Developing an intervention to equip nurses for acute life threatening events (ALTEs) in hospital:a phenomenological approach to healthcare research

Objectives: To understand staff's experiences of acute life threatening events (ALTEs) in a pediatric hospital setting. These data will inform an intervention to equip nurses with clinical and emotional skills for dealing with ALTEs. Method: A mixed design was used in the broader research program; this paper focuses on phenomenon-focused interviews analyzed using interpretative phenomenological analysis (IPA). Results: Emerging themes included staff's relationships with patients and the impact of personhood on their ability to perform competently in an emergency. More experienced nurses described "automatic" competence generated through increased exposure to ALTEs and were able to recognize "fumbling and shaking" as a normal stress response. Designating a role was significant to staff experience of effectiveness. Key to nurses' learning experience was reflection and identifying experiences as "teachable moments." Findings were considered alongside existing theories of self-efficacy, reflective thought, and advocacy inquiry to create an experiential learning intervention involving a series of clinical and role-related scenarios. Conclusion: The phenomenological work facilitated an in-depth reading of experience. It accentuated the importance of exposure to ALTEs giving nurses experiential knowledge to prepare them for the impact of these events. Challenges included bracketing the personhood of child patients, shifting focus to clinical tasks during the pressured demands of managing an ALTE, normalizing the physiological stress response, and the need for a forum and structure for reflection and learning. An intervention will be designed to provide experiential learning and encourage nurses to realize and benefit from their embodied knowledge.

Disentangling patient and public involvement in healthcare decisions:why the difference matters

Patient and public involvement has become an integral aspect of many developed health systems and is judged to be an essential driver for reform. However, little attention has been paid to the distinctions between patients and the public, and the views of patients are often seen to encompass those of the general public. Using an ideal-type approach, we analyse crucial distinctions between patient involvement and public involvement using examples from Sweden and England. We highlight that patients have sectional interests as health service users in contrast to citizens who engage as a public policy agent reflecting societal interests. Patients draw on experiential knowledge and focus on output legitimacy and performance accountability, aim at typical representativeness, and a direct responsiveness to individual needs and preferences. In contrast, the public contributes with collective perspectives generated from diversity, centres on input legitimacy achieved through statistical representativeness, democratic accountability and indirect responsiveness to general citizen preferences. Thus, using patients as proxies for the public fails to achieve intended goals and benefits of involvement. We conclude that understanding and measuring the impact of patient and public involvement can only develop with the application of a clearer comprehension of the differences.

Using secondary knowledge to support decision tree classification of retrospective clinical data

Retrospective clinical data presents many challenges for data mining and machine learning. The transcription of patient records from paper charts and subsequent manipulation of data often results in high volumes of noise as well as a loss of other important information. In addition, such datasets often fail to represent expert medical knowledge and reasoning in any explicit manner. In this research we describe applying data mining methods to retrospective clinical data to build a prediction model for asthma exacerbation severity for pediatric patients in the emergency department. Difficulties in building such a model forced us to investigate alternative strategies for analyzing and processing retrospective data. This paper describes this process together with an approach to mining retrospective clinical data by incorporating formalized external expert knowledge (secondary knowledge sources) into the classification task. This knowledge is used to partition the data into a number of coherent sets, where each set is explicitly described in terms of the secondary knowledge source. Instances from each set are then classified in a manner appropriate for the characteristics of the particular set. We present our methodology and outline a set of experiential results that demonstrate some advantages and some limitations of our approach. © 2008 Springer-Verlag Berlin Heidelberg.

