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Biomedical subjects

A M Rafferty

Publications and source records attributed to A M Rafferty.

At least 19 recordsLinked to original sources
PubMed2001

Endogenous and exogenous research? Findings from a bibliometric study of UK nursing research.

AIMS OF THE STUDY: This paper uses the findings of a recent bibliometric analysis of published UK nursing research to ask whether the field is characterized by a fundamental split between two underlying areas of research interest. These can be termed 'endogenous' and 'exogenous'. The former term describes research which tends to be concerned with problems and issues to do with nursing as a profession; the latter is concerned with problems and issues centring around the nursing of patients. DESIGN/METHODS: Papers in the Wellcome Trust's Research Outputs Database (ROD), a database of UK biomedical research, were analysed. Nursing papers published between 1988 and 1995 numbered 1,845, just less than 1% of the total papers in the ROD. RESULTS/FINDINGS: Analysis of the subfield identified that nursing research was atypical of biomedical research as a whole in a number of ways. One difference was that usually in biomedical research there is a general correlation between numbers of funders acknowledged on a paper, numbers of authors, and esteem of the journal in which a paper appears. In nursing there was, if anything, a tendency for highly esteemed papers to have fewer authors and be less likely to have acknowledged funding. However, the apparently endogenous and exogenous papers have quite different characteristics. This paper explores this apparent difference and possible reasons for this difference and will briefly compare nursing research with some other newly emerging social and academic groups. CONCLUSIONS: Thinking of nursing research outputs in this way can provide insight into the existence of different reward systems influencing nurse researchers. However, it is impossible to draw too confident a differentiation without reading each individual paper and making judgements about whether they are 'endogenous' or 'exogenous', a practice generally beyond the scope of bibliometric practice.

Authorship↗
PubMed2001

Are teamwork and professional autonomy compatible, and do they result in improved hospital care?

A postal questionnaire survey of 10 022 staff nurses in 32 hospitals in England was undertaken to explore the relationship between interdisciplinary teamwork and nurse autonomy on patient and nurse outcomes and nurse assessed quality of care. The key variables of nursing autonomy, control over resources, relationship with doctors, emotional exhaustion, and decision making were found to correlate with one another as well as having a relationship with nurse assessed quality of care and nurse satisfaction. Nursing autonomy was positively correlated with better perceptions of the quality of care delivered and higher levels of job satisfaction. Analysis of team working by job characteristics showed a small but significant difference in the level of teamwork between full time and part time nurses. No significant differences were found by type of contract (permanent v short term), speciality of ward/unit, shift length, or job title. Nurses with higher teamwork scores were significantly more likely to be satisfied with their jobs, planned to stay in them, and had lower burnout scores. Higher teamwork scores were associated with higher levels of nurse assessed quality of care, perceived quality improvement over the last year, and confidence that patients could manage their care when discharged. Nurses with higher teamwork scores also exhibited higher levels of autonomy and were more involved in decision making. A strong association was found between teamwork and autonomy; this interaction suggests synergy rather than conflict. Organisations should therefore be encouraged to promote nurse autonomy without fearing that it might undermine teamwork.

Cooperative Behavior↗
PubMed2000

Diffusion of the concept of patient advocacy.

PURPOSE: To examine the growth and diffusion through the USA and UK literature of nurses claims to patient advocacy. DESIGN: A bibliometric analysis of articles cited under the key descriptor "patient advocacy" in the International Nursing Index (INI) was undertaken. Analysis included output in 5-year accumulations from 1976 to 1995, and was focused on quantity of output and exposition of concerns through interpretation of the titles. Citation mapping was undertaken to trace dominant influences in the diffusion process. METHODS: Titles and countries of origin of the journal along with year of publication were organized into a database to provide quantitative material on comparative output from the USA and the UK. Citation profiles of key influencing authors were examined. FINDINGS: A role in patient advocacy was proposed in the American nursing literature in the late 1970s and in the British literature a decade later. Support for the role was evident in its use in professional organizations and schools. The pattern of dissemination illustrates the influence of American nursing on the professional role of nurses in the UK. CONCLUSIONS: On the basis of a stages model for diffusion of an innovation, patient advocacy has reached only preliminary stages of acceptance as an innovation in nursing.

Humans↗
PubMed1999

Nurse education in an international context: the contribution of contingency.

