Introduction to economic assessment - part 4.

This is the final in a series of four continuing professional development articles on economic assessment (EA), more specifically EA in the context of nurse-led service innovation. The series aims to equip readers with an understanding of: (a) the main requirements of EA; (b) definitions of relevant terminology; (c) different EA techniques and their associated strengths and weaknesses; and (d) procedures to assign monetary values to costs and benefits. The series introduces a methodology, with associated tools and templates, that has been used by practising nurses to conduct EAs. The aim of this article is to show readers how to put monetary values on the types of cost incurred, and benefits generated, by a service innovation.

Introduction to economic assessment - part 3.

This is the third in a series of four continuing professional development articles on economic assessment. The series aims to equip readers with the knowledge and skills to apply the principles of economic assessment in practice. The series describes a tried and tested methodology that has been used by practising nurses leading service innovations. In this article, we introduce tools and templates that have been developed specifically to support nurses applying the methodology.

Introduction to economic assessment - part 2.

This is the second in a series of four continuing professional development articles that explain some of the principles of economic assessment (EA) and describe how they may be applied in practice by front line practitioners leading service innovations. It introduces a methodology, with associated tools and templates, that has been used by practising nurses to conduct EAs. Our purpose is to equip readers with the knowledge to develop a technically competent, pragmatic EA that will contribute towards evidence-informed decision making and assure the best use of limited resources. If you have not already read the first article in this series ( McMahon and Sin 2013), we strongly advise you to do so as each article purposefully draws and builds on those that have gone before. The time out exercises in the first article required you to access source material located on the RCN website and identify a service innovation in your workplace. The time out exercises in this article draw in these same sources. We begin this article by recapping on the points covered in the first article before exploring the implications of the principles of EA and how to apply them in practice. In this article, we refer to and draw on a companion article published in this edition of Nursing Management ( pages 38-41) that sets out the most commonly cited approaches to EA in health and social care. We aim to enable readers, along with those they seek to influence, to make an informed decision as to what may be an appropriate EA approach in any specific context.

Making the economic case for nursing innovations: horses for courses.

In economic assessment, costs must be reviewed and expressed in monetary terms. Benefits, however, may be expressed differently depending on the specific approach. This article describes the techniques that nurses are likely to come across and use most often, while emphasising that there is no single 'best' approach. Different approaches serve different purposes and the choice of approach must be based on pragmatic decision making.

Introduction to economic assessment.

This is the first in a series of four continuing professional development articles that explain some of the principles of economic assessment and describe the most commonly cited approaches. The series aims to enable readers to critically examine economic assessments in the context of nurse-led service innovation. It introduces a tried-and-tested methodology, with associated tools and templates, used to conduct economic assessments in nursing. In this article, the principles of economic assessment are introduced and two case studies of nurse-led innovation are used to illustrate how they are applied in practice.

Medicalising disability? Regulation and practice around fitness assessment of disabled students and professionals in nursing, social work and teaching professions in Great Britain.

PURPOSE: The reliance on medical information and on occupational health (OH) professionals in ascertaining fitness of applicants and registrants within the educational and employment contexts may lead to the medicalisation of disability. The Disability Rights Commission's Formal Investigation into the regulation of three public sector professions of nursing, social work and teaching in Britain sheds light on the nature of regulatory fitness requirements and how these are implemented in practice. METHOD: The multi-pronged investigation included a review of relevant statutory and regulatory frameworks, formal written and oral evidence submitted by key stakeholder organisations and research into formal and informal fitness assessments within the education and employment contexts. RESULTS: There are varied and vague fitness requirements in all three professions. OH professionals figure prominently in formal and informal decision-making around fitness within education and employment settings, regardless of regulatory prescriptions. There is a multitude of approaches. There are, however, particular issues in the deployment of OH expertise within the employment setting. CONCLUSIONS: The determination of fitness should not rely solely on medical information. Blanket fitness requirements that are not contextualized against specific competencies for particular jobs are inappropriate. More collaborative and integrated working is necessary, particularly in exploring how reasonable adjustments may be provided to enable safe and effective practice. The positive spirit of the disability equality duty should be embraced.

