Carin Magnusson

Dr Carin Magnusson


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

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

Magnusson C, Finnerty G, Pope R (2005) Methodological triangulation in midwifery education research., Nurse Res 12 (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
Cresswell K, Howe A, Steven A, Smith P, Ashcroft D, Fairhurst K, Bradley F, Magnusson C, McArthur M, Pearson P, Sheikh A (2013) Patient safety in healthcare preregistration educational curricula: Multiple case study-based investigations of eight medicine, nursing, pharmacy and physiotherapy university courses, BMJ Quality and Safety 22 (10) pp. 843-854
Background We sought to investigate the formal and informal ways preregistration students from medicine, nursing, pharmacy and the allied healthcare professions learn about patient safety. Methods We drew on Eraut's framework on formal and informal acquisition of professional knowledge to undertake a series of phased theoretically informed, in-depth comparative qualitative case studies of eight university courses. We collected policy and course documentation; interviews and focus groups with educators, students, health service staff, patients and policy makers; and course and work placement observations. Data were analysed thematically extracting emerging themes from different phases of data collection within cases, and then comparing these across cases. Results We conducted 38 focus groups with a total of 162 participants, undertook 82 observations of practice placements/learning activities and 33 semistructured interviews, and analysed 44 key documents. Patient safety tended to be either implicit in curricula or explicitly identified in a limited number of discrete topic areas. Students were predominantly taught about safety-related issues in isolation, with the consequence of only limited opportunities for interprofessional learning and bridging the gaps between educational, practice and policy contexts. Although patient safety role models were key to student learning in helping to develop and maintain a consistent safety ethos, their numbers were limited. Conclusions Consideration needs to be given to the appointment of curriculum leads for patient safety who should be encouraged to work strategically across disciplines and topic areas; development of stronger links with organisational systems to promote student engagement with organisation-based patient safety practice; and role models should help students to make connections between theoretical considerations and routine clinical care.
Ramsay A, Magnusson C, Fulop N (2010) The relationship between external and local governance systems: the case of health care associated infections and medication errors in one NHS trust., Qual Saf Health Care 19 (6)
'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.
Magnusson C, O'Driscoll M, Smith P (2007) New roles to support practice learning - can they facilitate expansion of placement capacity?, Nurse Educ Today 27 (6) pp. 643-650
The National Health Service (NHS) Plan [Department of Health, 2000. The NHS Plan: A Plan for Investment, a Plan for Reform, The Stationery Office, London] set out an ambitious programme of growth for the number of students undertaking health professional education programmes. To meet this demand there is a growing and widely acknowledged need to increase the number of clinical placements needed by these students. This paper outlines the findings from a regional project that aimed to map the current pattern and availability of clinical placements for healthcare students by the collection of quantitative placement data (such as location, specialty, and number of mentors) as well as in-depth interviews with Clinical Placement Managers (CPMs). This article will focus on the findings from interviews with CPMs and their views and experiences of what role they can play in increasing placement capacity. The study revealed that the introduction of this role had facilitated the development and expansion of placement capacity, as the CPMs filled a gap in the form of up-to-date local knowledge about the clinical areas. The CPMs provided a much needed 'bridge' between the Higher Education Institution (HEI), the student and the clinical area. Recommendations are made in relation to future introduction of similar roles that aim to support student learning in practice. Furthermore, useful insights for ongoing policy implementation and development are highlighted.
Steven A, Magnusson C, Smith P, Pearson PH (2013) Patient safety in nursing education: Contexts, tensions and feeling safe to learn, Nurse Education Today
Education is crucial to how nurses practice, talk and write about keeping patients safe. The aim of this multisite study was to explore the formal and informal ways the pre-registration medical, nursing, pharmacy and physiotherapy students learn about patient safety. This paper focuses on findings from nursing. A multi-method design underpinned by the concept of knowledge contexts and illuminative evaluation was employed. Scoping of nursing curricula from four UK university programmes was followed by in-depth case studies of two programmes. Scoping involved analysing curriculum documents and interviews with 8 programme leaders. Case-study data collection included focus groups (24 students, 12 qualified nurses, 6 service users); practice placement observation (4 episodes = 19 hrs) and interviews (4 Health Service managers). Within academic contexts patient safety was not visible as a curricular theme: programme leaders struggled to define it and some felt labelling to be problematic. Litigation and the risk of losing authorisation to practise were drivers to update safety in the programmes. Students reported being taught idealised skills in university with an emphasis on 'what not to do'. In organisational contexts patient safety was conceptualised as a complicated problem, addressed via strategies, systems and procedures. A tension emerged between creating a 'no blame' culture and performance management. Few formal mechanisms appeared to exist for students to learn about organisational systems and procedures. In practice, students learnt by observing staff who acted as variable role models; challenging practice was problematic, since they needed to 'fit in' and mentors were viewed as deciding whether they passed or failed their placements. The study highlights tensions both between and across contexts, which link to formal and informal patient safety education and impact negatively on students' feelings of emotional safety in their learning. © 2013 Elsevier Ltd. All rights reserved.
Finnerty G, Magnusson C, Pope R (2007) Women's views of student midwives' involvement in maternity care, Evidence Based Midwifery 5 (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.
Allan HT, Magnusson C, Evans K, Ball E, Westwood S, Curtis K, Horton K, Johnson M (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, Nursing Inquiry 23 (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.
Finnerty G, Graham L, Magnusson C, Pope R (2006) Empowering midwife mentors with adequate training and support, British Journal of Midwifery 14 (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.
O'Driscoll MF, Smith PA, Magnusson CM (2009) Evaluation of a part-time adult diploma nursing programme - 'Tailor-made' provision?, NURSE EDUCATION TODAY 29 (2) pp. 208-216 CHURCHILL LIVINGSTONE
Steven A, Magnusson C, Smith P, Pearson PH (2014) Patient safety in nursing education: Contexts, tensions and feeling safe to learn, Nurse Education Today 34 (2) pp. 277-284
Education is crucial to how nurses practice, talk and write about keeping patients safe. The aim of this multisite study was to explore the formal and informal ways the pre-registration medical, nursing, pharmacy and physiotherapy students learn about patient safety. This paper focuses on findings from nursing.A multi-method design underpinned by the concept of knowledge contexts and illuminative evaluation was employed. Scoping of nursing curricula from four UK university programmes was followed by in-depth case studies of two programmes.Scoping involved analysing curriculum documents and interviews with 8 programme leaders. Case-study data collection included focus groups (24 students, 12 qualified nurses, 6 service users); practice placement observation (4 episodes=19. hrs) and interviews (4 Health Service managers).Within academic contexts patient safety was not visible as a curricular theme: programme leaders struggled to define it and some felt labelling to be problematic. Litigation and the risk of losing authorisation to practise were drivers to update safety in the programmes. Students reported being taught idealised skills in university with an emphasis on 'what not to do'.In organisational contexts patient safety was conceptualised as a complicated problem, addressed via strategies, systems and procedures. A tension emerged between creating a 'no blame' culture and performance management. Few formal mechanisms appeared to exist for students to learn about organisational systems and procedures.In practice, students learnt by observing staff who acted as variable role models; challenging practice was problematic, since they needed to 'fit in' and mentors were viewed as deciding whether they passed or failed their placements. The study highlights tensions both between and across contexts, which link to formal and informal patient safety education and impact negatively on students' feelings of emotional safety in their learning. © 2014 Elsevier Ltd.
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.

Additional publications