Notes on Nightingale: The Influence and Legacy of a Nursing Icon

{Excerpt}The centenary of the death of Florence Nightingale occurs on 13 August 2010. Like Charles Darwin, Charles Dickens, and John Stuart Mill, Nightingale is one of those monumental Victorians who were genuine household names in their day and for the generations that followed. Like her peers, she was a highly educated individual on a lifelong path of discovery, dedicated to knowledge and science in the service of a better society. But Nightingale was a singular individual among the great Victorians in that she was a woman—a woman who achieved a level of fame arguably surpassed only by the queen herself. Nightingale was also exceptional in that the work for which she is best known was not her science, literature, or philosophy, but the professionalizing of a domain of low status and semidomestic women\u27s work: nursing. In compiling this book, we have sought to take key elements of the Nightingale story and legacy and bring fresh analyses from leading scholars and thinkers in the field. The aim has been to provide both an update on the scholarship in several areas—the story of Nightingale in the Crimean War, her influence on the colonies of the British Empire, her contribution to statistical sciences, and her impact on the American nursing story—and a review of the current state of play with respect to the endless historiographical myths around her. The contributors represent a wide range of specialized knowledge on the heterogeneous topic of Florence Nightingale. Scholars, of course, have strongly held views and do not necessarily agree with one another. We do not attempt to adjudicate between competing perspectives in the discussion surrounding Nightingale, believing them to be symptomatic of a lively academic field in which scholars continue to debate the interpretation of sources and the significance of events. If Nightingale did not inspire controversy (and its sister, passion), would we still be interested in her a century after her death? Throughout the book there are shades of interpretation and emphasis that vary among contributors. Was Nightingale an opponent of germ theory? Did she create the new model of nursing from which all modern nursing sprang? Read on and make up your own mind! Our hope is that readers develop an awareness of the nuances of historical scholarship and the complexity of the past, as opposed to seeing it as a set of facts. Facts, as any good historian knows, are not set in stone but matters of interpretation. Nightingale lived a long time. She was also a prolific correspondent and writer, and thus the historical record from her own hand is plentiful. This surfeit of riches creates its own methodological challenges. Individuals change their views over time, they sometimes contradict themselves, they write their different messages to different audiences, and their words may mean something different to a contemporary reader. Nightingale\u27s persona evolved from a young passionate woman to a politically astute social actor to a much revered icon, and her writings reflect this evolution

Trouble with “status”: Competing models of British and North American public health nursing education and practice in British Malaya

This chapter has explored the role of training and education as a light- ning rod for rival models and interpretations of public health nursing. Nurses faced the constraints of conventional British social norms of class and gender in Malaya, contrasted with respect, status, and opportunities from North Americans. Hostility was displayed towards Americans within the Malayan medical services, affecting the way in which the RF-trained British nurses perceived colonial society, following their interaction with their friendlier and more egalitarian cross-Atlantic colleagues. The chapter also reveals how British, American, and international organizations’ efforts and funding to improve public health nursing in rural areas coincided with periods of increased nationalism in the 1920s and communism in the late 1940s and early 1950s. In the 1920s, in particular, the RF, rather than the British, drove public health nursing in Malaya, enhancing health care in politically fragile rural areas

Chapter 2 Trouble with “Status”

This chapter has explored the role of training and education as a light- ning rod for rival models and interpretations of public health nursing. Nurses faced the constraints of conventional British social norms of class and gender in Malaya, contrasted with respect, status, and opportunities from North Americans. Hostility was displayed towards Americans within the Malayan medical services, affecting the way in which the RF-trained British nurses perceived colonial society, following their interaction with their friendlier and more egalitarian cross-Atlantic colleagues. The chapter also reveals how British, American, and international organizations’ efforts and funding to improve public health nursing in rural areas coincided with periods of increased nationalism in the 1920s and communism in the late 1940s and early 1950s. In the 1920s, in particular, the RF, rather than the British, drove public health nursing in Malaya, enhancing health care in politically fragile rural areas

Integrating Key Nursing Measures into a Comprehensive Healthcare Performance Management System: A Tuscan Experience

This paper addresses the evaluation of nursing quality and safety beyond nursing tasks in specific healthcare settings and sets it in a context that conveys the sense of complexity and multifaceted nature of the contribution that nursing makes to the whole system. The paper describes research conducted in Tuscany during 2019 involving regional managers and heads of nursing departments. This research has led to the development of an integrated evaluation framework through focus groups and consensus process with the latter, which includes Performance Organizational climate data, Patient-Reported Experience Measures (PREMs), and Patient-Reported Outcome Measures (PROMs). This integrated framework aims at both making sense of extant measures as key performance indicators shared among different professionals while recognizing the important role of nursing care by adding specific measures and can be seen as a tool that boosts the sense of “teamness” in healthcare

Experience of mobile nursing workforce from Portugal to the NHS in UK: influence of institutions and actors at the system, organization and individual levels.

