A model for developing, implementing and evaluating a strategy to improve nursing and midwifery care

Background: Health care organizations world wide are faced with the need to develop and implement strategic organizational plans to meet the challenges of modern health care. There is a need for models for developing, implementing and evaluating strategic plans that engage practitioners, and make a measurable difference to the patients that they serve. This article describes the development of such a model to underpin a strategy for nursing and midwifery in an acute hospital trust. An integrated model: The processes for strategy development (values clarification, critical companionship and focus groups) are discussed, together with the development of processes for implementation, based upon a modification of the PARIHS (Promoting Action on Research Implementation in Health Services) conceptual framework. Finally, the methods for evaluating the strategy (a pre-test/post-test approach measuring the quality of nursing care, the degree to which the organization supports professional nursing care, the leadership styles of ward managers, and patient satisfaction with care) are described. Conclusion: The model is offered as one that may be of use to others who wish to develop an integrated approach to strategic change; an approach in which the development, implementation and evaluation of strategic plans are informed by the core values of nurses and midwives.

Shaping the Future of Mental Health Policy and Legislation in Northern Ireland: The Impact of Service User and Professional Social Work Discourses

This paper explores the complex interrelationship between service user and professional social work discourses and provides a critical commentary on their respective contributions to the recent review of mental health policy and legislation in Northern Ireland. The analysis indicates that dominant trends in mental health care, as mediated through service structures and institutional identities, have tended to prioritize the more coercive aspects of the social work role and reinforce existing power inequalities with service users. It is argued that such developments underline the need for a ‘refocusing’ debate in mental health social work to consider how a more appropriate balance can be achieved between its participatory/empowering and regulatory/coercive functions. Whilst highlighting both congruence and dissonance between respective discourses, the paper concludes that opportunities exist within the current change process for service users and social workers to build closer alliances in working together to reconstruct practice, safeguard human rights and develop innovative alternatives to a traditional bio-medical model of treatment.

Bystander-induced differentiation: a major response to targeted irradiation of a urothelial explant model.

A ureter primary explant technique, using porcine tissue sections was developed to study bystander effects under in vivo like conditions where dividing and differentiated cells are present. Targeted irradiations of ureter tissue fragments were performed with the Gray Cancer Institute charged particle microbeam at a single location (2 microm precision) with 10 3He2+ particles (5 MeV; LET 70 keV/microm). After irradiation the ureter tissue section was incubated for 7 days allowing explant outgrowth to be formed. Differentiation was estimated using antibodies to Uroplakin III, a specific marker of terminal urothelial differentiation. Even although only a single region of the tissue section was targeted, thousands of additional cells were found to undergo bystander-induced differentiation in the explant outgrowth. This resulted in an overall increase in the fraction of differentiated cells from 63.5+/-5.4% to 76.6+/-5.6%. These changes are much greater than that observed for the induction of damage in this model. One interpretation of these results is that in the tissue environment, differentiation is a much more significant response to targeted irradiation and potentially a protective mechanism.

Coercion in the Community: A Situated Approach to the Examination of Ethical Challenges for Mental Health Social Workers

Increasingly, mental health social workers in the United Kingdom and elsewhere in the world are employing coercive interventions with clients. This paper explores this trend in the context of community-based settings, using national and international research literature on this subject. It begins with a discussion about the complex, contested nature of ideas on coercion. The authors then explore debates about how coercion is perceived and applied in practice. They choose two forms of coercion*/informal types of leverage, and the legally mandated use of Community Treatment Orders*/to highlight the range of ethical problems and dilemmas that confront practitioners in this field. The authors conclude by developing a tentative, explanatory model to explain how and why mental health social workers should consider a more holistic, situated approach to help deal with ethical concerns about the use of coercion.

A 3-D well-differentiated model of pediatric bronchial epithelium demonstrates unstimulated morphological differences between asthmatic and nonasthmatic cells

There is a need for reproducible and effective models of pediatric bronchial epithelium to study disease states such as asthma. We aimed to develop, characterize, and differentiate an effective, an efficient, and a reliable three-dimensional model of pediatric bronchial epithelium to test the hypothesis that children with asthma differ in their epithelial morphologic phenotype when compared with nonasthmatic children. Primary cell cultures from both asthmatic and nonasthmatic children were grown and differentiated at the air-liquid interface for 28 d. Tight junction formation, MUC5AC secretion, IL-8, IL-6, prostaglandin E2 production, and the percentage of goblet and ciliated cells in culture were assessed. Well-differentiated, multilayered, columnar epithelium containing both ciliated and goblet cells from asthmatic and nonasthmatic subjects were generated. All cultures demonstrated tight junction formation at the apical surface and exhibited mucus production and secretion. Asthmatic and nonasthmatic cultures secreted similar quantities of IL-8, IL-6, and prostaglandin E2. Cultures developed from asthmatic children contained considerably more goblet cells and fewer ciliated cells compared with those from nonasthmatic children. A well-differentiated model of pediatric epithelium has been developed that will be useful for more in vivo like study of the mechanisms at play during asthma.

