PubMed · 15524249
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Jane Naish. The evolving nurse.. https://doi.org/10.7748/ns2004.10.19.5.13.c3724
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This project illustrates how benefits to patients, carers, staff and NHS trusts can result from service redesign that is targeted at improving services for patients with chronic obstructive pulmonary disease. Using a Continuous Quality Improvement methodology and 'plan-do-study-act' cycles, this project established key local measures for service redesign based on the national Ideal Design of Emergency Care project. These were to improve patients' experiences of care, by: decreasing patient journey time, improving patient, carer and staff experiences and reducing process variability. The result was a reduction in the average length of stay for patients and an increase in the numbers of patients admitted directly to the emergency medical unit and transferred to the respiratory department. Service users were actively involved in developing the changes. Although not generalizable, this project provides useful insights for consideration by others facing similar issues in their own organisations: we conclude that the methodology used in this study has been instrumental in improving key aspects of patient care, and that a similar methodological approach could be effective for other organisations.
OBJECTIVE: A survey entitled FEMME was conducted during 2002 in order to evaluate among French women doctors their own actual or future menopause perception and this before the WHI publication. The results of this American trial possibly modified the perception of these French women doctors. Therefore the same experts group conducted a new survey, from May to September 2003. The main aim of this survey was to evaluate the possible changes in the medical management of the actual or future menopause of these women, and secondarily to evaluate the changes in their patients' behaviour towards hormone replacement therapy (HRT). POPULATION AND METHODS: Postal auto administered questionnaires were sent to the same 10 000 French women doctors (GP or gynaecologist) whatever their menopausal status or their age. 1365 women doctors (respectively 18,5 or 11% of the gynaecologists or GPs contacted) were volunteers to participate in this survey. Among them, 1120 (84,9%) had already participated in the first part of this survey which took place before the WHI publication. RESULTS: 80% of these women doctors have been informed on WHI results principally by professional press or conferences. 70,9% changed their own actual or future menopause perception as follows. No additional selection of non hormonal treatment have been mentioned in comparison with the first part of the survey. On the other hand for HRT, selections of free estrogen plus progestin associations increased whereas those of fixed combinations decreased: this might be linked to the greater variety of estrogen doses, types of progestin and schedules of treatment (mostly with bleeding) offered by this kind of associations. Finally, duration of HRT is included between three and ten years in most cases. DISCUSSION AND CONCLUSION: Thus, unlike most of their patients, these women's physicians always preferred hormonal treatment for their own actual or future menopause. Only the conditions of these treatments have changed.
BACKGROUND: It was only at the start of the 21st century that the nursing profession in Ireland gained full entry to the academy, joining the ranks of the graduate professions in healthcare. Up to that time, the system of professional training of nurses in Ireland was based on the apprenticeship-training model. AIM: This paper critically analyses discourses opposing advanced educational preparation for nurses and the entry of nursing to higher education in order to reveal the discursive work they perform. METHODS: The study analyses historical and contemporary texts using a critical discursive approach. FINDINGS: The study uncovers common themes and continuities embedded in discourses concerning the role of the nurse and nurses' professional training. Through professional and popular debate, a particular and enduring set of images of the nurse was constructed, which was antithetical to the idea of a nurse receiving professional training in the academy. The debate was conducted by doctors, journalists, public officials, and by nurses, some of whom were ambivalent or even hostile to the notion of the educated nurse. Much of the debate concerned the role of the nurse and the relationship between knowledge/intelligence and practice/caring. CONCLUSIONS: As outsiders looking into the academy, nurses were required to justify their case for entry into higher education against a discursive backcloth that constructed a dichotomy between the mental and the manual and positioned nursing as a practical and commonsense occupation unworthy of academic study. In consequence, nursing was and continues to be challenged to expose, resist and counter the values and assumptions embedded in this backcloth as they strive to establish, maintain and consolidate their foothold in academia.