Doing Qualitative Research

The Wanless Report â?~Securing Our Future Health: Taking A Long-Term Viewâ?T - an independent review by Derek Wanless - is the first ever evidence-based assessment of the long-term resource requirements for the NHS.
It concludes that in order to meet peopleâ?Ts expectations and to deliver the highest quality over the next 20 years, the UK will need to devote more resources to health care and that this must be matched by reform to ensure that these resources are used effectively.
 - aims: 1. To examine the technological, demographic and medical trends over the next
two decades that may affect the health service in the UK as a whole.
2. In the light of (1), to identify the key factors which will determine the financial
and other resources required to ensure that the NHS can provide a publicly
funded, comprehensive, high quality service available on the basis of clinical
need and not ability to pay.
3. To report to the Chancellor by April 2002, to allow him to consider the possible
implications of th

Securing Our Future Health: Taking a Long-Term View. The Health Service in 2022

Time nurses spend with patients is associated with improved patient outcomes, reduced errors, and patient and nurse satisfaction. Few studies have measured how nurses distribute their time across tasks. We aimed to quantify how nurses distribute their time across tasks, with patients, in individual tasks, and engagement with other health care providers; and how work patterns changed over a two year period. Prospective observational study of 57 nurses for 191.3 hours (109.8 hours in 2005/2006 and 81.5 in 2008), on two wards in a teaching hospital in Australia. The validated Work Observation Method by Activity Timing (WOMBAT) method was applied. Proportions of time in 10 categories of work, average time per task, time with patients and others, information tools used, and rates of interruptions and multi-tasking were calculated. Nurses spent 37.0%[95%CI: 34.5, 39.3] of their time with patients, which did not change in year 3 [35.7%; 95%CI: 33.3, 38.0]. Direct care, indirect care, medication tasks and professional communication together consumed 76.4% of nurses' time in year 1 and 81.0% in year 3. Time on direct and indirect care increased significantly (respectively 20.4% to 24.8%, P < 0.01;13.0% to 16.1%, P < 0.01). Proportion of time on medication tasks (19.0%) did not change. Time in professional communication declined (24.0% to 19.2%, P < 0.05). Nurses completed an average of 72.3 tasks per hour, with a mean task length of 55 seconds. Interruptions arose at an average rate of two per hour, but medication tasks incurred 27% of all interruptions. In 25% of medication tasks nurses multi-tasked. Between years 1 and 3 nurses spent more time alone, from 27.5%[95%CI 24.5, 30.6] to 39.4%[34.9, 43.9]. Time with health professionals other than nurses was low and did not change. Nurses spent around 37% of their time with patients which did not change. Work patterns were increasingly fragmented with rapid changes between tasks of short length. Interruptions were modest but their substantial over-representation among medication tasks raises potential safety concerns. There was no evidence of an increase in team-based, multi-disciplinary care. Over time nurses spent significantly less time talking with colleagues and more time alone.

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How much time do nurses have for patients? a longitudinal study quantifying hospital nurses' patterns of task time distribution and interactions with health professionals

The need for critical thinking in nursing has been accentuated in response to the rapidly changing health care environment. Nurses must think critically to provide effective care whilst coping with the expansion in role associated with the complexities of current health care systems. This literature review will present a history of inquiry into critical thinking and research to support the conclusion that critical thinking is necessary not only in the clinical practice setting, but also as an integral component of nursing education programs to promote the development of nurses’ critical thinking abilities. The aims of this paper are: (a) to review the literature on critical thinking; (b) to examine the dimensions of critical thinking; (c) to investigate the various critical thinking strategies for their appropriateness to enhance critical thinking in nurses, and; (d) to examine issues relating to evaluation of critical thinking skills in nursing.

Critical thinking in nursing education: literature review

Nursing education in the European higher education area - variations in implementation.

Aim This study aims at examining nurses’ work in somatic and psychiatric wards in a hospital in Sweden.



Background  It is asked whether the humanistic ideology, emphasizing holistic care and human interaction more than practical skills, which has become widespread in the Swedish nursing education programmes, fits with the actual work that nurses carry out.



Method  In this study, diaries on work activities were written during 5 days by 30 nurses.



Results  It turned out that the nurses generally spend 38% of their working time with patients (nursing) and the remaining time on other activities.



Discussion  There are certain differences between clinics and they can to some extent be explained by differences in work organization.



Conclusion  The results in this piece of research indicate that a relatively small proportion of nurses’ working time is used for general and specific nursing. It should be asked whether or to what extent the humanistic and holistic perspective taught in nursing education will be utilized in practical nursing.

Nurses' everyday activities in hospital care.

Impact of the Bologna process in Bachelor nursing programmes: The Swedish case

Aim The aim is to study Registered Nurses’ opinions and reflections about their work tasks, competence and organization in acute hospital care.

Background  The definition of the role of nurses has changed over time and it is often discussed whether Registered Nurses have a professional status or not.

Method  A qualitative research design was used. Data were derived from written reflections on diaries and from focus group interviews.

Results  All respondents had difficulties in identifying the essence of their work. It can be argued that being ‘a spider in the web’ is an important aspect of the nursing profession.

Conclusion  Registered Nurses tend to regard their professional role as vague. Managers must be considered key persons in defining the professional role of Registered Nurses.

Implications for nursing management  This study contributes to an understanding of the managers’ and the importance of nursing education in Registered Nurses professional development.

Registered Nurses' views on their professional role

This study described the work content of registered nurses (RNs) employed in municipal health care. Diary notes of three working days from 34 RNs were analysed using content analysis, and a total of 3185 activities were identified. Of these, 2807 were analysed further and grouped by comparing similarities and differences. The content of the RNs' nursing activities consisted of assessing health, giving treatments and conducting check-ups, handling pharmaceuticals and teaching. In the administration category, the content comprised planning and reporting, followed by documentation. The RNs' role in municipal health care is consultative, which reinforces their need for competence in advanced nursing, as well as in leadership and pedagogy. RNs mostly work without colleagues and they are responsible for many seriously ill patients. In order to be confident in providing qualified nursing, specialist nursing education in elderly care is needed.

Carina Furåker

Papers

Nurses' everyday activities in hospital care.

Impact of the Bologna process in Bachelor nursing programmes: The Swedish case

Registered Nurses' views on their professional role

Registered nurses' everyday activities in municipal health care: A study of diaries

The everyday work at a Swedish emergency department – The practitioners’ perspective