Search PubMed⌕ Search

Biomedical subjects

A Kitson

Publications and source records attributed to A Kitson.

At least 19 recordsLinked to original sources
PubMed2002

Ingredients for change: revisiting a conceptual framework.

Finding ways to deliver care based on the best possible evidence remains an ongoing challenge. Further theoretical developments of a conceptual framework are presented which influence the uptake of evidence into practice. A concept analysis has been conducted on the key elements of the framework--evidence, context, and facilitation--leading to refinement of the framework. While these three essential elements remain key to the process of implementation, changes have been made to their constituent sub-elements, enabling the detail of the framework to be revised. The concept analysis has shown that the relationship between the elements and sub-elements and their relative importance need to be better understood when implementing evidence based practice. Increased understanding of these relationships would help staff to plan more effective change strategies. Anecdotal reports suggest that the framework has a good level of validity. It is planned to develop it into a practical tool to aid those involved in planning, implementing, and evaluating the impact of changes in health care.

Delivery of Health Care↗
PubMed2001

Nursing leadership: bringing caring back to the future.

Leadership, whether it is nursing, medical or healthcare leadership, is about knowing how to make visions become reality. The vision that many nurses hold dear to their hearts is one where patients are treated with dignity and respect at all times; where systems are designed for the benefit of individual needs; and where the work performed by nurses and other carers is valued and respected. Achieving such a vision will require a paradigm shift in the philosophy, priorities, policies, and power relationships of the health service. Fundamentally, it will require the rhetoric of patient centred care to become a reality. The following scenario is set in the UK in the year 2012 and describes a health service that is on the pathway to achieving this vision. It tells the story from a nursing perspective and outlines the three key foundation stones that helped nursing achieve the vision of a patient centred health service: (1) development of patient centred care measures as part of performance management and the clinical governance agenda; (2) leadership based on personal growth and development principles; (3) new clinical career and competency framework for nursing.

Career Mobility↗
PubMed2000

Towards evidence-based quality improvement: perspectives from nursing practice.

This paper explores how the evidence-based practice and quality improvement movements are informing our understanding of what counts as quality patient care. Implicit in the debate is that we have understood and can manage the concept of patient safety. Using a true case study, the paper will illustrate how a clearer, more integrated understanding of safety, evidence-based practice and quality improvement principles can lead to more effective care. Central to this shift is the ability to move out of traditional, professionally bound ways of thinking to new systems and new ways of providing patient-centred care. Equally, how we generate the evidence to find out how safe or otherwise health care delivery systems are, must be as important an area of investigation as the search for a new therapy or treatment for a particular disease.

Evidence-Based Medicine↗
PubMed1999

Nursing leadership: influencing and shaping health policy and nursing practice.

The leadership discourse in the United Kingdom has to date been concerned with professional issues and as a result has focused upon developing nurses and nursing. This paper reports on the findings of a research study which examined the broader socio-political factors impacting upon nursing leadership. The study forms an integral part of the Royal College of Nursing's leadership programme. The principal aim of the research was to examine critically contemporary nursing leadership within the context of health policy. An ethnographic approach was used. Informal semi-structured interviews were undertaken with a purposive sample of 24 leaders who were recognized for their effectiveness in leading nursing. Data were analysed for themes. The main themes are presented and discussed here. The findings of the study question the political success which the internally focused nature of leadership has had for the profession. Nursing and therefore nursing leadership is shaped dramatically by the impact of politics and policy. The research discovered that in recognition of this, contemporary nursing leadership has both an internal and an external focus. That is, effective nursing leadership currently is a vehicle through which both nursing practice and health policy can be influenced and shaped. The research also identified the profile of the effective nurse leader, together with the processes through which leaders interpret and translate between the macro issues of policy and the micro issues of practice. In addition, an understanding of what nursing leadership is, has been proposed. Appropriate recommendations for the future of nursing and nursing leadership are outlined.

Anthropology, Cultural↗
PubMed1999

Towards practice development--a vision in reality or a reality without vision?

