Situation Background Assessment Recommendation (SBAR): Undergraduate Perspectives

Situation Background Assessment and Recommendation (SBAR): Undergraduate Perspectives C Morgan, L Adams, J Murray, R Dunlop, IK Walsh. Ian K Walsh, Centre for Medical Education, Queen’s University Belfast, Mulhouse Building, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6DP Background and Purpose: Structured communication tools are used to improve team communication quality.1,2 The Situation Background Assessment and Recommendation (SBAR) tool is widely adopted within patient safety.3 SBAR effectiveness is reportedly equivocal, suggesting use is not sustained beyond initial training.4-6 Understanding perspectives of those using SBAR may further improve clinical communication. We investigated senior medical undergraduate perspectives on SBAR, particularly when communicating with senior colleagues. Methodology: Mixed methods data collection was used. A previously piloted questionnaire with 12 five point Lickert scale questions and 3 open questions was given to all final year medical students. A subgroup also participated in 10 focus groups, deploying strictly structured audio-recorded questions. Selection was by convenience sampling, data gathered by open text questions and comments transcribed verbatim. In-vivo coding (iterative, towards data saturation) preceded thematic analysis. Results: 233 of 255 students (91%) completed the survey. 1. There were clearly contradictory viewpoints on SBAR usage. A recurrent theme was a desire for formal feedback and a relative lack of practice/experience with SBAR. 2. Students reported SBAR as having variable interpretation between individuals; limiting use as a shared mental model. 3. Brief training sessions are insufficient to embed the tool. 4. Most students reported SBAR helping effective communication, especially by providing structure in stressful situations. 5. Only 18.5% of students felt an alternative resource might be needed. Sub analysis of the themes highlighted: A. Lack of clarity regarding what information to include and information placement within the acronym, B. Senior colleague negative response to SBAR C. Lack of conciseness with the tool. Discussion and Conclusions: Despite a wide range of contradictory interpretation of SBAR utility, most students wish to retain the resource. More practice opportunities/feedback may enhance user confidence and understanding. References: (1) Leonard M, Graham S, Bonacum D. The human factor: the critical importance of effective teamwork and communication in providing safe care. Quality & Safety in Health Care 2004 Oct;13(Suppl 1):85-90. (2) d'Agincourt-Canning LG, Kissoon N, Singal M, Pitfield AF. Culture, communication and safety: lessons from the airline industry. Indian J Pediatr 2011 Jun;78(6):703-708. (3) Dunsford J. Structured communication: improving patient safety with SBAR. Nurs Womens Health 2009 Oct;13(5):384-390. (4) Compton J, Copeland K, Flanders S, Cassity C, Spetman M, Xiao Y, et al. Implementing SBAR across a large multihospital health system. Jt Comm J Qual Patient Saf 2012 Jun;38(6):261-268. (5) Ludikhuize J, de Jonge E, Goossens A. Measuring adherence among nurses one year after training in applying the Modified Early Warning Score and Situation-Background-Assessment-Recommendation instruments. Resuscitation 2011 Nov;82(11):1428-1433. (6) Cunningham NJ, Weiland TJ, van Dijk J, Paddle P, Shilkofski N, Cunningham NY. Telephone referrals by junior doctors: a randomised controlled trial assessing the impact of SBAR in a simulated setting. Postgrad Med J 2012 Nov;88(1045):619-626.

Os Deputados Assistentes Sociais na Assembleia Nacional e na Assembleia da República Portuguesa: principais intervenções parlamentares entre 1949 e 2011

