The effectiveness of a nurse practitioner-led pain management team in long-term care: A mixed methods study

BACKGROUND: Considering the high rates of pain as well as its under-management in long-term care (LTC) settings, research is needed to explore innovations in pain management that take into account limited resource realities. It has been suggested that nurse practitioners, working within an inter-professional model, could potentially address the under-management of pain in LTC.

OBJECTIVES: This study evaluated the effectiveness of implementing a nurse practitioner-led, inter-professional pain management team in LTC in improving (a) pain-related resident outcomes; (b) clinical practice behaviours (e.g., documentation of pain assessments, use of non-pharmacological and pharmacological interventions); and, (c) quality of pain medication prescribing practices.

METHODS: A mixed method design was used to evaluate a nurse practitioner-led pain management team, including both a quantitative and qualitative component. Using a controlled before-after study, six LTC homes were allocated to one of three groups: 1) a nurse practitioner-led pain team (full intervention); 2) nurse practitioner but no pain management team (partial intervention); or, 3) no nurse practitioner, no pain management team (control group). In total, 345 LTC residents were recruited to participate in the study; 139 residents for the full intervention group, 108 for the partial intervention group, and 98 residents for the control group. Data was collected in Canada from 2010 to 2012.

RESULTS: Implementing a nurse practitioner-led pain team in LTC significantly reduced residents' pain and improved functional status compared to usual care without access to a nurse practitioner. Positive changes in clinical practice behaviours (e.g., assessing pain, developing care plans related to pain management, documenting effectiveness of pain interventions) occurred over the intervention period for both the nurse practitioner-led pain team and nurse practitioner-only groups; these changes did not occur to the same extent, if at all, in the control group. Qualitative analysis highlighted the perceived benefits of LTC staff about having access to a nurse practitioner and benefits of the pain team, along with barriers to managing pain in LTC.

CONCLUSIONS: The findings from this study showed that implementing a nurse practitioner-led pain team can significantly improve resident pain and functional status as well as clinical practice behaviours of LTC staff. LTC homes should employ a nurse practitioner, ideally located onsite as opposed to an offsite consultative role, to enhance inter-professional collaboration and facilitate more consistent and timely access to pain management.

Nurse-led home exercise programme improves physical function for people receiving haemodialysis

Nurse-led home exercise programme improves physical function for people receiving haemodialysis

The Evolution of 'Design Build Fly' Led Teaching in Aerospace Engineering

This paper describes the evolution of a ‘Design - Build-Fly’ (DBF) approach to the delivery and assessment of a Stage Three Aircraft Design module. It focuses on the primary learning outcomes around the design and manufacturing functions associated with the development of a remotely controlled aircraft. The work covers a six year period from 2011 to present mapping the transformation of the module from report based assessment to a more hands on approach resulting in a fully functioning remotely controlled aircraft. Results show that both the staff and student experience improved across key performance metrics including student feedback, learning and competency development. Challenges still remain in methods of placing students within teams and maintaining technical rigour in reporting as students develop vocational skills and more reflective writing styles.

GiveMe Shelter: a people-centred design process for promoting independent inquiry-led learning in engineering

It has become increasingly common for tasks traditionally carried out by engineers to be undertaken by technicians and technologist with access to sophisticated computers and software that can often perform complex calculations that were previously the responsibility of engineers. Not surprisingly, this development raises serious questions about the future role of engineers and the education needed to address these changes in technology as well as emerging priorities from societal to environmental challenges. In response to these challenges, a new design module was created for undergraduate engineering students to design and build temporary shelters for a wide variety of end users from refugees, to the homeless and children. Even though the module provided guidance on principles of design thinking and methods for observing users needs through field studies, the students found it difficult to respond to needs of specific end users but instead focused more on purely technical issues.

The £ for lb challenge – a lose – win – win scenario. Results from a novel workplace-based, peer-led weight management programme

Title: The £ for lb. Challenge – A lose - win – win scenario. Results from a novel workplace-based, peer-led weight management programme in 2016.

