A mixed methods study of the work patterns of full-time nurse practitioners in nursing homes

Aims and objectives: The aim of this study was to explore the integration of the nurse practitioner role in Canadian nursing homes to enable its full potential to be realised for resident and family care. The objective was to determine nurse practitioners' patterns of work activities. 

Background: Nurse practitioners were introduced in Canadian nursing homes a decade ago on a pilot basis. In recent years, government and nursing home sector interest in the role has grown along with the need for data to inform planning efforts. 

Design: The study used a sequential mixed methods design using a national survey followed by case studies. 

Methods: A national survey of nurse practitioners included demographic items and the EverCare Nurse Practitioner Role and Activity Scale. Following the survey, case studies were conducted in four nursing homes. Data were collected using individual and focus group interviews, document reviews and field notes. 

Results: Twenty-three of a target population of 26 nurse practitioners responded to the survey, two-thirds of whom provided services in nursing homes with one site and the remainder in nursing homes with as many as four sites. On average, nurse practitioners performed activities in communicator, clinician, care manager/coordinator and coach/educator subscales at least three to four times per week and activities in the collaborator subscale once a week. Of the 43 activities, nurse practitioners performed daily, most were in the clinician and communicator subscales. Case study interviews involved 150 participants. Findings complemented those of the survey and identified additional leadership activities. 

Conclusion: Nurse practitioners undertake a range of primary health care and advanced practice activities which they adapt to meet the unique needs of nursing homes. Relevance to clinical practice: Knowledge of work patterns enables nursing homes to implement the full range of nurse practitioner roles and activities to enhance resident and family care.

Methods for Optimal Work Instruction Delivery: Pictograms v Images

This paper focuses on quantifying the benefits of pictogram based instructions relative to static images for work instruction delivery. The assembly of a stiffened aircraft panel has been used as an exemplar for the work which seeks to address the challenge of identifying an instructional mode that can be location or language neutral while at the same time optimising assembly build times and maintaining build quality. Key performance parameters measured using a series of panel build experiments conducted by two separate groups were: overall build time, the number of subject references to instructional media, the number of build errors and the time taken to correct any mistakes. Overall build time for five builds for a group using pictogram instructions was about 20% lower than for the group using image based instructions. Also, the pictogram group made fewer errors. Although previous work identified that animated instructions result in optimal build times, the language neutrality of pictograms as well as the fact that they can be used without visualisation hardware mean that, on balance, they have broader applicability in terms of transferring assembly knowledge to the manufacturing environment.

Research methods for social work

The book considers

Modified stiffened panel analysis methods for laser beam and friction stir welded aircraft panels

The introduction of advanced welding methods as an alternative joining process to riveting in the manufacture of primary aircraft structure has the potential to realize reductions in both manufacturing costs and structural weight. Current design and analysis methods for aircraft panels have been developed and validated for riveted fabrication. For welded panels, considering the buckling collapse design philosophy of aircraft stiffened panels, strength prediction methods considering welding process effects for both local-buckling and post-buckling behaviours must be developed and validated. This article reports on the work undertaken to develop analysis methods for the crippling failure of stiffened panels fabricated using laser beam and friction stir welding. The work assesses modifications to conventional analysis methods and finite-element analysis methods for strength prediction. The analysis work is validated experimentally with welded single stiffener crippling specimens. The experimental programme has demonstrated the potential static strength of laser beam and friction stir welded sheet-stiffener joints for post-buckling panel applications. The work undertaken has demonstrated that the crippling behaviour of welded stiffened panels may be analysed considering standard-buckling behaviour. However, stiffened panel buckling analysis procedures must be altered to account for the weld joint geometry and process altered material properties. © IMechE 2006.

Grading gems: Appraising the quality of research about social work and social care.

The impetus towards basing practice and policy decisions more explicitly on sound research requires tools to facilitate the systematic appraisal of the quality of research encompassing a diverse range of methods and designs. Five exemplar tools were developed and assessed in terms of their usefulness in selecting studies for inclusion in a systematic review. The widely used ‘hierarchy of evidence’ was adapted and used to appraise internal validity. Four tools were then developed to appraise the external validity dimensions of generalizability (two scales) and methods of data collection (two scales). Methods of combining the scores generated by each tool were explored. Qualitative and quantitative studies were appraised, not separated into two spheres but by using complementary tools developed to appraise different aspects of rigour. There was a high level of agreement between researchers in applying the tools to twenty-two studies on decision making by professionals about the longterm care of older people. The scales for internal validity and generalizability discriminated between the qualities of studies appropriately. The two tools to appraise data collection gave diverse results. Excluding studies that scored in the lowest category on any scale appeared to be the scoring system that was most justifiable. This approach is presented to stimulate debate about the practical application of the evidence-based initiative to social work and social care. This study may assist in developing clearer definitions and common language about appraising rigour that should further the process of selecting robust research for synthesis to inform practice and policy decisions.

