Factors affecting the successful implementation and sustainability of the Liverpool Care Pathway for dying patients – a realist evaluation

Objectives: The Liverpool Care Pathway for the dying patient (LCP) was designed to improve end-of-life care in generalist health care settings. Controversy has led to its withdrawal in some jurisdictions. The main objective of this research was to identify the influences that facilitated or hindered successful LCP implementation.

Method: An organisational case study using realist evaluation in one health and social care trust in Northern Ireland. Two rounds of semi-structured interviews were conducted with two policy makers and twenty two participants with experience and/or involvement in management of the LCP during 2011 and 2012.

Results: Key resource inputs included facilitation with a view to maintaining LCP ‘visibility’, reducing anxiety among nurses and increasing their confidence regarding the delivery of end-of-life care; and nurse and medical education designed to increase professional self-efficacy and reduce misuse and misunderstanding of the LCP. Key enabling contexts were consistent senior management support; ongoing education and training tailored to the needs of each professional group; and an organisational cultural change in the hospital setting that encompassed end-of-life care.

Conclusion: There is a need to appreciate the organizationally complex nature of intervening to improve end-of-life care. Successful implementation of evidence-based interventions for end-of-life care requires commitment to planning, training and ongoing review that takes account of different perspectives, institutional hierarchies and relationships and the educational needs of professional disciplines. There is a need also to recognise that medical consultants require particular support in their role as gatekeepers and as a lead communication channel with patients and their relatives.

The Value and Contribution of Qualitative Research to Inform Nurse Education and Policy in Response to the Child’s Experience of Hospital

The aim of this article is to consider the value of qualitative research to inform nurse education and policy for the hospitalized child and young person (CYP). The theoretical issues and tensions inherent in qualitative research with children and young people’s nursing are presented in conjunction with a discussion and analysis of how the epistemological and ontological concepts underpin and guide research. It is then followed by an exploration of their influence on enabling nurses to understand the CYP’s perspective, before finally leading to an analysis of the impact on the development of policy and research.

A quality-scalable and energy-efficient approach for spectral analysis of heart rate variability

Today there is a growing interest in the integration of health monitoring applications in portable devices necessitating the development of methods that improve the energy efficiency of such systems. In this paper, we present a systematic approach that enables energy-quality trade-offs in spectral analysis systems for bio-signals, which are useful in monitoring various health conditions as those associated with the heart-rate. To enable such trade-offs, the processed signals are expressed initially in a basis in which significant components that carry most of the relevant information can be easily distinguished from the parts that influence the output to a lesser extent. Such a classification allows the pruning of operations associated with the less significant signal components leading to power savings with minor quality loss since only less useful parts are pruned under the given requirements. To exploit the attributes of the modified spectral analysis system, thresholding rules are determined and adopted at design- and run-time, allowing the static or dynamic pruning of less-useful operations based on the accuracy and energy requirements. The proposed algorithm is implemented on a typical sensor node simulator and results show up-to 82% energy savings when static pruning is combined with voltage and frequency scaling, compared to the conventional algorithm in which such trade-offs were not available. In addition, experiments with numerous cardiac samples of various patients show that such energy savings come with a 4.9% average accuracy loss, which does not affect the system detection capability of sinus-arrhythmia which was used as a test case. 

Characterisation of UK and Irish Cold-Pressed Rapeseed Oils in Relation to Quality Indices and Constituents.

Cold-pressed rapeseed oil (CPRSO) is produced when seeds from an oilseed rape crop are mechanically crushed whilst at a low temperature. CPRSO’s popularity is rapidly expanding and is now produced in most Northern European countries including both N.Ireland and ROI. The CPRSO industry is still relatively new and therefore not as widely researched as other high quality oils. Fifteen CPRSO from The UK, Ireland and France were examined to determine characteristic differences between the oils. Two samples of extra-virgin olive oil and two samples of refined rapeseed oil were also included in the investigation to assess performance against market competitors. The antioxidant potential of the oils was assessed using the ABTS and DPPH radical scavenging assays. Both unexpectedly showed that refined rapeseed oil had the highest potential whilst there was significant difference between many of the CPRSO’s. The acid value (ACOS method Cd 3d-63) ranged widely from 0.47-3.41. To predict the stability during storage, an accelerated oxidation test was carried out where the oils were placed in an oven (60°C) and peroxide value was monitored. The results showed extra-virgin olive oil underwent the least oxidation during the trial. The refined rapeseed oil suffered the worst levels of oxidation whilst the CPRSO’s performed similarly but with some variation. Fatty acid composition was investigated with GC-MS and some of the major fatty acids were found to differ significantly between producers. Minor compound analysis was achieved with extraction and identification through HPLC. All results are critically discussed and compared to relevant published studies.

‘Plugging the Gap’: Shared Education and the promotion of community relations through schools in Northern Ireland

Although there is no consensus amongst educationalists as to the role schools play as drivers of hostilities in divided societies, there is broad agreement that they can facilitate more positive intergroup relations. In Northern Ireland the promotion of school based inter-group contact has been offered as a means through which this can happen. Until 2007, the approach was twofold, reflected on the one hand in short-term contact opportunities for pupils in predominantly Catholic and Protestant schools, and on the other, in support for integrated schools which educate Catholics and Protestants together. In 2007 the Shared Education Programme was introduced to ‘bridge the gap’ between short-term opportunities for contact, and ‘full immersion’ integrated schools. Informed by contact theory, shared education offers curriculum based interaction between pupils attending all school types, aimed at promoting the type of contact likely to reduce negative social attitudes and ultimately contribute to social harmony. In this paper, we examine the impact of shared education thus far. Our analysis suggests that whilst shared education is generally effective in promoting positive assessments of other group members, there is a danger that programme impact may be inhibited by the foregrounding of educational over reconciliation priorities. Appreciating that the downplaying reconciliation objectives may have been necessary when the programme was established in order to maximize recruitment to it, we argue that if the full potential of shared education is to be realized, moving forward, it is important for schools to engage with issues of group differences.

Irish language education and the national ideal: The dynamics of nationalism in Northern Ireland

Since the beginning of the Northern Ireland conflict in the late 1960s, Irish nationalism has been identified as a prominent force in the political culture of the state. Recent studies have suggested, however, that the ‘Nationalist’ population has become increasingly content within the new political framework created by the peace process and the aspiration for Irish unity diminished. In placing the Northern Ireland situation within the theoretical framework of nationalism, this paper will analyse how these changing priorities have been possible. Through an analysis of Irish language study in Northern Ireland's schools, the paper will examine how the political ideals espoused by the nationalist Sinn Féin Party reflected the priorities of the ‘nationalist community’. It will be contended that the relationship between the ideology and ‘the people’ is much more complex than is often allowed for and that educational inequalities are a significant contributing factor to this.

Making Social Work Education App’ier : The Process of Developing Information-based Apps for Social Work Education and Practice

Mobile App technology in social work education remains in the embryonic stages of development with a few notable exceptions. The use of Apps in College and University settings has been reported in other sectors of higher education, although there is a paucity of research in relation to its relevance to social work education and practice. The following article describes the creation of four social work education and practice Apps by a team of social work educators. The primary focus is on the design process and the partnership approach to the creation of the tools. It also outlines the rationale for the App development, the working process and the theoretical framework underpinning mobile learning. Furthermore, it provides information on the level of usage of the Apps according to geographical location, download information and time spent on each section of the App. The article also incorporates a pragmatic summary of developmental guidelines which may aid social work educators in the development and implementation of specialist information-based Apps for education and practice.