Quality and quality assurance in the health care setting: an equitable life?

A qualitative study explaining nurses' perceptions of quality care for older people in long-term care settings in Ireland

AIM

The aim of this research was to explore nurses' perceptions of the attributes of quality care and the factors that facilitate or hinder high-quality nursing care in long-term care.

BACKGROUND

The quality of care for older people living in long-term care has been identified as an issue of concern in many nursing research studies. While many factors have been identified, it is difficult to determine key factors from current research.

METHOD

The study was a qualitative exploration of nurses' perceptions of quality care for older people and the factors that facilitate or hinder quality care. It involved 20 interviews with nurses. Respondents were asked to illustrate their accounts with examples from practice. This phase of the research was guided by the principles of hermeneutic phenomenology and the analysis process by Van Manen.

FINDINGS

The findings indicated that nurses perceived quality care for older people in Ireland as holistic, individualized and focused on promoting independence and choice. The research revealed, however, that care in many practice areas was not individualized, patient choice and involvement in decision making was limited and some areas engendered dependency. While staffing was identified as a factor which had an impact on the provision of patient choice, other issues, such as the motivation of staff, the role of the ward manager and the dominance of routine were also highlighted.

CONCLUSION

There is a need to review organizational approaches to care, develop patient centred approaches to care and provide educational support for managers.

RELEVANCE TO PRACTICE

This research focuses on care for older people; it helps practitioners identify key factors in the provision of quality care for older people living in long-term care.

The NHS as a learning organization: aspirations beyond the rainbow?

AIM

It is the intention of this paper to review the issues and challenges organizations face when aspiring to embrace and enact the tenets of a learning organization; and in particular the perceived impact on management strategy, structure and leadership styles. The paper is predicated on the premise that learning and knowledge act as vital strategic resources, crucial not only to organizations in terms of competitive advantage but to ethical enterprise per se.

BACKGROUND

Modern life is characterized by change, against the backdrop of this continual turmoil, organizational learning has emerged as a dominant theme within contemporary management theory, with many commentators increasingly locating the capacity of an aspiring organization to accommodate the ethos of organizational learning, as the vital component in ensuring enduring efficiency, innovation and competitiveness. However, the utility of such learning needs to be scrutinized and evaluated in terms of service need and expectation.

ORIGINS OF INFORMATION

The paper will expand upon wider theoretical debates extant within the literature, by considering the concept and utility of the learning organization with specific reference to management reform extant within the British National Health Service (NHS).

DATA ANALYSIS

During the course of the review the various the theoretical positions contributing to the notion of the learning organization will be analysed, the practical ramifications of which will be examined in the context of reflective practice, clinical supervision and the wider cultural background of nursing and the NHS.

CONCLUSIONS

The paper concludes that the NHS needs to reorientate management perspectives to focus attention more acutely on systems which are deliberately designed to facilitate shared learning, to unravel the ambiguities of organizational life, to affirm management belief in the nursing contribution and to achieve an as yet unrealized potential in terms of patient care and advanced nursing practice.

Towards an understanding of the human resource in the context of change in the NHS: economic sense versus cultural sensibilities?

The concepts involved in the process of managing change successfully in respect of the management of human resources are as complex as they are contentious, with arguments and counter-arguments espoused weekly in the seemingly ever-growing plethora of literature available. The following paper attempts to present a critical analysis of the management of change from the perspective of the human resource and to debate the relative merits pertaining to the imperatives of organizational design and culture, in conjunction with a plea to recognize and respect peoples' needs and feelings, in relation to the impact of internal market reform upon management practice within the context of the contemporary National Health Service (NHS). The paper is predicated upon the dual beliefs that people and organizations are dynamic entities being located both temporally and socially, and that any constructed criterions of success must, therefore, be evaluated not only in terms of the specific individual and/or organizational parameters but also in terms of the relative cultural, moral, philosphical and political ethos, and that as the human race largely survives and operates via organization, which in itself has to be managed, controlled and developed, managers are, therefore, a vital element of any successful organization.