Kathryn L. Jones

Nurse prescribing roles in acute care: an evaluative case study

AIM This paper is a report of an evaluation of the implementation of nurse prescribing in an acute care hospital in England. BACKGROUND At the time of the study, evaluation of nurse prescribing had taken place in community settings, but little was known about its impact and effectiveness in acute care. Although nurse prescribing has permitted doctor-nurse substitution in acute episodic care, some doctors have expressed concerns about patient safety in relation to nurse prescribing. METHODS A mixed methods single-case study was conducted in 2005-06, using purposive sampling. Semi-structured interviews were carried out with 18 hospital staff, non-participant observation of two nurses and two doctors undertaking 52 patient-prescriber consultations with 47 patients, and a questionnaire survey with 122 patients (response rate 61%: n=74). RESULTS Nurse prescribing was found to benefit patients through service delivery improvement and using staff skills differently. Nurse prescribers and their colleagues were positive about role and service changes and their impact on patient care. No differences were found between the ways in which nurses and doctors performed prescribing roles, but there was a statistically significant difference between the medication-related information satisfaction ratings of patients who had seen a nurse prescriber, compared to those seen by a doctor. CONCLUSION Nurses and doctors were found to provide equivalent care. Shared vision, local champions, action learning and peer support were the enabling factors that helped to embed the new prescribing roles within the study site.

Influencing the national policy process: the role of health consumer groups.

Introduction  Whilst recent research has focused on consumer involvement at local level in the UK, there have been few studies of the representation of user, carer and patients’ interests nationally. This paper concentrates on the role of health consumer groups in representing the collective interests of patients, users and carers in the national policy process.

Encountering Globalization: Professional Groups in an International Context

The market for professional services is increasingly international but comparisons have not been made between different professions nor on how state policies affect opportunities for mobility. This article considers three professions: engineers, physicians and psychologists and explores the similarities and differences in international labour market demand for occupations. It examines how state policies in four countries, Canada, Finland, France and the UK, aim to promote and control professional labour mobility and migration, and the differences across the three professions. Engineering is an international profession and the extent to which states encourage inward migration differs. Medicine is highly regulated in all four countries but inward migration of physicians varies depending on national policy. Psychologists are less mobile, and the extent of state sponsorship and regulation varies across countries. In all three professions, international organizations are a force encouraging global standards. The conclusion is that state policies reflect state interests and have a strong influence on patterns of mobility.

Withering the citizen, managing the consumer: complaints in healthcare settings

This paper considers concepts of citizenship and consumerism in light of complaints about healthcare, which have risen since the early1990s, due to a greater willingness by the healthcare user to complain, and also the reforms in complaint systems. The narrow legal model for dealing with complaints has been replaced by a managerial model based on corporate sector practice that views complaint handling as a way of retaining customers and organisational learning. The managerial model has proved difficult to embed into the English NHS and has been superposed with a centralised regulatory system that aims to manage performance while also being responsible for reviewing, complaints and being responsive to complainants. It is argued that this may have positive consequences in terms of improving healthcare quality but more negatively, the promotion of consumerism within complaints processes has led to a loss of the right to due process and public accountability.

Health, lifestyle, belief and knowledge differences between two ethnic groups with specific reference to tobacco, diet and physical activity

AIMS   To compare physical activity levels, body mass index, habitual diet, tobacco use and prevalence of non-communicable disease between the two ethnic groups and to identify predictors for differences between groups. BACKGROUND   Tobacco use, poor diet and physical inactivity are major lifestyle risk factors for chronic cardiovascular diseases, certain cancers, diabetes and chronic lung diseases. There are higher risk and incidence of these diseases in some ethnic groups, for example Asians have higher incidence of diabetes. DESIGN   Cross sectional survey. METHODS   Cross sectional survey of Asians of Indian descent and white British adults conducted between October-December 2009. Main outcome variables were lifestyle behaviours and BMI. Self-reported disease diagnosis was also collected. In a regression analysis, predictors of outcome variables were demographic variables and beliefs/attitudes/knowledge towards lifestyle behaviours. RESULTS/FINDINGS   Body mass index, tobacco use and non-communicable disease (except diabetes) were lower in Indians. Indians reported lower physical activity levels and greater salt use than Whites. Tobacco use was higher in Whites, but knowledge, attitudes and beliefs were similar between Whites and Indians. CONCLUSION   Health risk behaviour and morbidity are different between the two ethnic groups. Gender, age, educational level, beliefs, attitudes and knowledge do not explain these differences. Health promotion that aims to improve knowledge will probably not work and innovative methods are needed to improve health in high risk groups.