A presente dissertação é relativa aos assistentes sociais que exerceram funções de deputados em Portugal Continental, na Assembleia Nacional e na Assembleia da República Portuguesa. Procedeu-se à sua caracterização e à análise dos seus principais discursos parlamentares. A pertinência da investigação é justificada pela inexistência de trabalhos acerca da temática escolhida e pela reduzida produção académica no que respeita à vasta dimensão política do Serviço Social em Portugal. A investigação alicerçou-se numa pesquisa bibliográfica sobre os temas em foco, e documental, na análise das fichas biográficas dos deputados identificados e das transcrições textuais das sessões da Assembleia Nacional e da Assembleia da República Portuguesa, onde constam os discursos destes deputados. Estas fontes primárias estão acessíveis no sítio oficial da Assembleia da República (www.parlamento.pt). Pretende-se com este estudo abordar o lugar atribuído à Assembleia Nacional e à Assembleia da República Portuguesa nos respetivos regimes de ditadura e democracia e identificar e caracterizar académica, profissional e politicamente os assistentes sociais que exerceram estas funções. Objetiva-se ainda a análise das principais intervenções destes deputados no contexto da Assembleia Nacional e da Assembleia da República Portuguesa. Apurou-se que o número de deputadas à Assembleia Nacional e à Assembleia da República Portuguesa não variou significativamente nos regimes políticos abordados. Foram identificadas cinco deputadas à Assembleia Nacional, da V à XI legislatura (de 1949 a 1974 – 25 anos), sendo que a primeira deputada identificada exerceu funções ao longo da V e VI legislaturas da Assembleia Nacional. Após a queda do regime ditatorial e depois de 21 anos em democracia, assistentes sociais voltaram a exercer funções de deputados. Entre 1995 e 2011 exerceram funções seis deputados à Assembleia da República Portuguesa. Um deles desenvolveu atividades ao longo da X e XI legislaturas. Os resultados da investigação mostram que a maioria destes deputados são mulheres, havendo apenas um homem. Relativamente à formação académica dos deputados constatou-se que antes de 1974 o estabelecimento que formou mais assistentes sociais deputadas foi o Instituto de Serviço Social de Lisboa (3), seguido do Instituto Superior de Ciências Sociais e Políticas Ultramarinas (1) e do Instituto Superior de Serviço Social Pio XII, em Luanda (1). Os deputados à Assembleia da República formaram-se no Instituto Superior de Serviço Social de Coimbra (2); no Instituto Superior Bissaya Barreto, Coimbra (1); no Instituto Superior de Serviço Social do Porto (1); no Instituto Superior de Serviço Social de Lisboa (1) e no Instituto Superior de Serviço Social Pio XII, Luanda (1). As deputadas que exerceram funções durante o Estado Novo pertenciam à União Nacional e Acção Nacional Popular, sendo que uma delas pertencia à Ala Liberal da ANP. Quanto aos deputados que exerceram funções no período democrático percebe-se que todos eram vinculados a partidos do bloco central e da direita: uma deputada do PSD, uma do CDS e quatro deputados do PS. No que respeita às intervenções parlamentares dos deputados identificados, observou-se que as deputadas à Assembleia Nacional apresentaram e fundamentaram propostas de medidas de política social apoiando-se na sua experiência profissional, principalmente em debates em que o tema foi a família ou a pobreza. Os deputados à Assembleia da República direcionaram os seus discursos para o apoio e/ou complemento das iniciativas propostas pelo governo, pois quatro destes deputados exerceram funções enquanto o partido a que pertenciam estava na liderança do governo. Face á vastidão da temática abordada, a presente dissertação constitui-se como um primeiro contributo para a produção de bibliografia no âmbito da dimensão política do Serviço Social, reconhecendo-se a necessidade de aprofundar mais o tema. / This thesis is on social workers who acted as deputies in Portugal, on the National Assembly and the Assembly of the Portuguese Republic. Characterization and analysis of its key parliamentary speeches was the chosen procedure. The relevance of the research is justified by the lack of previous work on the chosen theme and the reduced academic outputs with respect to the vast political dimension of social work in Portugal. Research has its foundations in a literature research on the topics in focus, and also documentary, by the analysis of the biographical records of Members discussed and the verbatim transcripts of the sessions of the National Assembly and the Assembly of the Portuguese Republic, which contains the speeches of such Members. These primary sources include legislative sessions and are available on the Assembly of the Republic (www.parlamento.pt) official website. The study aims to address the place assigned to the National Assembly and the Assembly of the Portuguese Republic, regarding the respective regimes of dictatorship and democracy and to identify and characterize academically, professionally and politically, the social workers who have exercised these functions. Furthermore on the objective is the analysis of the main interventions in the context of such Members of the National Assembly and the Assembly of the Portuguese Republic. It was found that the number of deputies to the National Assembly and the Assembly of the Portuguese Republic did not significantly vary in both political regimes. Five deputies to the National Assembly were identified on the legislatures V to XI (1949-1974 - 25 years), with the first identified lady holding positions along the V and VI legislatures of the National Assembly. After the fall of the dictatorship and after 21 years of democracy, social workers returned to act as deputies. Between 1995 and 2011 held office six members of the Assembly of the Portuguese Republic. One developed activities along the X and XI legislatures of the Assembly of the Portuguese Republic. Research results show that the majority of these are women, and only one man. Regarding the academic training of the deputies, it was found that before 1974 the establishment that formed most of the social workers was, the Institute of Social Service of Lisbon (3), followed by the School of Social Science and Policy Overseas (1) and the Higher Institute of Social Service Pius XII in Luanda (1). Members of Parliament formed in the Institute of Social Service of Coimbra (2), the Higher Institute Bissaya Barreto, Coimbra (1), the Institute of Social Service of Porto (1), the Higher Institute of Social service of Lisbon (1) and the Institute of Social service Pius XII, Luanda(1). Deputies who held office during the New state belonged to the National Union and National People's Action parties, one of which belonged to the Liberal Wing of the ANP. As for the deputies who held office in the democratic period one realizes that all parties were bound to the central block and right wing: A Member of the PSD, one of CDS and four members of the PS. Regarding the parliamentary speeches of identified Members, it was noted that the National Assembly deputies presented and substantiated proposals for social policy measures relying on their professional experience, primarily on the debates in which the theme was family or poverty. Members of Parliament have directed their speeches to support and / or complement the initiatives proposed by the government, since four of these deputies exercise their functions while the party they belonged was in governmental leadership. Given the vastness of the topic addressed in this thesis, it constitutes itself as a first contribution to the production of literature within the political dimension of social work, recognizing the need to go deeper into the subject.

