New Public Management and Nursing Relationships in the NHS

Western governments face increasing demands to achieve both cost efficiency and responsiveness in their public services leading to radical and challenging transformations. Following the imposition of New Public Management (NPM) approaches within England, it is argued that similar elements of NPM can be also seen within Scottish healthcare, despite policy divergences following devolution. This thesis considers the influence of NPM on Scottish hospital frontline nursing staff in their work. It explores the ways in which managerial practices (specifically professional management; discipline & parsimony; standard setting & performance measurement; and consumerism) have shaped the working relationships, interactions, and knowledge-exchange between managers, staff and patients and the ability of staff to carry out nursing duties within an acute hospital setting. The study is a qualitative interpretivist study grounded in the methodology of adaptive theory and draws upon the works of Lipsky (1980) in order to explore how the front-line nurses cope with and resist the demands of the workplace. Based on thirty-one qualitative interviews with front-line nursing staff in an inner city hospital in Scotland, this thesis presents the findings resulting from nurses’ views of management, finances, policies, targets, audits and consumerism. The findings show that these nurses believe there has been a proliferation of targets, audits and policies, an increasing emphasis on cost efficiency and effectiveness, a drive for professional management and a greater focus on consumerism in NHS Scotland. These are all closely linked to the ethos of NPM. From the findings it can be seen that many elements influence the working relationships of the frontline hospital nursing staff. The study suggests that the main reason for conflict between managers and nursing staff is due to their differing foci. Managers are seen to concentrate on issues of targets, audits and budgets with little thought given to the impact these decisions will have on patient care or nurses’ working conditions. Furthermore the findings highlight high levels of micro-management, self-surveillance, control and the regulation of the frontline nursing staff which has led to tensions both between nursing staff and managers, but also with patients and the public. Finally, although there has supposedly been policy divergence between Scotland and England, this thesis has identified many similarities between Scottish and English polices and NPM approaches continues to influence the working relationships of front-line nursing staff within this study despite the rhetoric that Scotland has moved away from such practices

Revisiting Data: Secondary Analysis of Qualitative Data Exploring New Public Management and Nursing Relationships in the NHS

This case study addresses some of the challenges and opportunities of revisiting data for a new purpose. In 2011, data was collected for a PhD, which aimed to explore the impact of new public management and nursing relationships in the NHS. This was analysed and written up for a PhD thesis. However, only a proportion of the collected data made it into the final cut of the PhD. Within a PhD it is important to have a clear narrative and so it is likely that aspects of the data will be discarded or left until later. Several years after PhD completion, in response to new research concerns, the data was revisited with a view to further analysis in order to reveal possible new and previously hidden insights. This case study takes you step by step through the process used to do this, and highlights key points for decision-making to ensure rigour in this retrospective analysis

‘I mean, obviously you're using your discretion’: Nurses Use of Discretion in Policy Implementation.

This article explores the application of Lipsky’s (1980) notion of street-level bureaucracy for nursing staff. This article aims to demonstrate the importance of discretion within the day-to-day work of front-line nursing staff, which is similar to that of other public-sector workers. The findings are from an exploratory case study, based within a Scottish inner city hospital. It specifically focuses on how nurses can be seen to be street-level bureaucrats and how front-line nursing staff interpret policy. Discretion can be seen to be a significant feature within the front-line practice of nursing staff and this may have implications for the implementation of health policy

Experiences of people with intellectual disability and dementia:A systematic review

Background Dementia disproportionately affects people with intellectual disability. Most qualitative studies explore their experiences by utilising proxy-reports. A smaller number of studies illustrate the possibility of exploring perspectives directly from people with intellectual disability and dementia. Method This systematic review synthesised findings from existing studies (n = 8) that involve people with intellectual disability and dementia as participants to understand their experiences of dementia. Searches were conducted using CINAHL, PsychInfo and Social Services Abstracts. Results Findings include descriptions of changes in individual functioning, a narrowing of social worlds and of how people made sense of the changes despite often having no knowledge of their dementia diagnosis. Additionally, discussion focuses on how people's experiences are shaped by their environments. Conclusion The review recognises the complexities of speaking to people with intellectual disability about dementia, challenges views that people with intellectual and dementia cannot be involved in research and makes recommendations to support inclusion in future studies.Output Status: Forthcoming/Available Onlin

The experiences of family carers in the delivery of invasive clinical interventions for young people with complex intellectual disabilities: policy disconnect or policy opportunity?