Brief review of invariant texture analysis methods

This paper considers invariant texture analysis. Texture analysis approaches whose performances are not affected by translation, rotation, affine, and perspective transform are addressed. Existing invariant texture analysis algorithms are carefully studied and classified into three categories: statistical methods, model based methods, and structural methods. The importance of invariant texture analysis is presented first. Each approach is reviewed according to its classification, and its merits and drawbacks are outlined. The focus of possible future work is also suggested.

Innovative Approaches to Involving Service Users in Palliative Care Social Work Education

Service user involvement in social work education is now a firmly established concept in UnitedKingdom.As a result, it is common practice for service users to occupy central roles the education and training of social work students and staff in both qualifying and postqualifying programmes. This paper describes an initiative, undertaken inNorthern Ireland, which compares two methods of user involvement employed with undergraduate and postqualifying social work students. In both situations the students firstly observed discussedDVDexcerpts of narratives from people affected by cancer and secondly observed live facilitated interview with a 25-year-old male service user who shared his experiences being diagnosedwith cancer at a young age.Understanding the social work role in palliative care is crucial as all social workers, regardless of practice context, will have some degree involvement in helping individuals and families to address end-of-life care issues. paper compares the findings of evaluations from two student groups which may help inform social work educators about the effectiveness of different teaching methods used achieve meaningful and effective user involvement with seldom heard groups.

The Evolution of European Identity: Using biographical methods to study the development of European identity

Based upon the original application to the European Commission, this article gives insights into the thinking of the Euroidentities team at the point that the project began. The question: “Is the European ‘identity project’ failing?” is posed in the sense that the political and economic attainments of the European Union have not been translated into a sense of identity with or commitment to Europe from the populaces that have benefited from them. The urgency of European ‘identity work’ is asserted with a number of levels for the construction of European identity being hypothesized. Euroidentities is intended to break conceptual ground by bringing together on an equal footing two apparently antagonistic views of identity -- the collective and institutional and the individual and biographical – to give a more anchored and nuanced view of identity formation and transformation than either can provide on its own. Rather than following the dominant approaches to research on European identity that have been macro-theoretical and ‘top-down’, retrospective in-depth qualitative biographical interviews are planned since they provide the ideal means of gaining insight into the formation of a European identity or multiple identities from the ‘bottom up’ perspective of non-elite groups. The reliability of analysis will be buttressed by the use of contrastive comparison between cases, culminating in contrastive comparison across the national project teams between cases drawn from different ‘sensitized groups’ that provide the fieldwork structure of the project. The paper concludes with a summary of some of the more significant findings.

Survey research methods

book review

Relationship between work stress and body mass index among 45,810 female and male employees

Objective: The proportion of overweight and obese people has grown rapidly, and obesity has now been widely recognized as an important public health problem. At the came time, stress has increased in working life. The 2 problems could be connected if work stress promotes unhealthy eating habits and sedentary behavior and thereby contributes to weight gain. This study explored the association between work stress and body mass index (BMI; kg/m(2)). Methods: We used cross-sectional questionnaire data obtained from 45,810 female and male employees participating in the ongoing Finnish Public Sector Cohort Study. We constructed individual-level scores, as well as occupational- and organizational-level aggregated scores for work stress, as indicated by the demand/control model and the effort-reward imbalance model. Linear regression analyses were stratified by sex and socioeconomic status (SES) and adjusted for age, marital status, job contract, smoking, alcohol consumption, physical activity, and negative affectivity. Results: The results with the aggregated scores showed that lower job control, higher job strain, and higher effort-reward imbalance were associated with a higher BMI. In men, lower job demands were also associated with a higher BMI. These associations were not accounted for by SES, although an additional adjustment for SES attenuated the associations. The results obtained with the individual-level scores were in the same direction, but the relationships were weaker than those obtained with the aggregated scores. Conclusions: This study shows a weak association between work stress and BMI.

Electrical methods of controlling bacterial adhesion and biofilm on device surfaces.

This review will summarize the significant body of research within the field of electrical methods of controlling the growth of microorganisms. We examine the progress from early work using current to kill bacteria in static fluids to more realistic treatment scenarios such as flow-through systems designed to imitate the human urinary tract. Additionally, the electrical enhancement of biocide and antibiotic efficacy will be examined alongside recent innovations including the biological applications of acoustic energy systems to prevent bacterial surface adherence. Particular attention will be paid to the electrical engineering aspects of previous work, such as electrode composition, quantitative electrical parameters and the conductive medium used. Scrutiny of published systems from an electrical engineering perspective will help to facilitate improved understanding of the methods, devices and mechanisms that have been effective in controlling bacteria, as well as providing insights and strategies to improve the performance of such systems and develop the next generation of antimicrobial bioelectric materials.

Contemporary Studies of the Effectiveness of Social Work

This article is based upon an analysis of 95 experimental, quasi-experimental, preexperimental and client-opinion studies of the effectiveness of social work. Three-quarters of these screened studies show positive results within their different methodological conventions. An examination is made of which methods and patterns of helping are correlated with positive outcomes and the implications for practice, training, and management explored.