Attempts to reform nurse education in the U.K. have met with limited success. A brief examination of similar moves in other countries reveals a similar situation. Placing experiences in this country in the context of global reform, it is possible to suggest that three sets of conditions need to be satisfied for change to follow: these relate to context, convergence and contingency. Context refers to the creation of a positive climate of opinion or a case and pressure for change. Convergence refers to the fortuitous fusion of professional and government agendas. Contingency provides the unforeseen consequence, the spark that ignites a policy change. The implications for further educational reform in this country are briefly discussed.

Australia↗
PubMed1999

Nursing and the research assessment exercise: past, present and future.

In this paper we examine approaches to undertaking nursing research and building research capacity in higher education institutions in the United Kingdom (UK). First we review some of the main responses in the literature to the last two Research Assessment Exercises (RAE), then we report findings from a small study of nursing departments which entered the last RAE and finally we speculate on the likely future of nursing research in the light of recent education and health policy. We suggest that many of the difficulties experienced are an effect of contradictory health and education policies and rival ways of assessing research performance. Nursing education is caught in the 'pincer movement' of stringency in both sectors. In addition, the challenges of the RAE and the necessity to earn income from contracting with National Health Service (NHS) education and training consortia for teaching represent an outworking of two rival views of the role of higher education, broadly an elitist view and one that sees higher education as a supplier of the workforce needs of industry. In addition to this, the NHS R&D (research and development) strategy provides an alternative arena for collaboration, funding and reputation to that constructed by the RAE.

Evaluation Studies as Topic↗
PubMed1997

Health sector reform and trends in the United Kingdom hospital workforce.

OBJECTIVES: The authors examine changing trends in the profile and patterns of employment of the workforce in hospitals in the National Health Service (NHS) in the United Kingdom. The effect of the implementation of the NHS reforms is considered, with particular reference to the changing composition of the nursing workforce. The authors note that there are problems with establishing trend data because of altered information requirements as a result of the NHS reforms. METHODS: Analysis and review of data from secondary sources and research publications. RESULTS: Although hospital activity rates have grown, patient length of hospital stays decreased, and patient activity levels increased, there has not been a linked growth in the size of the nursing workforce. The main changes in the profile of the nursing workforce highlighted are a marked reduction in the numbers of nursing students and alterations in the skill mix between first- and second-level qualified nurses. The authors also note a large increase in the number of managerial and administrative staff employed and growth in medical staff numbers. Changes in working patterns and increases in contracting for support services and in the use of temporary staff also are discussed. CONCLUSIONS: There have been pronounced changes in the profile of the hospital workforce but little evaluation of the impact of these changes on outcomes of care.

Forecasting↗
PubMed1996

The theory/practice "gap': taking issue with the issue.

Theory/practice issues have a long-standing history in nurse education, and are a chronic source of controversy to which there is no easy or perfect solution. We have argued that it is the tension between theory and practice and research which can be usefully exploited in teaching and research. Students need to be introduced to the debates surrounding the genesis and generation of nursing knowledge. They need to gain an appreciation of what counts as nursing knowledge at different points in time and the politics which drive the legitimation of nursing theory and practice. Such an approach has much to offer in helping students deal with reality shock and make sense of their experience as they confront the ambiguities, uncertainties and contradictions that characterize the stock-in-trade of professional life.

Education, Nursing↗
PubMed1995

Art, science and social science in nursing: occupational origins and disciplinary identity.

This paper forms part of a wider study examining the history and sociology of nursing education in England between 1860 and 1948. It argues that the question of whether nursing was an art, science and/or social science has been at the 'heart' of a wider debate on the occupational status and disciplinary identity of nursing. The view that nursing was essentially an art and a 'calling', was championed by Florence Nightingale. Ethel Bedford Fenwick and her allies insisted that nursing, like other professions, was a 'scientific' and technical enterprise. Social scientists later came to challenge nursing's claim to professionalism by analysing nursing work first within the context of industrial psychology. But they also advocated a rapprochement between nursing, health services and social science research, a challenge which we are in nursing, still striving to meet. This paper argues for a strong coalition of nursing with its former nineteenth century ally, social science, in the continuing struggle for change within nursing and health care policy. Rather than searching for some rarified and purified essence of nursing knowledge, it argues that nurses need to join forces with sociologists and economists in striving to shape the agenda for health services research and provide the evidential basis for health policy transformation more generally.

Art↗