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    ABSTRACT: This paper aims to support the critical development of user involvement in systematic reviews by explaining some of the theoretical, ethical and practical issues entailed in 'getting ready' for user involvement. Relatively few health or social care systematic reviews have actively involved service users. Evidence from other research contexts shows that user involvement can have benefits in terms of improved quality and outcomes, hence there is a need to test out different approaches in order to realize the benefits of user involvement and gain a greater understanding of any negative outcomes. Setting up a service-user reference group for a review of user involvement in nursing, midwifery and health visiting research involved conceptualizing user involvement, developing a representation framework, identifying and targeting service users and creating a sense of mutuality and reciprocity. Recruitment was undertaken across England by two researchers. Members from 24 national consumer organizations were selected to participate in the review. Learning was gained about finding ways of navigating consumer networks and organizations, how best to communicate our goals and intentions and how to manage selection and 'rejection' in circumstances where we had stimulated enthusiasm. Involving service users helped us to access information, locate the findings in issues that are important to service users and to disseminate findings. User involvement is about relationships in social contexts: decisions made at the early conceptual level of research design affect service users and researchers in complex and personal ways.
    Health expectations: an international journal of public participation in health care and health policy 03/2009; 12(2):197-208. DOI:10.1111/j.1369-7625.2009.00535.x
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    ABSTRACT: Increasing mobility of healthcare professionals has led to concerns that certain countries or regions are depleted of sufficient staff to meet healthcare needs. In formulating appropriate strategies to ensure better retention locally, human resource managers are hindered by lack of information about migration patterns. PURPOSE AND AIMS: Purposes included studying movement of diploma nurses qualifying in England and contributing to literature on developing methods for obtaining migration data. Specific aims ascertained: regional variation in retention of locally trained nurses; associations between nurses' profile and retention in training region; and impact on each region of inter-regional movement of nurses. Questionnaires sent to a nationally representative cohort of adult branch nurses at qualification (n=1596) and at subsequent intervals thereafter provided data on all employment and other activities and geographical location of each. Event histories constructed from chart data were used to analyse length of retention in region of training and movements between regions. Retention was operationalised through developing the construct 'engagement with nursing'. Older entrants and those with children were more likely to nurse in their training region than younger and childless counterparts. Regions differed in retention of locally trained nurses and in the impact on their diplomate workforce of inter-regional movement. Regional variations were insufficiently explained by differences in nurses' profiles; hence influences of regional characteristics were also considered. Retention strategies should include maintaining the policy of recruiting greater diversity of entrants, particularly mature entrants and those who have children. In developing local strategies, each region needs: information about retention of different components of their workforce; and an understanding of how regional characteristics can facilitate or constrain retention. National and international workforce organisations need to plan how best to obtain accurate and comparable nurse migration data.
