancy of 250 residents. Officers in charge were surveyed. The results obtained indicated that approximately 25% of the homeless in Belfast hostels have a diagnosed mental disorder and that hospital closure has had a direct effect on the size of this percentage. In addition, it was found that the hostels generally are not able to offer the levels of therapy and support given in hospital or in designated hostels for people with mental health problems. Responses also suggest that support from Health Service personnel is less than satisfactory. While the findings in this study do not look at the entire homeless population in Northern Ireland, interesting and useful information emerged that has implications for policy and further areas of study elsewhere.