Carin Magnusson

Dr Carin Magnusson


Lecturer in Health Services Research
+44 (0)1483 684552
DK 04

Academic and research departments

School of Health Sciences.

Biography

Carin is a Lecturer in Health Services Research in the School of Health and Social Care. Her research interests are healthcare organisation and culture, including training, student retention and professional preparation. She has a particular interest in patient safety and issues of governance and accountability across healthcare organisations. This includes questions around how healthcare performance, quality and safety is regulated and monitored at all levels of the healthcare care system.

Research interests

Principal Investigator on the AaRK Project (Academic award and Recontextualising/Re-using Knowledge), which is exploring how newly qualified nurses use the knowledge learnt in university to allow them to organise, delegate and supervise care on the wards when working with and supervising healthcare assistants.

Teaching

Research methods and design.Qualitative methods and data analysis.Module leader: policy, politics and power.Research Governance.Ethnography.Case study methods.Patient Safety.

Departmental duties

Teaching and supervisionAll aspects of research projects:Grant proposal writingLiterature reviewsRecruitment and negotiating site accessData collection and analysisReport writingWriting for peer review journalsDissemination of research findings, presentation at conferences and funding bodies

Selected conference presentations

Magnusson C, Systems of Accountability for Patient Safety: The Case of Healthcare Associated Infections in NHS Acute Care, RCN Research Conference, Belfast, March 2013.

Magnusson, C, 'Organisational Governance: Accountability for Health Care Associated Infections' Poster, Patient Safety Congress, Birmingham, May 2010.

Magnusson, C, 'Organisational Governance: Accountability for Health Care Associated Infections', National Patient Safety Agency, London, Dec 2009.

Magnusson C, 'Governing for Patient Safety'. Workshop: Critical Perspectives on Governance. 15-17 April 2009. University of Bath. Full paper available at: http://www.bath.ac.uk/soc-pol/documents/GovernanceWorkshop09/group1-magnusson.pdf

Magnusson C, 'Organisational Governance and Patient Safety: Case of Healthcare Associated Infection (HCAI)'. 7th Annual Meeting of the Quality Improvement Research Network, 23 March 2009. Mannheim, Germany.

Magnusson, C & Horton, K, Student Retention in Higher Education: role and process of student exit interviews. Athens Institute for Education and Research, 26-29 May 2008, Athens.

Magnusson C, Volante M & Smith P, 'Supporting Student Nurses from Diverse Backgrounds'. RCN Joint Education Forums 1st International 'Beyond the borders' Conference, 5-7 July 2007 Brighton.

Smith P, Knibb W, Magnusson C & Bryan K, 'Health care assistant work: is it nursing?' Part of Symposium: What is nursing in the new millennium? 2007 RCN International Research Conference, 1-4 May 2007.

Smith P, Magnusson C, 'Emotions at Work: The Case of the British National Health Service (NHS). Royal College of Nursing Annual International Nursing Research Conference, 8-11 March 2005, Belfast.

Magnusson C, Finnerty G, Pope R, 'Methodological Triangulation in Midwifery Educational Research'. Hawaii Conference on Education, 3-6 January 2005, Honolulu, Hawaii.

Magnusson C, Crockford K, 'Mapping Clinical Placements: Putting meaning into data'. Developments in Nurse Education Conference, 10 June 2004, University of Salford.

