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Issue 95 - 5 June 2009


1.  Evidence-based practice: the debate
by Jordan, Sue & Segrott, Jeremy. Journal of Nursing Management, May 2008, Vol 16 Issue 4: p385-387
The article offers the author's views on evidence-based practice (EBP) in nursing together with its interpretations and ramifications. The author states that EBP has its proponents, detractors and ambivalent commentators. He is of the view that EBP is also being considered as much of a political and social entity as a clinical one, which is designed to bring legitimacy, recognition and status to the profession of nursing.

2. Evidence-based practice: implications and concerns
by Nolan, Peter & Bradley, Eleanor. Journal of Nursing Management, May 2008, Vol 16 Issue 4: p388-393
The aim of this paper was to undertake a brief critical appraisal of evidence-based practice (EBP) as it is currently perceived in health care settings.
Background: The past two decades have seen EBP become increasingly important in health care planning, clinical thinking, and choice of treatments. It is based on scientific rationalism and adherents claim that decisions based on EBP are superior to those based on other approaches to care. Concerns are now being expressed that positivistic approaches to health care fail to take into account people’s preferences, their internal resources and their personal understandings of health and wellbeing. It has been argued that there may be multiple types of evidence, all of which have a part to play in the formulation and execution of health care.
Methods: After a literature search, this paper argues that whereas EBP may be useful in treating conditions that have a biological cause, it may be less helpful in understanding and treating conditions that have their origins in the social, psychological or spiritual domains.
Results: The nature, strengths and limitations of evidence-based practice is discussed in this paper. Nurses are encouraged to develop the critical skills of evaluating EBP in the lives and experiences of the people they care for.
Conclusions: Evidence-based practice has a part to play in improving the treatment provided for patients. Nonetheless, nurses should be aware of other kinds of evidence, and appreciate that any single approach to determining care, no matter how popular, is likely to lead to a service that does not truly meet the complex individual needs of patients. Implications for nursing management In order for evidence-based practice to be safe, the nursing workforce must be able to evaluate the strength and relevance of research findings, and be able to understand that there are different kinds of evidence which should be called upon in order to respond sensitively and appropriately to the preferences of patients. A responsive workforce embraces multiple ways of thinking, respects different paradigms of care, and is able to respond to and respect the forms of care people value and seek. [ABSTRACT FROM AUTHOR]

3. Nursing Best Practice Guidelines: reflecting on the obscene rise of the void
by Holmes, Dave et al. Journal of Nursing Management, May 2008, Vol 16 Issue 4:p394-403

Aim(s): Drawing on the work of Jean Baudrillard and Michel Foucault, the purpose of this article is to critique the evidence-based movement [and its derivatives – Nursing Best Practice Guidelines (NBPGs)] in vogue in all spheres of nursing.
Background: NBPGs and their correlate institutions, such as the Registered Nurses’ Association of Ontario (RNAO) and ‘spotlight’ hospitals, impede critical thinking on the part of nurses, and ultimately evacuate the social, political and ethical responsibilities that ought to distinguish the nursing profession.
Evaluation: We contend that the entire NBPG movement is based on the illusion of scientific truth and a promise of ethical care that cannot be delivered in reality. We took as a case study the Registered Nurses’ Association of Ontario (RNAO), in the province of Ontario, Canada.
Key issues: NBPGs, along with the evidence-based movement upon which they are based, are adangerous technology by which healthcare organizations seek to discipline, govern and regulate nursing work.
Conclusion(s): Despite the remarkable institutional promotion of ‘ready-made’ and ‘ready-to-use’ guidelines, we demonstrate how the RNAO deploys BPGs as part of an ideological agenda that is scientifically, socially, politically and ethically unsound. Implications for nursing management Collaborations between health care organizations and professional organizations can become problematic when the latter dictate nursing conduct in such a way that critical thinking is impeded. We believe that nurse managers need to understand that the evidence-based movement is the target of well-deserved critiques. These critiques should also be considered before implementing so-called ‘Nursing Best Practice Guidelines’ in health care milieux. [ABSTRACT FROM AUTHOR]

