Paul Regan

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.

Reflective insights on group clinical supervision; understanding transference in the nursing context

Reflecting on group theory within clinical supervision offers useful vantage points from which to engage nursing and the helping professions in the task of supervisory practice. This paper presents reflective experiences of group clinical supervision training and practice through a critique of Hawkins and Shohet’s process centred model. The underlying premise of transference hypothesis is that experiences and memories from the past inform present behaviours. Little has been written about the hypothesis in relation to clinical supervision in nursing and the helping professions. However, the hypothesis was criticised by John M. Shlien in the 1980s and remains pertinent today due to expansion into social and healthcare practice. Reflective autobiographical diary entries focus on the model’s two latter stages which propose the use of Sigmund Freud’s transference hypothesis. The work of Freud, Foulkes, Heidegger and Hawkins and Shohet are synthesised and conclude with a phenomenological suggestion that immediacy and openness are necessary ontological conditions for group clinical supervision. Valuing empathic attunement to better understand group clinical supervision may be more important than theoretical distractions for non-therapeutic clinical supervision practice

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.

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.

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.