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      A birth centre's encounters with discourses of childbirth: how resistance led to innovation

      Sociology of Health & Illness
      Wiley

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          Does organisational culture influence health care performance? A review of the evidence.

          To review the evidence for a relationship between organisational culture and health care performance. Qualitative comprehensive review: all empirical studies exploring a relationship between organisational culture (broadly defined) and health care performance (broadly defined) were identified by a comprehensive search of the literature. Study methods and results were analysed qualitatively to provide a narrative review with integrative discussion. Ten studies met the inclusion criteria. There was considerable variation in the design, study setting, quality of reporting and aspects of culture/performance considered. Four of the ten studies reviewed in detail claimed to have uncovered supportive evidence for the hypothesis that culture and performance are linked. All the other studies failed to find a link, though none provided strong evidence against the hypothesis. There is some evidence to suggest that organisational culture may be a relevant factor in health care performance, yet articulating the nature of that relationship proves difficult. Simple relationships such as 'strong culture leads to good performance' are not supported by this review. Instead, the evidence suggests a more contingent relationship, in that those aspects of performance valued within different cultures may be enhanced within organisations that exhibit those cultural traits. A striking finding is the difficulty in defining and operationalising both 'culture' and 'performance' as variables that are conceptually and practically distinct. Considerably greater methodological ingenuity will be required to unravel the relationship(s) between organisational culture(s) and performance(s). Current policy prescriptions, which seek service improvements through cultural transformation, are in need of a more secure evidential base.
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            Who cares? Offering emotion work as a 'gift' in the nursing labour process.

            Who cares? Offering emotion work as a 'gift' in the nursing labour process The emotional elements of the nursing labour process are being recognized increasingly. Many commentators stress that nurses' 'emotional labour' is hard and productive work and should be valued in the same way as physical or technical labour. However, the term 'emotional labour' fails to conceptualize the many occasions when nurses not only work hard on their emotions in order to present the detached face of a professional carer, but also to offer authentic caring behaviour to patients in their care. Using qualitative data collected from a group of gynaecology nurses in an English National Health Service (NHS) Trust hospital, this paper argues that nursing work is emotionally complex and may be better understood by utilizing a combination of Hochschild's concepts: emotion work as a 'gift' in addition to 'emotional labour'. The gynaecology nurses in this study describe their work as 'emotionful' and therefore it could be said that this particular group of nurses represent a distinct example. Nevertheless, though it is impossible to generalize from limited data, the research presented in this paper does highlight the emotional complexity of the nursing labour process, expands the current conceptual analysis, and offers a path for future research. The examination further emphasizes the need to understand and value the motivations behind nurses' emotion work and their wish to maintain caring as a central value in professional nursing.
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              What counts as evidence in evidence-based practice?

              Considerable financial and philosophical effort has been expended on the evidence-based practice agenda. Whilst few would disagree with the notion of delivering care based on information about what works, there remain significant challenges about what evidence is, and thus how practitioners use it in decision-making in the reality of clinical practice. This paper continues the debate about the nature of evidence and argues for the use of a broader evidence base in the implementation of patient-centred care. Against a background of financial constraints, risk reduction, increased managerialism research evidence, and more specifically research about effectiveness, have assumed pre-eminence. However, the practice of effective nursing, which is mediated through the contact and relationship between individual practitioner and patient, can only be achieved by using several sources of evidence. This paper outlines the potential contribution of four types of evidence in the delivery of care, namely research, clinical experience, patient experience and information from the local context. Fundamentally, drawing on these four sources of evidence will require the bringing together of two approaches to care: the external, scientific and the internal, intuitive. Having described the characteristics of a broader evidence base for practice, the challenge remains to ensure that each is as robust as possible, and that they are melded coherently and sensibly in the real time of practice. Some of the ideas presented in this paper challenge more traditional approaches to evidence-based practice. The delivery of effective, evidence-based patient-centred care will only be realized when a broader definition of what counts as evidence is embraced.
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                Author and article information

                Journal
                SHIL
                Sociology of Health & Illness
                Wiley
                01419889
                14679566
                March 2007
                March 2007
                : 29
                : 2
                : 216-232
                Article
                10.1111/j.1467-9566.2007.00545.x
                12efe367-35c9-451c-b6e3-0b9c2e423399
                © 2007

                http://doi.wiley.com/10.1002/tdm_license_1.1

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