Jocalyn Lawler

Managing health care under New Public Management A Sisyphean challenge for nursing

The drive to reform the public health care system became a common feature of Australia’s political and economic landscape from the early 1980s. Health care reform in Australia has been underpinned by New Public Management (NPM) which was promoted as providing more transparent policy and empowering managers to manage service delivery. However, these claims are a fallacy and nursing and nursing care have been affected adversely and severely. General (generic) management structures have replaced established nursing management structures and the distance between politics (politicians) and health service managers has narrowed to the extent that there is now an unprecedented level of political interference in the daily management of health services, in direct contrast to the tenets of NPM. This article reports on the ‘reformed’ health care environment as experienced by nurse managers. They reported that their ability to manage nursing services and provide professional and clinical leadership has been seriously diminished, as has their work satisfaction, motivation and commitment. They also report uncertainty about their future as well as the future of nursing itself.

Recovery from disordered eating: what life histories reveal.

There are few studies seeking to understand the illness from the experiential perspective of a person who has recovered from an eating disorder. The clinical and research literature shows inconsistencies and varying degrees of support for the risk factors associated with eating disordered behaviour. It is important to note, however, that most contemporary research relies upon brief self-report questionnaires, which may be providing a fragmented picture of the behaviour. The focus of the current study is to gain a greater understanding of women’s perceptions of developing, living with and recovering from an eating disorder. This study reports interviews with five former eating disorder sufferers who were recruited via an advertisement placed in an Eating Disorders Support Network newsletter. Life histories were gathered from each woman and the paper reports how these women perceive the origins of their illness and what event(s) lead to their recovery. Participants’ narratives were analysed to elucidate themes pertaining to the lived experience of illness and recovery. The women talk about a lack of control of their lives and unrealistic family expectations as reasons for the development of their eating disordered behaviour. Recovery was very strongly related to self-determination and self-acceptance. Suggestions concerning new ways of conceptualising recovery from eating disordered behaviour are posited.

Development of a best practice model of midwifery-led antenatal care

Abstract The development and implementation of a model of midwifery-led antenatal care was the second phase of a larger project known as the Improving Patient Outcomes Project. The overall project aim was to demonstrate the effectiveness of evidencebased models and systems of care on improving patient outcomes. Survey results from local antenatal clinics had revealed an absence of evidence-based guidelines for the provision of antenatal midwifery care. Midwives and expert reviewers combined their experience to appraise the quality and relevance of currently available research evidence to develop a best practice model of antenatal care for low risk women in which the midwife is the lead antenatal care professional. The model offered a care plan for the pregnancy trimesters and outlined circumstances requiring referral to, or consultation with, a medical officer. In addition it offered women a flexible visit schedule and continuity of carer throughout the antenatal period. The methods used in this study may have general applicability to developing best practice models of antenatal care and for the validation of contemporary midwifery antenatal practice. The value of the model will be realised through its successful implementation by the midwifery profession and the evaluation of its effectiveness for women and their families.

TOPIC: The role of qualitative research in evidence based practice

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