Nursing
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Item Evaluating the impact of a new pay agreement on New Zealand nursing(Wiley-Blackwell, 2009) Buchan, James; North, N.Aim: This paper examines the labour market impact of a new national pay award for nurses implemented in New Zealand in 2004/5 - the Multi-Employer Collective Agreement (MECA). Background: The health system in New Zealand is unusual in that, while retaining a public sector system, the focus of pay determination for nurses over the last 20 years has shifted first from national to local pay determination, and then more recently reversed this trend, moving back to a national level pay determination. The shift back to a national pay determination approach in 2004/5 is therefore worthy of examination, both in terms of its labour market impact, and as a case study in the use of national level pay determination. Methods: The research was conducted in 2007-8. A rapid appraisal method was used, based on key stakeholder interviews, a document and literature review and a review and analysis of available data on the New Zealand nurse labour market, and trends in application rates to schools of nursing were assessed. In addition, interviews with managers of two District Health Boards, and interviews with five non-government employers of nurses, were conducted. Results: Indicators pointing to improvements included: steady (though not rapid) growth in staff numbers; reduced difficulty in recruiting; reduced vacancy rates; and increased application rates to schools of nursing. Managers interviewed in the study supported these positive indications, but some health-care employers not covered by the pay award reported negative knock-on effects (e.g. needing to match DHB rates, increased retention and recruitment difficulties). Conclusions: Available nurse labour market data provide an incomplete but compelling picture of the positive impacts of the MECA in a period of a very tight labour market. While much of the content of the 2004/5 agreement could be characterized as a 'normal' pay bargaining contract, there were also issues that differentiated it from the norm. In particular, it included an agreement to establish a safe staffing commission to assess the impact and implications of low staffing levels, nursing workload, and to establish guidelines on safe staffing and healthy workplaces. 2009 International Council of Nurses.Item Living in limbo -- patients with cystic fibrosis waiting for transplant(2006-05-25) MacDonald, KathLung transplant for patients with end-stage cystic fibrosis (CF) in the UK is recognized as the only successful treatment for CF patients with advanced lung disease. This study uses an exploratory approach to examine how patients with CF and their carers cope with the rigours of chronic illness and life on a transplant waiting list. Eight patients with CF, four awaiting transplant and four who had been transplanted within the previous 3years, along with five of their carers, were asked to recount their experiences using a semi-structured interview technique. Four themes emerged from the interview data; displacement, disorder, life in limbo and readjustment to wellness. Support appears to be particularly important to patients and families after false alarms occur, and upon return home after transplant. The small sample size precludes generalization of the results to all patients with CF but gives an in-depth insight into the lived experience of waiting for transplant.Item Sinking feeling.(RCN Publishing, 2009-06-24) Buchan, JamesAs the pound's value plunges, more nurses want to leave the UK, and fewer want to arrive.Item Dealing with chaos and complexity: the reality of interviewing children and families in their own homes(Blackwell Publishing Ltd, 2008) MacDonald, Kath; Greggans, AlisonAims. The aim of this paper is to share our experiences of dealing with chaos and complexity in interview situations in the home with children and young people. We highlight dilemmas relevant to dealing with multiple interruptions, building a rapport, consent and confidentiality. Furthermore, we discuss issues regarding the locus of power and control and offer some solutions based on our experiences. Background. Creating a safe environment is essential for qualitative research. Participants are more likely to open up and communicate if they feel safe, comfortable and relaxed. We conclude that interviewing parents and their children with cystic fibrosis in their own homes, is chaotic and appears to threaten the rigour of data collection processes. Limited attention or print space is paid to this issue, with published articles frequently sanitising the messiness of real world qualitative research. Design. Position paper. Methods. In this position paper, we use two case studies to illustrate ethical and pragmatic challenges of interviewing out in the field. These case studies, typical of families we encountered, help emphasise the concerns we had in balancing researcher-participant rapport with the quality of the research process. Conclusions. Dealing with perceived chaos is hard in reality, but capturing it is part of the complexity of qualitative enquiry. The context is interdependent with children's perceived reality, because they communicate with others through their environment. Relevance to practice. This paper gives researchers an insight into the tensions of operating out in the field and helps raise the importance of the environmental 'chaos' in revealing significant issues relevant to peoples daily lives. Knowing that unexpected chaos is part and parcel of qualitative research, will equip researchers with skills fundamental for balancing the well being of all those involved with the quality of the research process.Item The impact of health facilities on healthcare workers' well-being and performance(2009-07) Rechel, Bernd; Buchan, James; McKee, MartinThe impact of health facilities on patients has been extensively researched. Yet, while there is a growing recognition of the need for healthy working environments, little is known about how health facilities affect the staff working in them. This paper explores how the design of health facilities impacts on the well-being and performance of healthcare workers. The article is based on a review of published literature, identified through PubMed and Google, as well as through searches of websites of relevant organizations. Many traditionally designed health facilities seem to impact negatively on the well-being of healthcare workers, as well as on staff recruitment, retention and performance. Better-designed health facilities can improve working conditions and staff safety, and enable staff to do their job more efficiently. The needs of healthcare workers should be taken into account at the initial design stage of health facilities, ideally though direct involvement or meaningful consultation. 