51 resultados para end of life decision-making


Relevância:

100.00% 100.00%

Publicador:

Resumo:

Despite concerted academic interest in the strategic decision-making process (SDMP) since the 1980s, a coherent body of theory capable of guiding practice has not materialised. This is because many prior studies focus only on a single process characteristic, often rationality or comprehensiveness, and have paid insufficient attention to context. To further develop theory, research is required which examines: (i) the influence of context from multiple theoretical perspectives (e.g. upper echelons, environmental determinism); (ii) different process characteristics from both synoptic formal (e.g. rationality) and political incremental (e.g. politics) perspectives, and; (iii) the effects of context and process characteristics on a range of SDMP outcomes. Using data from 30 interviews and 357 questionnaires, this thesis addresses several opportunities for theory development by testing an integrative model which incorporates: (i) five SDMP characteristics representing both synoptic formal (procedural rationality, comprehensiveness, and behavioural integration) and political incremental (intuition, and political behaviour) perspectives; (ii) four SDMP outcome variables—strategic decision (SD) quality, implementation success, commitment, and SD speed, and; (iii) contextual variables from the four theoretical perspectives—upper echelons, SD-specific characteristics, environmental determinism, and firm characteristics. The present study makes several substantial and original contributions to knowledge. First, it provides empirical evidence of the contextual boundary conditions under which intuition and political behaviour positively influence SDMP outcomes. Second, it establishes the predominance of the upper echelons perspective; with TMT variables explaining significantly more variance in SDMP characteristics than SD specific characteristics, the external environment, and firm characteristics. A newly developed measure of top management team expertise also demonstrates highly significant direct and indirect effects on the SDMP. Finally, it is evident that SDMP characteristics and contextual variables influence a number of SDMP outcomes, not just overall SD quality, but also implementation success, commitment, and SD speed.

Relevância:

100.00% 100.00%

Publicador:

Resumo:

Bioenergy schemes are multi-faceted and complex by nature, with many available raw material supplies and technical options and a diverse set of stakeholders holding a raft of conflicting opinions. To develop and operate a successful scheme there are many requirements that should be considered and satisfied. This paper provides a review of those academic works attempting to deal with problems arising within the bioenergy sector using multi-criteria decision-making (MCDM) methods. These methods are particularly suitable to bioenergy given its multi-faceted nature but could be equally relevant to other energy conversion technologies. Related articles appearing in the international journals from 2000 to 2010 are gathered and analysed so that the following two questions can be answered. (i) Which methods are the most popular? (ii) Which problems attract the most attention? The review finds that optimisation methods are most popular with methods choosing between few alternatives being used in 44% of reviewed papers and methods choosing between many alternatives being used in 28%. The most popular application area was to technology selection with 27% of reviewed papers followed by policy decisions with 18%. © 2012 Elsevier Ltd.

Relevância:

100.00% 100.00%

Publicador:

Resumo:

Against a backdrop of ongoing educational reforms that seek to introduce Communicative Language Teaching (CLT) in Albanian primary and secondary state schools, Albanian teachers, among others, are officially required to use communication-based textbooks in their classes. Authorities in a growing number of countries that are seeking to improve and westernise their educational systems are also using communication-based textbooks as agents of change. Behind these actions, there is the commonly held belief that textbooks can be used to support teacher learning as they provide a visible framework teachers can follow. Communication-based textbooks are used in thousands of EFL classrooms around the world to help teachers to “fully understand and routinize change” (Hutchinson and Torres, 1994:323). However, empirical research on the role materials play in the classroom, and in particular the role of textbook as an agent of change, is still very little, and what does exist is rather inconclusive. This study aims to fulfill this gap. It is predominately a qualitative investigation into how and why four Albanian EFL teachers use Western teaching resources in their classes. Aiming at investigating the decision-making processes that teachers go through in their teaching, and specifically at investigating the relationship between Western-published textbooks, teachers’ decision making, and teachers’ classroom delivery, the current study contributes to an extensive discussion on the development of communicative L2 teaching concepts and methods, teacher decision making, as well as a growing discussion on how best to make institutional reforms effective, particularly in East-European ex-communist countries and in other developing countries. Findings from this research indicate that, prompted by the content of Western-published textbooks, the four research participants, who had received little formal training in CLT teaching, accommodated some communicative teaching behaviours into their teaching. The use of communicative textbooks, however, does not seem to account for radical, methodological changes in teachers’ practices. Teacher cognitions based on teachers’ previous learning experience are likely to act as a lens through which teachers judge classroom realities. As such, they shape, to a great degree, the decisions teachers make regarding the use of Western-published textbooks in their classes.

