An analysis of nursing in context: the effects of current health policy

Compassion in nursing: Solution or stereotype?

Compassion in healthcare has received significant attention recently, on an international scale, with concern raised about its absence during clinical interactions. As a concept, compassionate care has been linked to nursing. We examined historical discourse on this topic, to understand and situate current debates on compassionate care as a hallmark of high-quality services. Documents we looked at illustrated how responsibility for delivering compassionate care cannot be consigned to individual nurses. Health professionals must have the right environmental circumstances to be able to provide and engage in compassionate interactions with patients and their relatives. Hence, although compassionate care has been presented as a straightforward solution when crisis faces health services, this discourse, especially in policy documents, has often failed to acknowledge the system-level issues associated with its provision. This has resulted in simplistic presentations of 'compassion' as inexpensive and the responsibility of individual nurses, a misleading proposal that risks devaluing the energy and resources required to deliver compassionate care. It also overlooks the need for organisations, not just individuals, to be charged with upholding its provision.

Classifying nursing care to improve patient outcomes: The example of WISECARE

Currently, the vast majority of nursing practice is not assessed in any quantifiable manner, making it difficult to demonstrate explicitly the value of nursing to cancer care. This results from the lack of any meaningful or universal system or language that makes visible what nurses 'do'. As a consequence, nursing is often deemed invisible in terms of its importance in healthcare. A model for classifying nursing care may therefore address this situation, making nursing visible not just to policymakers but also to patients. This paper highlights the need for clarity in classifying nursing practice and presents a potential solution through the Workflow Information Systems for European Nursing Care (WISECARE) project. WISECARE was an EC-funded project which utilised state of the art information technology to develop an information tool which allowed a systematic approach to nursing practice through the classification of patient problems.

Beyond nursing nihilism, a Nietzschean transvaluation of neoliberal values

Like most goods-producing sectors in the West, modern health-care systems have been profoundly changed by globalization and the neoliberal policies that attend it. Since the 1970s, the role of the welfare state has been considerably reduced; funding and management of health systems have been subjected to wave upon wave of reorganization and assimilated to the private sector. At the same time, neoliberal policy has imposed the notion of patient empowerment, thus turning patients into consumers of health. The literature on nursing has accordingly reported on the significant repercussions on all aspects of the profession, from delivery of care and treatment, through training for new nurses, to legislated policy reforms regarding the role and responsibilities of modern nurses. In light of these developments, this paper analyses and theorizes about the way the injection of neoliberal policy is linked to and affects the practice of nursing. Drawing on a number of Nietzschean arguments, we begin with an exploration of the complex effects of neoliberalism, bureaucratization, and technocratization on the health system and the practice of nursing. Our main theoretical point here is that neoliberal policy engenders and promotes a neoliberal tide, which results in the conversion of the values that drive modern nursing practice. We then examine this tide in the light of Nietzsche's concepts. Starting with an analysis based on the ontology of the will to power, we show that nurses are dominated by neoliberal values embedded in technocratic and bureaucratic ideologies. Finally, we argue that the application of neoliberal policy constitutes a form of domestication from which one might potentially be freed through the Nietzschean concept of transvaluation of values. This transvaluation, as its freeing from some of the neoliberal tide, may be accomplished in accordance with a hierarchy of specific life-affirming values for nursing culture and practice.

Full steam ahead in 2010?

The Chief Nursing Officer’s February bulletin announced that the modernizing nursing careers framework is gathering momentum on many different fronts. However, it is not clear how this impetus and growing pace really affects some nurses.general practice nurses and advanced nurse practitioners (ANPs), for example, things seem to be speeding downhill.

Nursing shaping and influencing health and social care policy

AIM

This paper seeks to consider how nursing as a profession in the United Kingdom is developing its role in shaping and influencing policy using lessons learnt from a policy study tour undertaken in the United States of America and extensive experience as a senior nurse within the government, the health service and more recently within a Professional Organization.

BACKGROUND

The nursing profession faces major changes in health and health care and nurses need to be visible in the public debate about future models of health and health care.

