Michael Traynor

Research in nursing, midwifery, and the allied health professions: Quantum leap required for quality research

Although the United Kingdom invests almost £3.5bn (

Purity, Conversion and the Evidence Based Movements

5.5bn; €5.1bn) in medical research from public and private sources,1 73% of published research in nursing and 83% in occupational therapy remain unfunded.2 Underfunding in nursing and allied health professions is relative to that in comparable professions and to the size of their workforce. Recent reports indicate that nursing receives only 20% of that allocated to a national programme in teaching and learning of the Economic and Social Research Council. 2 3 Nurses, midwives, and members of the allied health professions represent two thirds of the staff responsible for direct care for patients, yet little is known of the clinical or cost effectiveness of the largest sector of care. For nurses, only 1482 research publications have appeared in eight years1; …

Increasing the impact of health services research

This article explores parallels between some aspects of the history of Judaeo Christianity and recent writing promoting evidence based medicine (EBM). Taking as a starting point Kristeva’s and Douglas’ investigations of Old Testament dietary regulation, it proposes that rigorous attention to research intake fulfils a similar symbolic function within these EBM texts as the strict dietary laws of Leviticus. It is noted that EBM texts also feature accounts of personal conversion central to evangelical religious discourse. The article examines two texts that promote EBM, published in 1991 and 1996, adopting a discourse analytic approach to identify the fundamental themes upon which these texts rely. While the earlier text features a harsh separation between wisdom and superstition, it is asked to what extent the more recent account of EBM, which appears to set up a new relationship between ‘external’ evidence and the realm of individual (professional) judgement, reflects one aspect of the new dispensation of the Christian New Testament and a movement away from strict dietary laws. It concludes that such parallels are only partial.

Indeterminacy and technicality revisited : how medicine and nursing have responded to the evidence based movement

A new report from the Health Foundation and Nuffield Trust suggests managers and policy makers are not able to base decisions about reforming health services on the best available evidence Improving quality and performance in the NHS requires a developmental approach that applies research to a planned process of change. Decision makers need many questions answering. How should clinical teams be organised and resourced to deliver higher quality, safer care? How could hospital environments be improved? How should local services be configured to ensure convenient access and optimal quality? And how can recruitment and retention of healthcare staff be enhanced? Despite clarity about the questions, decision makers feel they lack the research that would help them generate answers. So what can be done to improve the use of health service research? In 2002, the Health Foundation and the Nuffield Trust jointly commissioned a review of health services research in the United Kingdom.1 The aim was to examine how independent grant funders in health could enhance the contribution of health services research to improving services and policy making and to learn from the role of charitable foundations in other countries. Research for the review, conducted during January to August 2003, included interviews with 35 senior UK health services researchers, health service managers, policy makers, or research commissioners. It also included an analysis of case studies and a review of successful initiatives in the United States and Canada. The research showed that everyone involved with health services research is dissatisfied to some extent with the current research process, albeit from different perspectives (box 1). Improved hospital environments, such as this award-winning design (the new medical campus of the Norfolk and Norwich NHS Trust), are one result of the application of health services research ### Box 1: Perspectives on problem of health services research

Psychiatric Hospital Nursing Staff's Experiences of Participating in Group-Based Clinical Supervision: An Interview Study

In 1970 sociologists Jamous and Peloille proposed that occupational work could be understood as a combination of technical activity and indeterminate judgment and that the professions were characterised by high levels of indeterminacy relative to technicality. They argued that groups with low status or on the fringes of powerful professional groups were more likely to promote technically based reform, whereas elites were likely to resist with assertions of indeterminacy. Subsequent writers claimed that their notion of the indeterminacy/technicality ratio was more useful in analysis of professional ideology than in examinations of work content. During the 1990s the evidence based movement exerted a strong influence within the healthcare professions. Medicine and nursing responded in ways that reflected their differing status; however, both reactions included assertions that evidence based practice(EBP) could not take into account the subtle expertise required in daily clinical decision making. This paper argues that Jamous and Peloilles theories about technical reform and professional elites can help to explain responses to EBP. EBP was initially promoted by a relatively low-status speciality of medicine while nursing, as an emerging profession, has shown more enthusiasm for its activities being formalised in a technically based fashion.

Disciplinary processes and the management of poor performance among UK nurses: bad apple or systemic failure? A scoping study

Group-based clinical supervision is commonly offered as a stress-reducing intervention in psychiatric settings, but nurses often feel ambivalent about participating. This study aimed at exploring psychiatric nurses’ experiences of participating in group-based supervision and identifying psychosocial reasons for their ambivalence. Semi-structured interviews were conducted with 22 psychiatric nurses at a Danish university hospital. The results indicated that participation in clinical supervision was difficult for the nurses because of an uncomfortable exposure to the professional community. The sense of exposure was caused by the particular interactional organisation during the sessions, which brought to light pre-existing but covert conflicts among the nurses.

