Views of general practitioners and benzodiazepine users on benzodiazepines: A qualitative analysis

Effectively assisting benzodiazepine users to cease use requires a greater understanding of general practitioners' (GPs) and benzodiazepine users' views on using and ceasing benzodiazepines. This paper reports the findings from a qualitative study that examined the views of 28 GPs and 23 benzodiazepine users (BUs) in Cairns, Australia. A semi-structured interview was conducted with all participants and the information gained was analysed using the Consensual Qualitative Research Approach, which allowed comparisons to be made between the views of the two groups of interviewees. There was commonality between GPs and BUs on reasons for commencing benzodiazepines, the role of dependence in continued use, and the importance of lifestyle change in its cessation. However, several differences emerged regarding commencement of use and processes of cessation. In particular, users felt there was greater need for GPs to routinely advise patients about non-pharmacological management of their problems and potential adverse consequences of long-term use before commencing benzodiazepines. Cessation could be discussed with all patients who use benzodiazepines for longer than 3 months, strategies offered to assist in management of withdrawal and anxiety, and referral to other health service providers for additional support. Lifestyle change could receive greater focus at all stages of treatment. (c) 2005 Elsevier Ltd. All rights reserved.

Practices and views on fetal heart monitoring:A structured observation and interview study

Objective: To assess and explain deviations from recommended practice in National Institute for Clinical Excellence (NICE) guidelines in relation to fetal heart monitoring. Design: Qualitative study. Setting: Large teaching hospital in the UK. Sample: Sixty-six hours of observation of 25 labours and interviews with 20 midwives of varying grades. Methods: Structured observations of labour and semistructured interviews with midwives. Interviews were undertaken using a prompt guide, audiotaped, and transcribed verbatim. Analysis was based on the constant comparative method, assisted by QSR N5 software. Main outcome measures: Deviations from recommended practice in relation to fetal monitoring and insights into why these occur. Results: All babies involved in the study were safely delivered, but 243 deviations from recommended practice in relation to NICE guidelines on fetal monitoring were identified, with the majority (80%) of these occurring in relation to documentation. Other deviations from recommended practice included indications for use of electronic fetal heart monitoring and conduct of fetal heart monitoring. There is evidence of difficulties with availability and maintenance of equipment, and some deficits in staff knowledge and skill. Differing orientations towards fetal monitoring were reported by midwives, which were likely to have impacts on practice. The initiation, management, and interpretation of fetal heart monitoring is complex and distributed across time, space, and professional boundaries, and practices in relation to fetal heart monitoring need to be understood within an organisational and social context. Conclusion: Some deviations from best practice guidelines may be rectified through straightforward interventions including improved systems for managing equipment and training. Other deviations from recommended practice need to be understood as the outcomes of complex processes that are likely to defy easy resolution. © RCOG 2006.

Patient involvement in primary care mental health:a focus group study

Background: Patient involvement in health care is a strong political driver in the NHS. However in spite of policy prominence, there has been only limited previous work exploring patient involvement for people with serious mental illness. Aim: To describe the views on, potential for, and types of patient involvement in primary care from the perspectives of primary care health professionals and patients with serious mental illness. Design of study: Qualitative study consisting of six patient, six health professional and six combined focus groups between May 2002 and January 2003. Setting: Six primary care trusts in the West Midlands, England. Method: Forty-five patients with serious mental illness, 39 GPs, and eight practice nurses participated in a series of 18 focus groups. All focus groups were audiotaped and fully transcribed. Nvivo was used to manage data more effectively. Results: Most patients felt that only other people with lived experience of mental illness could understand what they were going through. This experience could be used to help others navigate the health- and social-care systems, give advice about medication, and offer support at times of crisis. Many patients also saw paid employment within primary care as a way of addressing issues of poverty and social exclusion. Health professionals were, however, more reluctant to see patients as partners, be it in the consultation or in service delivery. Conclusions: Meaningful change in patient involvement requires commitment and belief from primary care practitioners that the views and experiences of people with serious mental illness are valid and valuable.

