Evidence-Based Clinical Pathways To Manage Urinary Tract Infections in Long-Term Care Facilities:A Qualitative Case Study Describing Administrator and Nursing Staff Views

Objectives: This article examines the views of nursing staff and administrators in long-term care facilities (LTCFs) regarding a clinical pathway for managing urinary tract infections (UTIs) in LTCF residents. Design: A qualitative (case study) design was used. Setting: Data were collected from 8 LTCFs in southern Ontario and 2 in Iowa enrolled in a larger randomized controlled trial of clinical pathway for managing UTIs in LTCF residents, conducted between September 2001 and March 2003. The clinical pathway, designed to more effectively identify, diagnose, and treat UTIs, and reduce inappropriate antibiotics use for asymptomatic UTIs, introduced 2 decision tools to determine when to order a urine culture and initiate antibiotic treatment for suspected UTIs. Participants: We conducted 19 individual interviews with administrators and 10 focus groups with 52 nurses. Findings: Nurses generally thought that the pathways were well developed and easy to use, and administrators believed they were an important educational resource. Barriers to their use varied by group-initial lack of buy-in from nurses (medical directors), additional work (directors of nursing), and the need to change the protocol to exclude certain residents based on prior health conditions and/or pressure from physicians or families (nurses). Conclusions: Both administrators and staff, once familiar with a new clinical protocol to improve UTI management in LTCFs, generally supported its use. © 2007 American Medical Directors Association.

Neoliberalising a divided society? The regeneration of Crumlin Road Gaol and Girdwood Park, North Belfast

Regeneration projects take place within complex local policy environments and are also influenced by the global doctrine of neoliberalism, although the degree of influence will vary depending upon the historical, economic, social and political context. This article reviews and reflects upon the complexity of a neoliberalising policy environment in the regeneration of the divided city of Belfast. The territorial conflict in Northern Ireland has been expressed spatially and has thus affected urban regeneration. These issues are illustrated by a case study of the regeneration of the Crumlin Road Gaol and Girdwood Park in North Belfast, which sought to include both a neoliberalised economic development agenda and efforts to improve community relations through the promotion of shared space. The paper asks whether the management of community cohesion in cities experiencing conflict requires state intervention that at times goes beyond the ‘roll out’ and ‘roll back’ distinction found in neoliberal theory.

Promoting multicultural education in the primary classroom:Broadband videoconferencing facilities and digital video

The aim of this study was to explore the impact of interaction (through gathering local field data and engaging in remote reciprocal presentations) on aspects of multicultural awareness. Sixty-six 11-12-year-old Scottish primary school pupils collected data in the field from their local community through questionnaires, interviews, direct observation, digital images and video. From this they distilled a multimedia presentation, delivered by videoconference to a partner school in the USA, who reciprocated. There was some evidence of pre-post project gains in the complexity of the children's perceptions of their community environment, the ethnicity of their community, their own ethnicity, and news images. The children's use of language to define ethnicity also became more complex and their attitudes toward ethnic minorities became more inclusive. The implications for practice, policy and future research were explored. © 2004 Elsevier Ltd. All rights reserved.

The role of facilities manager in sustainable practice in the UK and Ireland

Purpose – The purpose of this paper is to explore the role of facilities managers in sustainable practice. It also analyzes the change in facilities management (FM) in terms of sustainability.

Design/methodology/approach – This research adopted a combination of literature review and expert interviews. Empirical data were collected through in-depth interviews with 40 industrial experts in the UK and Ireland.

Findings – The analysis of interview results shows a sustainable movement in the context of FM. Facilities managers play important roles in sustainable practice, including integrating all sustainability considerations, linking strategic level with operational level, incorporating FM knowledge and experience into design, disseminating sustainable knowledge and educating people and encouraging sustainability through innovation.

Research limitations/implications – This research goes beyond the limitations of existing studies that are characterized by a lack of positioning facilities managers in sustainability.

Practical implications – Sustainable delivery represents a direction of FM development. This research describes what facilities managers can do and how they should do for sustainable delivery of FM, based on which improvements are made and benefits are maximized.

Originality/value – This research provides a deeper insight into the FM role in the sustainable agenda. The findings of this research help industrial practitioners and academic researchers to better understand sustainable FM.

Facilities management: Tracing its development trajectory

Purpose – The purpose of this paper is to provide facilities management (FM) practitioners and researchers with a better understanding of the FM industry sector by analyzing the trend of its development.
Design/methodology/approach – Semi-structured interview is adopted in this research as the main methodology. In total, 30 FM professionals in the UK were interviewed to explore the past, present and future of FM. The analysis of interview results helps to identify the key areas in which FM has changed, is changing and will change. It also helps to explain the implications of FM development in each key area.
Findings – FM evolves and matures continuously. It is important for FM organizations and practitioners to recognize the dynamic nature of this industry sector, based on which they can develop appropriate strategies to adapt to changing circumstances. This is probably the only way for them to
keep pace with the times.
Originality/value – Both backward looking and forward looking are crucial to the development of an industry sector. However, existing studies on FM development are conducted through either review or outlook. On the other hand, most of these studies focus on one particular management area or one particular industry sector. Based on 30 expert interviews, this research attempts to bridge the knowledge gap and analyze the trend of FM development in a systematic way. A better understanding of the trend provides a possibility and a guide for FM organizations and practitioners to pursue best practice.

“It’s very complicated”: a qualitative study of medicines management in intermediate care facilities in Northern Ireland

Background: Intermediate care (IC) describes a range of services targeted at older people, aimed at preventing unnecessary hospitalisation, promoting faster recovery from illness and maximising independence. Older people are at increased risk of medication-related adverse events, but little is known about the provision of medicines management services in IC facilities. This study aimed to describe the current provision of medicines management services in IC facilities in Northern Ireland (NI) and to explore healthcare workers' (HCWs) and patients' views of, and attitudes towards these services and the IC concept. 

Methods: Semi-structured interviews were conducted, recorded, transcribed verbatim and analysed using a constant comparative approach with HCWs and patients from IC facilities in NI. 

Results: Interviews were conducted with 25 HCWs and 18 patients from 12 IC facilities in NI. Three themes were identified: 'concept and reality', 'setting and supply' and 'responsibility and review'. A mismatch between the concept of IC and the reality was evident. The IC facility setting dictated prescribing responsibilities and the supply of medicines, presenting challenges for HCWs. A lack of a standardised approach to responsibility for the provision of medicines management services including clinical review was identified. Whilst pharmacists were not considered part of the multidisciplinary team, most HCWs recognised a need for their input. Medicines management was not a concern for the majority of IC patients. 

Conclusions: Medicines management services are not integral to IC and medicine-related challenges are frequently encountered. Integration of pharmacists into the multidisciplinary team could potentially improve medicines management in IC.