Modelling Patient Duration of Stay to Facilitate Resource Management of Geriatric Hospitals

A fundamental aspect of health care management is the effective allocation of resources. This is of particular importance in geriatric hospitals where elderly patients tend to have more complex needs. Hospital managers would benefit immensely if they had advance knowledge of patient duration of stay in hospital. Managers could assess the costs of patient care and make allowances for these in their budget. In this paper, we tackle this important problem via a model which predicts the duration of stay distribution of patients in hospital. The approach uses phase-type distributions conditioned on a Bayesian belief network.

Does governance matter for aggregate health capital?

The point of departure of our analysis is the seminal work of Rodgers (1979) on the absolute and relative income hypotheses. We find that substituting the governance index for the Gini index is statistically the preferred regression model. Our findings lend support to the argument that governance matters. Further investigation provides evidence for two types of threshold effects: in terms of both absolute income and governance. For those countries below a threshold, absolute income is the most significant determinant of health, while for those above it, governance matters the most. The regression analyses are conducted on a sample of 112 states, which is representative of a wide range of absolute income and governance levels.

Country-wise differences in perception of health-related messages in cereal-based food products

The objective of the present study was to explore the impact of health-related messages on the perceived overall healthiness and consumers' likelihood to buy cereal-based products or non-cereal products containing beneficial compounds from grains, across four European countries. The data were collected from a sample of 2392 members of the public in Finland, Germany, Italy and the UK. The results from a conjoint task with a main effects additive model were reported. In general, the presence of a verbal health claim on foods had positive influence on respondents perception of healthiness and on likelihood to buy the products, whereas the pictorial health claims were found to have a weak influence on the two dependent variables. However, the findings showed that health-related information on food labels differently influenced the healthiness perception and the likelihood to buy the product across the four countries, suggesting that different cultures, traditions, and eating habits have to be taken into account before positioning cereal-based products containing beneficial compounds from grains on the market. (C) 2009 Elsevier Ltd. All rights reserved.

A Bayesian Network Hybrid Model for Representing Accident and Emergency Waiting Times

The paper introduces a new modeling approach that represents the waiting times in an Accident and Emergency (A&E) Department in a UK based National Health Service (NHS) hospital. The technique uses Bayesian networks to capture the heterogeneity of arriving patients by representing how patient covariates interact to influence their waiting times in the department. Such waiting times have been reviewed by the NHS as a means of investigating the efficiency of A&E departments (Emergency Rooms) and how they operate. As a result activity targets are now established based on the patient total waiting times with much emphasis on trolley waits.

Medium as message: Making an 'emancipating' film on mental health and distress

This article will be a reflective report, made by participants, facilitators and tutors on the first stage of a project entitled ‘Mentalentity’ which, had as it brief, the promotion of positive attitudes to mental health among men in rural areas. The arts ‘product’ is a 25 minute film made by a group of men in South Armagh using an action learning and action research approach.. The project is a paradigm of ‘action research’ using arts based methods also in that none of the men had ever been involved in filmmaking and had to learn a wide range of skills to convert the knowledge they were reflecting on into an arts product; avoiding the sensationalising of a very complex subject and, equally, the earnestness sometimes associated with ‘awareness raising’ projects. The project is funded by a statutory agency, the Southern Investing for Health Partnership, and is being implemented by two voluntary groups, Men Aware (South Armagh) and a pan-disability group, Out and About, working with Queen’s University, School of Education, Open Learning Programme, which facilitated and accredited the project and the Nerve Centre, an internationally renowned independent arts organisation which specialises in music, multimedia, and the moving image. The article will relate the project to a range of arts based projects undertaken by the contributors and will contextualize this work within the research in such fields as inclusive participative and emancipatory research, qualitative research methodologies, active learning pedagogy, arts based pedagogy, Social/ Relational model disability and cutting edge ‘psychosocial’ models in mental health.

Discrete Conditional Phase-type models utilising classification trees: Application to modelling health service capacities

Discrete Conditional Phase-type (DC-Ph) models consist of a process component (survival distribution) preceded by a set of related conditional discrete variables. This paper introduces a DC-Ph model where the conditional component is a classification tree. The approach is utilised for modelling health service capacities by better predicting service times, as captured by Coxian Phase-type distributions, interfaced with results from a classification tree algorithm. To illustrate the approach, a case-study within the healthcare delivery domain is given, namely that of maternity services. The classification analysis is shown to give good predictors for complications during childbirth. Based on the classification tree predictions, the duration of childbirth on the labour ward is then modelled as either a two or three-phase Coxian distribution. The resulting DC-Ph model is used to calculate the number of patients and associated bed occupancies, patient turnover, and to model the consequences of changes to risk status.