Exploring the experiences of nurses who care for children who have Acute Life Threatening Events (ALTE) in hospital

This thesis presents a program of work designed to explore and describe what the experience of caring for a child who has an Acute Life Threatening Event (ALTE) is like for the nurses. An ALTE may include a cardiac arrest, respiratory arrest or unplanned admission for a ward to the Paediatric Intensive Care unit. Using the MRC framework for the development of complex interventions, this information was then coupled with theory to develop the PREPARE and SUPPORT interventions. Given the wide-ranging and exploratory nature of this research, a pragmatic, mixed design approach was used to address the aims and objectives of the thesis. The mixed design approach included: a systematic literature review; international survey of practice; interviews with nurses and doctors using Interpretative Phenomenological Analysis; development, refinement and evaluation of interventions during a feasibility study. Two studies were identified through the systematic review which aimed to evaluate the effectiveness of debriefing. The studies did not provide evidence to support the use of these interventions within healthcare. The international survey of practice demonstrated hospitals were using interventions to both prepare and support nurses for these events. The preparatory interventions were clinically focused and the majority of the supportive interventions included a debrief. The interventions were not being evaluated for effectiveness. The interviews conducted with nurses and doctors provided insight into what that experience was like for the participants. Using the MRC framework, this evidence was coupled with theory to develop the PREPARE and SUPPORT interventions. A multidisciplinary working party used an iterative process to refine and evaluate the interventions and study procedures were explored through a feasibility study. The pragmatic, mixed design approach demonstrated how the empirical evidence was coupled with theory and clinical expertise to develop interventions for use within the healthcare environment.

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.

Automated prediction of deterioration of infants in paediatric intensive care using SpO2

Acute life-threatening events are mostly predictable in adults and children. Despite real-time monitoring these events still occur at a rate of 4%. This paper describes an automated prediction system based on the feature space embedding and time series forecasting methods of the SpO2 signal; a pulsatile signal synchronised with heart beat. We develop an age-independent index of abnormality that distinguishes patient-specific normal to abnormal physiology transitions. Two different methods were used to distinguish between normal and abnormal physiological trends based on SpO2 behaviour. The abnormality index derived by each method is compared against the current gold standard of clinical prediction of critical deterioration. Copyright © 2013 Inderscience Enterprises Ltd.

Predictability of unplanned extubations

Acute life threatening events such as cardiac/respiratory arrests are often predictable in adults and children. However critical events such as unplanned extubations are considered as not predictable. This paper seeks to evaluate the ability of automated prediction systems based on feature space embedding and time series methods to predict unplanned extubations in paediatric intensive care patients. We try to exploit the trends in the physiological signals such as Heart Rate, Respiratory Rate, Systolic Blood Pressure and Oxygen saturation levels in the blood using signal processing aspects of a frame-based approach of expanding signals using a nonorthogonal basis derived from the data. We investigate the significance of the trends in a computerised prediction system. The results are compared with clinical observations of predictability. We will conclude by investigating whether the prediction capability of the system could be exploited to prevent future unplanned extubations. © 2014 IEEE.

Institutional work at field-configuring events:shaping industry change within sustainable transitions

Adopting an institutional approach from organization studies, this paper explores the role of key actors on “purposeful governance for sustainability” (Smith, Voss et al. 2010: 444) through the case of smart metering in the UK. Institutions are enduring patterns in social life, reflected in identities, routines, rules, shared meanings and social relations, which enable, and constrain, the beliefs and behaviours of individual and collective actors within a field (Thornton and Ocasio 2008). Large-scale external initiatives designed to drive regime-level change prompt ‘institutional entrepreneurs’ to perform ‘institutional work’ – “purposive action aimed at creating, maintaining and disrupting institutions” (Lawrence and Suddaby, 2006). Organization scholars are giving increasing attention to ‘field-configuring events’ (FCEs) which provide social spaces for diverse organizational actors to come together to collectively shape socio-technical pathways (Lampel and Meyer 2008). Our starting point for this exploratory study is that FCEs can offer important insights to the dynamics, politics and governance of sustainability transitions. Methodologically, FCEs allow us to observe and “link field evolution at the macro-level with individual action at the micro-level” (Lampel and Meyer, 2008: 1025). We examine the work of actors during a series of smart metering industry forums over a three-year period (industry presentations [n= 77] and panel discussions [n= 16]). The findings reveal new insights about how institutional change unfolds, alongside technological transitions, in ways that are partial and aligned with the interests of powerful incumbents whose voices are frequently heard at FCEs. The paper offers three contributions. First, the study responds to calls for more research examining FCEs and the role they play in transforming institutional fields. Second, the emergent findings extend research on institutional work by advancing our understanding of a specific site of institutional work, namely a face-to-face inter-organizational arena. Finally, in line with the research agenda for innovation studies and sustainability transitions elaborated by Smith et al (2010), the paper illustrates how actors in a social system respond to, translate, and enact interventions designed to promote industrial transformation, ultimately shaping the sustainability transition pathway.