METHODS

This paper critically reviews recent UK and USA literature and policy with relevance to nursing.

RESULTS

Strategies that support nurses and nursing to influence policy are in place but more needs to be done to address all levels of nursing in order to find creative solutions that promote and increase the participation of nurses in the political process and health policy. There are lessons to be learnt in the UK from the US nursing experience. These need to be considered in the context of the UK and devolution.

CONCLUSIONS

Although much has been achieved in positioning nurses and nursing as an influencer in the arena of policy and political decision-making, there is a need for greater co-ordination of action to ensure that nursing is actively supported in influencing and shaping health and health care policy.

IMPLICATIONS FOR NURSING MANAGEMENT

All leaders and other stakeholders require to play their part in considering how the actions set out in this article can be taken forward and how gaps such as education, fellowship experience and media engagement can be addressed in the future.

Policy analysis: a framework for nurse managers

The lack of involvement of nurses in the policy process is an issue of concern which has resulted in calls for nurses to become more active in this area of activity. However, what is often less clear is precisely how this can be done. This paper presents a template for policy analysis which can be used by nurse managers. The nature of policy and policy analysis is explored to provide a broad context for the discussion and the need for managers and nurse managers in particular to be 'policy competent' is established, as a prerequisite for effective management. There is also an examination of policy analysis in nursing which demonstrates why a range of approaches to the analysis of policy is needed. Based on this, a particular framework for policy analysis which can be used by nurse managers is presented. The overall purpose of the paper is to encourage debate in this area and contribute to the development of a specific tool for policy analysis that may help ensure a nursing management perspective informs policy formation and implementation.

Determining the political influence of nurses who work in the field of hepatitis C: a Delphi survey

AIM

The principle aim of this study was to determine the political influence and the professional profile of nurses who work in the field of hepatitis C.

BACKGROUND

Hepatitis C has emerged as a major public health problem. Its growing impact on health services has led to the development and expansion of a range of specialist nursing roles in hepatitis C. The professional group has never been profiled in the current political and social context, although many nurses traverse patient, organizational and strategic levels of practice and service development.

DESIGN

A multi-centre survey design using the Delphi technique was undertaken to gain consensus. A total of 160 nurses who work in the field of hepatitis C, were invited to participate. The target population was located from 90 sites across the United Kingdom. Data collection comprised two questionnaire rounds. Final sample included 40 participants in round 1 and 34 in round 2.

FINDINGS

The results showed strong consensus on the necessity of structural and policy changes at national and regional levels and nurses' inclusion within that process. Of note was the need for policy group representation and engagement in the commissioning agenda. Overall, the findings demonstrate that most nurses have advanced contextual understanding of the issues. There is evidence of political activities and nursing influence at local and regional levels. This is less evident at national level, where there is only a core of active members.

CONCLUSION

These findings reveal nurses to be operating and thinking strategically without referencing their activities as political. Nurses should be more focused in translating strategic thinking into political activities. This should be coordinated and supported through the Hepatitis Nurse Specialist Forum to ensure nurses become increasingly visible in driving services forward at policy level.

RELEVANCE TO PRACTICE

Successive governments have failed to address the serious structural problems in resource allocation, lack of public awareness and policy direction. This is where patient, organizational and strategy levels interface in hepatitis C because policy affects patients and organizations, patient level care affects policy direction and nurses can influence all three.

Medical care practitioners: introducing a new profession into the UK

The NHS is suffering from a serious shortage of qualified medical staff. One possible solution is to introduce medical care practitioners (MCPs) (USA-style physician assistants) into the healthcare team. This article examines the history and role of PAs, as well as some of the issues concerning the role, and how other health professionals might perceive it. The article also describes one MCP programme that has already started in Britain at Wolverhampton University. The use of MCPs in the UK appears to offer a potential solution to reduce the current skill shortage in this country.