4. Evidence-informed practice: from individual to context
by Rycroft-Malone, Jo. Journal of Nursing Management, May 2008, Vol 16 Issue 4, p404-408
This commentary considers the shift in evidence-informed practice away from the individual practitioner to an acknowledgement that context is also important.
Background: The view of practitioner as ‘rational agent’ capable of searching, appraising and translating research evidence into individual practice has dominated the literature. However, a growing body of research leads us to question whether evidence use is indeed an individual activity.
Evaluation: Key research studies were purposively selected to build the case for the arguments made.
Key issues: Apart from attitude, there is little to indicate that any potential individual determinants influence research use. Views of what constitutes evidence for evidence-based practice have become more inclusive and sophisticated. Evidence tends to be contextually bound and individually interpreted and particularized within that context. As such, evidence use is beginning to be recognized more widely as a contingent process, which varies across setting and
time. A number of contextual factors have been found to be potentially influential including culture and leadership.
Conclusion(s) and implications for nursing management:  It cannot be assumed that evidence-based resources such as clinical guidelines will be accepted at face value by practitioners. Developing the skills of individuals to critically appraise research will not automatically lead to greater evidence use. Reviewing organizations’ capacity for evidence-informed practice as a system property and cultural factor may lead to insights about the barriers and facilitators to evidence use. Investing in the capability of key individuals at multiple levels of the organization as leaders of evidence-based practice activities may be one promising organizational

5. Navigating the evidence-based practice maze
by Hudson, Kathy et al. Journal of Nursing Management, May 2008, Vol 16 Issue 4:p409-416
This article’s purpose is to provide nurses with key points to consider in facilitating informed decision making while navigating the evidence-based practice (EBP) maze.
Background: EBP in nursing evolved from the medical model and continues developing within the holistic nursing paradigm. Inconsistent terminology, multiple applications, and lack of a unifying theory create challenges for nurses.
Key issues: Recognition that multiple knowledge sources to support clinical decision making have merit for facilitating ‘best’ patient outcomes; EBP must be an internalized value of professional nursing.
Conclusions: Multiple ways of knowing, or evidence, for informed clinical decision making must be considered based on situational context. No hierarchy fits all situations. Nurses must provide support and resources to facilitate nurse empowerment; nurses are accountable for using EBP to enhance patient outcomes.
Implications for nursing management Effective EBP implementation relies on nurses being cognizant of what current nursing EBP trends are based on and where they are going. Nurses have a key role in facilitating consensus regarding evidence to be used in EBP, and ensuring availability of resources for empowering nurses to be accountable for outcome-oriented patient care through utilizing EBP. [ABSTRACT FROM AUTHOR]

6. Beyond evidence-based nursing: tools for practice
by Jutel, Annemarie. Journal of Nursing Management, May 2008, Vol 16 Issue 4:p417-421
This commentary shares my views of evidence-based nursing as a framework for practice, pointing out its limitations and identifying a wider base of appraisal tools required for making good clinical decisions.
Background: As the principles of evidence-based nursing take an increasingly greater hold on nursing education, policy and management, it is important to consider the range of other decision-making tools which are subordinated by this approach.
Evaluation: This article summarizes nursing’s simultaneous reliance on and critique of evidence-based practice (EBP) in a context of inadequate critical reasoning. It then provides an exemplar of the limitations of evidence-based practice and offers an alternative view of important precepts of decision-making
Key issue: I identify means by which nurses can develop skills to engage in informed and robust critique of practices and their underpinning rationale.
Conclusion: Nurses need to be able to locate and assess useful and reliable information for decision-making. This skill is based on a range of tools which include, but also go beyond EBP including: information literacy, humanities, social sciences, public health, statistics, marketing, ethics and much more. Implications for nursing management This essay prompts nursing managers to reflect upon whether a flurried enthusiasm to adopt EBP neglects other important
decision-making skills which provide an even stronger foundation for robust nursing decisions. [ABSTRACT FROM AUTHOR]

