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Biomedical subjects

Keith Hurst

Publications and source records attributed to Keith Hurst.

14 recordsLinked to original sources
PubMed2006

UK ward design: patient dependency, nursing workload, staffing and quality-an observational study.

BACKGROUND: There are important relationships between ward design, patient welfare and staff activity in the literature but studies seem not to have tested all the variables. Whether ward designs influence nursing structures, processes and outcomes, therefore, has not been fully answered. While studies provide helpful guidance, nursing efficiency and effectiveness implications are speculative. OBJECTIVES: To improve nursing efficiency and effectiveness by capitalizing on the best ward design features. SETTING: A database consisting of 375 UK wards, constructed for other research and development purposes, was revisited and reconfigured for the present study. The database was updated between 2003 and 2004. PARTICIPANTS: Of 390 wards approached, 375 generated usable data. METHOD: Patient dependency, nursing activity, workload, nursing quality and staffing data in the original database were obtained using mainly non-participation observation methods. Later, wards were classified in eight ways and differences between ward types examined. RESULTS: Patient dependency did not stand out in any ward type but as the literature predicted, direct patient care was higher in Nightingale wards. Racetrack ward nursing activity was also close to idyllic. Bay wards, owing to their greater occupancy peaks and troughs, had a propensity to generate heavier workloads. Time-out and down-time were not excessive in any ward type, and it is likely that ward leadership may be compensating for some variables' negative effects. Racetrack wards were considerably less-well staffed and grade-mix dilute and consequently the cheapest. Quality scores were higher in Nightingale wards-nurses' greater observation capability was a significant factor. Wards' central-core configurations also influenced nursing efficiency and effectiveness. CONCLUSIONS: Racetrack wards have an edge over other ward designs. However, replicating Nightingale conditions by, for example, equalising occupancy, throughput and staffing and maximising nurses' substations, could engender similar outcomes elsewhere.

Dependency, Psychological↗
PubMed2006

British out-of-hours primary and community care: a review of the literature.

PURPOSE: This out-of-hours primary and community care services (more recently called unscheduled care) literature review sets out to build on the foundations set by earlier publications by examining old and fresh issues after the new General Medical Service contract was implemented in 2004. DESIGN/METHODOLOGY/APPROACH: Almost 140 publications were located, including a range of theoretical and empirical publications. FINDINGS: A total of seven themes emerge--varying from the most frequently discussed (service nature and value) to the least examined (information management and technology). ORIGINALITY/VALUE: Analysis not only underlines service problems and tensions noted previously but also generates new insights, which cannot be ignored if services are to be developed. Consequently, several recommendations are made.

After-Hours Care↗
PubMed2006

Primary and community care workforce planning and development.

AIM: This article reports a study that provided primary and community care managers with information, allowing them to: (a) evaluate the size and mix of their workforce; and (b) develop knowledgeable and skilled teams to meet the demands of growing and changing services. BACKGROUND: Primary and community care services are growing in the United Kingdom, but workforce planning and development, despite their wide-ranging cost and quality implications, have not received the same attention. Indeed, most primary and community care workforce planning and development issues are universal. Demand 1-1 side workforce planning is concerned not only with the number, but also with staff mix; but how these autonomous and isolated practitioners spend their time is unique. The other side of the equation, workforce supply, raises many recruitment and retention challenges for managers in many countries. Any country's main workforce planning methods apply equally well to primary care, but each is flawed. A second, main problem is that the methods lead to fragmented services, whereas modern workforce planning methods should be multidisciplinary. Consequently, it has never been more important for managers to have data and algorithms to develop appropriate care teams. METHOD: A large and versatile workforce database, profiling 304 English primary care trusts using demographic, socio-economic, mortality, morbidity, staffing and performance workforce-related variables, compiled in 2002 and updated yearly, is described. Data were supplemented with a systematic literature review leading to a 340-item annotated bibliography; and qualitative interviews with managers. RESULTS: Workforce size and mix are historical and irrational at best. Moreover, the number of variables that influence staffing is growing, thereby complicating workforce planning. CONCLUSION: Evaluating and adjusting the size and mix of teams using empirically determined community demand and performance variables based on the area's socio-economic characteristics is feasible.