Patients' and health professionals' views on primary care for people with serious mental illness:focus group study

Objective: To explore the experience of providing and receiving primary care from the perspectives of primary care health professionals and patients with serious mental illness respectively. Design: Qualitative study consisting of six patient groups, six health professional groups, and six combined focus groups. Setting: Six primary care trusts in the West Midlands. Participants: Forty five patients with serious mental illness, 39 general practitioners (GPs), and eight practice nurses. Results: Most health professionals felt that the care of people with serious mental illness was too specialised for primary care. However, most patients viewed primary care as the cornerstone of their health care and preferred to consult their own GP, who listened and was willing to learn, rather than be referred to a different GP with specific mental health knowledge. Swift access was important to patients, with barriers created by the effects of the illness and the noisy or crowded waiting area. Some patients described how they exaggerated symptoms ("acted up") to negotiate an urgent appointment, a strategy that was also employed by some GPs to facilitate admission to secondary care. Most participants felt that structured reviews of care had value. However, whereas health professionals perceived serious mental illness as a lifelong condition, patients emphasised the importance of optimism in treatment and hope for recovery. Conclusions: Primary care is of central importance to people with serious mental illness. The challenge for health professionals and patients is to create a system in which patients can see a health professional when they want to without needing to exaggerate their symptoms. The importance that patients attach to optimism in treatment, continuity of care, and listening skills compared with specific mental health knowledge should encourage health professionals in primary care to play a greater role in the care of patients with serious mental illness.

Postgraduate study and managers' subsequent work experience:an exploratory evaluation

Drawing on an exploratory qualitative study, this article considers the link between business school teaching at graduate level and subsequent work behaviour and experiences of former students. It evaluates the student experience some time after graduation. The findings of the retrospective evaluation point to the value of classroom peer discussion, the testing of ideas against prior work experience and the opportunity to make sense of organisational issues by setting them into broader context. The importance of andragogical approaches to teaching is discussed as well as the implications of the study findings for teaching quality enhancement. © 2009 Taylor & Francis.

Implementing a knowledge management system within an NHS hospital:a case study exploring the roll-out of an Electronic Patient Record (EPR)

This research aims to contribute to understanding the implementation of knowledge management systems (KMS) in the field of health through a case study, leading to theory building and theory extension. We use the concept of the business process approach to knowledge management as a theoretical lens to analyse and explore how a large teaching hospital developed, executed and practically implemented a KMS. A qualitative study was conducted over a 2.5 year period with data collected from semi-structured interviews with eight members of the strategic management team, 12 clinical users and 20 patients in addition to non-participant observation of meetings and documents. The theoretical propositions strategy was used as the overarching approach for data analysis. Our case study provides evidence that true patient centred approaches to supporting care delivery with a KMS benefit from process thinking at both the planning and implementation stages, and an emphasis on the knowledge demands resulting from: the activities along the care pathways; where cross-overs in care occur; and knowledge sharing for the integration of care. The findings also suggest that despite the theoretical awareness of KMS implementation methodologies, the actual execution of such systems requires practice and learning. Flexible, fluid approaches through rehearsal are important and communications strategies should focus heavily on transparency incorporating both structured and unstructured communication methods.

Practitioner perspectives on supply chain management and logistics:a study from the United Kingdom

Purpose: The focus of this paper is the evolution of supply chain management (SCM) and logistics, as well as of the relationship between them. Its purpose is to generate deep insights into practice, particularly in relation to the fundamental issue of how practitioners define these key terms and phrases. Research approach: A largely qualitative study which involved in depth interviews with managers from two third party logistics providers (3PLs)/distributors, two retailers and two manufacturers from the United Kingdom. This interview protocol is based on the template used in a previous study published over a decade ago. Findings and originality: The data collected during the focussed interviews in the United Kingdom is contrasted with results from the earlier study. The findings suggest that there is variation between practitioners particularly in relation to what SCM is specifically concerned with. This variation mirrors to a large extent the differing orientations and emphases evident in the many theoretical definitions of SCM that have been proposed in recent decades. Research impact: The authors introduced the concept of refined replication in SCM research. This allows previous research to be built upon in order to test understanding of SCM theory and its practical implementation among SCM professionals in the United Kingdom. Practical impact: A profile of SCM understanding and adoption by firms in the United Kingdom is presented .