7. A paradigm for the production of practice-based knowledge
by Reed, Pamela G & Lawrence, Lisa A. Journal of Nursing Management, May 2008, Vol 16 Issue 4:p422-432
The aim of this paper was to explore trends, arguments and issues surrounding knowledge production and nursing practice, and to propose a paradigm of practice-based knowledge along with strategies to promote theory-based knowledge development in practice.
Background: Practice-based knowledge has been marginalized in the current practice and research paradigms. Several reasons for this are presented, some of which may be addressed to facilitate a more inclusive approach to knowledge that can potentially advance patient care and the discipline.
Evaluation: Classic and contemporary scholarly sources in nursing, philosophy, education, social sciences and other areas were critically reviewed and applied to support the argument and propose a paradigm of practice-based knowledge production.
Key issues: A key point identified in the paper is that theory, meaning conceptualizations at all levels of abstraction, is an important tool of knowledge development in nursing practice as it is in traditional research.
Conclusions: Various strategies exist that can be employed to promote development and use of practice-based knowledge in the clinical setting. The strategies are innovative yet practical, and require the support and encouragement of nursing management for their successful implementation.
Implications for Nursing Management: Nursing managers can influence if not facilitate all of the strategies to promote practice-based knowledge development  identified in the paper. These efforts could give voice to the caregiver’s knowledge and, in turn, enhance patient care and the satisfaction and retention of nurses.

8. How patients’ experiences contribute to decision making: illustrations from DIPEx (personal experiences of health and illness)
by Ziebland, Sue & Herxheimer, Andrew. Journal of Nursing Management, May 2008, Vol 16 Issue 4:p433-439
To describe how people use their and other people’s experiences (‘experiential evidence’) in making health care decisions.
Background: People faced with health decisions may employ not only clinical evidence and advice, but also their own previous experiences and the experiences of others who have faced similar decisions. Professionals have taken little notice of people’s use of such experiential evidence and its importance in practice; acknowledging it would improve communication with patients. Methods: The data come from the DIPEx (personal experiences of health and illness) project, which involves rigorous analysis of narrative interviews of people with particular conditions, chosen to represent the widest practicable range of experiences of each condition. Each collection consists of 40–50 interviews.
Results: The analyses of people’s experiences are summarized for patients and professionals on a website ( ) and illustrated by clips (video, audio or written) from the interviews. We draw on the qualitative research conducted for DIPEx to consider some of the different ways that people integrate experiential information when they face decisions about antenatal screening, childhood immunization and treatment for cancer.
Conclusions: Other patients’ experiences are an important part of the evidence that people use when making decisions about health care. People are naturally drawn to other people’s stories, which add salience to medical information and make facts palatable and memorable. Patients’ experiences are not an alternative to the evidence base – they are part of it; to dismiss them as ‘anecdotes’ is a serious misunderstanding. There are established methods, grounded in social science traditions, which can be used to research and report patients’ experiences. Health professionals, as well as patients, need to consider and value this experiential evidence. Implications for Nursing Management: Managers and clinicians can help patients by guiding them to information resources, such as DIPEx, that present evidence-based health information through patients’ experiences. [ABSTRACT FROM AUTHOR]

9. Tensions and contradictions in nurses’ perspectives of evidence-based practice
by Rolfe, Gary et al. Journal of Nursing Management, May 2008, Vol 16 Issue 4:p440-451
To explore nurses’ understanding and interpretation of evidence-based practice (EBP).
Background: EBP has been welcomed into the nursing lexicon without a critical examination of its interpretation by practitioners. The literature suggests that there is a great deal of confusion and contradiction over the meaning and application of EBP. Although work has been conducted on how EBP might be implemented, the general issue of how nurses understand and use EBP is largely unexplored. This paper seeks to examine in depth the understandings of EBP, to enable managers, educationalists and policy makers to implement it more effectively.
Methods: All registered nurses, midwives and health visitors in one UK National Health Service (NHS) Trust were asked to complete a questionnaire in October 2006.
 Results: Despite a disappointing response rate (8.9%, 218/2438), the survey revealed interesting tensions and contradictions in nurses’ understanding of EBP. National and local guidelines, practitioners’ own experience and patients’ preferences were the main influences on nurses’ practice. Published research had relatively little impact, particularly among nurses graded E, F and G and those who had not attended a study day on EBP.
Conclusions: The hierarchies of  evidence propounded in local and national guidelines are not adopted by practising nurses, who use other sources of evidence, such as reflection on their own experiences, when making clinical decisions. However, subsuming published evidence to clinical judgement does not contradict the original tenets of EBP.
Implications for Nursing Management: Unless it is incorporated into national or local guidelines, research has relatively little impact on practice. To develop nursing practice and nursing knowledge, nurse leaders need to foster the synthesis of experiential knowledge and published research, in accordance with the founding principles of the EBP movement. [ABSTRACT FROM AUTHOR]

