Involving mental health service users in quality assurance

OBJECTIVE: This study compares the process and outcomes of two approaches to engaging mental health (MH) service users in the quality assurance (QA) process. BACKGROUND: QA plays a significant role in health and care services, including those delivered in the voluntary sector. The importance of actively, rather than passively, involving service users in evaluation and service development has been increasingly recognized during the last decade. DESIGN: This retrospective small-scale study uses document analysis to compare two QA reviews of a MH Day Centre, one that took place in 1998 as a traditional inspection-type event and one that took place in 2000 as a collaborative process with a user-led QA agenda. Setting and participants The project was undertaken with staff, volunteers and service users in a voluntary sector MH Day Centre. Intervention The study compares the management, style, evaluation tools and service user responses for the two reviews; it considers staff perspectives and discusses the implications of a collaborative, user-led QA process for service development. RESULTS: The first traditional top-down inspection-type QA event had less ownership from service users and staff and served the main purpose of demonstrating that services met organizational standards. The second review, undertaken collaboratively with a user-led agenda focused on different priorities, evolving a new approach to seeking users' views and achieving a higher response rate. CONCLUSIONS: Because both users and staff had participated in most aspects of the second review they were more willing to work together and action plan to improve the service. It is suggested that the process contributed to an evolving ethos of more effective quality improvement and user involvement within the organization.     

Endogenous and exogenous research? Findings from a bibliometric study of UK nursing research

AIMS OF THE STUDY: This paper uses the findings of a recent bibliometric analysis of published UK nursing research to ask whether the field is characterized by a fundamental split between two underlying areas of research interest. These can be termed 'endogenous' and 'exogenous'. The former term describes research which tends to be concerned with problems and issues to do with nursing as a profession; the latter is concerned with problems and issues centring around the nursing of patients. DESIGN/METHODS: Papers in the Wellcome Trust's Research Outputs Database (ROD), a database of UK biomedical research, were analysed. Nursing papers published between 1988 and 1995 numbered 1,845, just less than 1% of the total papers in the ROD. RESULTS/FINDINGS: Analysis of the subfield identified that nursing research was atypical of biomedical research as a whole in a number of ways. One difference was that usually in biomedical research there is a general correlation between numbers of funders acknowledged on a paper, numbers of authors, and esteem of the journal in which a paper appears. In nursing there was, if anything, a tendency for highly esteemed papers to have fewer authors and be less likely to have acknowledged funding. However, the apparently endogenous and exogenous papers have quite different characteristics. This paper explores this apparent difference and possible reasons for this difference and will briefly compare nursing research with some other newly emerging social and academic groups. CONCLUSIONS: Thinking of nursing research outputs in this way can provide insight into the existence of different reward systems influencing nurse researchers. However, it is impossible to draw too confident a differentiation without reading each individual paper and making judgements about whether they are 'endogenous' or 'exogenous', a practice generally beyond the scope of bibliometric practice.     

The culture of midwifery in the National Health Service in England

The culture of midwifery in the National Health Service was examined in order to foster understanding of the context of midwifery practice. In-depth interviews were conducted with midwives in five, very different, sites across England. The culture which emerged was one of service and sacrifice where midwives lacked the rights as women which they were required to offer to their clients. There was a lack of mutual support and of positive role models of support with considerable pressure to conform. Guilt and self-blame were common as was learned helplessness and muting. The dilemmas of this culture are considered and the resistance which it offered to change in relationships. Change was either resisted, brought about by stealth or strategically planned to equip midwives to change their culture.     

Skills competency in nurse education: nurse managers' perceptions of diploma level preparation

This paper reports on part of a national study conducted between 1994 and 1996, the overall aim of which was to examine the 'fitness for purpose' of the Project 2000 nursing education reforms. The study used multiple methods of data collection, including an individual and group interview study of nurse managers (n = 132) and a national survey of Project 2000 diplomates and traditionally prepared registered nurses (n = 5417). Findings in relation to the managers' expectations and experiences of diplomates are presented. This includes views on the level of skills achievement and skills acquisition of diploma level education. The qualities of the diplomates are discussed and this includes those areas where the skills of the diplomates are felt to achieve what is required of the role. Also included is an exploration of those skills which the managers felt fell short of expectations. Managers raised the long-standing concerns of clinical skills and competencies and discussed these in relation to the changing health care environment and the relative roles of other health care workers. The conclusions highlight the need to identify what could be seen as the 'core skills' required of a registered nurse and the need to explore the environment in which the diplomate takes up first appointment.     

Three‐Dimensional Ultrasound Imaging of Mammary Ducts in Lactating Women

Objective. The main function of the breast is to produce milk for offspring. As such, the ductal system, which carries milk from the milk‐secreting glands (alveoli) to the nipple, is central to the natural function of the breast. The ductal system is also the region in which many malignancies originate and spread. In this study, we aimed to assess the feasibility of manual mapping of ductal systems from 3‐dimensional (3D) ultrasound data and to evaluate the structures found with respect to conventional understanding of breast anatomy and physiology. Methods. Three‐dimensional ultrasound data of the breast were acquired using a mechanical system, which captures data in a conical shape covering most of the breast without excessive compression. Manual mapping of the ductal system was performed using custom software for data from 4 lactating volunteers. Results. Observational results are presented for ultrasound data from the 4 lactating volunteers. For all volunteers, only a small number of ductal structures were engorged with milk, suggesting that the lactiferous activity of the breast may be localized. These enlarged ducts were predominantly found in the inferior lateral quadrant of each breast. The observation was also made that the enlarged, milk‐storing parts of the duct were spread throughout the ductal system and not directly below the nipple as conventional anatomy suggests. Conclusions. Ultrasound visualization of the 3D structure of milk‐laden ducts in an uncompressed breast has been shown. Using manual tracing, it was possible to track milk‐laden ducts of diameters less than 1 mm.     

护生执业资格考试成绩预测模型的研究

通过对156名通过护士执业资格考试学生的在校课程成绩进行因子分析,研究课程间的内部结构,找出课程与护士执业资格考试之间的联系,旨在提高教学效果和考试通过率。根据因子分析的结果建立课程与护士执业考试成绩的多元线性回归预测模型,经检验预测精度高,误差低。