A distance education case study: A comparison of instructional delivery methods practiced by higher education faculty and emerging standards

The purpose of this research was to compare the delivery methods as practiced by higher education faculty teaching distance courses with recommended or emerging standard instructional delivery methods for distance education. Previous research shows that traditional-type instructional strategies have been used in distance education and that there has been no training to distance teach. Secondary data, however, appear to suggest emerging practices which could be pooled toward the development of standards. This is a qualitative study based on the constant comparative analysis approach of grounded theory.^ Participants (N = 5) of this study were full-time faculty teaching distance education courses. The observation method used was unobtrusive content analysis of videotaped instruction. Triangulation of data was accomplished through one-on-one in-depth interviews and from literature review. Due to the addition of non-media content being analyzed, a special time-sampling technique was designed by the researcher--influenced by content analyst theories of media-related data--to sample portions of the videotape instruction that were observed and counted. A standardized interview guide was used to collect data from in-depth interviews. Coding was done based on categories drawn from review of literature, and from Cranton and Weston's (1989) typology of instructional strategies. The data were observed, counted, tabulated, analyzed, and interpreted solely by the researcher. It should be noted however, that systematic and rigorous data collection and analysis led to credible data.^ The findings of this study supported the proposition that there are no standard instructional practices for distance teaching. Further, the findings revealed that of the emerging practices suggested by proponents and by faculty who teach distance education courses, few were practiced even minimally. A noted example was the use of lecture and questioning. Questioning, as a teaching tool was used a great deal, with students at the originating site but not with distance students. Lectures were given, but were mostly conducted in traditional fashion--long in duration and with no interactive component.^ It can be concluded from the findings that while there are no standard practices for instructional delivery for distance education, there appears to be sufficient information from secondary and empirical data to initiate some standard instructional practices. Therefore, grounded in this research data is the theory that the way to arrive at some instructional delivery standards for televised distance education is a pooling of the tacitly agreed-upon emerging practices by proponents and practicing instructors. Implicit in this theory is a need for experimental research so that these emerging practices can be tested, tried, and proven, ultimately resulting in formal standards for instructional delivery in television education. ^

Profile of planning: A study of a three-year project on the implementation of collaborative library media programs

The implementation of collaborative planning and teaching models in ten flexibly scheduled elementary and middle school library media centers was studied to determine which factors facilitated the collaborative planning process and to learn what occurs when library media specialists (LMSs) and classroom teachers (CTs) plan together. In this qualitative study, 61 principals, CTs, and LMSs were interviewed on a range of topics including the principal's role, school climate, the value of team planning, the importance of information literacy instruction, and the ideal learning environment. Other data sources were observations, videotapes of planning sessions, and documents. This three-year school reform effort was funded by the Library Power Project to improve library programs, to encourage collaborative planning, and to increase curricular integration of information literacy skills instruction. ^ The findings included a description of typical planning sessions and the identification of several major factors which impacted the success of collaborative planning: the individuals involved, school climate, time for planning, the organization of the school, the facility and collection, and training. Of these factors, the characteristics and actions of the people involved were most critical to the implementation of the innovation. The LMS was the pivotal player and, in the views of CTs, principals, and LMSs themselves, must be knowledgeable about curriculum, the library collection, and instructional design and delivery; must be open and welcoming to CTs and use good interpersonal skills; and must be committed to information literacy instruction and willing to act as a change agent. The support of the principal was vital; in schools with successful programs, the principal served as an advocate for collaborative planning and information literacy instruction, provided financial support for the library program including clerical staff, and arranged for LMSs and CTs to have time during the school day to plan together. ^ CTs involved in positive planning partnerships with LMSs were flexible, were open to change, used a variety of instructional materials, expected students to be actively involved in their own learning, and were willing to team teach with LMSs. Most CTs planning with LMSs made lesson plans in advance and preferred to plan with others. Also, most CTs in this study planned with grade level or departmental groups, which expedited the delivery of information literacy instruction and the effective use of planning time. ^ Implications of the findings of this research project were discussed for individual schools, for school districts, and for colleges and universities training LMSs, CTs, and administrators. Suggestions for additional research were also included. ^

