Crinson, Iain; (2003) The ideological framework of nursing practice within a health care system in transition. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Nurses who have practised within the NHS over the last decade have arguably experienced more change and concomitant demands upon their clinical practice than any other period in the history of modem nursing. The research problem is concerned with the material and temporal relationship that pertains between the processes of structural and organisational change within the health care system and nurses discourses of practice. The research question that follows, is what are the discourses or frames of meaning that nurses as a profession draw upon in managing the practical problems of delivering care to patients, and what are the social structural mechanisms that shape this knowledge. In addressing this question, the thesis employs a qualitative research method, a series of focus group discussions involving different groups of nurses in order to establish the range of discourses concerning the developments that have occurred in their professional practice. In particular those changes in practice that have directly resulted from the organisational reforms within the NHS that have been instigated by both Conservative and New Labour governments in the 1990s. The analysis of this qualitative data is not tied to either a subjectivist or objectivist understanding of social reality, but seeks to apply an analytical framework informed by the methodological principles of critical realism. The objective is to postulate those necessary rather than contingent causal social structural relationships that are the condition for the generation of these nursing discourses during a time of organisational transition within the NHS. The thesis concludes with the assertion that the professional practices of nurses are shaped by a range of disparate and often contradictory ideological elements, which in many ways mirror the tensions, contradictions and politics that characterise the state provision and delivery of health care within a late modem market economy. In addition, the specific context of nursing practice, whether this be the 'community' or the hospital-setting, is central to the shaping of the specific combination of ideological elements that nurses draw upon in their discourses of practice

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