Abstract:This discussion paper sets out some major concerns with the introduction of critical paths into the Australian health care system. It is argued that in their current form as devised in North America, critical paths may not be appropriate to our organisation of health care and may in fact be detrimental to the development of nursing practice. The discussion centres around the socio-political context of the development of managed care in North America, as well as research findings from the implementation of crit… Show more
“…Emotional support, education and encouragement or counselling are nursing activities as much as removing a surgical drain, yet they are not definable as a costing. A clinical pathway is a document about resources as much as it is about clinical care; 41 where it is used, nurses may see the devaluing of the above-named aspects of their practice.…”
The Australian healthcare system is undergoing changes that are impacting tangibly on professional nursing practice. While the evidence is clear that the changes pose a challenge to maintaining standards amidst resource cuts and restructuring, the processes through which these changes occur and the decisions which drive the reforms remain complex and largely obscure. This paper intends to stimulate further thinking and debate among nurses about the effects of these reforms on the conduct of practice, both in terms of our emerging discipline and our ability to conduct clinical nursing practice. It offers a way of understanding the policy 'reform' process through an application of policy analysis grounded in critical social theory. The discussion sets out to apply these analytical propositions to specific events that constitute examples of change in the nursing workplace, and to focus on the implications for nurses and health service clientele.
“…Emotional support, education and encouragement or counselling are nursing activities as much as removing a surgical drain, yet they are not definable as a costing. A clinical pathway is a document about resources as much as it is about clinical care; 41 where it is used, nurses may see the devaluing of the above-named aspects of their practice.…”
The Australian healthcare system is undergoing changes that are impacting tangibly on professional nursing practice. While the evidence is clear that the changes pose a challenge to maintaining standards amidst resource cuts and restructuring, the processes through which these changes occur and the decisions which drive the reforms remain complex and largely obscure. This paper intends to stimulate further thinking and debate among nurses about the effects of these reforms on the conduct of practice, both in terms of our emerging discipline and our ability to conduct clinical nursing practice. It offers a way of understanding the policy 'reform' process through an application of policy analysis grounded in critical social theory. The discussion sets out to apply these analytical propositions to specific events that constitute examples of change in the nursing workplace, and to focus on the implications for nurses and health service clientele.
“…[nurses are] beguiled into accepting strategies and thinking more akin to corporate business interest revolving around the efficient operation of health care facilities, than their own discipline ( Gibb and Banfield 1996, 43).…”
The social production of an enterprise clinic: nurses, clinical pathway guidelines and contemporary healthcare practices
In this paper I critically engage with the forming of contemporary nursing practice with/in an ‘enterprise clinic’ in order to discuss the practical potential of developing a mode of reflective practice that is a critical ontology of self. Critical engagement in the paper is secured through a ‘troubling’ of the relationship between the contemporary practices of both the self and governance, without the reduction of one to the other. The paper draws on my doctoral study in which I combined the techniques of ethnography and discourse analysis in order to critically examine registered nurses’ employment of clinical pathway guidelines through an analysis of the political technologies through which that engagement was constituted. This critical purchase was applied because of the influence of the contemporary ‘problematisation’ of healthcare provision in western society on the formation and deployment of the professional identities of nurses.
“…The health‐care system is under pressure to provide quality care with less financial resources for a growing and aging population (Williams & Botti, 2002). It is clear that there are increasing pressures on ICU bed availabilities within the health‐care system (Gibb & Banfield, 1996). The cost pressures on the health‐care system translate to pressures on hospitals to move patients back into the community as soon as possible (Gibb & Banfield, 1996).…”
Section: Discussionmentioning
confidence: 99%
“…It is clear that there are increasing pressures on ICU bed availabilities within the health‐care system (Gibb & Banfield, 1996). The cost pressures on the health‐care system translate to pressures on hospitals to move patients back into the community as soon as possible (Gibb & Banfield, 1996). Systems have been established to measure the efficiencies of the various hospital activities.…”
Evidence indicates that the poorly managed transfer of a patient from the intensive care unit (ICU) to the ward can lead to physical and psychological complications for the patient, and often require ICU readmission and rehospitalization. Reviewing this patient transfer process to improve the quality of care would be a positive step towards enhancing patients' recovery and providing skills to staff. The aim of this paper is to review case studies of transferring ICU patients to general wards in order to identify the shortcomings of this process. A literature review was conducted to evaluate current practices in the ICU transfer process. The results of this paper have clinical implications, suggest approaches to improve support for patients and their carers, and provide strategies to improve the transfer procedure.
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