This paper describes the development of a conceptual framework for practice development. Drawing on the authors' combined experiences of facilitating developments in practice, a conceptual framework is proposed. It is argued that much practice development in health care today lacks a systematic approach and is often undertaken by individual practitioners who are poorly prepared for their roles. A short history of practice development is outlined to contextualize current development activities. The proposed framework is located in a critical social science philosophy and it is suggested that such a philosophy enables individual growth and development, empowerment of practitioners and the generation of cultural change that sustains continuous growth and innovation in practice. An example of the framework in use is described and recommendations proposed to enable organizations to embrace a systematic approach to practice development.

Clinical Competence↗
PubMed1998

Using a supervisory framework to support and evaluate a multiproject practice development programme.

The paper describes a multiproject practice development programme undertaken over a period of 1 year. The background and development of the programme are outlined, whilst attention is paid to the innovatory nature of the work, particularly the use of inductive, deductive and integrated approaches to both change implementation and project supervision. The programme was monitored throughout using different data sources and the paper uses evaluative material retrospectively to provide answers to organizational and professional difficulties which arose during the course of the programme. The authors conclude that the use of combinations of different models for practice development has potential, but requires careful supervision. They also recommend that those involved in practice development are made fully aware of its local or micropolitics, and develop strategies to deal with change before it occurs, not after it has taken place.

Evidence-Based Medicine↗
PubMed1998

Enabling the implementation of evidence based practice: a conceptual framework.

The argument put forward in this paper is that successful implementation of research into practice is a function of the interplay of three core elements--the level and nature of the evidence, the context or environment into which the research is to be placed, and the method or way in which the process is facilitated. It also proposes that because current research is inconclusive as to which of these elements is most important in successful implementation they all should have equal standing. This is contrary to the often implicit assumptions currently being generated within the clinical effectiveness agenda where the level and rigour of the evidence seems to be the most important factor for consideration. The paper offers a conceptual framework that considers this imbalance, showing how it might work in clarifying some of the theoretical positions and as a checklist for staff to assess what they need to do to successfully implement research into practice.

Evidence-Based Medicine↗
PubMed1997

Developing excellence in nursing practice and care.

In this article, change, innovation and excellence in nursing practice are discussed. The author argues that nurses must take control of the systems they use to deliver patient care before they can successfully implement change and improve practice.

Humans↗
PubMed1997

Using evidence to demonstrate the value of nursing.

This article explores the position of nursing in relation to the evidence-based medicine (EBM) and clinical effectiveness (CE) initiatives. It argues that both activities are based on at least three implicit assumptions. By exploring these assumptions nurses can become more involved in evidence-based practice and clinical effectiveness activities.

Evidence-Based Medicine↗
PubMed1997

Future imperatives: developing health visiting in response to changing demands.

This paper is based on work undertaken by the National Institute for Nursing to establish mechanisms to enable purchasers to be more explicit about purchasing health visiting services by the commissioning health authority. The paper describes work undertaken to identify current issues, through selected reviews of the literature, the use of questionnaires, interviews with key stakeholders and, as a result, the development of an 'ideal model for practice' for health visitors. The development of possible outcome measures for health visiting practice is also considered in the context of changing health-care demand and delivery which is both a feature and the future of community care.

Community Health Nursing↗
PubMed1997

Practitioner based quality improvement: a review of the Royal College of Nursing's dynamic standard setting system.

OBJECTIVE: To explore and describe the implementation of the Royal College of Nursing's approach to audit--the dynamic standard setting system--within the current context of health care, in particular to focus on how the system has developed since its inception in the 1980s as a method for uniprofessional and multiprofessional audit. DESIGN: Qualitative design with semistructure interviews and field visits. SETTING: 28 sites throughout the United Kingdom that use the dynamic standard setting system. SUBJECTS: Quality and audit coordinators with a responsibility for implementing the system; clinical staff who practice the system. MAIN MEASURES: Experiences of the dynamic standard setting system, including reasons for selection, methods of implementation, and observed outcomes. RESULTS: Issues relating to four themes emerged from the data: practical experiences of the system as a method for improving patient care; issues of facilitation and training; strategic issues of implementation; and the use of the system as a method for multiprofessional audit. The development of clinical practice was described as a major benefit of the system and evidence of improved patient care was apparent. However, difficulties were experienced in motivating staff and finding time for audit, which in part related to the current format of the system and the level of training and support available for clinical staff. Diverse experiences were reported in the extent to which the system had been integrated at a strategic level of quality improvement and its successful application to multiprofessional clinical audit. CONCLUSIONS: The Royal College of Nursing's dynamic standard setting system can successfully be used as a method for clinical audit at both a uniprofessional and multiprofessional level. However, to capitalise on the strengths of the system, several issues need to be considered further. These include modifications to the system itself, as well as a more strategic focus on resources and support for audit, better integration of quality initiatives in health care, and a continuing focus on ways to achieve true multiprofessional collaboration and involvement of patients in clinical audit.

