Book Review
Nursing Administration in the 21st Century - A Self-Care Theory Approach
Sarah E Allison and Katherine E McLaughlin-Rendenning
1999; Sage Publications;
Marilyn Chew
Nursing Director, Royal Children's Hospital; Health Service District, Community Child Health Service, Riverton - Statewide Program, QLD
This book aims to provide practical application of a nursing theory framework to the management and operation of nursing services. The authors employ Orem's self-care deficit nursing theory as the foundation for describing the 'product' of nursing for nurse administrators and extend thinking beyond a purely managerial approach. They guide the reader to describe the essential contributions of nursing to the overall provision of health services.
Although the discussion is based entirely in the American and Canadian context, it spans a range of hospital and community based services and the content is relevant and should appeal to nurse leaders in Australia. Allison and McLaughlin-Rendenning put a passionate case forward to ensure that there is leadership in nursing, and that nursing concepts and frameworks are integral to all aspects of nursing service administration.
The authors devote the first chapter to describing trends in health care organisations, which include resource restraint, changes in population demographics and consumer expectations of health care services. The ensuing two chapters build on these themes to articulate the importance of defining the unique and distinct care provided by nurses - to ensure a discipline focus within an interdisciplinary environment and to ensure that nurses have a 'mental model' that guides administration of nursing services as well as nursing practice. The authors describe the integration of the mental model, in this case self care and dependent care, into the organisational big picture.
In doing so, the authors are able to provide some practical examples of how nurse administrators in acute and community health care services have used and could use the mental model of self care and dependent care to determine the specific roles of nursing in facilitating achievement of the models and to ascertain when and why nursing services are needed. They acknowledge the important role of nurse leaders in providing direction for the achievement of organisational goals and objectives.
The authors systematically describe the application of the self care and dependent care model to service planning for populations and individuals, standards of nursing practice, clinical communication, quality improvement and achieving outcomes that are related to patients. They propose for example, systems of patient classifications based on nursing theory as opposed to nursing activities that are generated by medical orders.
The final chapters are devoted to the integration of nursing theory into financial and human resource management practice to ensure that there is cost effective utilisation of resources to match identified needs of populations and individuals. Chapter 11 presents an interesting perspective on staffing mix and the appropriate use of nurses with basic and advanced level skills.
Finally the authors provide an overview of strategies to incorporate theory based nursing in the organisation. Whilst not exclusive to nursing, they include strategic planning, communication, change management, education and continuous quality improvement.
In summary the authors present a framework for planning, implementing and evaluating health care services using nursing theory. There is discussion on a broad range of management issues from a nursing perspective. In reality, however, it would be necessary for nurse administrators to also have a broad theoretical knowledge of contemporary management theory and practice to make more effective use of the ideas and concepts that are presented. To the authors' credit they have included a number of very practical applications of theory to practice across a variety of practice settings.
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