Names: Damien Bennett, Declan Bradley, Angela McComb, Amy Kiernan, Tracey Owen

Background: Tackling obesity is a public health priority. The £ for lb. Challenge is the first country wide, workplace-based peer-led weight management programme in the UK or Ireland with participants from a range of private and public businesses in Northern Ireland (NI).
Intervention: The intervention was workplace-based, led by workplace Champions and based on the NHS Choices 12 week weight loss guide. It operated from January to April 2016. Overweight and obese adult workers were eligible. Training of Peer Champions (staff volunteers) involved two half day workshops delivered by dieticians and physical activity professionals.
Outcome measurement: Weight was measured at enrolment and 12 weekly intervals. Changes in weight, % weight, BMI and % BMI were determined for the whole cohort and sex and deprivation subgroups.
Results: There were 1513 eligible participants from 35 companies. Engagement rate was 98%. 75% of participants completed the programme. Mean weight loss was 2.4 kg or 2.7%. Almost a quarter (24%) lost at least 5% initial bodyweight. Male participants were over twice as likely to complete the programme and three times more likely to lose 5% body weight or more. Over £17,000 was raised for NI charities.
Discussion: The £ for lb. Challenge is a successful health improvement programme with important weight loss for many participants, particularly male workers. With high levels of user engagement and ownership and successful multidisciplinary collaboration between public health, voluntary bodies, private and public companies it is a novel workplace based model with potential to expand.

Stakeholder-led science: engaging resource managers to identify science needs for long-term management of floodplain conservation lands

Floodplains pose challenges to managers of conservation lands because of constantly changing interactions with their rivers. Although scientific knowledge and understanding of the dynamics and drivers of river-floodplain systems can provide guidance to floodplain managers, the scientific process often occurs in isolation from management. Further, communication barriers between scientists and managers can be obstacles to appropriate application of scientific knowledge. With the coproduction of science in mind, our objectives were the following: (1) to document management priorities of floodplain conservation lands, and (2) identify science needs required to better manage the identified management priorities under nonstationary conditions, i.e., climate change, through stakeholder queries and interactions. We conducted an online survey with 80 resource managers of floodplain conservation lands along the Upper and Middle Mississippi River and Lower Missouri River, USA, to evaluate management priority, management intensity, and available scientific information for management objectives and conservation targets. Management objectives with the least information available relative to priority included controlling invasive species, maintaining respectful relationships with neighbors, and managing native, nongame species. Conservation targets with the least information available to manage relative to management priority included pollinators, marsh birds, reptiles, and shore birds. A follow-up workshop and survey focused on clarifying science needs to achieve management objectives under nonstationary conditions. Managers agreed that metrics of inundation, including depth and extent of inundation, and frequency, duration, and timing of inundation would be the most useful metrics for management of floodplain conservation lands with multiple objectives. This assessment provides guidance for developing relevant and accessible science products to inform management of highly dynamic floodplain environments. Although the problems facing managers of these lands are complex, products focused on a small suite of inundation metrics were determined to be the most useful to guide the decision making process.

Evaluation of Community-led Complementary Feeding and Learning Sessions

Thesis (Master's)--University of Washington, 2016-08

Sharing the vision: representing the matters of concern for design-led fledgling companies in Scotland

Design is being performed on an ever-increasing spectrum of complex practices arising in response to emerging markets and technologies, co-design, digital interaction, service design and cultures of innovation. This emerging notion of design has led to an expansive array of collaborative and facilitation skills to demonstrate and share how such methods can shape innovation. The meaning of these design things in practice can't be taken for granted as matters of fact, which raises a key challenge for design to represent its role through the contradictory nature of matters of concern. This paper explores an innovative, object-oriented approach within the field of design research, visually combining an actor-network theory framework with situational analysis, to report on the role of design for fledgling companies in Scotland, established and funded through the knowledge exchange hub Design in Action (DiA). Key findings and visual maps are presented from reflective discussions with actors from a selection of the businesses within DiA's portfolio. The suggestion is that any notions of strategic value, of engendering meaningful change, of sharing the vision of design, through design things, should be grounded in the reflexive interpretations of matters of concern that emerge.

Diseño de alumbrado público de la calle 26 de Bogotá D.C. con bombilla LED

Tesis (Ingeniero Eléctrico). -- Universidad de La Salle. Faculltad de Ingeniería. Programa de Ingeniería Eléctrica, 2013