Risks to home care workers: Professional perspectives

Care at home is fundamental to community care policy, but the simultaneous growth of health and safety regulation has implications for home care services because of the duty of employers towards home care workers. This grounded theory study set in Northern Ireland used data from 19 focus groups and nine semi-structured interviews with a range of health and social services professionals and managers to explore perspectives on planning long term care for older people. Home care workers faced a wide range of hazards in the homes of clients, who themselves were faced with adapting their living habits due to their changing health and care needs and 'risks.' Creative approaches were used to ensure the health and safety of home care workers and simultaneously to meet the choices of clients. Staff experienced feelings of conflict when they judged it necessary to impose their way of providing home care and thus impose their values on clients to create a safe working environment. There was variation between and within organizations in terms of the staff focus on client needs or on their employer responsibility towards home care workers. The planning of home care services must take account of both the choices of clients and the hazards facing home care staff.

Decisional responsibility for mechanical ventilation and weaning: an international survey

Introduction: Optimal management of mechanical ventilation and weaning requires dynamic and collaborative decision making to minimize complications and avoid delays in the transition to extubation. In the absence of collaboration, ventilation decision making may be fragmented, inconsistent, and delayed. Our objective was to describe the professional group with responsibility for key ventilation and weaning decisions and to examine organizational characteristics associated with nurse involvement.

Methods: A multi-center, cross-sectional, self-administered survey was sent to nurse managers of adult intensive care units (ICUs) in Denmark, Germany, Greece, Italy, Norway, Switzerland, Netherlands and United Kingdom (UK). We summarized data as proportions (95% confidence intervals (CIs)) and calculated odds ratios (OR) to examine ICU organizational variables associated with collaborative decision making.

Results: Response rates ranged from 39% (UK) to 92% (Switzerland), providing surveys from 586 ICUs. Interprofessional collaboration (nurses and physicians) was the most common approach to initial selection of ventilator settings (63% (95% CI 59 to 66)), determination of extubation readiness (71% (67 to 75)), weaning method (73% (69 to 76)), recognition of weaning failure (84% (81 to 87)) and weaning readiness (85% (82 to 87)), and titration of ventilator settings (88% (86 to 91)). A nurse-to-patient ratio other than 1:1 was associated with decreased interprofessional collaboration during titration of ventilator settings (OR 0.2, 95% CI 0.1 to 0.6), weaning method (0.4 (0.2 to 0.9)), determination of extubation readiness (0.5 (0.2 to 0.9)) and weaning failure (0.4 (0.1 to 1.0)). Use of a weaning protocol was associated with increased collaborative decision making for determining weaning (1.8 (1.0 to 3.3)) and extubation readiness (1.9 (1.2 to 3.0)), and weaning method (1.8 (1.1 to 3.0)). Country of ICU location influenced the profile of responsibility for all decisions. Automated weaning modes were used in 55% of ICUs.

Conclusions: Collaborative decision making for ventilation and weaning was employed in most ICUs in all countries although this was influenced by nurse-to-patient ratio, presence of a protocol, and varied across countries. Potential clinical implications of a lack of collaboration include delayed adaptation of ventilation to changing physiological parameters, and delayed recognition of weaning and extubation readiness resulting in unnecessary prolongation of ventilation.

The role of the Professional Engineer in the 21st century

In light of the current world economic and environmental crisis due in part to
unsustainable development and poor financial planning, 21st Century engineers are faced with unprecedented challenges of developing a sustainable world in balance with the forces of nature to combat global environmental, social and economic crises. The European Union, the United States of America and a number of other countries have identified that smart solutions and highly skilled professionals are needed to survive climate change and create long-term prosperity. In this paper the evolution of the changing career of the engineer will be presented. The policy background to the current system of engineering education at bachelor’s and graduate level in Ireland will be introduced and perceptions of engineering as a profession by society in general, and by
school leavers selecting third level courses will be discussed. The role of the engineer as a specialist, expert or generalist will also be studied in terms of the changing demands and needs of society. Finally the responsibility of universities, through broad-based multidisciplinary teaching and training, to prepare the next crop of engineers will be examined.