Social funds as a strategy for poverty reduction in Jamaica: An exploratory study

This study explored the relationship between social fund projects and poverty reduction in selected communities in Jamaica. The Caribbean nation's social fund projects aim to reduce “public” poverty by rehabilitating and expanding social and economic infrastructure, improving social services, and strengthening organizations at the community level. Research questions addressed the characteristics of poverty-focused social fund projects; the nexus between poverty reduction and three key concepts suggested by the literature— community (citizen) participation, social capital, and empowerment; and the impact of the projects on poverty. ^ In this qualitative study, data were collected and triangulated by means of in-depth, semi-structured interviews, supplemented by key informant data; non-participant observation; and document reviews. Thirty-four respondents were interviewed individually at eight rural and urban sites over a period of four consecutive months, and 10 key informants provided supplementary data. Open, axial, and selective coding was used for data reduction and analysis as part of the grounded theory method, which included constant comparative analysis. The codes generated a set of themes and a substantive-formal theory. Findings were crosschecked with interview respondents and key informants and validated by means of an audit trail. ^ The results have revealed that the approach to poverty reduction in social fund-supported communities is a process of development-focused collaboration among various stakeholders. The process encompasses four stages: (1) identifying problems and priorities, (2) motivating and mobilizing, (3) working together, and (4) creating an enabling environment. The underlying stakeholder involvement theory posits that collaboration increases the productivity of resources and creates the conditions for community-driven development. In addition, the study has found that social fund projects are largely community-based, collaborative, and highly participatory in their implementation, as well as prescription-driven, results-oriented, and leadership-dependent. Further, social capital formation across communities was found to be limited, and in general, the projects have been enabling rather than empowering. The projects have not reduced poverty per se; however, they have been instrumental in improving conditions that were concomitants of poverty. ^

A case study: Perceptions of the induction process of intern principals in Broward County Public Schools

The case study is a qualitative study of the perceptions of a purposeful sample of intern principal participants in Broward County Public School's 2001-2003 principal leadership induction program through survey, interview and document analysis of their experiences concerning their success or failure in achieving the position of principal. The study focused on constructs of professional and organizational socialization and instructional leadership that research suggests are vital and integrated components of the effective development of aspiring instructional leaders. ^ The findings revealed that purposeful mentoring, a variety of site placement, hands on practical experiences, in addition to the quality of experience measured by the number of years prior experience are positively reported to affect the degrees of success perceived by intern principals. The study validated the interrelatedness of the three constructs professional and organizational socialization and instructional leadership as components that are realized in the development process through formal and informal characteristics of socialization. The data gathered would be of benefit to principal leadership program designers to assist in their understanding of participants' successes and failures that influence individual needs based on their experience as perceived by this group. ^ Implications for further study are the need for better understanding of leadership development, continued reinforcement of best practices such as mentoring, site shadowing and coaching, clarification of the administrator's role, data analysis, curriculum implementation and student achievement. Organizations need to implement a common set of expectations, reasoning, attitudes, and understanding of purpose that guide behaviors. Recommendations are to design leadership induction programs to meet individual strengths and weaknesses not a one-size-fits-all program including a constructive and prescriptive two-way feedback system, select and assign mentors based on their expertise and candidate needs, varied site placements, develop skills to build collaborative relationships, and a standards based monitoring and assessment system to document program mastery and completion. ^

Swimming against the tide: A study of a youth enrichment program seeking to empower inner-city Black youth