'Do no harm'? Professional regulation of disabled nursing students and nurses in Great Britain.

AIM: This paper is a report of the findings of a General Formal Investigation launched by the Disability Rights Commission, Great Britain into the impact of regulatory fitness standards on disabled people, and on nursing students and nurses in particular. BACKGROUND: The potential for systemic discrimination against disabled nursing professionals lies in the existence and nature of regulatory fitness standards, as well as in how these are interpreted and implemented in practice. METHODS: A review of relevant legislation, regulation and guidance was conducted to explore the interaction of the regulatory framework with the Disability Discrimination Act. A formal call to key national stakeholder organizations solicited information on perceptions of the regulatory framework and the adequacy of guidance issued. Independent research was commissioned on disabled people's disclosure of disability, informal and formal decision-making around fitness within the educational, and employment contexts. An Inquiry Panel examined all evidence sources, solicited further oral evidence from key organizations, and developed recommendations. FINDINGS: No mention was found of the Disability Discrimination Act in any regulation and guidance governing nursing prior to 2006. There are particular requirements for 'good health and good character'. Respondents from key national stakeholder organizations, higher educational institutions and employers struggle to interpret the fitness requirements consistently. Implementation is variable, with reliance on ad hoc self-initiated strategies. The variability of interpretation and implementation can lead to discrimination against disabled people. CONCLUSION: The imprecision of fitness requirements and variability of implementation raise serious doubts about their utility in managing risk.

The interpretation and implementation of regulatory fitness requirements.

The Disability Rights Commission launched a general formal investigation (FI) into the impact of fitness standards on disabled people studying, qualifying, registering and working in three public sector professions, including nursing. The FI's review of statutory and regulatory frameworks identified a significant amount of primary and secondary legislation and guidance, with an array of fitness requirements of statutory basis. There is, however, scant reference to the Disability Discrimination Act. The FI additionally issued a forma call for evidence targeting key stakeholder organizations, exploring how these interpret and implement regulations and guidances. Responding organizations acknowledge that the potential for, and reality of, discrimination exists and stems from highly variable and subjective interpretations and implementation of the regulatory fitness requirements. There is a widely perceived lack of adequate and clear guidance for practice purposes. Fitness requirements can discourage disabled people from attempting entry into the profession. A risk-averse culture discourages disclosure, and can affect the types and timeliness of support being provided to disabled students and professionals.

Expectations of support among White British and Asian-Indian older people in Britain: the interdependence of formal and informal spheres.

Abstract The discourse surrounding community care characterises informal support being superior to and preferred over formal sources of support, with this distinction buttressed by policy changes. There is a lack of understanding of the interdependence of both spheres of support. This article argues that an individual's experience and expectation of one type of support is often made in relation to his or her understanding, expectation and experience of other sources of support. There is also an urgent need to understand how these associations operate in a cross-cultural context as it is naïve to assume that normative expectations will remain constant when the relationship between family, state and other sources of support are unstable. This article reports on findings emerging from part of a Growing Older study funded by the Economic and Social Research Council of Great Britain to explore the relationship between quality of life and the social networks and support of older people from different ethnic groups. Research involved the use of a questionnaire comprising closed- and open-ended questions. In addition, in-depth qualitative interviews covering the existence and nature of social networks and support, as well as perceptions and expectations of these, were also conducted. This article reports on data relating to a sample comprising seven White British men, 10 White British women, 12 Asian-Indian men, and nine Asian-Indian women aged 55 and over derived from the Family Resources Survey. Findings reveal that the high level of expectation for family support amongst Asian-Indian respondents coexists with a high level of expectation for state support and an acknowledgement that the ideal of family support may not always materialise. Amongst White British respondents, the high level of expectation for state support exists regardless of whether the respondent has satisfactory informal social networks. This expectation is commonly expressed in terms of rights and entitlement by White British respondents but not by Asian-Indians. Associated with this, Asian-Indian respondents display a consistently lower level of awareness and usage of a range of health and social care services. Regardless of the extent of current and past usage of services, however, respondents from both groups overwhelmingly indicate an expectation for the continued provision of such services as they would like to be able to use one or more of these at some stage.