Moving beyond heterosexism? The good, the bad and the indifferent in accounts of others’ reactions to important life events

Latterly the psychology of sexualities has diversified. There has been increased engagement with queer theory and a heightened focus on sexual practices alongside continued interrogation of heteronormativity via analyses of talk-in-interaction. In this article, I offer an argument for juxtaposing the incongruent in order to further interrogate manifestations of heterosexism in lesbian, gay, bisexual, trans and queer (LGBTQ) people’s lives. In this case, accounts of others’ reactions to a happy event and to a sad experience. By drawing on two contrasting data corpuses – 124 people planning or in a civil partnership and 60 women who had experienced pregnancy loss – there is increased potential for understanding variation in ‘normative’ and/or heteronormative interpretations of LGBTQ lives. I suggest that, despite significant legal and structural gains for LGBTQ communities in a number of Western countries in recent years, and lively internal debates within the psychology of sexualities field, critical examination of manifestations of heterosexism should remain a central focus.

Is pregnancy a teachable moment for diet and physical activity behaviour change? An interpretative phenomenological analysis of the experiences of women during their first pregnancy

OBJECTIVES: Pregnancy may provide a 'teachable moment' for positive health behaviour change, as a time when women are both motivated towards health and in regular contact with health care professionals. This study aimed to investigate whether women's experiences of pregnancy indicate that they would be receptive to behaviour change during this period. DESIGN: Qualitative interview study. METHODS: Using interpretative phenomenological analysis, this study details how seven women made decisions about their physical activity and dietary behaviour during their first pregnancy. RESULTS: Two women had required fertility treatment to conceive. Their behaviour was driven by anxiety and a drive to minimize potential risks to the pregnancy. This included detailed information seeking and strict adherence to diet and physical activity recommendations. However, the majority of women described behaviour change as 'automatic', adopting a new lifestyle immediately upon discovering their pregnancy. Diet and physical activity were influenced by what these women perceived to be normal or acceptable during pregnancy (largely based on observations of others) and internal drivers, including bodily signals and a desire to retain some of their pre-pregnancy self-identity. More reasoned assessments regarding benefits for them and their baby were less prevalent and influential. CONCLUSIONS: Findings suggest that for women who conceived relatively easily, diet and physical activity behaviour during pregnancy is primarily based upon a combination of automatic judgements, physical sensations, and perceptions of what pregnant women are supposed to do. Health professionals and other credible sources appear to exert less influence. As such, pregnancy alone may not create a 'teachable moment'. Statement of contribution What is already known on this subject? Significant life events can be cues to action with relation to health behaviour change. However, much of the empirical research in this area has focused on negative health experiences such as receiving a false-positive screening result and hospitalization, and in relation to unequivocally negative behaviours such as smoking. It is often suggested that pregnancy, as a major life event, is a 'teachable moment' (TM) for lifestyle behaviour change due to an increase in motivation towards health and regular contact with health professionals. However, there is limited evidence for the utility of the TM model in predicting or promoting behaviour change. What does this study add? Two groups of women emerged from our study: the women who had experienced difficulties in conceiving and had received fertility treatment, and those who had conceived without intervention. The former group's experience of pregnancy was characterized by a sense of vulnerability and anxiety over sustaining the pregnancy which influenced every choice they made about their diet and physical activity. For the latter group, decisions about diet and physical activity were made immediately upon discovering their pregnancy, based upon a combination of automatic judgements, physical sensations, and perceptions of what is normal or 'good' for pregnancy. Among women with relatively trouble-free conception and pregnancy experiences, the necessary conditions may not be present to create a 'teachable moment'. This is due to a combination of a reliance on non-reflective decision-making, perception of low risk, and little change in affective response or self-concept.

