Management review of nursing systems

This paper describes the systems of nursing operating at a major cancer centre in the United Kingdom. The review was undertaken over a period of 8 weeks and 11 wards were included. The systems being implemented were primary nursing, team nursing and patient allocation. Methods of enquiry included questionnaires, non-participative observation and interviews. The results of the review found the nursing systems to be at various stages of implementation, and that in reality, not all wards were operating the system they said they were. A pragmatic mixture of team nursing and primary nursing as described by Hegyvary (1982) was being practised on some of the wards. The report makes recommendations for change, and concludes by discussing the future implications for cancer nursing at the centre.     

EXPLORING SYMPTOMS IN PATIENTS MANAGED WITHOUT DIALYSIS: A QUALITATIVE RESEARCH STUDY

Little is known about the prevalence and burden of symptoms in patients managed without dialysis. This study was the result of a larger study exploring the experiences of 30 such patients and their trajectories to death. Data were analysed relating to symptoms once the patients had been referred to a Renal Supportive Care Service based in the East End of London, UK. A high symptom prevalence was found with 30 different symptoms reported at first consultation. Widely reported symptoms impacting on daily living included breathlessness, oedema, pruritus, nausea and vomiting and pain. Findings indicate that as symptoms escalate and death approaches, some symptoms, such as fluid overload and lethargy become difficult to treat indicating that death is close. This new knowledge can help staff as they attempt to determine when the end of life is approaching in order to support and care for patients appropriately. This paper highlights a need for effective identification and management of symptoms as they arise and further exploration of the effects of these symptoms on daily living.     

What do nurses do? An observational survey of the activities of nurses on acute surgical and rehabilitation wards

Aim  The subject of the study described in this article is an activity analysis of nursing care given on an acute surgical ward at a District General Hospital as compared to that given on a rehabilitation ward at a Community Hospital.
Methods  Obtaining a global overview of nursing activities on the two study wards was a focal issue. The project consisted of undertaking in excess of 60 h of observation with 10 registered nurses (RNs) of various grades in the two settings.
Findings It was found that both sets of nurses undertook similar types of activities. Overall more indirect care activities than direct care occurred on both wards. These findings are similar to the findings of other studies where the majority of RNs' activities are said to relate to the co-ordinating and management aspects of patient care.
Conclusion  It is concluded that the 'glue function' or maintaining a holistic overview of patient care given by all members of the health care team is an important part of nursing care delivery.     

Theories of risk and safety: what is their relevance to nursing?

Aim  The aim of this paper is to review key theories of risk and safety and their implications for nursing.
Background  The concept of of patient safety has only recently risen to prominence as an organising principle in healthcare. The paper considers the wider social context in which contemporary concepts of risk and safety have developed. In particular it looks at sociological debates about the rise of risk culture and the risk society and their influence on the patient safety movement.
Key issues  The paper discusses three bodies of theory which have attempted to explain the management of risk and safety in organisations: normal accident theory, high reliability theory, and grid-group cultural theory. It examine debates between these theories and their implications for healthcare. It discusses reasons for the dominance of high reliability theory in healthcare and its strengths and limitations.
Conclusion  The paper suggest that high reliability theory has particular difficulties in explaining some aspects of organisational culture. It also suggest that the implementation of high reliability theory in healthcare has involved over reliance on numerical indicators. It suggests that patient safety could be improved by openness to a wider range of theoretical perspectives.     

The student experience of undergraduate education: the relationship between academic and clinical learning environments

This paper examines the experiences of the authors as undergraduate nursing students (one from a university background, the other from a polytechnic).The paper particularly focuses upon an examination of the relationship between the academic and clinical learning environments. The authors attempt to explain aspects of this relationship from their own personal interpretations. They consider the discrepancies they have experienced between the two settings, in relation to both general philosophies of nursing and issues relating to actual nursing intervention. Reasons why the discrepancies exist are considered along with the ways students cope with the situation.Finally the paper considers the implications of student experience in relation to the proposed changes in nurse education, and recognises the need to consider the situation of those who have graduated from nursing degree programmes.     

