Elaine Ball

Breastfeeding Mothers’ Experiences The Ghost in the Machine

We critically review qualitative research studies conducted from 2000 to 2012 exploring Western mothers’ breastfeeding experiences. We used the search criteria “breastfeeding,” “qualitative,” and “experiences” to retrieve 74 qualitative research studies, which were reduced to 28 when the terms “existential’’ and “research’’ were applied. We found that the impact of technology and the pervasive worldwide marketing of infant formula devalued breastfeeding mothers’ narratives in a number of ways. Women’s bodies were viewed as machine-like objects and the breast was seen as a disembodied object. Dominated by technological narrative, women’s bodies were considered unpredictable and hormonal, needing to be managed by health care professionals. This means the disseminating breastfeeding discourse needs to be reinterpreted for practical use. We found that some of the researchers utilized narrative informed by phenomenological philosophy that appears to edge closer to understanding mothers’ experiences in a more profound way than nonphenomenological research. However, we need to be mindful of the transparency of terms in replacing one form of technological narrative with another.

Plethora or paucity: a systematic search and bibliometric study of the application and design of qualitative methods in nursing research 2008-2010.

Qualitative methodology has increased in application and acceptability in all research disciplines. In nursing, it is appropriate that a plethora of qualitative methods can be found as nurses pose real-world questions to clinical, cultural and ethical issues of patient care (Johnson, 2007; Long and Johnson, 2007), yet the methods nurses readily use in pursuit of answers remains under intense scrutiny. One of the problems with qualitative methodology for nursing research is its place in the hierarchy of evidence (HOE); another is its comparison to the positivist constructs of what constitutes good research and the measurement of qualitative research against this. In order to position and strengthen its evidence base, nursing may well seek to distance itself from a qualitative perspective and utilise methods at the top of the HOE; yet given the relation of qualitative methods to nursing this would constrain rather than broaden the profession in search of answers and an evidence base. The comparison between qualitative and quantitative can be both mutually exclusive and rhetorical, by shifting the comparison this study takes a more reflexive position and critically appraises qualitative methods against the standards set by qualitative researchers. By comparing the design and application of qualitative methods in nursing over a two year period, the study examined how qualitative stands up to independent rather than comparative scrutiny. For the methods, a four-step mixed methods approach newly constructed by the first author was used to define the scope of the research question and develop inclusion criteria. 2. Synthesis tables were constructed to organise data, 3. Bibliometrics configured data. 4. Studies selected for inclusion in the review were critically appraised using a critical interpretive synthesis (Dixon-Woods et al., 2006). The paper outlines the research process as well as findings. Results showed of the 240 papers analysed, 27% used ad hoc or no references to qualitative; methodological terms such as thematic analysis or constant comparative methods were used inconsistently; qualitative was a catch-all panacea rather than a methodology with well-argued terms or contextual definition.

Change and the NHS workforce: Ambivalence, anxiety and anger

Working in a healthcare system defined by change necessitates, at the least, some degree of intermittent observation. Being commited to change to ensure delivery of 21st century care asks for much more. It means trusting and believing in change. Yet sometimes change in the National Health Service evokes amongst staff a view that reforms are not always thought through from implementation to evaluation, and are determined by overriding political agendas which results in NHS users are exhibiting an ambivalent or anxious response to change measures (Wallace & Taylor-Gooby 2009). As a result, implementation can be hampered; and impacts further when a sense of mistrust is inculcated within an institution and change is viewed skeptically (Greener & Martin Powell 2008). This is not helped when reform from 2007-2009 came with job freezes and financial budgeting deficits, rather than reform to improve quality (Peters 2009; Craig & Adams 2007). Such strategies may or may-not have long-term cost effective outcomes, but what worries practitioners is that a reduction in the provision of services made available to patients might ensue (White 2008). It is feared that the tension between quality and budgeting constraints will only increase in the current climate. It is therefore timely that change is debated when reform frameworks and market-style initiatives are in such proliferation.

An analysis of delegation styles among newly qualified nurses

Aim The aim of this research was to explore how newly qualified nurses learn to organise, delegate and supervise care in hospital wards when working with and supervising healthcare assistants. It was part of a wider UK research project to explore how newly qualified nurses recontextualise the knowledge they have gained during their pre-registration nurse education programmes for use in clinical practice. Method Ethnographic case studies were conducted in three hospital sites in England. Data collection methods included participant observations and semi-structured interviews with newly qualified nurses, healthcare assistants and ward managers. A thematic analysis was used to examine the data collected. Findings Five styles of how newly qualified nurses delegated care to healthcare assistants were identified: the do-it-all nurse, who completes most of the work themselves; the justifier, who over-explains the reasons for decisions and is sometimes defensive; the buddy, who wants to be everybodys friend and avoids assuming authority; the role model, who hopes that others will copy their best practice but has no way of ensuring how; and the inspector, who is acutely aware of their accountability and constantly checks the work of others. Conclusion Newly qualified nurses require educational and organisational support to develop safe and effective delegation skills, because suboptimal or no delegation can have negative effects on patient safety and care.