Aims and objectives. To explore the experiences of family carers in the delivery of invasive clinical interventions within community settings. Background. Many young people with intellectual disabilities present with complex health needs and require clinical interventions to sustain life. As the population lives into older age there is growing demand for the delivery of these interventions within the community setting. Design. An interpretivist qualitative design. Methods. Ten family carers of children with intellectual disabilities and complex care needs requiring invasive clinical interventions participated in semi-structured interviews. Results. There are barriers identified regarding the delivery of invasive clinical interventions in the home setting by social care support workers. These include a reluctance to carry out invasive clinical interventions both for family carers and staff, anxiety, a lack of knowledge and training and difficulties in recruiting appropriate staff. Conclusions. There needs to be strategic policy developments focusing on this population who are cared for in the community and require invasive clinical interventions. Relevance to clinical practice. Registered Nurses have a key role in educating and preparing families and social care support workers to safely deliver invasive clinical interventions in community settings for both children and adults with intellectual disabilities

A new era of social policy integration? Looking at the case of health, social care and housing

Service integration is a global trend aiming to create partnerships, cost-effectiveness and joined-up working across public and third sector services to support an ageing population. However, social policy research suggests that the policy making process behind integration and implementation is complex, contradictory and full of tension. This paper explores social policy integration at the ground-level of services in the health and housing sector within a new integrated model for housing for older people. The paper applies a critical Lipskian approach to show the housing can promote integration for both users and wider stakeholders. Front-line workers were central to service integration, often working to integration principles despite policy changes and uncertainty. Challenges of social policy integration include the gaps between policy and practice and the developing nature of interaction at the ground-level – most notable the role of technology. Technology and digital health platforms could enhance service user and practitioner interactions at the ground-level. The paper calls for renewed focus on policy processes in relation to service integration and consideration of new forms of service user, practitioner and policy maker interaction.Output Status: Forthcoming/Available Onlin

Talking Technology Enabled Care - A personalised, visual digital platform to transform health, social care and housing services

The aim of the Talking Technology Enabled Care project was to conduct a feasibility study to co-design, implement, evaluate and deliver a novel, visual, digital care management application for those who find communicating their health needs challenging. The project has been funded by Innovate UK. Effective communication is at the heart of holistic healthcare. Enabling people to talk about their needs and concerns is the first step in providing care that addresses these concerns, supports recovery and self-management. Technology is a potential enabler of communication between individuals and those in their informal or professional care network. Technological solutions can enhance communication among professionals who are encouraged to work together across traditional boundaries to provide holistic healthcare that addresses individuals’ health, social care and housing needs. However, for individuals with communication difficulties expressing their needs is especially challenging and the inability to collect and share information electronically inhibits interagency working. Harnessing –and developing –existing technology that enables talk between individuals with communication difficulties, carers and service professionals can address communication barriers and enhance integrated care delivery between the health, social care and housing sectors

Health-related behaviours of nurses and other healthcare professionals: a cross-sectional study using the Scottish health survey