2008 Elsevier Ltd. All rights reserved.Item Assessing the impact of a new health sector pay system upon NHS staff in England(BioMed Central, 2008-06-30) Buchan, James; Evans, DavidBackground: Pay and pay systems are a critical element in any health sector human resource strategy. Changing a pay system can be one strategy to achieve or sustain organizational change. This paper reports on the design and implementation of a completely new pay system in the National Health Service (NHS) in England. 'Agenda for Change' constituted the largest-ever attempt to introduce a new pay system in the UK public services, covering more than one million staff. Its objectives were to improve the delivery of patient care as well as enhance staff recruitment, retention and motivation, and to facilitate new ways of working. Methods: This study was the first independent assessment of the impact of Agenda for Change at a local and national level. The methods used in the research were a literature review; review of 'grey' unpublished documentation provided by key stakeholders in the process; analysis of available data; interviews with key national informants (representing government, employers and trade unions), and case studies conducted with senior human resource managers in ten NHS hospitals in England Results: Most of the NHS trust managers interviewed were in favour of Agenda for Change, believing it would assist in delivering improvements in patient care and staff experience. The main benefits highlighted were: 'fairness', moving different staff groups on to harmonized conditions; equal pay claim 'protection'; and scope to introduce new roles and working practices. Conclusion: Agenda for Change took several years to design, and has only recently been implemented. Its very scale and central importance to NHS costs and delivery of care argues for a full assessment at an early stage so that lessons can be learned and any necessary changes made. This paper highlights weaknesses in evaluation and limitations in progress. The absence of systematically derived and applied impact indicators makes it difficult to assess impact and impact variations. Similarly, the lack of any full and systematic evaluation constrained the overall potential for Agenda for Change to deliver improvements to the NHS.Item The Adventures of Super Nurse: using technology to enhance student engagement in nursing curriculum(2009-11-27) MacDonald, KathThe Nature of Nursing module aims to help students' to develop a professional identity that is principle and theory based. The module addresses the elements of nursing's metaparadigm; nursing knowledge, professional issues and promoting health,augmented by theories of communication, which are core to the profession. At the end of the module students were asked to think creatively to portray in groups their understanding of the Nature of Nursing. We present one group's depiction.Item The relationship between socio-economic status and lexical development(Taylor & Francis, 2008-04) Black, Esther; Peppé, Sue JE; Gibbon, FionaThe British Picture Vocabulary Scale, second edition (BPVS-II), a measure of receptive vocabulary, is widely used by speech and language therapists and researchers into speech and language disorders, as an indicator of language delay, but it has frequently been suggested that receptive vocabulary may be more associated with socio-economic status. Studies on this topic have produced conflicting results. This study reviews the literature and tests the hypothesis that receptive vocabulary is associated with socio-economic status. The BPVS-II was administered to 76 typically-developing children aged 4 to 11, classified according to deprivation category, in Edinburgh, Scotland. The results showed no significant correlation between the two measures. Error patterns within the results are examined to discover why there should be discrepancy between them and the findings of other studies. The interaction between word frequency and the items used in the BPVS-II is examined, and implications for the use of the BPVS-II with all children of primary school age are discussed.Item A response to Haigh (2005): Where are the keynote debates in nurse education?(Elsevier, 2006-01) Munro, KathleenHaigh (2005) asserted that 'there is no strong element of debate detectable in the discipline of nurse education' and presented four hypotheses to justify her stance. In many respects, it could be argued that she is correct as there is little apparent evidence of literary debate between nurse education authors, unlike the established practice of philosophy of education scholars in relation to general and liberal education.Item Healthcare graduates for the 21st century; Knowledge and attitudes relating to alcohol and brief interventions.(2009-11-27) Gill, Jan; Nicol, Maggie; Gibson, Caroline; O'May, FionaFinal year students studying a variety of healthcare courses (involving inter-professional education), at six Scottish universities completed a questionnaire (spring 2009). While changes in current health policy endorse graduate attributes promoting shared responsibility, an overlapping of roles, analysis of findings revealed differences between the professions in terms of level of understanding of health guidelines, acceptance of role and perceived confidence in personal knowledge relating to alcohol misuse. Two professions were predominantly viewed as key to this area of practice only by their own students (OT and pharmacy) while three (speech and language, radiography, dietetics) doubted the importance of their role.