The origins of current nurse education policy and its implications for nurse educators

The publication of Fitness for Practice [UKCC Commission for Nursing and Midwifery Education, 1999. Fitness for Practice (Chair Sir Leonard Peach). UKCC, London] in the United Kingdom (UK) came at a time when anxiety was being expressed by UK government and the National Health Service (NHS) over the suitability of newly trained nurses to be 'fit for purpose'. There had been growing disquiet that the education reforms of the 1990s, which had seen nurse education move into higher education, had failed to deliver skilled nurses for the modern healthcare system. Fitness for Practice (loc. cit.) became the driving force behind government's attempts to bring about change nurse education policy. In the process of these reforms, nurse educators were marginalised and portrayed a negative light. The implementation time of the report was one to two years. This makes the policy ripe for discussion and analysis to explore the complexity of its recommendations, and its implications for UK nurse educators within a higher education context.

The tensions between education and models of nurse preparation

This article seeks to explore the relationship that has evolved between the training and education models of nurse preparation since the creation of the NHS. Through the process of professional reflection it intends to investigate how each model develops the profession and enhances care delivery. It seeks to move away from an either/or approach that has dominated the nurse education debate, and instead seeks to identify the potential benefits, as well as the tensions, of trying to integrate these models into a modern context. In so doing, this article hopes to inform practitioners about the debate so that they can engage with it more fully and effectively.

Palliative care provision and its impact on psychological morbidity in cancer patients

In response to many influences, palliative care services in the UK are evolving rapidly, and are increasingly challenged to demonstrate equity, access and effectiveness. This article discusses the principles, philosophy and status of palliative care in the UK in the context of recent NHS developments. A case study is employed in order to critically evaluate the implementation of the palliative care approach, focusing on the specific issue of the assessment of anxiety and depression in the cancer setting. The provision of a comprehensive and integrated clinical service is a constant challenge in this patient group. In order to increase awareness and facilitate further development of patient services, and ultimately improve clinical practice, several factors are highlighted. These include the impact of multiprofessional team care, the problems inherent in the diagnosis of depression and the question of whether cancer nurses are adequately prepared to handle patients' psychological morbidity.

Ethical issues regarding human cloning: a nursing perspective

Advances in cloning technology and successful cloning experiments in animals raised concerns about the possibility of human cloning in recent years. Despite many objections, this is not only a possibility but also a reality. Human cloning is a scientific revolution. However, it also introduces the potential for physical and psychosocial harm to human beings. From this point of view, it raises profound ethical, social and health related concerns. Human cloning would have an impact on the practice of nursing because it could result in the creation of new physiological and psychosocial conditions that would require nursing care. The nursing profession must therefore evaluate the ethics of human cloning, in particular the potential role of nurses. This article reviews the ethical considerations of reproductive human cloning, discusses the main reasons for concern, and reflects a nursing perspective regarding this issue.

Economic incentive in community nursing: attraction, rejection or indifference?

BACKGROUND: It is hard to imagine any period in time when economic issues were more visible in health sector decision-making. The search for measures that maximize available resources has never been greater than within the present decade. A staff payroll represents 60%-70% of budgeted health service funds. The cost-effective use of human resources is thus an objective of paramount importance.Using incentives and disincentives to direct individuals' energies and behaviour is common practice in all work settings, of which the health care system is no exception. The range and influence of economic incentives/disincentives affecting community nurses are the subject of this discussion paper. The tendency by nurses to disregard, and in many cases, deny a direct impact of economic incentives/disincentives on their motivation and professional conduct is of particular interest. The goal of recent research was to determine if economic incentives/disincentives in community nursing exist, whether they have a perceivable impact and in what areas. CONCLUSION: Understanding the value system of community nurses and how they respond to economic incentives/disincentives facilitates the development of reward systems more likely to be relevant and strategic. If nurse rewards are to become more effective organizational tools, the data suggest that future initiatives should:bullet; Improve nurses' salary/income relativities (e.g. comparable pay/rates);bullet; Provide just compensation for job-related expenses (e.g. petrol, clothing);bullet; Introduce promotional opportunities within the clinical area, rewarding skill and competence development;bullet; Make available a range of financed rewards.- Direct (e.g. subsidized education, additional leave, insurance benefits);- Indirect (e.g. better working conditions, access to professional support network, greater participation in decision-making bodies).