My publications

Publications

Evidence-based practice (EBP) and Shared decision-making (SDM) are changing the nature of healthcare decisions. Evidence-based practice is a systematic approach of critical importance to medical practice intended to optimise decision-making by emphasising the value and use of evidence from scientific resources. Shared decision-making involves treating patients as partners, involving them in decision-making, and enlisting their sense of responsibility for their care while respecting their individual values and concerns. This study is theoretically driven by a curiosity of understanding the link between evidence-based practice, shared decision-making and patient-centred communication in order to achieve optimal care. It is broadly accepted that healthcare decisions require the integration of both research evidence and individual preferences. In the last decades, SDM has been hailed as the new paradigm for the doctor-patient relationship by health institutions and policy makers. However, the meaning and practical implications of such a new paradigm have been difficult to ascertain. To date, the need to consider patients as active partners in healthcare decision-making is growing. Yet, there has been little discussion resolving the potential conflict between promoting patient participation in decision-making regarding their health and the reliant on evidenced-based options. The thesis original contribution to knowledge is to fill these knowledge gaps by exploring the views and experiences of both users and providers of diabetes care about patient involvement in decision-making. This research, using interviews, aims to develop a greater understanding of patients and doctors experience of communicating treatment and management during medical encounters, in light of the need for a more person-centred approach in decision-making to enhance quality of patient care and improve outcomes. Forty-six semi-structured interviews were conducted with doctors and patients with Type 2 Diabetes from one of the government hospitals in Eastern Province, Saudi Arabia. Data were analysed with the aid of NVivo using thematic analysis. Evidence suggests that people living with diabetes in Saudi Arabia seem to value opportunities to be involved in everyday decision-making about their care. How these opportunities are created, understood, supported and sustained in healthcare settings remains to be determined. In this study, most of the doctors reported that involving patients into decision-making was challenging because most patients did not feel they had sufficient knowledge and confidence to do so; however, many patients reported that they did want to engage in decisions about their health but did not feel actively listened to, respected, and empowered to do so. Both groups of participants identified contrasting expectations and perceptions regarding communication within the doctor-patient relationship. The findings of this study demonstrate the need for doctors to collaboratively pursue opportunities to ensure that person-centred interactions are more consistently evident in practice. The study not only adds to what is known about the benefits of patient participation, but also provides robust evidence for policy makers and practitioners arguing for the benefits of this. Keywords: Evidence-based practice, shared decision-making, type 2 diabetes, patients’ preferences and participation, self-management.
G Finnerty, C Magnusson, R Pope (2007)Women's views of student midwives' involvement in maternity care, In: Evidence Based Midwifery5(4)pp. 137-142
Background. Despite a focus on user involvement in healthcare services and education in the UK, there is little evidence of women's views of education in midwifery practice. Aim. To identify women's perceptions of clinical teaching and learning in midwifery practice, in order to inform the midwifery curriculum. Method. Qualitative structured telephone interviews were conducted with 18 women who had been involved in a larger study that had used non-participant observation visits in hospital and community environments, 12 of whom were primiparae Thematic content analysis of the data was undertaken, based on a framework used in the larger study. Findings. Women described both physical and emotional support as being offered by student midwives. Some talked about student midwives' tentativeness and reduced confidence levels during episodes of care, but most expressed appreciation for the students' presence. Conclusions. More innovative ways to involve service users in the midwifery curriculum are needed, alongside research to evaluate them. More careful consideration needs to be given for student midwives' involvement in maternity care, with better preparation for both students and women. © 2007 The Royal College of Midwives.
G Finnerty, L Graham, C Magnusson, R Pope (2006)Empowering midwife mentors with adequate training and support, In: British Journal of Midwifery14(4)pp. 187-190
In this article, the authors illuminate some of the hidden aspects of the mentor role, which often go unnoticed in challenging clinical settings. Four key areas have been selected for the purpose of stimulating thought and debate on current mentorship issues: preparedness for the mentor role; management of students' clinical learning and skills development; processes of practice assessment and support for the mentoring role. The findings demonstrate the need for increased funding to enhance the clinical curriculum. This includes formal protection of time for mentors to provide quality learning experiences. Investment in the mentor/student dyad is essential as successful mentoring can literally be a 'gift' to student midwives.
MF O'Driscoll, PA Smith, CM Magnusson (2009)Evaluation of a part-time adult diploma nursing programme - 'Tailor-made' provision?, In: NURSE EDUCATION TODAY29(2)pp. 208-216 CHURCHILL LIVINGSTONE
A Steven, C Magnusson, P Smith, PH Pearson (2014)Patient safety in nursing education: Contexts, tensions and feeling safe to learn, In: NURSE EDUCATION TODAY34(2)pp. 277-284 CHURCHILL LIVINGSTONE
HT Allan, C Magnusson, K Horton, K Evans, E Ball, K Curtis, M Johnson (2015)People, liminal spaces and experience: understanding recontextualisation of knowledge for newly qualified nurses., In: Nurse Educ Today35(2)pp. e78-e83
