Evidence-based Nursing in the IED: From Caring to Curing?

Danish hospitals are major sites of healthcare reform, and new public management accountability and performance management tools have been applied to improve the quality and efficiency of services. One consequence of this is that nurses’ work in hospitals is increasingly standardized through medical evidence. Using Bourdieu’s theory of practice in combination with an ethnographic field study, it is analyzed how the nurses of a Danish Integrated Emergency Department respond to the changing conditions of work. It is illuminated how two opposing approaches to nursing of humanistically and pluralistically oriented caring, and evidence-based scientifically oriented curing inform nursing in the department. The curing approach is however trumping the caring approach. Curing creates new nursing career pathways and is by some nurses embraced with enthusiasm. For others, the new situation creates tension and distress. It is illustrated how the nurses position their practice in relation to the changing working conditions taking sides for either curing or caring, or finding a way to maneuver in between the two. The article argues that the normative enforcement of the curing approach may carry unintended side effects to the goals of quality and efficiency enhancements

Evidence-based Nursing in the IED: From Caring to Curing?

Danish hospitals are major sites of healthcare reform, and new public management accountability and performance management tools have been applied to improve the quality and efficiency of services. One consequence of this is that nurses’ work in hospitals is increasingly standardized through medical evidence. Using Bourdieu’s theory of practice in combination with an ethnographic field study, it is analyzed how the nurses of a Danish Integrated Emergency Department respond to the changing conditions of work. It is illuminated how two opposing approaches to nursing of humanistically and pluralistically oriented caring, and evidence-based scientifically oriented curing inform nursing in the department. The curing approach is however trumping the caring approach. Curing creates new nursing career pathways and is by some nurses embraced with enthusiasm. For others, the new situation creates tension and distress. It is illustrated how the nurses position their practice in relation to the changing working conditions taking sides for either curing or caring, or finding a way to maneuver in between the two. The article argues that the normative enforcement of the curing approach may carry unintended side effects to the goals of quality and efficiency enhancements

Samarbejde via social kapital og relationel koordinering – hvem trækker det længste strå?

Artiklen har fokus på, hvordan et sociologisk begreb som social kapital transformeres til et organisatorisk begreb og indarbejdes i ledelseskoncepter, hvor begrebet får en ganske anden betydning. Artiklen forholder sig kritisk til to ledelseskoncepter: Virksomhedens sociale kapital og relationel koordinering og viser gennem en undersøgelse indenfor hospitalssektoren, hvordan koncepterne er med til at legitimere en ledelsespraksis og magtforhold, der ligger langt fra begrebernes oprindelige betydning. Det fremgår tillige, at der er store udfordringer med at leve op til det, koncepterne lover, nemlig at skabe overensstemmelse mellem produktivitet, kvalitet og et godt psykisk arbejdsmiljø.The article focuses on how social capital, as a sociological concept, is transformed to an organizational concept and integrated in management concepts which change the meaning of the concept. The article relates critically to two management concepts: Workplace social capital and relational coordination and shows, through an analysis within the hospital sector, how the concepts contribute to legitimate a management practice and power relations far from the original meaning of the concepts. This creates great challenges to meet the expectations promised in the concepts, namely to ensure compliance between productivity, quality and human well-being

Management of low back pain in Ghana : a survey of self-reported practice

Background and Purpose: Practice variation exists in the physiotherapy management of low back pain (LBP) across several countries. Previous studies indicate that treatment strategies used may not always be in line with evidence-based practice. Most of these studies however were conducted in developed countries. This study sought to investigate the management of LBP in Ghana in order to add to the emergent literature regarding practice in developing nations. Methods: A web-based self-report questionnaire was made available to all eligible members of the Ghana Physiotherapy Association. Results: The survey achieved a response rate of 67%. Over 60% of physiotherapists in Ghana had less than 5years of practice experience, worked in large facility hospitals and had no post-graduate further training. Most LBP patients seen were chronic, and over 60% of treatment sessions used multiple therapies and included exercises, advice, massage, electrotherapy and manual therapy. Conclusion: This first mapping of physiotherapy management of LBP in Ghana shows an overt multimodal approach. There was potential good practice with the high use of exercise and advice, the equally high utilization of passive treatments however showed variance to recommendations of guidelines. The findings of this study have implications for clinical practice and physiotherapy education and research.</p

Transformational change in a hospital:How time and history constitute leadership agency

This paper addresses a research gap in showing how the complexity of change leadership in the hospital sector can be understood in the dialectics between local leadership and its near and wider context. Specifically, leadership is connected to the history and temporality of the field as core constituents of leaders’ change agency, and politics and policy are foregrounded as temporal elements in leadership. Presenting a longitudinal study of leaders’ struggles, the paper offers novel theoretical and practical insights that raise questions concerning healthcare manageability and the scope of what is possible in leadership at a given moment in time.This paper addresses a research gap in showing how the complexity of change leadership in the hospital sector can be understood in the dialectics between local leadership and its near and wider context. Specifically, leadership is connected to the history and temporality of the field as core constituents of leaders’ change agency, and politics and policy are foregrounded as temporal elements in leadership. Presenting a longitudinal study of leaders’ struggles, the paper offers novel theoretical and practical insights that raise questions concerning healthcare manageability and the scope of what is possible in leadership at a given moment in time