Staff Skill Mix Research Articles

Effects of size of health service on scope of rural nursing practice

This paper presents the findings of an analysis of the activities of rural nurses from a national audit of the role and function of the rural nurse (Hegney, Pearson and McCarthy 1997). The results suggest that the size of the health service (defined by the number of acute beds) influences the activities of rural nurses. Further, the study reports on the differences of the context of practice between different size rural health services and the impact this has on the scope of rural nursing practice. The paper will conclude that the size of the health service is an outcome of rurality (small population densities, distance from larger health facilities, lack of on-site medical and allied health staff). It also notes that the size of the health service is a major contextual determinant of patient acuity and staff skill-mix in small rural hospitals, and therefore the scope of rural nursing practice.

Individualized care: is it possible to plan and carry out?

The purpose of the study reported in this paper was to assess the reality of attempting to deliver individualized nursing care. An ethnographic case study research design was used on a nursing development ward. The organizational framework was a mixture of primary nursing and team nursing. Activities of three patients were observed over 4 days each, covering 16 hours of the 24-hour period for each patient. The observations were unstructured, but attempted to relate activities to the nursing care plan. Informal, semi-structured, tape-recorded interviews were undertaken with 12 of the ward staff, qualified and unqualified. The interviews asked questions relating to aspects of planning care, delivering care and ensuring continuity of care. In addition, two nurses kept diaries of significant events for 5 days. Field notes of observations were coded for analysis, interviews were transcribed and coded and diaries were coded. The findings suggest that whereas the patient is offered choice on some occasions, at other times the patients fit into the routine. Supervision of meals and the use of the care plan were issues raised. Communication between nurses was reported to be well-developed and helped to ensure continuity of care. Difficulties in delivering individualized care were related to issues of skill mix and lack of support staff.

Assessing patient dependency and staff skill mix.

An assessment tool was developed to measure patient dependency and staff skill mix in a child psychiatry inpatient unit. The authors discuss the results of a three-month pilot implementation. The implications for practice include adjustments in staff duty rotas, allocation of skill mix and the systematic assessment of patient dependency before inpatient admission.

Why a traditional health outcomes approach will fail in health care and a possible solution.

This paper challenges the assumption that improved knowledge of health outcomes and their causation will lead to more rational decision-making, resulting in improved care at lower costs. The assumption implies that the health system completely controls all those functions, factors and initiatives that can affect the implementation of the standard. These include policies, procedures, applications of techniques, skill mix of staff, inter-team interaction, communication systems, education, and so on. Changes in policy do not automatically mean a change in practice. Implementation is often approached in a manner that is perceived by staff as punitive, focusing on changing the individual rather than the system in which they work. Not only is this approach opposite to basic total quality management principles, but it also fails to acknowledge that most of the improvements arising from the health outcomes approach are a result of staff being prepared to continuously work harder, often ignoring the 'system', to maintain their high standard. However, continuing deterioration in the system in which they work sets the scene for an accident or incident to occur. The answer lies in revisiting the traditional quality assurance cycle and acknowledging that health care has never been able to effectively 'close the feedback loop', that is, the health system is continuously increasing the sophistication of data collection techniques without giving equal consideration to what needs to be done to ensure effective implementation and evaluation. This paper outlines how Campbelltown Health Service directly addressed this issue through its process of achieving international certification to ISO 9002:1994.

Use of games in the clinical setting as an aid to teaching.

Gaming is increasingly being used in nursing curricula as an alternative form of learning in the clinical setting. This article discusses the advantages and disadvantages of the use of games and describes the design of a game for use by any skill mix of staff.

Protocols: guidance for good practice

The use of standardised protocols in patient care is becoming widespread. They offer a positive adjunct to nurses, but can be misused by managers to effect changes in staffing skill mix. This article offers guidance for nurses on the essential criteria a protocol must achieve before being considered acceptable.

Staff deployment and skill mix

Staff deployment and skill mix