Transferring knowledge of manufacturing techniques within a subsidiary of a multi-national corporation

With the growth of the multi-national corporation (MNCs) has come the need to understand how parent companies transfer knowledge to, and manage the operations of, their subsidiaries. This is of particular interest to manufacturing companies transferring their operations overseas. Japanese companies in particular have been pioneering in the development of techniques such as Kaizen, and elements of the Toyota Production System (TPS) such as Kanban, which can be useful tools for transferring the ethos of Japanese manufacturing and maintaining quality and control in overseas subsidiaries. Much has been written about the process of transferring Japanese manufacturing techniques but much less is understood about how the subsidiaries themselves – which are required to make use of such techniques – actually acquire and incorporate them into their operations. This research therefore takes the perspective of the subsidiary in examining how knowledge of manufacturing techniques is transferred from the parent company within its surrounding (subsidiary). There is clearly a need to take a practice-based view to understanding how the local managers and operatives incorporate this knowledge into their working practices. A particularly relevant theme is how subsidiaries both replicate and adapt knowledge from parents and the circumstances in which replication or adaptation occurs. However, it is shown that there is a lack of research which takes an in-depth look at these processes from the perspective of the participants themselves. This is particularly important as much knowledge literature argues that knowledge is best viewed as enacted and learned in practice – and therefore transferred in person – rather than by the transfer of abstract and de-contextualised information. What is needed, therefore, is further research which makes an in-depth examination of what happens at the subsidiary level for this transfer process to occur. There is clearly a need to take a practice-based view to understanding how the local managers and operatives incorporate knowledge about manufacturing techniques into their working practices. In depth qualitative research was, therefore, conducted in the subsidiary of a Japanese multinational, Gambatte Corporation, involving three main manufacturing initiatives (or philosophies), namely 'TPS‘, 'TPM‘ and 'TS‘. The case data were derived from 52 in-depth interviews with project members, moderate-participant observations, and documentations and presented and analysed in episodes format. This study contributes to our understanding of knowledge transfer in relation to the approaches and circumstances of adaptation and replication of knowledge within the subsidiary, how the whole process is developed, and also how 'innovation‘ takes place. This study further understood that the process of knowledge transfer could be explained as a process of Reciprocal Provider-Learner Exchange that can be linked to the Experiential Learning Theory.

Experiential learning:inspiring the business leaders of tomorrow

Purpose: The complex challenges of sustainable development and the need to embed these issues effectively into the education of future business leaders has never been more urgent. The purpose of this paper is to discuss different approaches taken by two UK signatories to the UN Principles for Responsible Management Education (PRME). Design/methodology/approach: The two approaches examined are: MSc Entrepreneurship students opting for placements with social enterprises; and MBA students undertaking workshops using "live" case studies. A content analysis of the experiences of students from their written reflective narratives is presented. This is supplemented by reflections of the facilitators and tutors. Findings: The analysis reveals that the opportunity to work with social entrepreneurs and/or "responsible" business professionals provides the business students with inspirational role models and positive social learning opportunities. Research limitations/implications: This paper suggests that experiential learning is an effective way of integrating ethics, responsibility and sustainability into the curriculum but the research draws on the experience of two schools. Further research is important to explore these findings in other contexts. Practical implications: The authors argue that direct exposure to a business culture (and/or behaviour) that is predicated upon ethical/social responsibility and sustainability is an effective means to embed these values in the curriculum. Originality/value: This paper contributes by drawing on social psychological research related to behaviour change to examine how experiential learning on traditional Business Masters programmes can provide students with the knowledge, motivation and skills to contribute positively to society, in a way that more traditional pedagogies cannot. © Emerald Group Publishing Limited.

Using an experiential business game to stimulate sustainable thinking in marketing education

Recent years have seen a significant increase in the importance of environmental protection and sustainability to consumers, policy makers, and society in general. Reflecting this, most organizations are at least aware of this new agenda and wish to be seen as taking steps to improve behaviors in this regard. However, there appears to be a gap between this evolving agenda and the comparatively low level of knowledge that marketing managers actually have of the environmental impact of their own functional decisions. We suggest that this low knowledge level may be due, in part, to the marketplace focus of foundational marketing educational programs, and we attempt to show how broadening the horizons of marketing courses can help students (i.e., future managers) more deeply understand the environmental consequences of their actions. We demonstrate the use of a novel business game, based on the Life Cycle Assessment method, as the foundational cornerstone for the development of a broad understanding of the environmental impact of marketing decisions and actions for the entire life cycle of a product—from raw material extraction to ultimate disposal. The results of an empirical study show that this approach increases students’ appreciation for, and understanding of, these fundamental environmental sustainability concepts.