BACKGROUND: Little is known about how newly qualified nurses delegate to health care assistants when delivering bedside care. AIM: To explore newly qualified nurses' experiences of delegating to, and supervising, health care assistants. DESIGN: Ethnographic case studies. SETTINGS: In-patient wards in three English National Health Service (NHS) acute hospitals. PARTICIPANTS: 33 newly qualified nurses were observed, 10 health care assistants and 12 ward managers. METHODS: Participant observation and in-depth interviews. FINDINGS: We suggest that newly qualified nurses learn to delegate to, and supervise, health care assistants through re-working (`recontextualising') knowledge; and that this process occurs within a transitional (`liminal') space. CONCLUSIONS: Conceptualising learning in this way allows an understanding of the shift from student to newly qualified nurse and the associated interaction of people, space and experience. Using ethnographic case studies allows the experiences of those undergoing these transitions to be vocalised by the key people involved.
C Magnusson, G Finnerty, R Pope (2005)Methodological triangulation in midwifery education research., In: Nurse Res12(4)pp. 30-39
This paper describes how the use of methodological triangulation can enrich the research process. The first section of the paper provides a brief outline of a national research project that studied 'pairs' of student midwives and their mentors in practice, and discusses the strengths and weaknesses of the approach. It then moves on to describe the combination of methods chosen for one aspect of the project before providing illustrative examples from the data that show how the triangulation of methods gave depth to the analysis
'Organisational governance'--the systems, processes, behaviours and cultures by which an organisation leads and controls its functions to achieve its objectives--is seen as an important influence on patient safety. The features of 'good' governance remain to be established, partly because the relationship between governance and safety requires more investigation.
K Cresswell, A Howe, A Steven, P Smith, D Ashcroft, K Fairhurst, F Bradley, C Magnusson, M McArthur, P Pearson, A Sheikh (2013)Patient safety in healthcare preregistration educational curricula: multiple case study-based investigations of eight medicine, nursing, pharmacy and physiotherapy university courses, In: BMJ QUALITY & SAFETY22(10)pp. 843-854 BMJ PUBLISHING GROUP
HT Allan, C Magnusson, K Evans, E Ball, S Westwood, K Curtis, K Horton, M Johnson (2016)Delegation and supervision of healthcare assistants’ work in the daily management of uncertainty and the unexpected in clinical practice: invisible learning among newly qualified nurses, In: Nursing Inquiry23(4)pp. 377-385 Wiley
The invisibility of nursing work has been discussed in the international literature but not in relation to learning clinical skills. Evans and Guile’s (Practice-based education: Perspectives and strategies, Rotterdam: Sense, 2012) theory of recontextualisation is used to explore the ways in which invisible or unplanned and unrecognised learning takes place as newly qualified nurses learn to delegate to and supervise the work of the healthcare assistant. In the British context, delegation and supervision are thought of as skills which are learnt “on the job.” We suggest that learning “on-the- job” is the invisible construction of knowledge in clinical practice and that delegation is a particularly telling area of nursing practice which illustrates invisible learning. Using an ethnographic case study approach in three hospital sites in England from 2011 to 2014, we undertook participant observation, interviews with newly qualified nurses, ward managers and healthcare assistants. We discuss the invisible ways newly qualified nurses learn in the practice environment and present the invisible steps to learning which encompass the embodied, affective and social, as much as the cognitive components to learning. We argue that there is a need for greater understanding of the “invisible learning” which occurs as newly qualified nurses learn to delegate and supervise.
C Magnusson, M O'Driscoll, P Smith (2007)New roles to support practice learning - Can they facilitate expansion of placement capacity?, In: NURSE EDUCATION TODAY27(6)pp. 643-650 CHURCHILL LIVINGSTONE
Abstract This study explores the perceptions of Directors of Nursing from NHS acute Trusts in England, on caring practices. The aspiration of the NHS is to deliver good care to patients and their families. The NHS constitution states that the ‘NHS is there to improve health and wellbeing, and it touches our lives at times of basic human need, when care and compassion are what matter most’ (DH 2013:2). However, recent inquiries into poor care have created a searching debate regarding standards of nursing care, leadership, culture and practice. Directors of Nursing play a significant role in influencing care, as they are charged with responsibilities relating to providing assurance of standards of care within NHS Trusts. However, little is known about the perceptions of Directors of Nursing in NHS acute Trusts, on caring practices. The study aimed to construct a grounded theory of the perceptions of Directors of Nursing from NHS acute Trusts, on caring practices. The study also sought to understand the social, political, professional and organisational challenges facing Directors of Nursing. Twelve Directors of Nursing from NHS acute Trusts in England were interviewed between July 2013 and January 2014 using semi-structured questions. A constructivist grounded theory approach was adopted to support the co-construction of the theory by exploring how the participants construct their worlds or reality. Through the co-construction approach a theory of ‘Directors of Nursing Perceptions on Caring: Post Francis Paradoxes’ revealed that the participants are working within a paradoxical NHS system in response to findings from the Mid Staffordshire NHS Foundation Trust inquiry. The theory is supported by three categories of: ‘trusting my senses’; ‘avoiding becoming collateral damage’; and ‘being in a different place’. The three paradoxes that emerged were: the need to produce reliable high-quality assurance about standards of care in the NHS which detracted from and impacted on the Directors of Nursing roles in supporting internal assurances processes. Secondly, external monitoring standards did not capture the ‘real’ warning signals of care failings as intended. Thirdly, the reliance on intuitive skills to give assurances of caring practices was considered necessary to support the demanding monitoring and assurance processes. This study captures a challenge, as perceived by Directors of Nursing, regarding how external regulatory demands can be accommodated alongside the internal organisational requirements to lead the improvement agenda of patient care standards. Directors of Nursing need then to balance the competing priorities in their roles whilst supporting and leading a nursing workforce to deliver ethical caring practices. Recommendations are made for research, education and practice.

Additional publications