3 resultados para Collective working experiences

em Glasgow Theses Service


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Since the findings of a Fatal Accident Inquiry (FAI) in 2010, clinicians working in Scotland have been advised to discuss the risk of Sudden Unexpected Death in Epilepsy (SUDEP) with patients immediately or soon after a diagnosis of epilepsy is made. A thematic analysis was used to describe the experiences discussing SUDEP of 10 clinicians (six Consultant Neurologists and four Neurology Registrars) working in Scotland. Five themes were found: Clinicians employ a ‘SUDEP protocol’, suggesting there is a standardised way of discussing SUDEP with patients and all clinicians routinely discuss SUDEP with newly diagnosed epilepsy patients; The FAI has diffused into practice through meetings and discussions with colleagues; ‘Breaking Good News’ refers to the ambivalence clinicians feel about discussing SUDEP; ‘Falsely anticipating anxiety’ refers to clinicians anticipating a distressed response from patients despite this very rarely occurring; Clinicians suggest that ‘pressure hinders effective communication’ to patients – suggesting that the pressure to discuss SUDEP early after diagnosis may have an emotional impact on patients and affect the amount of information they can take in. Implications for guideline development are discussed.

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The purpose of the thesis is to examine the relationship between tourism and the local culture expressed in culinary experiences offered in the traditional, nostalgic-themed markets that have arisen as popular attractions in the 21 st century. Central to the thesis is an examination of how the traditional cultural values are articulated in the production, promotion and consumption of culinary experiences in order to understand the value of culture when embedded in the process of commodification, as well as to understand influential socio-cultural factors. The thesis investigates the potential of traditional markets to promote food as the main attraction in the market. Field studies were conducted from December 2012–March 2014 in eight traditional markets in the central region of Thailand. Based on the ethnographic approach in studying the narratives in the markets, a variety of methods were implemented in the process of data collection. Besides observational analysis of the venue, semi-structured interviews and the self-administered questionnaires were used to collect data from actors who engage in food experiences, including management team members, food traders and visitors. Data was also collected from interviews with officers working for Tourism Authority of Thailand (TAT).  Keys findings of the thesis reveal that the cultural expressions of food experience in each market is an outcome of both the interactions of worldviews expressed by actors involved in the traditional market and the socio-cultural condition of Thailand. The relationships between stakeholders’ attitudes towards food experiences and the commercial potentials and limitations of food were analysed. The analysis of the cultural value of culinary experiences demonstrates that the existing academic discussions of the authenticity of tourism are insightful in explaining the character of food experiences offered in this tourism scenario. Most importantly, authenticity in tourism experiences, being a desirable element in culinary experiences, is a reflection of the how the pre-modern aspect of Thai society is embraced in a contemporary context. In addition, the commodification of culinary culture generates multidimensional consequences on the value of traditional culture and local lives. Moreover, the performance of culinary experiences can be viewed from the perspective of how Thai society interacts with globalization. The thesis also points out that it is possible to compare the situation of the traditional markets with the marketing positioning of food in Thai tourism marketing policy.

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Background: The evidence base on end-of-life care in acute stroke is limited, particularly with regard to recognising dying and related decision-making. There is also limited evidence to support the use of end-of-life care pathways (standardised care plans) for patients who are dying after stroke. Aim: This study aimed to explore the clinical decision-making involved in placing patients on an end-of-life care pathway, evaluate predictors of care pathway use, and investigate the role of families in decision-making. The study also aimed to examine experiences of end-of-life care pathway use for stroke patients, their relatives and the multi-disciplinary health care team. Methods: A mixed methods design was adopted. Data were collected in four Scottish acute stroke units. Case-notes were identified prospectively from 100 consecutive stroke deaths and reviewed. Multivariate analysis was performed on case-note data. Semi-structured interviews were conducted with 17 relatives of stroke decedents and 23 healthcare professionals, using a modified grounded theory approach to collect and analyse data. The VOICES survey tool was also administered to the bereaved relatives and data were analysed using descriptive statistics and thematic analysis of free-text responses. Results: Relatives often played an important role in influencing aspects of end-of-life care, including decisions to use an end-of-life care pathway. Some relatives experienced enduring distress with their perceived responsibility for care decisions. Relatives felt unprepared for and were distressed by prolonged dying processes, which were often associated with severe dysphagia. Pro-active information-giving by staff was reported as supportive by relatives. Healthcare professionals generally avoided discussing place of care with families. Decisions to use an end-of-life care pathway were not predicted by patients’ demographic characteristics; decisions were generally made in consultation with families and the extended health care team, and were made within regular working hours. Conclusion: Distressing stroke-related issues were more prominent in participants’ accounts than concerns with the end-of-life care pathway used. Relatives sometimes perceived themselves as responsible for important clinical decisions. Witnessing prolonged dying processes was difficult for healthcare professionals and families, particularly in relation to the management of persistent major swallowing difficulties.