An exploration of the working life and role of the ward manager within an acute care hospital organisation

The ward manager’s role is a complex one that involves meeting financial targets, responding to changes in organisational structures and ensuring the delivery of quality patient care. Whilst the ward manager’s role remains key to service delivery, there has been limited research on the current role from the perspective of ward managers. A survey of ward managers, exploring aspects of their working lives and potential enablers of the ward manager role, is described. The variety of activities within the role was a source of job satisfaction despite the challenge of ‘keeping on top of everything’. Potential role enablers included having protected time for the managerial aspects of the role. The study findings indicate the need to understand the role of the ward manager with particular reference to job satisfaction, and the underpinning support required to enable ward managers to execute the role effectively.

Building Alliances: Incentives and Impediments in the UK Health Consumer Group Sector

This paper addresses the incentives and impediments to alliance formation in the UK health consumer group sector. Research funded by the Economic and Social Research Council shows that links between groups are extensive and highly valued. However, they take place in the context of competition for resources and influence within New Labours reform agenda. Drawing on theories from sociology and political science this paper shows how in recent years the working environment of groups has shaped cooperation. However, alliance working carries opportunity costs and doubts remain about their ability to survive once these external stimuli disappear.

Representing Whom? U.K. Health Consumer and Patients’ Organizations in the Policy Process

This paper draws on nearly two decades of research on health consumer and patients’ organizations (HCPOs) in the United Kingdom. In particular, it addresses questions of representation and legitimacy in the health policy process. HCPOs claim to represent the collective interests of patients and others such as relatives and carers. At times they also make claims to represent the wider public interest. Employing Pitkin’s classic typology of formalistic, descriptive, symbolic, and substantive representation, the paper explores how and in what sense HCPOs represent their constituencies. We found that policymakers themselves are less concerned with formal mechanisms adopted by groups and are more concerned with credibility, in particular whether HCPOs carry the confidence of their constituents. While some concerns about legitimacy remain, particularly in relation to funding from commercial interests, we argue that HCPOs bring a unique perspective to the policy process and to focus purely on formalistic representation provides only a partial understanding of their representative role and a constrained view of their collective moral claims.

The literature review

Any part of this publication may be copied, reproduced or adapted to meet local needs, without permission from the authors, provided the parts reproduced are distributed free, or at cost and not for commercial ends, and the source is fully acknowledged as given below. Please send copies of any materials in which text or illustrations have been used to WEDC Publications at the address given overleaf. (2002) Water supply and sanitation access and use by physically disabled people: literature review. WEDC, Loughborough University, UK. This document is an output from a project funded by the UK Department for International Development (DFID) for the benefit of low-income countries. The views expressed are not necessarily those of DFID. Designed and produced at WEDC. iii Acknowledgements The authors would like to thank the following for their valuable contributions to this publication: Barbara Dobson from the Centre for Research in Social Policy, Loughborough University, for guidance and comments on Chapter 3. Advisory Panel members for comments: Heather Payne, Healthlink Worldwide UK, for remedying omissions, constructive comments and proofreading of the final draft. Adam Platt, Helpage International, for additional references and up-to-date research findings. for supplying video images on which the cover illustration was based. iv Contents List of acronyms vii 1. Introduction 1 1.1 Scope of the review 1 1.2 Background context 1 1.2.1 Human rights 2 1.2.2 The social model of disability 3 1.2.3 Poverty and disability 3 1.2.4 Economics 4 1.2.5 Mainstreaming 5 1.2.6 Disability in different cultures 6 1.3 Problem statement 6 1.4 Purpose of research, review, methodology, limitations 7 1.5 Definitions of some concepts and terms used in this study 7 1.5.1 Physical disabilities: 7 1.5.2 Domestic water cycle 8 1.5.3 Access/accessibility 8 1.5.4 Low-income communities 8 1.6 Report structure and format 8