Modernizing the British National Health Service (NHS) -- some ideological and policy considerations: a commentary and application

The modernization of the British National Health Service, discussed by Peter Bradshaw in his paper, is having profound effects on nursing and patient care. The aim of this paper is to engage with the debate he has initiated in order to demonstrate its importance to nursing. The focus will be on key elements of the policy process not addressed by Peter Bradshaw as his emphasis was mainly on ideological concerns, but which nonetheless warrant consideration. These include the increasingly important role of evidence in policy making, and the role of nurses in the policy process. To this end four main themes are explored. First, specific comment is made on some of the points raised by Peter Bradshaw, in the context of the available evidence; secondly the role of evidence in the formulation and evaluation of policy is discussed; thirdly the policy process and nursing is examined; finally some tentative suggestions are made concerning the actions nurses and nurse managers can take to become more active in the health policy arena. The intention is to use Peter Bradshaw's work as a point of departure in examining further, some of the issues he highlights and to contribute to the debate.

Children's nursing and interprofessional collaboration: challenges and opportunities

Interprofessional working has been the subject of recent debate in the nursing press. Despite this heightened scrutiny little attention has been given to putting this development in the context of practitioners working within children's nursing. This paper seeks to redress this imbalance by focusing on the challenges and opportunities for professional development that interprofessional collaboration working offers. This is illustrated by acknowledging existing themes of good practice, and identifying the potential for new ways of working that maintain professional status, skills and knowledge but also facilitate wider collaboration.

A survey of 'teamwork' in mental health: is it achievable in practice?

As part of an ENB educational evaluation of teamworking in mental health, a report-and-respond survey was used as one of five data collection methods. This instrument disseminated earlier findings back to the participants and invited further comments. This article discusses the usefulness of this type of survey as a data collection tool and presents the findings of the survey which was administered to service professionals, educationalist, students, users and carers involved in mental health throughout England. The findings show that when groups of professionals are working within increasingly tight financial constraints and increased workloads, multiprofessional teamworking can be scarce in reality. These tensions present issues for nurse education and training at both pre- and post-registration levels in relation to the teaching of, for and about effective teamwork.

The importance of nursing values in interprofessional collaboration

Nursing values are fundamental to the practice of nursing. They guide standards for action, provide a framework for evaluating behaviour and influence practice decisions. Despite the importance that can be attributed to nursing values, acknowledgement of them is difficult to find in the current debate about how interprofessional working is changing the healthcare system in which nurses currently work. This article argues that the profession needs to demonstrate that values are not only a theoretical concept but also that they can, and do, have a profound impact on the practical working life of nurses delivering care in collaboration with other professions.

Providing seamless community health and social services

This article reviews a variety of Government community health policies and initiatives, from the NHS and Community Care Act 1990 to the emergence of primary care groups (PGCs). The Labour administration abolished GP fundholding and has placed considerable emphasis on its commitment to partnership with the care professions. The Government is also expecting a commitment to partnership between the community care professions in order to reflect the entwined social and health-care needs of the individual requiring care in the community. The role of the district nursing service has been brought into focus with the opportunity of representation at PCG board level. Evaluating how a district nursing service may integrate with social services is therefore, and appropriate strategy for assessing whether recent policy initiatives go far enough at grass roots level in facilitating collaboration and quality community care.

Nursing in the public sphere: health policy research in a changing world

AIMS OF THE PAPER

To identify recent trends in the academic field of health policy, setting them in the context of wider changes in the socio-political and research environments and considering their implications for nursing research.

BACKGROUND

Health policy is a well-established field of academic study and research in the United Kingdom (UK). The 1990s have seen some important intellectual developments in this field, as well as some major changes in the context of health-related research.

DESIGN

A selective review of the relevant literature.

