Quality of care for residents dying in Ontario long-term care facilities:Findings from a survey of directors of care

The purpose of this study was to collect information on the practice of end-of-life (EOL) care in long-term care (LTC) facilities in the Province of Ontario, Canada. A cross-sectional survey of directors of care in all licensed LTC facilities in the province was conducted between September 2003 and April 2004. Directors of care from 426 (76% response rate) facilities completed the postal survey questionnaire. The survey results identified communication problems between service providers and families, inadequate staffing levels to provide quality care to dying residents, and the need for training to improve staff skills in providing EOL care. Directors of care endorsed the use of a number of strategies that would improve the care of dying residents. Logistic regression analysis identified the eight most important items predictive of facility staff having the ability to provide quality EOL care. The findings contribute to the current discussion on policies for meeting the care needs of residents in LTC facilities until life's end. © 2006 Centre for Bioethics, IRCM.

Agitating for a design and regeneration agenda in a postconflict city: the case of Belfast

Introduction

Belfast has been a focus of academic attention for the last forty years with most interest centred on various aspects of ‘the Troubles’. Where there has been interest in the built environment, it has largely been about how the ‘security situation’ impacted directly on architecture and on the design and layout of social housing. This paper seeks to go beyond this to explore how the political- administrative culture of ‘the Troubles’ interacted with ‘normal’ market forces to shape the central area of the city, and to consider the responses of a recently formed activist group, known as the Forum for Alternative Belfast (hereafter referred to as the Forum). The paper is written by three of the directors of the Forum.1 Moreover, the empirical research presented here was undertaken by the Forum as part of a campaign to address issues relating to the design, layout and quality of Belfast’s built environment. In the longstanding tradition of participant observation working within an action-research paradigm, the participants have attempted to offer an account that is evidentially and purposefully selfcritical and reflective. It is of course recognised that while this approach offers many positive attributes, such as phenomenological access through immersion in the project, it also has the potential to bring compromise on research detachment and objectivity.2 To address the latter, the authors have attempted
to avoid polemical argument, and to support claims with primary or secondary research evidence. The authors also acknowledge that action-research has a chequered history; however, they would argue
that their approach is faithful to a concept that sees ‘research’ defined as understanding and ‘action’ defined as seeking change. The Forum’s very purpose is to seek change, but to do this requires evidence, collaboration and demonstration. And in this sense, it is a learning process for all participants, including the research activists, government officials, community organisations and students. The authors also recognise the complexity of factors that affect urban management and change, particularly in a city such as Belfast, which has had to cope with political violence for over thirty years. And they appreciate that in the context of conflict, governance is skewed to cope with political realities. Hamdi reminds us, however, that in practice there is an ‘important dialectic between top-down planning, with its formal and designed laws and structures, and bottom-up selforganizing collectivism—those “quantum and emergent systems” which Jane Jacobs argued long ago give cities their life and order.’3

Charabanc, cultural capital and the men of recognised credit

This paper compares the cultural legacy of the all-female Charabanc with that of Field Day, its fellow counterpart in the Irish Theatre touring movement in the 1980s. It suggests that a conscious awareness amongst the all-male Field Day board of successful writers and directors of what Bourdieu has called 'cultural capital' is implicated in the enduring authority of the work of that company within the history of Irish theatre. Conversely the paper considers if the populist Charabanc, in its steadfast refusal to engage with the hierarchies of academia and publishing, was too neglectful of the cultural capital which it accrued in its heyday and has thus been party to its own occlusion from that same history.

Identifying educational needs in end-of-life care for staff and families of residents in care facilities.

AIM: the purpose of this article is to describe educational needs in end-of-life (EoL) care for staff and families of residents in long-term care (LTC) facilities in the province of Ontario, Canada. Barriers to providing end-of-life care education in LTC facilities are also identified. DESIGN, SETTING AND PARTICIPANTS: cross-sectional survey of directors of care in all licensed LTC facilities in the province of Ontario, Canada. RESULTS: directors of care from 426 (76.9% response rate) licensed LTC facilities completed a postal-survey questionnaire. Topics identified as very important for staff education included pain and symptom management and communication with family members about EoL care. Priorities for family education included respecting the residents' expressed wishes for care and communication about EoL care. Having sufficient institutional resources was identified as a major barrier to providing continuing education to both staff and families. CONCLUSION: through examining educational needs in EoL care this study identified an environment of inadequate staffing and over-burdened care providers. The importance of increased staffing concomitant with education is a priority for LTC facilities.

Personal and Public Involvement and its impact - Monitoring, measuring and evaluating the impact of Personal and Public Involvement (PPI) in Health and Social Care in Northern Ireland.