A critical commentary on management science in relation to reforms after institutional National Health Service failures

AIM(S) A discussion paper on the United Kingdom (UK) National Health Service (NHS) market reforms. BACKGROUND NHS market reforms reliance on management science methods introduced a fundamental shift in measuring care for commissioning. EVALUATION A number of key reports are discussed in relation to NHS market reforms and management science. KEY ISSUES NHS market reforms were influenced through a close alliance between policy makers, the department of health, free market think tanks and management consultancies. The timing of reforms coincided with reports on NHS failings and the evolution of measurement methods to focus on finance. CONCLUSIONS The balance in favour of measurement practises is of concern. Management science methods are criticised in the Francis Report yet promoted as the solution to some of the key findings; why may be explained by the close alliance. IMPLICATIONS FOR NURSING MANAGEMENT A return to principles of management involving consensus, trust and involvement to promote quality care and use management science methods to this end.

Putting knowledge to work in clinical practice : understanding experiences of preceptorship as outcomes of interconnected domains of learning

AIMS AND OBJECTIVES To explore how preceptor support can assist newly qualified nurses to put knowledge to work across interconnected forms of knowledge when delegating to healthcare assistants. BACKGROUND Current literature on preceptorship in nursing has failed to explore how competence is underpinned by knowledge frameworks in clinical practice. DESIGN An ethnographic case study in three hospital sites in England (2011-2014). METHODS Data collection included participant observation, interviews with 33 newly qualified nurses, 10 healthcare assistants and 12 ward managers. Data were analysed using thematic analysis. A tool to assist newly qualified nurses to delegate and supervise newly qualified nurses during the preceptorship period was developed and piloted with thirteen newly qualified nurses in the same sites. A process evaluation was undertaken. FINDINGS Focusing on a key task for newly qualified nurses, delegation to healthcare assistants, we argue that preceptorship can support newly qualified nurses as they put knowledge to work in the transition from qualifying student to newly qualified nurses. In supportive ward cultures, limited access to formal preceptorship can be bolstered by team support. newly qualified nurses in less supportive ward cultures may have both a greater need for preceptorship and fewer compensatory mechanisms available to them when formal preceptorship is not available. We argue that organisational learning contexts and individual learning styles (interconnected domains of learning) are key to understanding effective preceptorship. CONCLUSIONS We suggest that putting knowledge to work early in their careers with preceptorship support may assist newly qualified nurses to develop confidence and competence in delegation and supervision of healthcare assistants. RELEVANCE TO CLINICAL PRACTICE Our findings suggest that newly qualified nurses need to be supported by effective preceptorship in their learning as they transition from undergraduate to post graduate. Preceptorship programmes at ward and organisational level need to recognise the intensity of the learning required during this transition phase.

Borrowing against the future: the response to the public consultation on the NHS bursary

This paper discusses the UK Governments public consultation into the NHS bursary and the response from the Nursing and Midwifery Council. A public consultation stipulated that the current arrangements for funding, by the State, were not to be considered for discussion. Instead, the consultation only appraised views that would lead to the successful introduction of student finance loans for NHS professional education. Testimonies from nurses, midwives and nursing students expressed concern that the new funding arrangements were unaffordable, dis-incentivising and biased towards the marketisation of student loans in the UK, yet the changes went ahead. The changes to NHS bursary funding resulted from the UK Governments desire for growth in student numbers (and ostensibly not growth in financial figures), and the fact that nursing (and other healthcare) students will become more fiscally indebted, despite societys moral obligation to them.

NHS market liberalisation and the TTIP agreement

Governments over the past three decades have undermined the founding principles of the NHS through reforms and market liberalisation. With greater involvement of commercial interests in health care, the NHS will become less democratic and transparent. Recent reforms, which were intended to improve productivity, quality and cost efficiency, have left the NHS exposed to the unwieldy model of market liberalisation and the attrition of public health care. The role of community nurses has been particularly destabilised by commissioning, as their work is difficult to measure. The advent of the Transatlantic Trade and Investment Partnership could further undermine the NHS to the benefit of international commercial interests.