10. Exploring the evidence base of patient involvement in the management of health care services
by Haigh, Carol A. Journal of Nursing Management, May 2008, Vol 16 Issue 4:p452-462
This paper aims to explore the evidence base of patient involvement in the management of health care services.
Background: It has been suggested that, as well as acknowledging the role that service users could play in deciding their own treatment, they should also be involved in the managerial aspects of health service delivery. However, there is no robust evidence base to support user involvement either in terms of patient preference or in terms of improved service outcomes.
Methods:  Seven databases were searched using the search terms ‘user involvement’ and ‘service management’. Terms were adjusted for each database to maximize the number of hits. Each paper was graded using the sophisticated typology developed by the UK
Department of Health.
Results:  Four key issues emerged surrounding organizational power, shared meaning, liaison and user contribution.
Conclusions: There is a reasonable body of robust qualitative evidence surrounding user involvement in health service management but a disappointing lack of quantitative studies or mixed methods approaches.
Implications for nursing management:  Using the emergent messages will assist service mangers in enhancing user/provider collaborations. [ABSTRACT FROM AUTHOR]

Journals - Table of Contents

11. From Nursing Times 19 May 2009, Vol 105, No 19

11A. Widen recruitment net to avoid crisis
11B. Conservatives would 'trust nurses' to care without top-down targets; Parkinson defends Margaret Haywood sacking
11C. PM's commission uses web to seek nurse views; NHS quality indicators go live; School nurses taking on child protection roles
11D. Tool for inpatients with diabetes improves care and reduces stay; Congress rejects youth cardiac testing
11E. An end to violence?
11F. Current ward manager roles do not reflect nurses' career ambitions
11G. Developing community-based activities for inpatients in a mental health hospital
11H. Nurses' role in helping to rehabilitate patients to return to health after critical illness
11I. Exploring patients' experiences of a nurse-led follow-up service after critical care
11J. New guidance on how to avoid inserting female-length urinary catheters into men
11K. Effective team leadership: techniques that nurses can use to improve teamworking
11L. Health promotion in sexual health 2: how to put theory into practice and empower clients
11M. On how technology can help nurses improve patient care
11N. The NHS has a moral duty not to waste its resources

