Susan McLaren

‘The tender trap’: gender, part‐time nursing and the effects of ‘family‐friendly’ policies on career advancement

With the Government promoting flexible and ‘family-friendly’ policies within the NHS, an increase in the number of part-time nurses is imminent, particularly in view of current pro-active recruitment drives in this area. Research, however, indicates that it is mainly female employees who continue to utilise such policies with few male nurses employed on a part-time or flexible basis. Working part-time and taking career breaks, usually because of caring commitments, results in female nurses falling behind male colleagues in terms of career development and promotion prospects, with managers selecting males over females (particularly those who work part-time) regarding functional role allocation in the hospital setting. Based on a recent study of full-time and part-time nurses and their managers in three Outer London NHS Trusts, this paper argues that so-called ‘family-friendly’ policies must target both sexes and that the underlying attitudes of men to childcare and the domestic division of labour must change before the sexes can compete on equal terms in the workplace. Until this happens men will continue to advance the development of their nursing careers more rapidly than women. Already, in a female-dominated area of employment, male nurses form a disproportionate percentage of those in higher grades and management posts.

Nutritional support in acute stroke: the impact of evidence-based guidelines

BACKGROUND AND AIMS Stroke patients experience multiple impairments which impair ability to eat and render them vulnerable to the deleterious sequelae of malnutrition. This study aimed to develop, implement and evaluate evidence-based guidelines for nutrition support following acute stroke using a multifaceted change management strategy. METHODS Prospective quasi-experimental design. Documentation of two groups of 200 acute stroke patients admitted to medical and care of the elderly wards of an acute NHS Trust in South London was surveyed using a checklist before and after implementation of 24 guidelines for nutritional screening, assessment and support. Guidelines were based on systematic literature review and developed by consensus in a nurse-led multiprofessional group; implemented via a context-specific, multifaceted strategy including opinion leaders and educational programmes linked to audit and feedback. STAFF OUTCOMES: Compliance with guidelines by doctors, nurses, therapists. PATIENT OUTCOMES Changes in Barthel Index scores and Body Mass Index in hospital, infective complications, length of stay, discharge destination. RESULTS Statistically significant improvements in compliance with 15 guidelines occurred in the post-test group. Infective episodes showed a significant reduction in the post-test group but other patient outcomes were unaffected. CONCLUSIONS Implementation of evidence-based guidelines for nutritional support following acute stroke using a multifaceted strategy was associated with improvements in documented practice and selected patient outcomes.

Partnerships for changing practice: Lessons from South Thames Evidence-based Practice project (STEP)

Partnership working is central to the rubric of contemporary health policy. This paper discusses and analyses the STEP partnership model and the issues emerging for academic and service coalitions, which were formed for the purpose of implementing evidence-based practice in nine clinical centres. Using a framework for collaboration, key themes for successful partnerships are summarised in a model as contextual factors: articulating a clear purpose, identifying the capacity to collaborate, ensuring wide organisational ownership, nurturing fragile relationships and securing collaborative, mutually beneficial outcomes. The paper focuses on the experience of setting up, managing, supporting and evaluating the STEP partnership from the perspective of academic and clinical leads and the independent evaluation.

Implementing evidence-based guidelines for nutrition support in acute stroke.

This work forms part of the South Thames Evidence-Based Practice (STEP) Project funded in 1996 by what was then South Thames Research and Development Directorate of the UK Department of Health. STEP was a major multidisciplinary initiative supported by collaborative partnerships between university departments and National Health Service (NHS) Trusts with the aim of evaluating implementation of research evidence in a variety of settings. External evaluation was done by King’s College. A range of topics was identified with substantial evidence bases. South London Trusts were invited to participate where topics matched their service priorities. 9 projects were sited in 8 Trust locations and focused on leg ulcer management, pressure area care, continence, breast feeding, family centred care in schizophrenia, discharge planning, nutrition (2 projects), and rehabilitation management in stroke. Each project reported separately, and separate academic teams provided internal and external overview evaluation reports.1–,2 The following is a description of one of these projects, which focused on nutrition for patients with acute stroke. Stroke is a major cause of mortality, morbidity, and enduring disability in industrialised countries, producing a range of problems that influence eating and dietary intake.3–,4 Nutrition in hospital affects progress and response to treatment, morbidity, mortality, and unplanned readmission.5 On admission, 16–31% of patients with stroke have indices of malnutrition,6–,7 and the rate increases thereafter. Almost 50% of patients admitted to rehabilitation units are affected,8–,9 with multiple nutritional risk factors conferring increased vulnerability. Malnutrition has been linked with increased risk of death and dependency after stroke.9–,10 To address these concerns, the STEP Project for nutrition support in acute stroke aimed to develop, implement, and evaluate evidence-based multiprofessional guidelines. The academic and clinical managers at the institution of the project agreed on …

Leading opinion and managing change in complex organizations: Findings from the South Thames Evidence-based Practice project

Opinion-leaders have been described in the research literature as credible experts, capable of supporting, facilitating or advocating change and influencing health professionals to adopt innovatory, evidence-based approaches to their practice (Lomas et al., 1991; Thomson et al., 1999). However, information is lacking on the complexity of selection and training, and of the role support that is necessary to enable opinion-leaders to function effectively. This paper focuses on the experience of using opinion-leaders to implement practice change as part of a multi-faceted approach within the South Thames Evidence-based Practice project (STEP), drawing on information integrated from a cross-case analysis and the independent evaluation. Key findings are that the opinion-leader role is complex and challenging, and requires a broad balance of research, management and leadership competences to inform selection and training.