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Accountability in Nursing and
Midwifery
Second edition
Edited by
Stephen Tilley
BA, RMN, PhD
Senior Lecturer, Nursing Studies
University of Edinburgh
Edinburgh
and
Roger Watson
BSc PhD RGN CBiol FIBiol ILTM FRSA
Professor of Nursing
School of Nursing, Social Work and Applied Health Studies
University of Hull
Hull
Blackwell
Science
Accountability in Nursing and Midwifery
Accountability in Nursing and
Midwifery
Second edition
Edited by
Stephen Tilley
BA, RMN, PhD
Senior Lecturer, Nursing Studies
University of Edinburgh
Edinburgh
and
Roger Watson
BSc PhD RGN CBiol FIBiol ILTM FRSA
Professor of Nursing
School of Nursing, Social Work and Applied Health Studies
University of Hull
Hull
Blackwell
Science
© 1995 Chapman & Hall
© 2004 by Blackwell Science Ltd
a Blackwell Publishing company
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First edition published by Chapman & Hall 1995
Second edition published by Blackwell Science Ltd 2004
Library of Congress Cataloging-in-Publication Data
Accountability in nursing and midwifery / edited by Stephen Tilley and
Roger Watson. — 2nd ed.
p. ; cm.
Rev. ed. of: Accountability in nursing practice / edited by Roger
Watson. London : Chapman & Hall, 1995.
Includes bibliographical references and index.
ISBN 0-632-06469-2 (pbk. : alk. paper)
1. Nursing—Standards—Great Britain. 2. Midwifery—Standards—Great
Britain. 3. Responsibility. 4. Clinical competence.
[DNLM: 1. Midwifery—standards. 2. Nursing—standards. 3. Nursing
Care—standards. 4. Quality Assurance, Health Care. WY 16 A172 2004]
I. Tilley, Stephen. II. Watson, Roger, 1955– III. Accountability in
nursing practice.
RT85.5.A25 2004
610.73′06′9—dc22
2003020922
ISBN 0-632-06469-2
A catalogue record for this title is available from the British Library
Set in 10.5/12.5pt Sabon
by Graphicraft Limited, Hong Kong
Printed and bound in Great Britain using acid-free paper
by TJ International Ltd, Padstow, Cornwall
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The opinions expressed in this book are those of the editors and authors concerned.
These views are not necessarily those held by Blackwell Publishing.
Contents
Contributors xi
Preface xiii
1 Introduction 1
Roger Watson and Stephen Tilley
Historical perspective 1
An accountant looks at nursing 1
Accountability and clinical governance 2
Accountability and the law 2
A policy perspective 3
An NHS trust perspective 3
A manager speaks 4
Caring for children 4
Learning disabilities 5
Midwifery 5
Community nursing 6
Mental health nursing 7
Research 8
Conclusion 8
2 The Development of Nursing as an Accountable Profession 9
Susan McGann
Introduction 9
Historical perspective 9
The British Nurses’ Association 10
Mrs Bedford Fenwick 10
Professional registration 12
Matrons’ Council of Great Britain and Ireland 12
Political perspective 14
Early registration bill 15
The war 16
Registration Act 1919 18
Conclusions 19
vi Contents
3 Accountability and Clinical Governance in Nursing:
a Critical Overview of the Topic 21
Kerry Jacobs
Introduction 21
Accountability 26
Accountability and reform 30
Clinical governance 32
Conclusion 36
4 Accountability and Clinical Governance 38
Roger Watson
Introduction 38
Clinical governance 39
Why do we have clinical governance? 39
Poor care 42
Short cuts 43
Trust 44
Conclusion 45
5 The Legal Accountability of the Nurse 47
John Tingle
Introduction 47
The concept of accountability and the new NHS 47
Accountability is not irrelevant 48
Labels can obscure meanings 48
Ideas behind the label 48
This chapter 48
Legal accountability 49
Interests, rights and duties: the role of the law 49
The Ms B. case 49
Dispute resolution, compensation and punishment 50
Establishing nursing negligence 50
Vicarious liability 51
The aim of the law: compensation 51
Clinical negligence law today: all change? 51
Regulation, deterrence and education: the role of the law 52
Evidence-based healthcare and the courts 54
The scandals of recent years 54
The law affects all aspects of nursing 55
The various forms of accountability 55
Accountable to whom? 56
Accountability and sanctions 57
The allocation and management of healthcare resources:
the nurse’s role 58
Contents vii
A conflict of accountability 58
The role of the law: legal accountability 59
Cases of resource and negligence 59
Conclusion 63
6 Accountability and Clinical Governance: a Policy Perspective 64
Tracey Heath
Introduction 64
Background: the NHS pre-1997 64
The Labour Government’s challenge 66
Practising within an era of increasing accountability 68
Towards a modern and dependable NHS: the Labour
Government’s response 68
Accountability and clinical governance 70
Organisational accountability 70
Reflections on the broader policy context 74
Conclusion 76
7 Accountability in NHS Trusts 77
Stephen Knight and Tony Hostick
Introduction 77
Clinical governance 77
Responsibilities of trusts 78
Professional self-regulation 82
A systematic approach to decision making 84
Implications for practice 84
Conclusion 86
8 Accountability and Clinical Governance in Nursing:
a Manager’s Perspective 87
Linda Pollock
Introduction 87
Background context 87
Clinical governance as a concept 88
The meaning of clinical governance 88
Our interpretation of clinical governance 89
Has clinical governance made a difference? 91
Clinical governance and its impact at board level 91
Clinical governance structures as a vehicle for change 92
Clinical governance and people governance 93
Clinical governance and its impact on nursing 95
Clinical governance and cultural change 96
Sharing good practice 97
Evidence-based practice – the reality 98
viii Contents
9 Working with Children: Accountability and Paediatric Nursing 99
Gosia Brykczyñska