12. Employment Today, June 2009, Issue 138

12A. No time to stagnate
Most of us look forward to an annual pay increase each year, if only to keep up with the rising cost of living. For many though, the chances of that are ooking increasingly slim over the next year. Reports indicate a number of organisations have recently frozen wages and salaries, while others are considering pay cuts. It’s a tough ask on already hard-working and often financially stretched staff, but when the alternative is no job at all, there’s little option but to grit your teeth and get on with it. Or is there?
12B. Silver lining
Perceptions are hard to change, says Phil Maguire, but he and his team at Oceania Group are working hard to change the way their industry is seen
12C. Attitude counts
They’re often put in the ‘too hard’ basket, but employing people with disabilities has benefits for all involved.
12D. Please re-lease me
Executive leasing is experiencing a boom in some regions, but in others the number of available contracts has greatly diminished.
12E. Tough times + simple technology = true love
If there was ever a time for HR to be looking at how it can do more with less, it’s now, says Liz Tibbutt.
12F. Talent, technology, tactics
Organisations with successful talent management programmes are able to respond quickly to challenges.
12G. The ABCs of business success
Strengthening workforce skills can build employee engagement and provide a framework for future success.
12H. Bonus—a dirty word in the public sector
Recent controversies over incentive payments in the public sector have the potential to set back employee engagement and effectiveness in our crown agencies.ppa Youngman.
12I. Pushing the envelope
CEO performance reviews are often more about reviewing remuneration than appraising performance, says Gordon Davidson.
12J. Adding service to software
Payroll should play a support role and not take centre stage.
12K. Test your knowledge
There have already been several legislation changes this year, and some new case law. Are you up to date with it all?
Workplace dilemmas: Actions speak louder
Getting your workplace involved in charity work sounds like a good idea, but does it really pay off? 
12M. Remuneration: Salary reviews in hard times
When times are tough, it’s sure to have an impact on your salary budget.
12N. Recruitment: Experience the winner
Although unemployment is increasing as firms cut staff, the skills shortage is far from over in some areas. 
12O. Wellness at work: The cost of illness
The potential payoff to the economy from preventing illness in the workplace is huge, according to new research from Southern Cross.
12P. HRINZ news: Seeking relevance for today’s business
The new editor of the New Zealand Journal of Human Resource Management (NZJHRM), Dr Jarrod Haar, shares his thoughts.
12Q. Learning & development: Easy learning
Building workforce capability through e-learning makes better use of a worker’s time, space and place, and offers access to rich resources, say John Clayton
12R. Public sector: Too late is too late
The Employment Relations Act requires an employee to raise a personal grievance within 90 days.

Conferences, training and seminars

13. The National Safety Show 09
22 & 23 July 2009
Venue: ASB Showgrounds, Greenlane, Auckland
More information:

14. National Council of Women Conference
Date: 18-20 September 2009
Venue: Brentwood Hotel, Wellington

15. Immunisation Conference 2009 - From Science to Service Delivery
Date: 20-21 November 2009
Venue: University of Auckland Business School
More information:

News - National

16. $48m ambulance boost to add 100 paramedics
Dominion Post - 5 June 2009
A government injection of $28 million into the ailing ambulance service will provide 100 additional frontline paramedics, 10 for the Wellington region. Health Minister Tony Ryall announced the funding yesterday as part of a $48m package tagged for the ambulance sector, to be rolled out in the next four years

17. Doctors push for child safety
NZ Herald - Jun 05, 2009
The Ministry of Health is backing much of a wide-ranging safety agenda proposed to tackle what children's surgeons say is a "rapidly deteriorating situation" for New Zealand children.

18. Deskside vigil on hospital staff blowouts
Waikato Times - 4 June 2009
Maternity leave, salaries, overtime and recruitment will come under scrutiny at Waikato Hospital as managers scramble to reduce a staffing budget blowout of $1.5 million every month

19. Review aims to cut $8m
Nelson Mail - 4 June 2009
The Nelson Marlborough District Health Board is undertaking a major review in an attempt to cut about $8 million from its budget to break even over the next three years

News - International

20. New Study: Bankruptcy Tied To Medical Bills
The Washington Post - 4 June 2009
Sixty-two percent of all bankruptcies filed in 2007 were linked to medical expenses, according to a nationwide study released today by the American Journal of Medicine

21. Childhood vaccinations should be compulsory, says former head of BMA
Telegraph - 4 Jun 2009
Children should not be allowed into school unless they can prove they have had their vaccinations, Sir Sandy Macara, a former chairman of the British Medical Association has said.

22. Tetley tea advert banned over misleading health claims
The Telegraph - 3 June 2009
A Tetley tea advert has been banned for misleading viewers into thinking it has health benefits when the advertising watchdog says there is no evidence to suggest it is better for you than water

23. Sydney Uni drops radiation therapy course
Sydney Morning Herald - May 22, 2009
THE University of Sydney will drop its undergraduate course in radiation therapy from next year, raising fears of a shortage of trained workers.

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