‘The more things change the more they stay the same’: factors affecting the implementation of the nursing process

Abstract

One of the biggest problems currently facing the nursing profession is that of implementing the nursing process. Innovations in health care often elicit obstructions, and objective data which might help us to understand and overcome these implementation problems are lacking. The present study considered these problems by contrasting two groups of psychiatric nurses both of whom had received an in-service course in behaviour therapy. One group went on to implement this training by conducting behavioural nursing care plans with their patients, whereas the second group did not do so. A retrospective analysis of 25 variables associated with these groups of nurses indicated that neither subject variables, test scores nor learning during the course were good predictors of the nurses' implementations of the nursing process. An alternative basis for predicting and facilitating implementation is discussed. This focuses on institutional variables which may exert more control over the use of the nursing process than the personal characteristics of individual nurses. The implications of this analysis are important for the selection, training and motivation of nurses.

The Tradition of Toughness: A Study of Nonprofessional Nursing Care in Psychiatric Settings

“…Both issues continue to be of primary concern to psychiatric nursing. The results of this study as well as that of Milne's (1985) suggest that nursing care is dependent more on the hospital's prevailing ideology and less on personal attributes of its nursing staff.…”

“…However, only a few researchers continued the study of authoritarianism to show that clinical effectiveness (Canter) and excessive dependence on physical intervention strategies were influenced by the level of authoritarianism (Scott & Philip, 1985). In a study of 55 psychiatric nurses, Milne (1985) found no relationship between personality variables and job performance and concluded that institutional variables may exert more control over job performance than personality correlates. These findings suggest that the degree of authoritarianism may be primarily determined by the setting and not by individual personalities.…”

Record‐keeping and routine nursing practice: the view from the wards

“…The traditional response to organizational failure is to blame the individuals concerned and to call for additional education and training (see for example, Bowman et al 1983 ). However, as a number of authors have pointed out, the disappointments of the nursing process may more accurately attributed to its failure to take account of the fundamental nature of nursing work in a complex organization such as the modern hospital ( de la Cuesta 1983; Milne 1985, Melia 1987, Keyzer 1988). Walton (1986) raises the issue of whether the nursing process was simply asking too much of nurses.…”

“…Moreover, for nursing staff, the relationship of the care accurately attributed to its failure to take account of the fundamental nature of nursing work in a complex organiz-plan to the welfare of the patient was far from clear. Care plans were regarded as imposed formalities to be filled in ation such as the modern hospital (de la Cuesta 1983; Milne 1985, Melia 1987, Keyzer 1988). Walton (1986) when time was left to do them, something for administrative rather than practical purposes.…”

Staff Members' Beliefs About Seclusion and Restraint in Child Psychiatric Hospitals

“…This represents a significant gap in our understanding of aggression management in child psychiatric facilities, as compared with a considerable body of literature related to adult patients. The latter demonstrates that institutional variablesincluding generally held attributions about psychiatric symptomatology, values, standards of practice, rules, social norms, and performance expectations of staff and patientsexert significant influence on the management of aggression (Goffman, 1961;Milne, 1985;Stanton & Schwartz, 1954;Stotland & Kobler, 1965).…”