    International Journal of Nursing Studies 08/2008; 45(7):1064-80. DOI:10.1016/j.ijnurstu.2007.07.001
  • International Journal of Nursing Studies 06/2008; 45(5):805-6. DOI:10.1016/j.ijnurstu.2007.10.014
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    Journal of Clinical Nursing 06/2008; 17(9):1251-3. DOI:10.1111/j.1365-2702.2006.01904.x
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    ABSTRACT: In the UK policy recommends that service users (patients, carers and the public) should be involved in all publicly funded health and social care research. However, little is known about which approaches work best in different research contexts and why. The purpose of this paper is to explain some of the theoretical limitations to current understandings of service user involvement and to provide some suggestions for theory and methods development. This paper draws upon findings from a review of the research 'evidence' and current practice on service user involvement in the design and undertaking of nursing, midwifery and health visiting research. A multi-method review was commissioned by the NHS Service Delivery and Organisation (SDO) Research and Development Programme. The timeframe was April 2004-March 2005. The full report (Ref: SDO/69/2003) and supplementary bibliography are available from: http://www.sdo.lshtm.ac.uk. REVIEW METHODS/DATA: Initial searches of the health and social care literature and consultations with researchers were used to develop a broad definition of the topic area. A service user reference group (26 members) worked with the project team to refine the scope of the review, to set inclusion criteria and develop a framework for the analysis. Systematic searches of the literature were undertaken online and through library stacks (345 relevant documents were identified). Ongoing and recently completed studies that had involved service users were identified through online databases (34 studies) and through a national consultation exercise (17 studies). Selected studies were followed up using telephone interviews (n=11). Members of the service user reference group worked with the research team to advise on key messages for dissemination to different audiences. Information was gained about contextual factors, drivers, concepts, approaches and outcomes of service user involvement in nursing, midwifery and health visiting research, as well as developments in other research fields. Synthesis of this information shows that there are different purposes and domains for user involvement, either as part of researcher-led or user-led research, or as part of a partnership approach. A number of issues were identified as being important for future research. These include: linking different reasons for service user involvement with different outcomes; understanding the relationship between research data and service user involvement, and developing conceptualisations of user involvement that are capable of accommodating complex research relationships. Suggestions for the development of practice include: consideration of diversity, communication, ethical issues, working relationships, finances, education and training. Because research is undertaken for different reasons and in different contexts, it is not possible to say that involving service users will, or should, always be undertaken in the same way to achieve the same benefits. At a research project level uniqueness of purpose is a defining characteristic and strength of service user involvement.
    International Journal of Nursing Studies 03/2008; 45(2):298-315. DOI:10.1016/j.ijnurstu.2006.09.010
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    ABSTRACT: Understanding patients' experiences of their interactions with health services is an important step in building quality from within. The purpose of this article is to look at the possibilities for involving service users in the development of the National Health Service in England through the structure of integrated care pathways (ICPs). A systematic literature review was undertaken to identify how patient experiences have been attained and used in three clinical areas: cataract care, hip replacement and knee arthroscopy. The information was weighted according to methodological criteria and synthesized according to the typical stages of each pathway. Key issues were summarised thematically across each pathway. The findings relate to the use of patient views and experiences within organisational structures, service development, methodological research, education and training. The article identifies important issues of practical significance for involving service users in the planning and development of patient focused ICPs: such as the diversity of patients, perspectives of continuity, information and patient support and the need for methodological research. The review is limited in that the literature across all three pathways tends to report findings of small studies undertaken in one clinical service or setting and most studies are not randomised or controlled. The literature identified by the review contains important messages for both NHS policy and future research to involve service users in the planned expansion and plurality of NHS care.
    International Journal of Health Care Quality Assurance 02/2007; 20(2-3):195-214. DOI:10.1108/09526860710743345
  • Nursing History Review 02/2007; 15:11-28. DOI:10.1891/1062-8061.15.11
  • Journal of Interprofessional Care 07/2006; 20(3):317-9. DOI:10.1080/13561820600725662
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    Journal of Clinical Nursing 07/2006; 15(6):785-7; discussion 787-9. DOI:10.1111/j.1365-2702.2005.01335.x
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    ABSTRACT: Although increasing numbers of graduates now enter the UK labour market, there has been little evaluation of the benefits that this component of the workforce is reported to bring to employing organisations. This study focused on nursing; a profession in which graduate entry is increasing but potential benefits of moving to all-graduate entry are strongly contested. Career behaviour and expectations of graduate nurses were compared with those of diploma-qualified nurses. Career behaviours were similar but differences were found in fulfilment of expectations that reflected findings reported for graduates in other employment contexts. Graduates entered nursing with higher expectations than diplomates but these were often unfulfilled. Graduates reported lower levels of satisfaction than diplomates over time and became less likely to intend remaining in nursing. Implications for increasing graduate entry are discussed, together with strategies to facilitate better synchronisation between graduate expectations and opportunities within the NHS and beyond.
    Human Resource Management Journal 06/2006; 16(3):287 - 312. DOI:10.1111/j.1748-8583.2006.00015.x
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