A longitudinal qualitative exploration of healthcare and informal support needs among survivors of critical illness: the RELINQUISH protocol.

Introduction and background: Survival following critical illness is associated with a significant burden of physical, emotional and psychosocial morbidity. Recovery can be protracted and incomplete, with important and sustained effects upon everyday life, including family life, social participation and return to work. In stark contrast with other critically ill patient groups (eg, those following cardiothoracic surgery), there are comparatively few interventional studies of rehabilitation among the general intensive care unit patient population. This paper outlines the protocol for a sub study of the RECOVER study: a randomised controlled trial evaluating a complex intervention of enhanced ward-based rehabilitation for patients following discharge from intensive care. Methods and analysis: The RELINQUISH study is a nested longitudinal, qualitative study of family support and perceived healthcare needs among RECOVER participants at key stages of the recovery process and at up to 1 year following hospital discharge. Its central premise is that recovery is a dynamic process wherein patients’ needs evolve over time. RELINQUISH is novel in that we will incorporate two parallel strategies into our data analysis: (1) a pragmatic health services-oriented approach, using an a priori analytical construct, the ‘Timing it Right’ framework and (2) a constructivist grounded theory approach which allows the emergence of new themes and theoretical understandings from the data. We will subsequently use Qualitative Health Needs Assessment methodology to inform the development of timely and responsive healthcare interventions throughout the recovery process. Ethics and dissemination: The protocol has been approved by the Lothian Research Ethics Committee (protocol number HSRU011). The study has been added to the UK Clinical Research Network Database (study ID. 9986). The authors will disseminate the findings in peer reviewed publications and to relevant critical care stakeholder groups.

Participation Space Studies: a socio-technical exploration of activist and community groups’ use of online and offline spaces to support their work

Participation Space Studies explore eParticipation in the day-to-day activities of local, citizen-led groups, working to improve their communities. The focus is the relationship between activities and contexts. The concept of a participation space is introduced in order to reify online and offline contexts where people participate in democracy. Participation spaces include websites, blogs, email, social media presences, paper media, and physical spaces. They are understood as sociotechnical systems: assemblages of heterogeneous elements, with relevant histories and trajectories of development and use. This approach enables the parallel study of diverse spaces, on and offline. Participation spaces are investigated within three case studies, centred on interviews and participant observation. Each case concerns a community or activist group, in Scotland. The participation spaces are then modelled using a Socio-Technical Interaction Network (STIN) framework (Kling, McKim and King, 2003). The participation space concept effectively supports the parallel investigation of the diverse social and technical contexts of grassroots democracy and the relationship between the case-study groups and the technologies they use to support their work. Participants’ democratic participation is supported by online technologies, especially email, and they create online communities and networks around their goals. The studies illustrate the mutual shaping relationship between technology and democracy. Participants’ choice of technologies can be understood in spatial terms: boundaries, inhabitants, access, ownership, and cost. Participation spaces and infrastructures are used together and shared with other groups. Non-public online spaces, such as Facebook groups, are vital contexts for eParticipation; further, the majority of participants’ work is non-public, on and offline. It is informational, potentially invisible, work that supports public outputs. The groups involve people and influence events through emotional and symbolic impact, as well as rational argument. Images are powerful vehicles for this and digital images become an increasingly evident and important feature of participation spaces throughout the consecutively conducted case studies. Collaboration of diverse people via social media indicates that these spaces could be understood as boundary objects (Star and Griesemer, 1989). The Participation Space Studies draw from and contribute to eParticipation, social informatics, mediation, social shaping studies, and ethnographic studies of Internet use.

The Sales Process Practice of Food and Drink SMEs - A Holistic Conceptual Framework: Steps, dimensions, barriers and enablers.

Purpose –The research examines the sales process practised by SMEs, and barriers and enablers that hinder and support effective selling practices from the selling organisation’s perspective in Scottish-based Food and Drink firms. Design/methodology approach - – The paper adopts an interpretivist perspective with qualitative data gathered through face-to-face semi-structured interviews. 20 people involved in selling activities were interviewed from 15 SMEs across Scotland. Thematic analysis established key findings regarding the sales process practice. Findings – Five themes emerged that affect the operationalisation of the selling process: the owner manager has considerable involvement in the sales process, SMEs with some degree of sales knowledge take a more systematic approach, SMEs lack awareness of how CRM technology can assist them, power is tipped in favour of the buyer and, the geographic location of the SME places constraints on how SMEs conduct business Research limitation/implication – Thematic analysis was chosen over other more traditional methods due to the lack of relevant quantitative data. The phenomenon of the research and research methodology means that it will not be possible to repeat this study and replicate its findings. However, the process that has been adopted does provide a basis for future research. Originality/value - The paper identifies areas where future research is required in the field alongside suggestions where policy makers and government business agencies might focus intervention to assist SMEs improve delivery of the sales process and selling effectiveness

Understanding nurses’ decision-making when managing weaning from mechanical ventilation: a study of novice and experienced critical care nurses in Scotland and Greece.

Aim and objectives To examine how nurses collect and use cues from respiratory assessment to inform their decisions as they wean patients from ventilatory support. Background Prompt and accurate identification of the patient's ability to sustain reduction of ventilatory support has the potential to increase the likelihood of successful weaning. Nurses' information processing during the weaning from mechanical ventilation has not been well-described. Design A descriptive ethnographic study exploring critical care nurses' decision-making processes when weaning mechanically ventilated patients from ventilatory support in the real setting. Methods Novice and expert Scottish and Greek nurses from two tertiary intensive care units were observed in real practice of weaning mechanical ventilation and were invited to participate in reflective interviews near the end of their shift. Data were analysed thematically using concept maps based on information processing theory. Ethics approval and informed consent were obtained. Results Scottish and Greek critical care nurses acquired patient-centred objective physiological and subjective information from respiratory assessment and previous knowledge of the patient, which they clustered around seven concepts descriptive of the patient's ability to wean. Less experienced nurses required more encounters of cues to attain the concepts with certainty. Subjective criteria were intuitively derived from previous knowledge of patients' responses to changes of ventilatory support. All nurses used focusing decision-making strategies to select and group cues in order to categorise information with certainty and reduce the mental strain of the decision task. Conclusions Nurses used patient-centred information to make a judgment about the patients' ability to wean. Decision-making strategies that involve categorisation of patient-centred information can be taught in bespoke educational programmes for mechanical ventilation and weaning. Relevance to clinical practice Advanced clinical reasoning skills and accurate detection of cues in respiratory assessment by critical care nurses will ensure optimum patient management in weaning mechanical ventilation