Health benefits for health and social care clients attending an Integrated Health and Social Care day unit (IHSCDU): a before‐and‐after pilot study with a comparator group

It is thought that integrating health and social care provision can improve services, yet few evaluations of integrated health and social care initiatives have focused on changes in clinical outcomes and used comparator groups. The aim of this pilot study was to identify whether attendance at an integrated health and social care day unit (IHSCDU) affected selected outcomes of functional mobility, number of prescribed medications, and physical and psychological well‐being. A secondary aim was to examine the utility of the tools to measure these outcomes in this context; the feasibility of the recruitment and retention strategy and the utility of the comparator group. A before‐and‐after comparison design was used with non‐randomised intervention and comparator arms. The intervention arm comprised 30 service users attending the IHSCDU and the comparator arm comprised 33 service users on a community nursing caseload. Measures of functional mobility (Barthel's Index) and physical and psychological well‐being (SF‐12^®) were taken from all participants in both arms at three data collection points: baseline, 4 and 9 months later, between November 2010 and September 2012. Participants and outcomes were identified prospectively and in both arms, the individual was the unit of assignment. No significant changes were noted in functional mobility and psychological well‐being and the number of medications prescribed increased in both arms. There was a trend towards a significant difference between study arms in the change in the SF‐12^® physical health outcome measure and this outcome measure could be usefully explored in future studies. The recruitment and retention strategy was feasible although our comparator group had some limitations in not being closely matched in terms of age, functional mobility and mental well‐being.     

Empowerment in welfare markets

The NHS and community care reforms have been promoted as a means of boosting efficiency and making services more responsive to clients. The government has urged health and social services to establish processes by which clients’ views are identified but with no firm requirement that these are prioritized within the commissioning process. Whilst it is expected that the NHS and local authorities will respond to government exhortations, this paper suggests that there are compelling political, financial and organizational reasons why the opportunities for power sharing may differ between the two types of authority.     

Research on the informal carer: a selected literature review

This paper gives a selected review of the available research on the role of the family in caring for elderly or handicapped relatives in the community. In particular, studies which describe who the carers are, the nature of their responsibilities and the physical and emotional costs of caring are examined. The implications of the findings from these studies and the recommendations made for improved care are discussed. A need for further research in this area is identified, particularly from a nursing perspective.     

Developing indicators for measuring Research Capacity Development in primary care organizations: a consensus approach using a nominal group technique

Research Capacity Development (RCD) in the National Health Service supports the production of evidence for decision-making in policy and practice. This study aimed to establish a level of consensus on a range of indicators to measure research capacity in primary care organizations. Indicators were developed in a two-stage process using workshops and modified nominal group technique. In 2005, workshops were used to generate possible indicators from a wide range of research active and research-interested people. A theoretical framework of six principles of RCD was used to explore and identify indicators. Data were thematically coded, and a 129-item, 9-point Likert scale questionnaire was developed. A purposive sample of nine experts in developing research capacity in primary care agreed to take part in a nominal group in April 2006. The questionnaire was circulated prior to the meeting, and analysis of the responses formed the basis for structured discussion. Participants were then asked to rescore the questionnaire. Only seven participants were able to take part in the discussion and rescore stages. Data were analysed in two ways: level of relevance attributed to each indicator as a measure of organizational RCD, represented by median responses (medians of 7–9 defined strong support, 4–6 indicated moderate support and 1–3 indicated weak support), and level of consensus reached by the group. Consensus was reached if 85% of the group rated an indicator within the same band. Eighty-nine (68%) indicators were ranked as strongly relevant, and for seventy-three of these indicators, a consensus was reached. The study was successful in generating a set of agreed indicators considered relevant for measuring RCD in primary care organizations. These will form the basis of a pilot tool kit to assist primary care organizations to develop research capacity. Further work will explore the applicability of the indicators in practice.