Introduction 99
Definition of paediatric nursing 100
Ability 101
Obligations 103
Involving parents 104
Autonomy of children 106
Authority 107
Free will and choice 108
Power and political action 109
Responsibility 111
Responsibilities for treatment 111
Consequences of responsibility 113
Responsibility of parents and children 114
Conclusion 116
10 Accountability and Clinical Governance in Learning
Disability Nursing 117
Bob Gates, Mick Wolverson and Jane Wray
Introduction 117
Clinical governance in learning disability nursing and
guidelines for practice 118
Consent 120
Interdisciplinary working 120
Evidence-based practice 121
Advocacy 121
Autonomy 121
Relationships 122
Confidentiality 122
Risk assessment and management 122
The challenges of effectively implementing clinical governance
in services for people with learning disabilities 123
Fragmented partnership working 125
User and carer involvement 125
The spectrum of need 126
Quality of life 126
Solutions to the barriers associated with implementing clinical
governance in learning disability services 127
Conclusion 131
11 Where does the Buck Stop? Accountability in Midwifery 132
Rosemary Mander
Introduction 132
What is meant by accountability? 133
[...]... nurses continued in the years leading up to World War I At an international level, the ICN held meetings and congresses in Berlin in 1904, in Paris in 1907, in London in 1909 and in Cologne in 1912 For nurses campaigning for professional status and registration against prejudice and apathy in their own countries, the international meetings were of the greatest value: ‘It is an inspiration and source... United Kingdom Central Council for Nursing, Midwifery and Health Visiting, included somewhere in the spectrum xiv Preface The advent of clinical governance has, on the one hand, brought accountability into clearer focus and, on the other hand, changed the nature of accountability in nursing Clinical governance provides a framework, essentially lacking in previous years, within which nurses and other... instead endorses the value of a ‘discourse of individual accountability in nursing Accountability and clinical governance Clinical governance has been a relatively recent addition to the guidelines for working with patients in the NHS The second editor examines the relationship between accountability in nursing and midwifery and clinical governance If accountability is still the hallmark of a profession,... affecting the accountability of community nursing Current issues in community nursing Resource allocation and skill mix Delegation and skill mix Legal and professional issues in community nursing Clinical governance Clinical effectiveness and evidence-based practice Role developments Nurse prescribing Primary healthcare and public health nursing Conclusion 13 Clinical Governance, Accountability and Mental... of accountability in nursing and midwifery which did not include clinical governance would be incomplete In order to address this, therefore, the present volume includes contributions from practice which examine the issue of clinical governance from a number of perspectives and also chapters in which the link between accountability and clinical governance is examined Two of the major issues of the introduction... clinical governance in learning disability nursing Midwifery Rosemary Mander distinguishes nursing from midwifery and reckons that midwifery could learn a great deal from the nursing literature about accountability because it is not covered to any great extent in the midwifery literature Perhaps this is because midwives take a certain degree of autonomy, 6 Introduction and therefore accountability, for... conclude in the same way: community nursing is challenging and satisfying and issues of accountability remain at the heart of practice Mental health nursing Stephen Tilley reflects upon the in uence that clinical governance may have had upon accountability in mental heath nursing The major change, since 1995, is that the introduction of clinical governance has put evidence-based practice at the heart of clinical... as nursing, which at one point in its history was striving to be considered accountable and therefore a profession, was only 2 Introduction seeing one side of the accountability coin In fact, such a struggle for accountability may have been naive to the extent that accountability is imposed rather than self-claimed, and nursing, and other healthcare professions, including medicine, have now imposed accountability. .. registration died in 1919 – perhaps this was significant The historical and political perspective on the development of professional nursing offered by McGann, taking us up to 1919 and establishing the historical basis for claims of accountability linked to professional registration, continues to inform the ongoing debate about accountability in nursing An accountant looks at nursing Kerry Jacobs brings a welcome... aware of the constraints of accountability in research This is a task which must be addressed by those providing undergraduate and postgraduate research courses for nursing and midwifery students Conclusion Accountability remains a key topic and clinical governance has become a key topic for the professions of nursing and midwifery The editors, apart from their own chapters, now hand over to the other . Hull
Hull
Blackwell
Science
Accountability in Nursing and Midwifery
Accountability in Nursing and
Midwifery
Second edition
Edited by
Stephen Tilley
BA,. guidelines
for working with patients in the NHS. The second editor examines the rela-
tionship between accountability in nursing and midwifery and clinical gov-
ernance.
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