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Title: An analysis of the involvement of community nurses in clinical governance
Author: Howell, Jane
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2006
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The introduction of clinical governance requires that community nurses participate in the development of corporate accountability for clinical performance, accounting for normality as well as exceptional events in practice. The ability to deal with change has become a necessary part of the community nursing role, a factor complicated by the geographical spread and stratification of community nursing teams. If the development of clinical governance is to avoid domination by medical or managerial perspectives, each staff group is required to represent their standpoint. This is a study of the enacted narrative in the community context, to understand how nurses narrate and justify their involvement in these reforms and, to examine the development of a negotiated consensus by community nursing teams. A research approach within the social constructionist tradition informed by Burke’s (1969) dramatist pentad was used to explore and interpret the respondents’ accounts. Narratives of clinical governance were obtained from unstructured interviews with twenty staff, including district nurses and managers in two NHS trusts. The study findings suggested the continuing penetration of nursing practice by management systems, and associated hybridisation of nursing and management roles. Nursing governance is enacted through clinical audit and standard setting systems, building on the history of nursing involvement in these initiatives to develop a nursing consensus on the governance of nursing practice. The majority of nurses are presented as disengaged from these events, with the resultant nursing governance systems underpinned by an apparent rather than actual consensus.  The uncertainty of the community nursing knowledge base in the face of clinical governance is illustrated, with practitioners reliant on rationalities drawn from managerial and evidence based logics. It is argued that the marginalisation of the nursing perspective by nursing governance systems, may result in a failure of the profession to develop the dialectical skills and articulacy required to present the nursing perspective in this and future developments. Difficulties arising from the way in which clinical governance is being developed are identified. The findings suggest the requirement of a revised approach to the management of nurses, enabling the explicit inclusion of the nursing majority in future policy implementation.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available