Technical efficiency:efficiency, change, technical progress and productivity growth in the national health systems of continental African countries

In May 2006, the Ministers of Health of all the countries on the African continent, at a special session of the African Union, undertook to institutionalise efficiency monitoring within their respective national health information management systems. The specific objectives of this study were: (i) to assess the technical efficiency of National Health Systems (NHSs) of African countries for measuring male and female life expectancies, and (ii) to assess changes in health productivity over time with a view to analysing changes in efficiency and changes in technology. The analysis was based on a five-year panel data (1999-2003) from all the 53 countries of continental Africa. Data Envelopment Analysis (DEA) - a non-parametric linear programming approach - was employed to assess the technical efficiency. Malmquist Total Factor Productivity (MTFP) was used to analyse efficiency and productivity change over time among the 53 countries' national health systems. The data consisted of two outputs (male and female life expectancies) and two inputs (per capital total health expenditure and adult literacy). The DEA revealed that 49 (92.5%) countries' NHSs were run inefficiently in 1999 and 2000; 50 (94.3%), 48 (90.6%) and 47 (88.7%) operated inefficiently in 2001, 2002, and 2003 respectively. All the 53 countries' national health systems registered improvements in total factor productivity attributable mainly to technical progress. Fifty-two countries did not experience any change in scale efficiency, while thirty (56.6%) countries' national health systems had a Pure Efficiency Change (PEFFCH) index of less than one, signifying that those countries' NHSs pure efficiency contributed negatively to productivity change. All the 53 countries' national health systems registered improvements in total factor productivity, attributable mainly to technical progress. Over half of the countries' national health systems had a pure efficiency index of less than one, signifying that those countries' NHSs pure efficiency contributed negatively to productivity change. African countries may need to critically evaluate the utility of institutionalising Malmquist TFP type of analyses to monitor changes in health systems economic efficiency and productivity over time. African national health systems, per capita total health expenditure, technical efficiency, scale efficiency, Malmquist indices of productivity change, DEA

A biography:fabrications in the life of an ERP package

This paper provides an account of the way Enterprise Resource Planning (ERP) systems change over time. These changes are conceptualized as a biographical accumulation that gives the specific ERP technology its present character, attributes and historicity. The paper presents empirics from the implementation of an ERP package within an Australasian organization. Changes to the ERP take place as a result of imperatives which arise during the implementation. Our research and evidence then extends to a different time and place where the new release of the ERP software was being 'sold' to client firms in the UK. We theorize our research through a lens based on ideas from actor network theory (ANT) and the concept of biography. The paper seeks to contribute an additional theorization for ANT studies that places the focus on the technological object and frees it from the ties of the implementation setting. The research illustrates the opportunistic and contested fabrication of a technological object and emphasizes the stability as well as the fluidity of its technologic. Copyright © 2007 SAGE.

Crossing threshold periods in the retail life cycle:Insights from Wal-Mart international

This article takes a broader theoretical perspective of the retail life cycle by incorporating threshold periods at important inflection points in the international growth process. Specifically, it considers one threshold interval between an early phase of disjointed international expansion and a more focused, accelerated international growth programme. It concludes that executives need to consider a set of threshold periods during the development and growth of international store operations, understand why these events occur, and consider in what ways to respond to them to overcome and cross the threshold. Salient lessons are extracted from Wal-Mart's experiences during the threshold period for other international managers. © 2005 Elsevier Ltd. All rights reserved.

The MacDQoL individualized measure of the impact of macular degeneration on quality of life: reliability and responsiveness

PURPOSE: To investigate the MacDQoL test-retest reliability and sensitivity to change in vision over a period of one year in a sample of patients with age-related macular degeneration (AMD). DESIGN: A prospective, observational study. METHOD: Patients with AMD from an ophthalmologist's list (n = 135) completed the MacDQoL questionnaire by telephone interview and underwent a vision assessment on two occasions, one year apart. RESULTS: Among participants whose vision was stable over one year (n = 87), MacDQoL scores at baseline and follow-up were highly correlated (r = 0.95; P < .0001). Twelve of the 22 scale items had intraclass correlations of >.80; only two were correlated <.7. There was no difference between baseline and follow-up scores (P = .85), indicating excellent test-retest reliability. Poorer quality of life (QoL) at follow-up, measured by the MacDQoL present QoL overview item, was associated with deterioration in both the better eye and binocular distance visual acuity [VA] (r = 0.29; P = .001, r = 0.21; P = .016, respectively; n = 135). There was a positive correlation between deterioration in the Mac. DQoL average weighted impact score and deterioration in both binocular near VA and reading speed (r = 0.20; P = .019, r = 0.18; P = .041, respectively; n = 135). CONCLUSION: The MacDQoL has excellent test-retest reliability. Its sensitivity to change in vision status was demonstrated in correlational analyses. The measure indicates that the negative impact of AMD on QoL increases with increasing severity of visual impairment.