Relevância:

100.00% 100.00%

Publicador:

Resumo:

OBJECTIVES: To understand older adults' experiences of moving into extra care housing which offers enrichment activities alongside social and healthcare support. DESIGN: A longitudinal study was conducted which adopted a phenomenological approach to data generation and analysis. METHODS: Semi-structured interviews were conducted in the first 18 months of living in extra care housing. Interpretative phenomenological analysis was used because its commitment to idiography enabled an in-depth analysis of the subjective lived experience of moving into extra care housing. Themes generated inductively were examined against an existential-phenomenological theory of well-being. RESULTS: Learning to live in an extra care community showed negotiating new relationships was not straightforward; maintaining friendships outside the community became more difficult as capacity declined. In springboard for opportunity/confinement, living in extra care provided new opportunities for social engagement and a restored sense of self. Over time horizons began to shrink as incapacities grew. Seeking care illustrated reticence to seek care, due to embarrassment and a sense of duty to one's partner. Becoming aged presented an ontological challenge. Nevertheless, some showed a readiness for death, a sense of homecoming. CONCLUSIONS: An authentic later life was possible but residents required emotional and social support to live through the transition and challenges of becoming aged. Enhancement activities boosted residents' quality of life but the range of activities could be extended to cater better for quieter, smaller scale events within the community; volunteer activity facilitators could be used here. Peer mentoring may help build new relationships and opportunities for interactive stimulation. Acknowledging the importance of feeling-empathic imagination-in caregiving may help staff and residents relate better to each other, thus helping individuals to become ontologically secure and live well to the end.

Relevância:

100.00% 100.00%

Publicador:

Resumo:

Objective: The Any Qualified Provider framework in the National Health Service has changed the way adult audiology services are offered in England. Under the new rules, patients are being offered a choice in geographical location and audiology provider. This study aimed to explore how choices in treatment are presented and to identify what information patients need when they are seeking help with hearing loss. Design: This study adopted qualitative methods of ethnographic observations and focus group interviews to identify information needed prior to, and during, help-seeking. Observational data and focus group data were analysed using the constant comparison method of grounded theory. Study sample: Participants were recruited from a community Health and Social Care Trust in the west of England. This service incorporates both an Audiology and a Hearing Therapy service. Twenty seven participants were involved in focus groups or interviews. Results: Participants receive little information beyond the detail of hearing aids. Participants report little information that was not directly related to uptake of hearing aids. Conclusions: Participant preferences were not explored and limited information resulted in decisions that were clinician-led. The gaps in information reflect previous data on clinician communication and highlight the need for consistent information on a range of interventions to manage hearing loss.

Relevância:

100.00% 100.00%

Publicador:

Resumo:

Background Against a backdrop of recommendations for increasing access to and uptake of early surgical intervention for children with medically intractable epilepsy, it is important to understand how parents and professionals decide to put children forward for epilepsy surgery and what their decisional support needs are. Aim The aim of this study was to explore how parents and health professionals make decisions regarding putting children forward for pediatric epilepsy surgery. Methods Individual interviews were conducted with nine parents of children who had undergone pediatric epilepsy surgery at a specialist children's hospital and ten healthcare professionals who made up the children's epilepsy surgery service multidisciplinary healthcare team (MDT). Three MDT meetings were also observed. Data were analyzed thematically. Findings Four themes were generated from analysis of interviews with parents: presentation of surgery as a treatment option, decision-making, looking back, and interventions. Three themes were generated from analysis of interviews/observations with health professionals: triangulating information, team working, and patient and family perspectives. Discussion Parents wanted more information and support in deciding to put their child forward for epilepsy surgery. They attempted to balance the potential benefits of surgery against any risks of harm. For health professionals, a multidisciplinary approach was seen as crucial to the decision-making process. Advocating for the family was perceived to be the responsibility of nonmedical professionals. Conclusion Decision-making can be supported by incorporating families into discussions regarding epilepsy surgery as a potential treatment option earlier in the process and by providing families with additional information and access to other parents with similar experiences.