Serious inequities in our K-12 public education system, particularly in regard to the quality of education in predominately Black inner-city schools, are well-documented in the literature (Freeman, 1998; Ross, 1998). Moreover, there is general agreement that the most effective means of ameliorating that situation is through well-thought-out after-school programs and partnership initiatives (Beck, 1993; Gardner et al., 2001). ^ The purpose of this qualitative study was to examine the programmatic interventions of a youth enrichment program for inner-city Black youth currently in place at the Overtown Youth Center (OYC) in Miami, Florida, in order to: (a) discern those factors that support its claim that it is making a difference in students’ lives, (b) explore how any such factors are implemented, and (c) determine whether its interventions have served to equalize the playing field for these youth. ^ Two primary methods of data collection were used for this study. The first was participant observation conducted over the course of two years through a partnership initiative established and led by this author. The second was through in-depth interviews of the Center’s founder, staff, and students. Secondary methods used were the recording of informal conversations and the analysis of written documents. ^ Analysis of the data yielded four features of the Center that are indispensible to the students’ growth. The center provides the youth with (a) physical and psychological safety, (b) supportive relationships, (c) exposure to cultural and educational opportunities, and (d) assistance in building self-esteem. ^ The most significant finding of the study was that OYC has been successful at making a difference in students’ lives and at increasing their aspirations to attend college. By addressing the full spectrum of their needs, the Center has given them many of the necessary tools with which to compete and thereby helped equalize their opportunities to succeed in school and in life. ^ The study also noted a number of challenges for the Center to examine. The main issues that need to be addressed more seriously are staff turnover, staff indifference, nepotism, inconsistent student attendance, and insufficient focus on racial issues and African-American-centered education. Meeting those challenges would engender even greater positive outcomes.^

L’engagement au développement professionnel des infirmières œuvrant en centre hospitalier universitaire : une étude qualitative descriptive.

Le développement professionnel (DP) des infirmières est essentiel et déterminant dans l’obtention d’une meilleure qualité de soins. Pour se réaliser, le développement professionnel nécessite un engagement individuel des infirmières elles-mêmes. Or, une disparité est observée en centre hospitalier universitaire (CHU) entre la volonté exprimée par les infirmières de poursuivre leur DP et leur assiduité dans les activités de développement offertes par les organisations. L’objectif de cette étude qualitative est de décrire la perception des infirmières œuvrant en CHU (n=8) en regard des facteurs organisationnels susceptibles de favoriser leur engagement à poursuivre leur développement professionnel. Cette analyse a été effectuée à partir de huit entrevues individuelles semi-dirigées réalisées auprès d’infirmières œuvrant dans le secteur de chirurgie du CHU Sainte-Justine. Les résultats démontrent que de nombreux facteurs organisationnels et individuels. Les principaux facteurs influant sur l’engagement des infirmières sont : a) un environnement favorable au DP; b) l’accessibilité au DP et; c) des modalités de DP variées. Les modalités les plus favorables sont celles favorisant leur autonomie et incitant leur implication. En conclusion, pour obtenir un maximum d’engagement des infirmières, les organisations doivent présenter une offre de DP variée et structurée, répondant aux besoins professionnels des infirmières, tout en mitigeant l’impact des contraintes liées à leur fonction et à leur vie personnelle.

A Study of Implicit Leadership Theories Among Business & Management Undergraduate Students

This qualitative study explores the subjective experience of being led by investigating the impact of their Implicit Leadership Theories (ILTs) on followers’ cognitive processes, affective responses and behavioural intentions towards leadership-claimants. The study explores how such responses influence the quality of hierarchical work-place relationships using a framework based on Leader-Member Exchange (LMX) Theory. The research uses focus groups to elicit descriptions of ILTs held by forty final year undergraduate Business and Management students. The data was then analysed using an abductive process permitting an interpretative understanding of the meanings participants attach to their past experiences and future expectations. This research addresses a perceived gap by making a theoretical contribution to knowledge and understanding in this field, focusing on how emotional responses affect their behaviour, how this impacts on organisational outcomes, and what the implications are for HRD practitioners. The findings support previous research into the content and structure of ILTs but extend these by examining the impact of affect on workplace behaviour. Findings demonstrate that where follower ILT needs are met then positive outcomes ensued for participants, their superiors, and their organisations. Conversely, where follower ILT needs are not matched, various negative effects emerged ranging from poor performance and impaired well-being, to withdrawal behaviour and outright rebellion. The research findings suggest dynamic reciprocal links amongst outcomes, behaviours, and LMX, and demonstrate an alignment of cognitive, emotional and behavioural responses that correspond to either high-LMX or low-LMX relationships, with major impacts on job satisfaction, commitment and well-being. Copyright

Contexts That Inform Racial Awareness and Affect Teaching Practice: A Study of White Bilingual Teachers

Thesis (Ph.D.)--University of Washington, 2016-08