CONCLUSIONS

The Department of Health's new Research & Development strategy can be understood as part of a wider trend, moving away from the traditional, university-based model of knowledge production towards a new one which involves other groups, such as employers, practitioners and patients. This may increase the opportunities for health care professionals in general - and nurses in particular - to influence the research agenda and to participate as researchers in the critical evaluation of health policy.

Nursing, politics and policy: a response to Clifford

Political decisions and social policy initiatives have an impact on the practice of nursing and on the provision of health care. In this paper, we develop the argument that nurses, therefore, need to have political awareness. Developing a critical approach to politics and policy in nursing includes, first, developing an awareness of the range of structural and ideological factors underpinning the emergence of policies. This, we argue, is an essential backdrop to the analysis of the impact on nursing and health care of specific policy initiatives. To illustrate this approach, we present a brief analysis of health policy under the last government, and consider how this came to impact on nursing. We then go on to outline health policy emerging under the present government, and consider how this reflects a commitment to 'third way' politics. Having considered the possible impact of new health policy on nursing, we suggest, finally, approaches to the teaching of politics and policy in nurse education programmes.

Collaboration in cancer nursing practice

Although nursing represents around half of Europe's healthcare budgets, its impact is seldom evaluated. However, given the current era of cost-containment, nursing must prove the value of its clinical effectiveness. Through European collaboration, the WISECARE project is working towards identifying the unique contribution of cancer nursing. This paper will explain the rationale and goals of the WISECARE project and demonstrate the collaborative processes involved within such a project. The latest results of the project will be presented to prove the value of collaboration in ensuring the development of European standards of nursing care.

Changing values for nursing and health promotion: exploring the policy context of professional ethics

In this article we illustrate, and argue for, the importance of researching the social context of health professionals' ethical agendas and concerns. We draw upon qualitative interview data from 20 nurses working in two occupational health sites, and our discussion focuses mainly upon aspects of the shifting 'ethical context' for those nurses with a health promotion remit who are working in the British National Health Service. Within this discussion we also raise a number of potentially substantive issues, including the risks of colluding in 'double standards', and the tensions between the practitioner and managerial roles in nursing. Overall, we hope to pose questions about the best ways to understand the ethical agency and responsibilities of health professionals.

The new public management and the new nursing: related by rhetoric? Some reflections on the policy process and nursing

The importance of health policy in terms of its effects on nursing is now recognized as an issue of concern for nurses; however, the essentially dynamic character of policy requires that consideration of its nature and consequences is continuous. This paper addresses the parallel development of the New Public Management (NPM) and the New Nursing as a means of demonstrating the perceived disjunction between events in nursing and the wider policy arena. The nature of policy is discussed and the relationship between the NPM and the New Nursing is explored. An examination of the unintended consequences of policy implementation and the role of rhetoric in the development of the NPM and the New Nursing demonstrates that these contrasting ideologies have emerged from a similar set of circumstances and have developed along a broadly similar timescale. The final effects of this process, however, are not yet clear. It is suggested that although the processes of policy formation and implementation are inherently complex there is an opportunity for nurses to exert some influence over them. Finally it is argued that if nurses become skilled in the art of rhetoric and combine this with a thorough understanding of the policy process they may be able to shape policy directly when and where it is implemented.

Policy as an influence on public health nursing education in the Republic of Ireland

Nurses are recognizing the need to influence health care policies; this requires an understanding of the ways in which policies are made. The key players and processes which influence public policy in the Republic of Ireland and the lack of policies referring explicitly to nurses and nursing are discussed in relation to a public health nursing curriculum. The lack of specific policies on nursing has had deleterious effects on some aspects of the curriculum but has also given the planners freedom to include primary health care and nursing values. It is argued that it may be better to have few policies than inappropriate ones. The preferred solution would be for nurses to be more involved in wider policy-making, ensuring that policies reflect nursing values and concerns. An opportunity for a nursing voice to be heard and relevant policies recommended is provided by the Irish government's Commission on Nursing.