In UK, since 2010 shortages of nurses and policy changes led many health service providers to become more active in recruiting nurses from the European Union Member States. This article analyses the experience of Portuguese nurses working in the English NHS considering the individual and organizational factors that affect the quality and duration of nurses' migration experience, future career plans and expectations. Twenty-seven semi-structured interviews were conducted at the individual, organizational and policy levels in UK with Portuguese nurses and NHS healthcare staff in 2015-16. The results demonstrate that organizational settings, conditions, actors' attitudes and level of support influence nurses' level of commitment to their employer and their overall mobility experience. Professional achievements, professional and personal sources of support made these nurses evaluate their overall mobility experience as positive, even overcoming personal challenges such as homesickness. The results reveal that migration is accomplished through constant interaction between institutions and individual actors at different levels. Understanding the influencing factors as well as the complex and dynamic nature of a professional's decision-making can design more effective retention responses

Cross-sectional examination of the association between shift length and hospital nurses job satisfaction and nurse reported quality measures

Background: Twenty-four hour nursing care involves shift work including 12-h shifts. England is unusual in deploying a mix of shift patterns. International evidence on the effects of such shifts is growing. A secondary analysis of data collected in England exploring outcomes with 12-h shifts examined the association between shift length, job satisfaction, scheduling flexibility, care quality, patient safety, and care left undone. Methods: Data were collected from a questionnaire survey of nurses in a sample of English hospitals, conducted as part of the RN4CAST study, an EU 7th Framework funded study. The sample comprised 31 NHS acute hospital Trusts from 401 wards, in 46 acute hospital sites. Descriptive analysis included frequencies, percentages and mean scores by shift length, working beyond contracted hours and day or night shift. Multi-level regression models established statistical associations between shift length and nurse self-reported measures. Results: Seventy-four percent (1898) of nurses worked a day shift and 26% (670) a night shift. Most Trusts had a mixture of shifts lengths. Self-reported quality of care was higher amongst nurses working ≤8 h (15.9%) compared to those working longer hours (20.0 to 21.1%). The odds of poor quality care were 1.64 times higher for nurses working ≥12 h (OR = 1.64, 95% CI 1.18–2.28, p = 0.003). Mean ‘care left undone’ scores varied by shift length: 3.85 (≤8 h), 3.72 (8.01–10.00 h), 3.80 (10.01–11.99 h) and were highest amongst those working ≥12 h (4.23) (p < 0.001). The rate of care left undone was 1.13 times higher for nurses working ≥12 h (RR = 1.13, 95% CI 1.06–1.20, p < 0.001). Job dissatisfaction was higher the longer the shift length: 42.9% (≥12 h (OR = 1.51, 95% CI 1.17–1.95, p = .001); 35.1% (≤8 h) 45.0% (8.01–10.00 h), 39.5% (10.01–11.99 h). Conclusions: Our findings add to the growing international body of evidence reporting that ≥12 shifts are associated with poor ratings of quality of care and higher rates of care left undone. Future research should focus on how 12-h shifts can be optimised to minimise potential risks

Towards achieving interorganisational collaboration between health-care providers:a realist evidence synthesis