Aims: To estimate the prevalence and co-occurrence of health-related behaviours among nurses in Scotland relative to other healthcare workers and those in non-healthcare occupations. Design: Secondary analysis of nationally representative cross-sectional data, reported following STROBE guidelines. Methods: Five rounds (2008-2012) of the Scottish Health Survey were aggregated to estimate the prevalence and co-occurrence of health-related behaviours (smoking, alcohol consumption, physical activity, fruit/vegetable intake). The weighted sample (n=18,820) included 471 nurses (3%), 433 other healthcare professionals (2%), 813 unregistered care workers (4%), and 17,103 in non-healthcare occupations (91%). Logistic regression models compared prevalence of specific health-related behaviours and principal component analysis assessed co-occurrence of health-related behaviours between occupational groups. Results: Nurses reported significantly better health-related behaviours relative to the general working population for smoking, fruit/vegetable intake, and physical activity. No significant difference was found for alcohol consumption between occupational groups. Nurses reported lower levels of harmful co-occurring behaviours (tobacco smoking and alcohol consumption) and higher levels of preventative behaviours (physical activity and fruit/vegetable intake) compared to the general working population. Other healthcare professionals had the lowest level of harmful health behaviours and highest level of preventative health behaviours. Health-related behaviours were poorest among unregistered care workers. Conclusion: Nurses’ health-related behaviours were better than the general population but non-adherence to public health guidelines was concerning. Impact: Nurses play an important role in health promotion through patient advice and role-modelling effects. To maximise their impact healthcare providers should prioritise increasing access to healthy food, alcohol awareness and smoking cessation programmes

Communication to Adult Patients Undergoing Cancer Care by Non-Specialist Nurses: a Scoping Review Protocol

Introduction Little is known regarding how non-specialist nurses communicate with patients living with cancer when the patients are receiving care outside of their cancer units/teams. This scoping review aims to identify, examine and report on the currently available evidence about communication by non-specialist nurses when caring for adults living with cancer outside of their cancer care unit/teams. Methods and analysis A scoping review following the JBI methodology for scoping reviews will be conducted. We will search for empirical studies that meet the inclusion criteria in six databases (MEDLINE, PubMed, CINAHL, Embase, Scopus and PsycINFO). Handsearching in references of included articles will be performed to find additional articles. The population of interest will be non-specialist nurses. Three concepts will be explored, namely (1) all adult patients living with cancer, (2) a focus on three stages of the cancer continuum of care (cancer diagnosis, treatment and survivorship) and (3) a focus on communication between non-specialist nurses and patients living with cancer. We will include studies describing all healthcare settings outside patients’ specialised cancer units or oncology teams. After article selection, two reviewers will independently screen titles and abstracts and perform a full-text article review, risk of bias assessments and data extraction. A third reviewer will resolve all disagreements. A narrative summary will provide an overview of how the results relate to the research aims and questions. The included articles will be limited to English and published between 2012 and 2023. Ethics and dissemination No ethical approval is required since we will use publicly available empirical research sources. This review will provide current research on communication by non-specialist nurses with patients with a cancer diagnosis outside of an oncology setting, evidence that will support effective communication. As such, we aim to disseminate the findings in academic conferences and peer-reviewed journals

Couples with intellectual disability where one partner has dementia – a scoping review exploring relationships in the context of dementia and intellectual disability

Relationships and marriages between couples with intellectual disability are to be celebrated, as is the longer life expectancy now enjoyed by many with intellectual disability. However, dementia disproportionately affects people with intellectual disability, especially people with Down's syndrome. Research into experiences of couples without intellectual disability who are affected by dementia suggests that a relational perspective provides health and social care professionals with information to support the wellbeing of both partners. This dyadic perspective is missing for couples with an intellectual disability where one partner has dementia. There is currently no evidence base informing how each partner may best be supported. This scoping review, with three separate searches, aims to address this gap. The first search sought to establish if any studies had explored the experiences of couples with intellectual disability where one partner has dementia. After determining that no studies have been published to date, the review explores what is known about relationships in the context of dementia (N = 8) and in the context of intellectual disability (N = 10), in second and third searches. Different ways to approach care and support in relationships among partners, staff and other family members were identified and it was evident that support could act as a facilitator as well as a barrier to people and their relationships. While the lives of couples affected by dementia appeared to remain largely private, couples with intellectual disability had a high involvement of staff and family members in their life. Potential implications for future research with couples with intellectual disability affected by dementia are discussed, highlighting the importance of exploring how couples navigate emotional complexities and changes in their relationship, while understanding that the context in which the lives of people with intellectual disability take place and relationships happen is different