Dealing with a problem that doesn't exist?:Professional responses to female perpetrated child sexual abuse

Female involvement in sexual offences against children is more common than is generally thought and has serious implications for the long-term emotional and psychological well-being of victims. Drawing on findings from: a comprehensive review of the literature; an overview of relevant literature and legislation; and an electronic survey of Multi-Agency Public Protection Panels; this paper explores the criminal justice response to female sex offending in England, Wales and Northern Ireland. The literature highlights that the way in which professionals identify and respond to child sexual abuse has been shown to be influenced by the gender of the perpetrator. Equally, whilst similar to male sex offending in terms of the intrusiveness and seriousness of the abuse, some aspects of female sex offending can cause particular problems for professionals. The fact that some sexual abuse can be disguised as childcare can make it difficult for professionals to identify this type of abuse whilst high rates of co-offending bring additional difficulties in determining the degree of female involvement and assigning responsibility. The survey findings indicate that risk assessment tools for female sex offenders is a key area requiring development and point towards small inconsistencies in the current practice of risk assessing females in the community. The survey also identifies the lack of treatment programmes for this group of offenders as well as drawing attention to the need for national policies and procedures, staff training and the identification of areas of good practice. Increased discussion and debate about how best to work with this group of sex offenders is also required. Copyright © 2007 John Wiley & Sons, Ltd.

Corporate Social Responsibility within the Northern Ireland Construction Industry: A Regional Review

As the construction industry continues to struggle with a poor societal image, many organizations have adopted a positive corporate social responsibility (CSR) towards their surrounding environment, with the objective of improving their persona within social circles. The aim of this research is to identify and document the various approaches adopted by UK contractors in relation to their international counterparts to aid in the identification of possible future benefits which may be exploitable.
In order to acquire the relevant information, a number of qualitative methodologies are adopted including a review of the current literature on the topic along with a detailed semi-structured interview with a UK based industry professional that specializes in corporate social responsibility. Through assessing the findings using qualitative analysis software, it is possible to disseminate the information, resulting in the identification of key findings. This research concludes that a number of factors profoundly affect corporate social responsibility within the UK versus other regions. These factors are identified as the effect of the recession, implementation and reporting along with competitiveness within the sector.
The impaction for practice within the UK construction sector of this research is that it enables various industry leaders to actively consider the findings of the research while also vigorously encouraging the establishment and development of corporate social responsibility, not only within their respective organizations, but within the construction industry as a whole. This would not only result in a more environmentally sustainable industry, but would also raise the awareness of the sector locally, nationally and internationally, therefore improving the overall perception of the sector on a variety of levels. This will ultimately lead to a more sustainable, environmentally friendly and collective industry while also considering the needs of one of its most important external stakeholders – the local community.

Alcohol, Tobacco and Pharmacy Students: Usage and Views on Professional Issues

Introduction/background: This study aimed to ascertain pharmacy students’ use and views on cigarettes and alcohol (including in relation to provision of health promotion advice) and to establish if alcohol intake affected academic performance. Within the United Kingdom (UK), there has been limited research conducted in this area
Methods: Following ethical approval, pharmacy students (n=581) were invited to participate in a pre-piloted electronic questionnaire, consisting of 21 questions on smoking and alcohol. Descriptive statistics and non-parametric tests were used for data analyses.
Results: A response rate of 64.5% (375/581) was obtained (69.9% female, 30.2% male). Many respondents (77.9%) reported that they drank alcohol; whereas only 3.7% stated they currently smoked cigarettes. Students who drank alcohol were more likely to fail elements of the program than those who did not. Less than half (47.8%) were in agreement that it was hypocritical for a pharmacist to give health promotion advice and then get drunk outside of work.
Discussion/conclusions: Students seem to consider that lifestyle recommendations are less relevant for themselves and also that a pharmacist’s responsibility centers on providing advice, rather than being a role-model. Alcohol consumption appears to negatively influence academic achievement.

Professional Educational Psychology and Community Relations Education in Northern Ireland.

This article provides an account of practice-based research of, at least, one-star quality in terms of its contribution to both theory and practice. Aimed at practitioner (as opposed to academic) psychologists, the article addresses a dimension of the practitioner role that has remained silent in the literature. The article makes creative and original connections between school effectiveness, school improvement and education in a divided society. Post 11th September, the article was described as being highly original, significant and relevant to all practising educational psychologists. Concrete evidence for this is gained from, eg: hits on the online electronic version (2002-2003 Annual Report of the Association of Educational Psychologists), citations in reviews of research, and author invitations to present his work at UK and international practitioner psychology conferences. The article is published in the premier journal reporting on quality applied educational research and practice within the United Kingdom and beyond.