Background Interorganisational collaboration is currently being promoted to improve the performance of NHS providers. However, up to now, there has, to the best of our knowledge, been no systematic attempt to assess the effect of different approaches to collaboration or to understand the mechanisms through which interorganisational collaborations can work in particular contexts. Objectives Our objectives were to (1) explore the main strands of the literature about interorganisational collaboration and to identify the main theoretical and conceptual frameworks, (2) assess the empirical evidence with regard to how different interorganisational collaborations may (or may not) lead to improved performance and outcomes, (3) understand and learn from NHS evidence users and other stakeholders about how and where interorganisational collaborations can best be used to support turnaround processes, (4) develop a typology of interorganisational collaboration that considers different types and scales of collaboration appropriate to NHS provider contexts and (5) generate evidence-informed practical guidance for NHS providers, policy-makers and others with responsibility for implementing and assessing interorganisational collaboration arrangements. Design A realist synthesis was carried out to develop, test and refine theories about how interorganisational collaborations work, for whom and in what circumstances. Data sources Data sources were gathered from peer-reviewed and grey literature, realist interviews with 34 stakeholders and a focus group with patient and public representatives. Review methods Initial theories and ideas were gathered from scoping reviews that were gleaned and refined through a realist review of the literature. A range of stakeholder interviews and a focus group sought to further refine understandings of what works, for whom and in what circumstances with regard to high-performing interorganisational collaborations. Results A realist review and synthesis identified key mechanisms, such as trust, faith, confidence and risk tolerance, within the functioning of effective interorganisational collaborations. A stakeholder analysis refined this understanding and, in addition, developed a new programme theory of collaborative performance, with mechanisms related to cultural efficacy, organisational efficiency and technological effectiveness. A series of translatable tools, including a diagnostic survey and a collaboration maturity index, were also developed. Limitations The breadth of interorganisational collaboration arrangements included made it difficult to make specific recommendations for individual interorganisational collaboration types. The stakeholder analysis focused exclusively on England, UK, where the COVID-19 pandemic posed challenges for fieldwork. Conclusions Implementing successful interorganisational collaborations is a difficult, complex task that requires significant time, resource and energy to achieve the collaborative functioning that generates performance improvements. A delicate balance of building trust, instilling faith and maintaining confidence is required for high-performing interorganisational collaborations to flourish. Future work Future research should further refine our theory by incorporating other workforce and user perspectives. Research into digital platforms for interorganisational collaborations and outcome measurement are advocated, along with place-based and cross-sectoral partnerships, as well as regulatory models for overseeing interorganisational collaborations. Study registration The study is registered as PROSPERO CRD42019149009. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 6. See the NIHR Journals Library website for further project information

Integrating preparation for care trajectory management into nurse education: competencies and pedagogical strategies

Nurses make an important contribution to the organisation and coordination of patient care but receive little formal educational preparation for this work. This paper builds on Allen's care trajectory management framework to specify evidence‐based and theoretically informed competencies for this component of the nursing role and proposes how these might be incorporated into nursing curricula. This is necessary so that at the point of registration nurses have the expertise to realise their potential as both providers and organisers of patient care and are better able to articulate and develop this aspect of nursing practice

How, when, and why do inter-organisational collaborations in healthcare work? A realist evaluation

BackgroundInter-organisational collaborations (IOCs) in healthcare have been viewed as an effective approach to performance improvement. However, there remain gaps in our understanding of&nbsp;what&nbsp;helps IOCs function, as well as&nbsp;how&nbsp;and&nbsp;why&nbsp;contextual elements affect their implementation. A realist review of evidence drawing on 86 sources has sought to elicit and refine context-mechanism-outcome configurations (CMOCs) to understand and refine these phenomena, yet further understanding can be gained from interviewing those involved in developing IOCs.MethodsWe used a realist evaluation methodology, adopting prior realist synthesis findings as a theoretical framework that we sought to refine. We drew on 32 interviews taking place between January 2020 and May 2021 with 29 stakeholders comprising IOC case studies, service users, as well as regulatory perspectives in England. Using a retroductive analysis approach, we aimed to test CMOCs against these data to explore whether previously identified mechanisms, CMOCs, and causal links between them were affirmed, refuted, or revised, and refine our explanations of how and why interorganisational collaborations are successful.ResultsMost of our prior CMOCs and their underlying mechanisms were supported in the interview findings with a diverse range of evidence. Leadership behaviours, including showing vulnerability and persuasiveness, acted to shape the core mechanisms of collaborative functioning. These included our prior mechanisms of trust, faith, and confidence, which were largely ratified with minor refinements. Action statements were formulated, translating theoretical findings into practical guidance.ConclusionAs the fifth stage in a larger project, our refined theory provides a comprehensive understanding of the causal chain leading to effective collaborative inter-organisational relationships. These findings and recommendations can support implementation of IOCs in the UK and elsewhere. Future research should translate these findings into further practical guidance for implementers, researchers, and policymakers.</p