Intensive care survivors’ experiences of ward-based care: Meleis’ theory of nursing transitions and role development among critical care outreach services.

Aims and objectives. To explore the psychosocial needs of patients discharged from intensive care, the extent to which they are captured using existing theory on transitions in care and the potential role development of critical care outreach, follow-up and liaison services. Background. Intensive care patients are at an increased risk of adverse events, deterioration or death following ward transfer. Nurse-led critical care outreach, follow-up or liaison services have been adopted internationally to prevent these potentially avoidable sequelae. The need to provide patients with psychosocial support during the transition to ward-based care has also been identified, but the evidence base for role development is currently limited. Design and methods. Twenty participants were invited to discuss their experiences of ward-based care as part of a broader study on recovery following prolonged critical illness. Psychosocial distress was a prominent feature of their accounts, prompting secondary data analysis using Meleis et al.’s mid-range theory on experiencing transitions. Results. Participants described a sense of disconnection in relation to profound debilitation and dependency and were often distressed by a perceived lack of understanding, indifference or insensitivity among ward staff to their basic care needs. Negotiating the transition between dependence and independence was identified as a significant source of distress following ward transfer. Participants varied in the extent to which they were able to express their needs and negotiate recovery within professionally mediated boundaries. Conclusion. These data provide new insights into the putative origins of the psychosocial distress that patients experience following ward transfer. Relevance to clinical practice. Meleis et al.’s work has resonance in terms of explicating intensive care patients’ experiences of psychosocial distress throughout the transition to general ward–based care, such that the future role development of critical care outreach, follow-up and liaison services may be more theoretically informed.

Exploring human resource development: a level of analysis approach.

Levels of analysis perform an important function in framing research and practice in human resource development (HRD). The purpose of this paper is to examine the concept of HRD from the individual, organizational and community/societal levels of analysis. The paper highlights both the distinctiveness and usefulness of each level of analysis, identifies tensions within and between them, and outlines differences in underpinning assumptions, characteristics of HRD provision and delivery of HRD interventions. By adopting this approach, the paper draws attention to variations in meaning, intent, content and practice with implications for developing both the theory and practice of HRD.

The Development of a Holistic and Quantitative Tool for the Assessment and Improvement of Survey Quality.

There are a variety of guidelines and methods available to measure and assess survey quality. Most of these are based on qualitative descriptions. In practice, they are not easy to implement and it is very difficult to make comparisons between surveys. Hence there is a theoretical and pragmatic demand to develop a mainly quantitative based survey assessment tool. This research aimed to meet this need and make contributions to the evaluation and improvement of survey quality. Acknowledging the critical importance of measurement issues in survey research, this thesis starts with a comprehensive introduction to measurement theory and identifies the types of measurement errors associated with measurement procedures through three experiments. Then it moves on to describe concepts, guidelines and methods available for measuring and assessing survey quality. Combining these with measurement principles leads to the development of a quantitative based statistical holistic tool to measure and assess survey quality. The criteria, weights and subweights for the assessment tool are determined using Multi-Criteria Decision-Making (MCDM) and a survey questionnaire based on the Delphi method. Finally the model is applied to a database of surveys which was constructed to develop methods of classification, assessment and improvement of survey quality. The model developed in this thesis enables survey researchers and/or commissioners to make a holistic assessment of the value of the particular survey(s). This model is an Excel based audit which takes a holistic approach, following all stages of the survey from inception, to design, construction, execution, analysis and dissemination. At each stage a set of criteria are applied to assess quality. Scores attained against these assessments are weighted by the importance of the criteria and summed to give an overall assessment of the stage. The total score for a survey can be obtained by a combination of the scores for every stage weighted again by the importance of each stage. The advantage of this is to construct a means of survey assessment which can be used in a diagnostic manner to assess and improve survey quality.

Exploring perspectives on Human Resource Development: an introduction.

The problem and the solution. This issue overview presents a brief justification for adopting a multiperspectival approach to theory and practice in human resource development (HRD). It is argued that such an approach has the potential to add theoretical depth and breadth to HRD discourse as well as contributing to reflective HRD practice.The contributions are then briefly introduced.

Reconceptualising moderation in asynchronous online discussions using grounded theory.

This paper reports a grounded theory study of e-moderation of asynchronous online discussions, to explore the processes by which tutors in higher education decide when and how to e-moderate. It aims to construct a theory of e-moderation based on some key factors which appear to influence e-moderation. It discusses previous research on the definition and practice of e-moderation, and then describes the study, which involved four e-moderators working in two different university contexts. Key themes on e-moderation, which emerged using a grounded theory approach, are discussed. It proposes a paradigm framework for e-moderation and suggests that as a facilitative activity, it should be sufficiently contained within ‘a ring-fenced learning arena’. Factors outwith and inside the ring-fence which appear to influence e-moderation and their implications for future theory development and validation are discussed. Keywords: e-moderation; grounded theory; online learning; asynchronous discussions; ring-fence