Interviews with a small group of nurses working in a primary nursing ward were content analysed using the Ethnograph computer program. In response to some very general questions about their views of primary nursing, the respondents talked at some length about their improved knowledge of patients, about better communication, about their relationships with patients and relatives and about personal responsibility. They did not talk spontaneously about controlling their own practice, decision-making, autonomy or accountability. Such terms did not form part of their vocabulary in describing their work though these issues were raised obliquely in the conversations. The value of the change in the way of organizing the delivery of nursing care was seen more in terms of its potential for developing therapeutic relationships rather than in terms of personal professional development. Increased knowledge of and responsibility for specific patients coupled with the greater continuity of care they were able to provide, gave them greater job satisfaction than they had previously experienced.
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.
Journal of Advanced Nursing 15, 614-620 M A C G U I R E J . M . ( 2 0 0 6 ) M AC G U I R E J . M . ( 2 0 0 6 ) Journal of Advanced Nursing 53(1), 65-74Putting nursing research findings into practice: research utilization as an aspect of the management of change This paper discusses a number of different levels at which the implementation of nursing research findings needs to be addressed and identifies 10 areas of potential difficulty: the complexity of the change process, the genesis of research programmes, the formulation of research questions, differences in theoretical approaches, timescales and planning cycles, information overload, credibility, applicability, response to change and the management of change. An attempt is made to shift the nature of the discourse from the personal to the organizational and from a diffusionist perspective to that of change management. It is suggested that it is simplistic to regard the apparent lack of take-up of research-based practice findings as a failure on the part of individual nurses to respond rationally to the production of new information. The integration of research and practice has to be addressed at all levels within an organization; from policy statements to procedure manuals and from managers, educators and clinicians to support workers within the framework of the management of change. The potential of action research and quality circles in this context is touched on.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.