Implementing a resuscitation policy for patients at the end of life in an acute hospital setting: qualitative study

Objective : To explore attitudes and experiences of doctors and nurses regarding cardiopulmonary resuscitation for patients with end stage illness in an acute hospital. Design : Qualitative study; thematic analysis of two audio-taped focus groups and four semi-structured interviews. Setting : Acute district hospital, Northern Ireland. Participants : Seven nurses and nine doctors; varying nationality, gender and years of professional experience; involved in cardiopulmonary resuscitation decision-making. Results : Participants reported different interpretations of resuscitation policy and of what do not attempt to resuscitate (DNAR) decisions meant in relation to practical care for patients. This confusion in translating policy into practice contributed to communication difficulties in initiating, documenting and implementing cardiopulmonary resuscitation decisions. Participants were aware of how clinical conditions could change and reported uncertainty in determining end stage illness; they expressed fears of potential consequences of DNAR decisions for patients' care. The more disease-centred approach of doctors to patients' management, compared to nurses' more patient-centred approach, contributed to inter-professional conflict within teams. Doctors identified training needs in applying resuscitation policy and ethical principles in `real life' and nurses identified a need for ongoing professional support, which was perceived as being less available to junior doctors. Personal relationships between staff and patients, cultural reluctance to address sensitive issues and local community expectations of relatives being involved in decisions added to policy implementation difficulties. Conclusions : The findings indicate a need for ongoing staff support and training in applying resuscitation policy to decisions for patients with end stage illness in an acute hospital. They support suggestions that reviews of local resuscitation policy and of national guidelines should be undertaken with openness and honesty regarding the goals, opportunities and difficulties involved in trying to deliver good end of life care in local settings. Palliative Medicine 2007; 21 : 305—312 Key Words: do not attempt resuscitation (DNAR) • end stage illness • inter-professional • policy • resuscitation decisions

Validity of the Perceived Health Competence Scale in a UK primary care setting.

The Perceived Health Competence Scale (PHCS) is a measure of self-efficacy regarding general healthrelated behaviour. This brief paper examines the psychometric properties of the PHCS in a UK context. Questionnaires containing the PHCS, the SF-36 and questions about perceived health needs were posted to 486 patients randomly selected from a GP practice list. Complete questionnaires were returned by 320 patients. Analyses of these responses provide strong evidence for the validity of the PHCS in this setting. Consequently, we conclude that the PHCS is a useful addition to measures of global self-efficacy and measures of self-efficacy regarding specific behaviours in the toolkit of health psychologists. This range of self-efficacy assessment tools will ensure that psychologists can match the level of specificity of the measure of expectancy beliefs to the level of specificity of the outcome of interest.

Hamiltonian Tomography in an Access-Limited Setting without State Initialization

We propose a scheme for the determination of the coupling parameters in a chain of interacting spins. This requires only time-resolved measurements over a single particle, simple data postprocessing and no state initialization or prior knowledge of the state of the chain. The protocol fits well into the context of quantum-dynamics characterization and is efficient even when the spin chain is affected by general dissipative and dephasing channels. We illustrate the performance of the scheme by analyzing explicit examples and discuss possible extensions.

An experience of attempting to apply the randomised controlled trial (RCT) design in a ‘real world’ community-based clinical setting – one family therapist’s current journey. Context, 99, 6-9.

This paper describes an early career researcher's expereince of using randomised controlled trial methodology to investigarte the effectiveness of psychotherapeutic interventions for traumatised families in a 'real world' setting.

The Private Finance Initiative: An Evolving Research Agenda

This article considers the development of the Private Finance Initiative (PFI) and contends that it is now deeply embedded and intertwined in policies to renew and modernize the United Kingdom's public services. After briefly reviewing prior research based upon the themes proposed by Broadbent and Laughlin (1999), this article suggests a new research agenda to reflect how the PFI has matured and developed in recent years.

Governance and charities: An exploration of key themes and the development of a research agenda

The concept of governance has been widely discussed in both the business and non-business sectors. The debate has also been entered into within the charity sector, which comprises over 169,000 organizations in the UK. The UK-based Charity Commission, which describes itself as existing to ‘promote sound governance and accountability’, has taken a lead in this debate by promoting greater regulation and producing numerous recommendations with regard to the proper governance of charitable organizations. However, the concept of what is meant by governance is unclear and a myriad of ideas are placed under the umbrella of ‘good governance’. This paper explores the major themes that form the basis of much of this discussion, examining both the theoretical underpinnings and empirical investigations relating to this area (looking from the perspective of the key stakeholders in the charity sector). Based on an analysis of the extant literature, this paper presents a broad definition of governance with respect to charities and outlines a future research agenda for those interested in adding to knowledge in this area.