Anne Mulhall

Assessing organisational readiness for change: use of diagnostic analysis prior to the implementation of a multidisciplinary assessment for acute stroke care

BackgroundAchieving evidence-based practice in health care is integral to the drive for quality improvement in the National Health Service in the UK. Encapsulated within this policy agenda are challenges inherent in leading and managing organisational change. Not least of these is the need to change the behaviours of individuals and groups in order to embed new practices. Such changes are set within a context of organisational culture that can present a number of barriers and facilitators to change. Diagnostic analysis has been recommended as a precursor to the implementation of change to enable such barriers and facilitators to be identified and a targeted implementation strategy developed. Although diagnostic analysis is recommended, there is a paucity of advice on appropriate methods to use. This paper addresses the paucity and builds on previous work by recommending a mixed method approach to diagnostic analysis comprising both quantitative and qualitative data.MethodsTwenty staff members with strategic accountability for stroke care were purposively sampled to take part in semi-structured interviews. Six recently discharged patients were also interviewed. Focus groups were conducted with one group of registered ward-based nurses (n = 5) and three specialist registrars (n = 3) purposively selected for their interest in stroke care. All professional staff on the study wards were sent the Team Climate Inventory questionnaire (n = 206). This elicited a response rate of 72% (n = 148).ResultsA number of facilitators for change were identified, including stakeholder support, organisational commitment to education, strong team climate in some teams, exemplars of past successful organisational change, and positive working environments. A number of barriers were also identified, including: unidisciplinary assessment/recording practices, varying in structure and evidence-base; weak team climate in some teams; negative exemplars of organisational change; and uncertainty created by impending organisational merger.ConclusionThis study built on previous research by proposing a mixed method approach for diagnostic analysis. The combination of qualitative and quantitative data were able to capture multiple perspectives on barriers and facilitators to change. These data informed the tailoring of the implementation strategy to the specific needs of the Trust.

Cultural discourse and the myth of stress in nursing and medicine

Nursing has within the last 20 years firmly embraced the idea that practice should be based on substantive research. Yet many of the issues with which modern nursing is grappling encompass complex multifaceted aspects which are difficult to conceptualise or define. Stress is one such concept which has been increasingly invoked in both health care and lay discourses as an explanation for illness and general misfortune. A number of models of stress have been proposed which have to a greater, or lesser extent also been adopted by the lay public. In many respects nursing models of health and illness have more in common with lay, rather than biomedical, conceptualisations of illness aetiology. However, it is unclear to what extent nursing, lay and biomedical ideas about stress overlap. This paper attempts to explore some of these issues by describing the semantic origins of stress and the ways in which it is conceptualised and invoked in both the professional and lay discourse. The many approaches to stress research are explored and some of the constraints pertaining to them discussed. The question is also raised as to why certain discourses on stress have arisen within particular professional domains, and why the nursing contribution to stress research has been marginalised. An ideological component to the stress discourse is identified, and the importance of nursing and other professional disciplines recognising this, and also those macro-level factors which may affect health and illness, is stressed.

Anthropology, nursing and midwifery : a natural alliance ?

Anthropology, and its supposed operationalisation within transcultural nursing, is becoming increasingly prominent in educational curricula in the U.K. This increase in interest is driven both by governmental pressure to provide more culturally appropriate care, and an intuitive notion that anthropology, nursing and other related professions such as midwifery have a common basis of mutually overlapping and re-enforcing theory and practice. This paper explores the question of whether there is a natural alliance between anthropology, and the applied aspects of health care disciplines such as nursing and midwifery, by examining some of the concepts underlying each discipline, and the ways in which these concepts are applied in practice. Anthropology is the study of culture, and it is suggested that a more complete understanding of this central concept is essential if it is to be utilised in the applied disciplines encompassed by the practice of nursing and midwifery.