Objects and the production of technological forms of life:understanding organisational arrangements from a postsocial perspective

Objects are produced within, and simultaneously affect, the process of organizing as a consequence of their interaction within social collectives. This paper discusses the impact and influences of the growth of post-social relations, between human and technological objects, on social and organisational arrangements. The paper presents a discussion largely at the conceptual level and draws from a variety of literatures, including the burgeoning sociology of science literature. The discussion in this paper is based on a view that posits the growth of intimate links with epistemic objects within organisations and society. Organising through networks of post-social relations increasingly comes to affect the manner in which differing groups of organisational participants, and particularly various categories of knowledge workers, experience time and spatial arrangements within organisations.

Understanding change in the public sector:a local authority case study

Increasingly managers in the public sector are being required to manage change, but many of the models of change which are available to them have been developed from private sector experience. There is a need to understand more about how the change process unfolds in the public sector. A case study of change in one local authority over the period 1974-87 is provided. The events surrounding housing decentralisation and the introduction of community development are considered in detail. To understand these events a twofold model of change is proposed: a short wave model which explains a change project or event; and a long wave model which considers how these projects or events might be linked together to provide a picture of an organisation over a longer period. The short wave model identifies multiple triggers of change and signals the importance of mediators in recognising these triggers. The extent to which new ideas are implemented and the pace of their adoption is influenced by the balance of power within the organisation and the political tactics which are used. Broad phases in the change process can be identified, but there is not a simple linear passage through these. The long wave model considers the way in which continuity and change feed off one another. It suggests that periods of relative stability may be interspersed with more radical transformations as the dominant paradigm guiding the organisation shifts. However, such paradigmatic shifts in local government may be less obvious than in the private sector due to the diverse nature of the former.

The process of strategic change:a management perspective

This thesis is concerned with the management processes concerned with complex strategic decision in organisations. The research has sought to explore these processes by taking as its focus the reconstruction of decision processes a) on the basis of an historical study of an industry and in particular a major company in that industry; and b) the perception and understanding of strategic decision processes and change by managers involved in companies in that industry. The main body of analysis and theoretical contributions arise from the detailed analysis of extended depth interviews with managers carried out in 1980 and 1983 which trace thirteen years of the strategic development of a firm. In so doing, extensive use is made of verbatim accounts by managers of events and their interpretation of events. This is then compared with data gathered from.similar interviews with managers of two other companies and examined in the light of existing research and theory in the field. The thesis both provides a detailed insight into the processes associated with the identification and resolution of complex strategic issues and also generates a body of theory concerning the mechanisms by which strategic decisions and the processes of strategic change are interwoven with the cultural and political fabric of organisations. The thesis is divided into four parts. The first part deals with the background to the research, provid1ng a fuller summary of the purpose, structure and content of the thesis and a discussion of relevant previous research and the methodology employed herein. The second part mainly provides case studies of the industry and the main company studied. The third part is a detailed presentation and analysis of data. The fourth part is a synthesis of the findings and consolidation of the theoretical interpretation advanced in the thesis.

Managerial job satisfaction:a longitudinal study

The study examines the job satisfaction of supervisors and managers in four organisations over time. It also considers the importance which they attached to different facets of their job. The major objectives were: To examine the constituent dimensions of job satisfaction at intervals over one year. To examine reasons for change inthe level of job satisfaction at intervals over one year. To provide information on job satisfaction for those concerned with job satisfaction policies. The sample consisted of one hundred and eight people. Each was interviewed on at least three occasions over the course of a year. Interviews took place at predetermined time intervals. The study shows that job satisfaction is dynamic over a relatively short period of time. The ratings which supervisors and managers gave to aspects of their job did not, however, all change by equal amounts or in the same direction. Changes in job satisfaction were associated with events experienced but it was the meaning of those events to correspondents which appeared to be particularly important. People tended to adopt a localised frame of reference when considering their work situation. Certain job variables, such as variety, were consistently and positively correlated with job satisfaction. With some other variables, the relationship varied across time. Frequently, age and job level moderated the association between independent variables and job satisfaction. Links were found between the quality of life and job satisfaction. There was a consistent positive association between job satisfaction and life satisfaction. However, the job was rarely considered to be the main factor contributing to a person's quality of life. The research highlights the difficulties and desirability of introducing standardised job satisfaction policies in the light of individual differences. In addition, it demonstrates that merely correlating variables with job satisfaction at one point in time may conceal complex relationships and meanings. A new measure of job satisfaction - whereby facets are assessed and rated relative to each other was also developed as part of this study.