Clinical supervision: insider reports of a private world

An exploratory study, funded by the Department of Health, London and the Scottish Home and Health Department, Edinburgh, was conducted over an 18-month period to provide an informed view on possible assessment tools that could be used to assess the impact of clinical supervision (CS) in nursing and to report on the CS activities in 23 selected sites in England and Scotland. The study not only examined the utility of several standardized research instruments, to be reported separately, but also explored the experience of a small sub-sample of nurses ( n =34) engaged in CS, as supervisors and supervisees. Interviews were undertaken to help better understand some of the issues involved around the domains of structure, process and outcome. Respondents reported an enthusiasm for the opportunity to talk meaningfully to a trusted colleague about their personal circumstances at work. Such opportunities were particularly welcomed by nurses who wished to reflect upon their own practice with patients, especially when dealing with their clinical conditions which were upsetting, or otherwise challenging, and sometimes harrowing. Substantive and methodological areas of interest for future research are suggested.     

The politics of nursing: a case study–clinical grading

This paper is a study of the clinical grading policy for nurses in the United Kingdom and the extent to which the participating groups in the policy development process realized then objectives The study is based on the literature available at the time of the research and the results of structured interviews with a range of individuals involved in the policy process The results expose the cleavages between the different representative groups on the staff side They also shed light on the differing power bases of the groups involved In particular, they expose the weakness of nursing as a professional pressure group and the strength of the state and its agents in determining the outcomes of policy in the public arena It is suggested that this weakness vis-à-vis the state is responsible for the failure of nurses to achieve a reward system which recognizes the value of clinical nursing expertise, and that the 'clinical grading' system, in practice, is having the opposite effect The policy is explored from its origins, its acceptance on to the political agenda, its negotiation and agreement, its contentious implementation, the final outcomes, and its failure to establish a valid'clinical'pay structure     

Analysing qualitative interview data: addressing issues of validity andreliability

Over the last 20 years qualitative research methods have increased in popularity in the field of nursing research, yet critical issues of validity and reliability are often overlooked in published research reports Thus, the aim of this paper is to describe the steps which the author followed to address issues of rigour in one qualitative research study The study was conducted to explore the health visitor's role in identifying and working with vulnerable families in the community in relation to child protection Thispaper will focus on how issues of validity and reliability were addressed in terms of qualitative interview data     

Evaluation of a problem-based curriculum in midwifery

OBJECTIVE: to evaluate the implementation of a 'problem-based' learning (PBL) curriculum within midwifery. DESIGN: a 'realistic evaluation' model based on cost-effectiveness models of economics, and incorporating both qualitative and quantitative methodology. The design used historical comparison, comparing students following the new curriculum with a baseline of previous student cohorts and exploring staff and student experiences. SETTING: a 'new' university, providing a degree-level 18 month pre-registration midwifery programme for an intake of about 40 students per cohort. PARTICIPANTS: all students in the cohort qualifying immediately before the implementation and all those in the first cohort following the new curriculum were invited to participate fully. Assessment outcomes for three cohorts of students qualifying before and the first three cohorts qualifying following the change were analysed. All clinical staff directly involved in mentoring the relevant student groups, all academic staff involved in delivering the new curriculum and the course external examiner were invited to participate. Intervention: the evaluation studied a major change in the way the overall midwifery curriculum was delivered, widely described as PBL. MEASUREMENTS: students' experiences and perspectives were sought through review of routine evaluation documents, nominal group technique exercises and focus group discussions at about six months following qualification. Clinical staff experiences and perspectives were sought through written structured questionnaires. Academic staff views were sought through personal semi-structured interviews. Participant observation of the process, review of course documents and of staff reflective commentaries were also conducted. Data on student completion rates and final grade were analysed. FINDINGS: although students' views of the curriculum were generally positive, they experienced some discomfort and difficulty in adjustment to a new style of learning. Small group learning, independence and skills in using and conveying information and research evidence were valued aspects of the new approach. Quality of clinical placement experience and university-practice links were an important area of positive experience or concern. Clinical staff views of the curriculum showed considerable stability, with major concerns being the balance of theory and practice time and skills which were not influenced by the curriculum change. At both points, ability to critically evaluate and use evidence in practice was regarded highly. Student outcomes showed some evidence of possible divergence of grades in the new curriculum. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the manner and context of implementation of educational change may have important implications for student experiences and outcomes and the experiences of educators. Adequate preparation at all levels for a different, more independent style of learning is important and students are likely to need clear guidance and feedback on their progress in the early stages of the curriculum, to monitor progress and to provide reassurance. Longer-term research is needed to assess the impact of PBL on theory-practice links and on the midwives as practitioners.     

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.     

Assessing strength of preference for abortion method using 'willingness to pay': a useful research technique for measuring values

Policy makers and practitioners need to differentiate between patient preferences which are strongly held, and those which are not. This study measured not only women's preferences for medical abortion versus surgical vacuum aspiration, but also the strength of these preferences, using a 'willingness to pay' (WTP) technique. Fifty women were recruited and interviewed prior to and following termination of early pregnancy. Due to the sensitivity of the situation, the WTP approach was administered by interview. Results revealed that 34 (64%) preferred to have the medical method. The amounts offered for each method were similar; however, a minority gave higher values for the medical method, thus for those women their strength of preference for that method was more intense. Validity of the technique was supported by the finding of a positive association with social class and the importance women attached to having choice. It is argued that WTP is an acceptable method for the elicitation of strength of treatment preferences. Its further use by nurses and midwives to assess health care preferences should be explored, particularly when considering aspects of care which are traditionally difficult to identify and measure.