Introduction
This report details the findings from research conducted across Northern Ireland’s Health and Social Care Trusts during 2015 which examines the current state of Personal and Public Involvement (PPI). This is about how service users, carers and patients engage with staff, management and directors of statutory health and social care organisations. Most statutory health and social care organisations must, under legislation, meet the requirements of PPI. PPI has been part of health and social care policy in Northern Ireland since 2007 and became law two years later with the introduction of the Health and Social Care Reform Act (2009). It is, therefore, timely that PPI is now assessed in this systematic way in order to both examine the aspects which are working well and to highlight those areas where improvements need to be made. As far as possible, this Summary Report is written in an accessible way, avoiding jargon and explaining key research terms, so as to ensure it is widely understood. This is in keeping with established good practice in service user involvement research. This summary, therefore, gives a picture of PPI in Northern Ireland currently. There is also a fuller report which gives a lot more details about the research and findings. Information on this is available from the Public Health Agency and/or the Patient and Client Council.

Ethics in neuroscience graduate training programs:Views and models from Canada

Consideration of the ethical, social, and policy implications of research has become increasingly important to scientists and scholars whose work focuses on brain and mind, but limited empirical data exist on the education in ethics available to them. We examined the current landscape of ethics training in neuroscience programs, beginning with the Canadian context specifically, to elucidate the perceived needs of mentors and trainees and offer recommendations for resource development to meet those needs. We surveyed neuroscientists at all training levels and interviewed directors of neuroscience programs and training grants. A total of 88% of survey respondents reported general interest in ethics, and 96% indicated a desire for more ethics content as it applies to brain research and clinical translation. Expert interviews revealed formal ethics education in over half of programs and in 90% of grants-based programs. Lack of time, resources, and expertise, however, are major barriers to expanding ethics content in neuroscience education. We conclude with an initial set of recommendations to address these barriers which includes the development of flexible, tailored ethics education tools, increased financial support for ethics training, and strategies for fostering collaboration between ethics experts, neuroscience program directors, and funding agencies. © 2010 the Authors. Journal Compilation © 2010 International Mind, Brain, and Education Society and Blackwell Publishing, Inc.

Evidence-Based Clinical Pathways To Manage Urinary Tract Infections in Long-Term Care Facilities:A Qualitative Case Study Describing Administrator and Nursing Staff Views

Objectives: This article examines the views of nursing staff and administrators in long-term care facilities (LTCFs) regarding a clinical pathway for managing urinary tract infections (UTIs) in LTCF residents. Design: A qualitative (case study) design was used. Setting: Data were collected from 8 LTCFs in southern Ontario and 2 in Iowa enrolled in a larger randomized controlled trial of clinical pathway for managing UTIs in LTCF residents, conducted between September 2001 and March 2003. The clinical pathway, designed to more effectively identify, diagnose, and treat UTIs, and reduce inappropriate antibiotics use for asymptomatic UTIs, introduced 2 decision tools to determine when to order a urine culture and initiate antibiotic treatment for suspected UTIs. Participants: We conducted 19 individual interviews with administrators and 10 focus groups with 52 nurses. Findings: Nurses generally thought that the pathways were well developed and easy to use, and administrators believed they were an important educational resource. Barriers to their use varied by group-initial lack of buy-in from nurses (medical directors), additional work (directors of nursing), and the need to change the protocol to exclude certain residents based on prior health conditions and/or pressure from physicians or families (nurses). Conclusions: Both administrators and staff, once familiar with a new clinical protocol to improve UTI management in LTCFs, generally supported its use. © 2007 American Medical Directors Association.

UK publicly funded Clinical Trials Units supported a controlled access approach to share individual participant data but highlighted concerns

OBJECTIVES: Evaluate current data sharing activities of UK publicly funded Clinical Trial Units (CTUs) and identify good practices and barriers.

STUDY DESIGN AND SETTING: Web-based survey of Directors of 45 UK Clinical Research Collaboration (UKCRC)-registered CTUs.

RESULTS: Twenty-three (51%) CTUs responded: Five (22%) of these had an established data sharing policy and eight (35%) specifically requested consent to use patient data beyond the scope of the original trial. Fifteen (65%) CTUs had received requests for data, and seven (30%) had made external requests for data in the previous 12 months. CTUs supported the need for increased data sharing activities although concerns were raised about patient identification, misuse of data, and financial burden. Custodianship of clinical trial data and requirements for a CTU to align its policy to their parent institutes were also raised. No CTUs supported the use of an open access model for data sharing.

CONCLUSION: There is support within the publicly funded UKCRC-registered CTUs for data sharing, but many perceived barriers remain. CTUs are currently using a variety of approaches and procedures for sharing data. This survey has informed further work, including development of guidance for publicly funded CTUs, to promote good practice and facilitate data sharing.

Implementing Risk Management::A Study of Major Malaysian Corporations

This study presents findings from a series of interviews with Risk Managers and/or Chief Risk Officers from major Malaysian companies about the prerequisites for the effective implementation of Risk Management programmes. The interviews highlight the importance of a number of factors, including: a strong commitment from the Board of Directors and Management in general, a desire for an appropriate risk culture, the development of formal Risk Management frameworks and policies, a recognition of the importance of risk communication, the appointment of a Chief Risk Officer (CRO) and the development of a complementary system of internal audit.