Caring after Francis: moral failure in nursing reconsidered:

The rise of managerialism within healthcare systems has been noted globally. This paper uses the findings of a scoping study to investigate the management of poor performance among nurses and midwives in the United Kingdom within this context. The management of poor performance among clinicians in the NHS has been seen as a significant policy problem. There has been a profound shift in the distribution of power between professional and managerial groups in many health systems globally. We examined literature published between 2000 and 10 to explore aspects of poor performance and its management. We used Web of Science, CINAHL, MEDLINE, British Nursing Index, HMIC, Cochrane Library and PubMed. Empirical data are limited but indicate that nurses and midwives are the clinical groups most likely to be suspended and that poor performance is often represented as an individual deficit. A focus on the individual as a source of trouble can serve as a distraction from more complex systematic problems.

Humanism and its critiques in nursing research literature.

This discussion paper considers recent nursing failures. Drawing on a selection of key literature and ongoing research, it argues that nursing failures are a possibly inevitable consequence of work in healthcare systems with their combination of cognitive, bureaucratic, professional and work-related pressures. It also argues that nursing has a residual tendency to be viewed as primarily character-based moral work and that this can encourage understandings of causes of failures and their solutions in similar terms, i.e. as moral failures of caring requiring recruitment of those with the appropriate characters. Drawing on ongoing research with those training for the profession at an English university, it suggests that while the profession focuses on the recruitment of those with a ‘caring’ orientation it has not developed an adequate explanation to support new recruits in understanding the causes of inadequate practice. This leaves those entering the profession without a strong model with which to understand their own work or its failures-what I refer to as ‘critical resilience’.

A systematic review of electrical stimulation for pressure ulcer prevention and treatment in people with spinal cord injuries

AIM This paper raises for debate the issue of how humanist ideas have been taken up by nurse scholars, particularly in research literature. BACKGROUND Many nurses from the mid-1970s onwards have described and promoted humanism as an appropriate philosophical basis for nursing practice and research. This has been partly in an attempt to sharply differentiate the profession from medicine, and later, managerialism, which have been represented as reductionist and failing to adequately respond to the whole patient. METHODS A summary of definitions of humanism and critiques of humanism in broad philosophical literature is followed by an examination and critique of literature appearing in PubMed published within nursing scholarship from 1976 to 2007 which discusses or promotes humanism in nursing practice or research. FINDINGS Writers have attempted to enhance the importance of nursing by associating it with the humanistic project of accepting responsibility for realizing our human potential. They have promoted a version of research which is qualitative and centres on understanding individual lifeworlds of research participants because of a strong valuing of the experiences and perspectives of the individual. Much of the literature on this topic describes this humanism in dualistic contrast to medico-scientific reductionism and objectivity. CONCLUSION Some of the presentations of humanistic nursing lack rigour and can be seen as doing little more than reproducing professional ideology. Scholars and others in the field of nursing could take the trouble to submit these ideologies to proper scrutiny.

Parallel vigilance: Parents’ dual focus following diagnosis of Type 1 diabetes mellitus in their young child

Abstract Context Electrical stimulation (ES) can confer benefit to pressure ulcer (PU) prevention and treatment in spinal cord injuries (SCIs). However, clinical guidelines regarding the use of ES for PU management in SCI remain limited. Objectives To critically appraise and synthesize the research evidence on ES for PU prevention and treatment in SCI. Method Review was limited to peer-reviewed studies published in English from 1970 to July 2013. Studies included randomized controlled trials (RCTs), non-RCTs, prospective cohort studies, case series, case control, and case report studies. Target population included adults with SCI. Interventions of any type of ES were accepted. Any outcome measuring effectiveness of PU prevention and treatment was included. Methodological quality was evaluated using established instruments. Results Twenty-seven studies were included, 9 of 27 studies were RCTs. Six RCTs were therapeutic trials. ES enhanced PU healing in all 11 therapeutic studies. Two types of ES modalities were identified in therapeutic studies (surface electrodes, anal probe), four types of modalities in preventive studies (surface electrodes, ES shorts, sacral anterior nerve root implant, neuromuscular ES implant). Conclusion The methodological quality of the studies was poor, in particular for prevention studies. A significant effect of ES on enhancement of PU healing is shown in limited Grade I evidence. The great variability in ES parameters, stimulating locations, and outcome measure leads to an inability to advocate any one standard approach for PU therapy or prevention. Future research is suggested to improve the design of ES devices, standardize ES parameters, and conduct more rigorous trials.