Evaluation Studies as Topic↗
PubMed1996

Achieving improvement through quality: an evaluation of key factors in the implementation process.

Quality, audit and standard setting are major issues on the present day nursing and health care agenda. Considerable time, energy and resources have been invested in developing and implementing a range of different quality and audit systems, yet there is limited evidence to date to suggest that they are having any significant impact in terms of changing practice and improving patient care. This paper will present the results of a study undertaken to evaluate the implementation of three of the most common nursing quality systems used in the United Kingdom: Monitor, Qualpacs and the dynamic standard setting system (DySSSy). In each case, the focus was on identifying key factors in the process of implementation that could predict positive programme outcomes--defined in terms of acceptance by clinical nursing staff and perceived impact on the quality of patient care. The study adopted a three-stage evaluation design, with three distinct levels of investigation and analysis, and utilized a range of descriptive and exploratory methods. In total, 14 sites implementing one of the three nursing quality systems were studied. Additional data, derived from individuals' experiences of implementing quality in nursing, were used to enhance and validate the findings. The results indicated a number of important system-related, contextual and practical issues of implementation. These were underpinned by two key factors, defined as ownership for quality and action to improve. However, most present day nursing quality programmes appear to be failing to embrace these two concepts simultaneously. The paper will conclude by discussing the implications of these findings for future developments in nursing and health care quality improvement.

Attitude of Health Personnel↗
PubMed1996

From research to practice: one organizational model for promoting research-based practice.

This paper describes a framework used by the National Institute for Nursing in Oxford to integrate research, development and practice. With the increasing attention given to the topic of how research findings are implemented into clinical practice, it was felt important to share the challenges that have arisen in attempting to combine traditional research activities with more practice-based development work. The emerging conceptual framework, structures and functions are described, highlighting the variety of partnerships to be established in order to achieve the goal of integrating research into practice. While the underpinning principles of the framework-generating knowledge, implementing research into practice and evaluating the effectiveness of programmes-are not new, it is the way they have been combined within an organizational structure that could be helpful to others considering such a strategy. Both the strengths and weaknesses of the framework are discussed, a number of conclusions drawn as to its robustness and consideration given to its replication.

Diffusion of Innovation↗
PubMed1996

Clinical practice development and research activities in four district health authorities.

This review is based on findings from a postal survey undertaken between March and September 1993 to elicit information from nurses in four district health authorities regarding development and research activity in which they were involved. The objectives of the review were to obtain baseline information on the extent, variety and scope of work being carried out, to provide staff with a mechanism for networking good practice and to identify any areas of replication. A snowball sampling technique was used to obtain information from nursing personnel. A total of 141 responses were received out of which 4% (n = 5) reported no activity. Response rates varied between organizations and specialist groups but were similar in terms of the number of small-scale clinical practice developments undertaken without identified support or supervision. Fifty-five per cent (n = 75) of the reported developments related to the organization and management of services while 11% (n = 15) focused on consumer-related issues. Few studies identified dissemination strategies and there was generally a lack of clarity over expected benefits of the study in terms of measurable outcomes to the organization, nursing staff or patients. Funding for clinical practice development and research in nursing was found to be very sparse; the reasons for this were not identified. Overall the review confirmed statements from other sources (DoH, 1993 a,b) that nursing development and research tends to be small scale and unsupported with nursing staff trying hard to implement research findings or be innovative in their practice without the necessary expertise and support. Such findings have implications for the current drive to implement research into practice.

Clinical Nursing Research↗