Community Health Nursing↗
PubMed2005

Relationships between patient dependency, nursing workload and quality.

The nature and value of dependency-acuity-quality (DAQ) demand-side nursing workforce planning methods are set in the context of nursing workforce planning and development. Extensive DAQ data from one of the largest UK nursing workforce studies (347 wards) involving 64 high-quality and 62 low-quality hospital wards, are reconsidered in a workload and quality context. Results generate new insights; for example, poor quality care is more likely to be a feature of larger wards with fluctuating workloads than smaller wards with consistently high workloads owing to inflexible nurse staffing. Nursing activity and staffing differences between high- and low-quality wards are highlighted. Recommendations are made to improve nursing management and practice as well as the next phase of DAQ studies.

Dependency, Psychological↗
PubMed2004

Clinical and education implications of shift work.

Yorkshire teaching hospital staffs' perceptions before and after implementing a junior doctor shift system are reported. The study is placed in context by discussing the European Working Time Directive and the New Deal for Doctors. Five education and clinical issues are examined using data from activity diaries and attitude questionnaires. Interesting findings emerge that sometimes contradict the literature. Important recommendations are made to ease the NHS's inevitable move towards shift work.

Hospitals, Teaching↗
PubMed2003

Building a research conscious workforce.

With the aim of building a research conscious workforce, the former Northern and Yorkshire Research and Development office explored the nature and purpose of research and development (R&D) support for NHS staff. Part of the study used a questionnaire to seek healthcare professionals' R&D education and training needs. Some findings were unexpected, such as the significant differences between professional groups' needs and preferences. Recommendations, therefore, include local, flexible R&D education and training programmes.

Attitude of Health Personnel↗
PubMed2003

Antenatal screening: why do women refuse?

Due to the large number of children with disabilities in the local area, Calderdale and Kirklees Health Authority commissioned a research project. The aim was to explore the issues surrounding antenatal screening--the needs of parents and the risk of giving birth to a baby with a disability. Triangulation using both qualitative and quantitative methods was used and data was collected through questionnaires, interviews and focus groups. Findings led to the identification of themes: access of local services, parents knowledge of antenatal screening tests and local services, and professionals beliefs around antenatal screening issues. The project highlights professional's lack of knowledge and therefore the need for antenatal screening coordinators in all Trusts, in-service training, improved information for parents and education in the community, especially for 'at risk' groups such as ethnic minorities.

Adult↗
PubMed2002

Evaluating self-managed integrated community teams.

After briefly describing self-managed integrated community teams, the authors explore potential and actual methods of evaluating their structures, processes and outcomes. Primary health care staff in three comparable sites were studied using non-participant observation, interviews, focus groups and questionnaires. After describing the fieldwork, the authors examine integrated team structures, which are characterised by a large number of barriers that integrated teams face. Processes surrounding different working practices are explored next. Ways of unifying health care professional practice in integrated teams are suggested using evidence from both the literature and fieldwork. Outcomes that emerged after one year of the new teams' lives are discussed in detail. The difficulty in establishing acceptable outcomes, especially the validity and reliability of outcome measures, is considered. Throughout, the positive and negative aspects of integrated teams emerging from the fieldwork are compared and contrasted with issues in the literature. Finally, recommendations are made to help strengthen integrated teams in the UK.

Attitude of Health Personnel↗
PubMedDate not supplied

Nursing by numbers.

In the face of NHS budget cuts, nurses are being asked to justify their workforce numbers. Keith Hurst reviews some of the tools available for calculating staffing levels, examines their pros and cons, and discusses their application.

Activities of Daily Living↗