Woman-centred care

Changes over the past decade have emphasised the individual service user and their relationship with the health service. Within the maternity services this has been interpreted as woman-centred care a result of key initiatives; the Winterton Report (House of Commons, 1992. Maternity Services. Second Report of the Health Committee (Winterton Report), Vol. 1. HMSO, London) and Changing Childbirth (DoH, 1993a, Changing childbirth: reports of the expert maternity group parts 1 & 2. HMSO, London). Changing Childbirth outlined key principles of the maternity services and the need for the woman (and her partner, if she wishes) to be the focus of care. The key principles are choice, continuity and control. High quality care depends on the recognition of individuals as having unique needs which continues to be reflected within contemporary policy documents (DoH, 1997, The new NHS: modern and dependable. HMSO, London). This paper presents findings related to the provision of woman-centred care from a national research and development study. The study design incorporated (i): a national survey which was undertaken with midwives, midwife supervisors and doctors; and (ii): in-depth case studies in which information was obtained through interviews with midwives, midwife supervisors, educators, managers, doctors and mothers. Midwives, at all levels, are involved in changing maternity service provision and adapting to new systems of care which aim to increase continuity of care and carer for the woman. The researchers sought to understand how woman-centred care was interpreted and experienced in practice. The findings have been used to identify the continuing educational needs of midwives, and to develop an open learning educational package to meet identified need. The curriculum was designed to enhance the move towards the provision of a more integrated woman-centred service.

A forest model archive?

The recent history and current trends in the collection and archiving of forest information and models is reviewed. The question is posed as to whether the community of forest modellers ought to take some action in setting up a Forest Model Archive (FMA) as a means of conserving and sharing the heritage of forest models that have been developed over several decades. The paper discusses the various alternatives of what an FMA could be, and should be. It then goes on to formulate a conceptual model as the basis for the construction of a FMA. Finally the question of software architecture is considered. Again there are a number of possible solutions. We discuss the alternatives, some in considerable detail, but leave the final decisions on these issues to the forest modelling community. This paper has spawned the “Greenwich Initiative” on the FMA. An internet discussion group on the topic will be started and launched by the “Trafalar Group”, which will span both IUFRO 4.1 and 4.11, and further discussion is planned to take place at the Forest Modelling Conference in Portugal, June 2002.

Numerical simulation of vacuum dezincing of lead alloy

Removing zinc by distillation can leave the lead bullion virtually free of zinc and also produces pure zinc crystals. Batch distillation is considered in a hemispherical kettle with water-cooled lid, under high vacuum (50 Pa or less). Sufficient zinc concentration at the evaporating surface is achieved by means of a mechanical stirrer. The numerical model is based on the multiphysics simulation package PHYSICA. The fluid flow module of the code is used to simulate the action of the stirring impeller and to determine the temperature and concentration fields throughout the liquid volume including the evaporating surface. The rate of zinc evaporation and condensation is then modelled using Langmuir’s equations. Diffusion of the zinc vapour through the residual air in the vacuum gap is also taken into account. Computed results show that the mixing is sufficient and the rate-limiting step of the process is the surface evaporation driven by the difference of the equilibrium vapour pressure and the actual partial pressure of zinc vapour. However, at higher zinc concentrations, the heat transfer through the growing zinc crystal crust towards the cold steel lid may become the limiting factor because the crystallization front may reach the melting point. The computational model can be very useful in optimising the process within its safe limits.

Image denoise by fourth-order PDE based on the changes of laplacian

Fourth-order partial differential equation (PDE) proposed by You and Kaveh (You-Kaveh fourth-order PDE), which replaces the gradient operator in classical second-order nonlinear diffusion methods with a Laplacian operator, is able to avoid blocky effects often caused by second-order nonlinear PDEs. However, the equation brought forward by You and Kaveh tends to leave the processed images with isolated black and white speckles. Although You and Kaveh use median filters to filter these speckles, median filters can blur the processed images to some extent, which weakens the result of You-Kaveh fourth-order PDE. In this paper, the reason why You-Kaveh fourth-order PDE can leave the processed images with isolated black and white speckles is analyzed, and a new fourth-order PDE based on the changes of Laplacian (LC fourth-order PDE) is proposed and tested. The new fourth-order PDE preserves the advantage of You-Kaveh fourth-order PDE and avoids leaving isolated black and white speckles. Moreover, the new fourth-order PDE keeps the boundary from being blurred and preserves the nuance in the processed images, so, the processed images look very natural.

Sustainable Olympic design and urban development

With appropriate planning and design, Olympic urban development has the potential to leave positive environmental legacies to the host city and contribute to environmental sustainability. This book explains how a modern Olympic games can successfully develop a more sustainable design approach by learning from the lessons of the past and by taking account of the latest developments. It offers an assessment tool that can be tailored to individual circumstances – a tool which emerges from the analysis of previous summer games host cities and from techniques in environmental analysis and assessment.

Workplace violence and intentions to quit: results from a survey of London nurses

Study Objective: Work-place violence, harassment and abuse is an increasing feature of nurses’ experience of work in many countries. There is some evidence that the experience of workplace violence affects levels of job satisfaction (Hesketh et al 2003) and career decisions (e.g. Mayer et al 1999, Fernandes et al 1999). This paper reports on verbal and physical abuse by patients, relatives and carers, as well as racial and sexual harassment in Acute Hospitals in London and investigates whether workplace violence affects nurses’ intentions to leave either their current job or the nursing profession, controlling for a number of other factors that are known to affect career decisions, such as workload, pay and own health. Method: A questionnaire designed by two of the authors (Reeves and West) to assess many different aspects of nurses work life was used in a postal survey of nurses grades A to I practising in twenty London acute trusts in 2002. A total of 6,160 clinical nurses were mailed the questionnaires and 2,880 returned completed questionnaires, resulting in an overall response rate of 47%, discounting undelivered questionnaires. Respondents worked in a wide variety of clinical settings but mainly in acute medical and surgical wards. In addition to descriptive statistics, results were analysed using logistic regression with robust standard errors: the appropriate test when the dependent variable is dichotomous and the individual respondents clustered within units (nurses working within hospitals are not statistically independent). Results: Our results show high levels of racial (%), sexual (%) and other, unspecified forms of harassment (%), as well as verbal and physical abuse (14% had been physically assaulted with 5% being assaulted more than once), over the previous 6 months. A very small number (1%) reported experiencing all three forms of harassment; 12% two forms and 29% one form. Only 45% of this sample intended to stay in nursing for at least 3 years; 40% were undecided and 15% intended to leave. Logistic regression estimates showed that reported levels of abuse and harassment had a significant impact on respondents’ career intentions, even in models that controlled for known factors affecting career decisions. About 70% of our respondents reported that they had had too little training in dealing with aggressive behaviour—or none at all—but there was no statistical relationship between lack of training and reported assaults. Conclusions: The international shortage of health care workers is due at least in part to low retention rates. It is crucial to investigate nurses’ experiences of work to identify the factors that shape their career decisions. Workplace violence is increasingly acknowledged as an international, service-wide, health care problem. This paper adds to the literature that shows that workplace violence has an impact on nurses’ career decisions. The implications for managers and policy makers are that strengthening systems of security and providing nurses with training in interpersonal relationships including dealing with aggressive patients could slow nurse turnover.

Tied to the job: affective and relational components of nurse retention

Paper investigates whether affective and relational components of nurses' experience of work have a significant impact on their intentions to leave either the job or the nursing profession in models that control for other factors (sociodemographic, work conditions, perceptions of quality of care) that are known to affect career decisions. [Abridged Abstract]