Extensão universitária e associativismo popular : um estudo a partir da educação ambiental crítica

Partimos do pressuposto que a universidade pública é um bem do povo e deve servir aos interesses da sociedade, sobretudo aos interesses daqueles cuja vida é ameaçada mediante as condições desiguais sob as quais a sociedade capitalista se funda. Entendemos que a extensão universitária é uma atividade da universidade e deve, como ensino e pesquisa, ser reconhecida como produtora de conhecimentos e não por trabalhos assistenciais, como se caracteriza, na realidade concreta, a extensão universitária analisada nesta dissertação. Com base nisso, o trabalho que se segue discorre sobre a relação de dependência das associações populares, ligadas ao movimento da economia popular solidária à extensão da Universidade Federal do Rio Grande – FURG, especificamente aquela realizada pelo Núcleo de Desenvolvimento Social e Econômico – NUDESE-FURG, da região de Rio GrandeRS. O objetivo do trabalho foi conhecer a relação entre o núcleo e as associações, problematizando-a com base em alguns princípios da Educação Ambiental Crítica (diálogo, totalidade, relação teoria/prática e participação social). O referencial que sustenta o trabalho articula autores da sociologia do trabalho, economia da educação, ecologia política, geografia crítica, todos, de alguma forma, ligados ao materialismo histórico como perspectiva de análise. O trabalho se caracteriza como um estudo de caso, onde os principais recursos perpassaram pela análise de documentos e, fundamentalmente, as entrevistas gravadas e transcritas na íntegra, pelas quais nosso estudo se baseia. A análise do material foi feita a partir dos pressupostos da análise crítica do discurso, a qual busca entrelaçar os pronunciamentos dos sujeitos com a totalidade social na qual o discurso está inscrito, possibilitando o alcance do significado concreto. O estudo demonstra que a extensão universitária desenvolvida pelo NUDESE-FURG tem características assistencialistas, cuja consequência prática é a realização de atividades para os trabalhadores associados (principalmente elaboração e gestão de projetos), impedindo que as associações desenvolvam suas ações sem depender do núcleo. Além disso, ao assumir recursos financeiros oriundos de projetos (via editais), as associações apenas transferem para o Estado a condição de dependência do intermediário, o que não extingue o problema, mas reafirma-o. Por isso, entendemos que a Educação Ambiental Crítica oferece, por meio dos princípios que utilizamos, um instrumento crítico importante ao estudo de processos e políticas que buscam a emancipação dos sujeitos. Isso porque, também, ao reconhecer a crise socioambiental que vivemos, fruto do modo de produção capitalista, dos conflitos existentes na sociedade (portanto dos diferentes interesses, concepções e valores em disputa), pela apropriação da riqueza produzida, podem-se possibilitar conhecimentos úteis dos trabalhadores das associações. Para que isso aconteça, defendemos o encontro da extensão universitária do NUDESE-FURG com a Educação Ambiental Crítica, caso a emancipação, de fato, esteja no horizonte das práticas deste núcleo, já que pelo estudo, nesta pesquisa, predomina dependência de tais grupos do NUDESE-FURG.

An interpretative phenomenological analysis of the lived experience of suicidal behaviour

Background: In Scotland, suicide prevention is a major public health challenge, with two people, on average, dying every day due to suicide. Any efforts to prevent suicide should be aided by research. Existing research on suicide is dominated by quantitative research that has largely focused on providing explanatory accounts of suicidal phenomena. Research providing rich and detailed accounts of suicidal behaviour among individuals who have directly experienced it is growing but remains relatively embryonic. This study sought to supplement existing understanding of attempted suicide specifically by exploring the processes, meaning and context of suicidal experiences among individuals with a history of attempted suicide. Methods: The study used a retrospective qualitative design with semi-structured in-depth interviews. Participants were patients (n=7) from a community mental health service in Glasgow, Scotland who had attempted suicide within the previous 12-month period. The interviews were transcribed verbatim and were analysed for recurrent themes using interpretative phenomenological analysis (IPA). Results: Three super-ordinate themes, each with inter-related sub-themes, emerged from the analysis. 1) “Intentions”: This theme explored different motives for suicide, including providing relief from upsetting feelings; a way of establishing control; and a means of communicating with others. 2) “The Suicidal Journey”: This theme explored how individuals’ thinking can change when they are suicidal, including feeling overwhelmed by a build-up of distress and a narrowing of their perspective. 3) “Suicidal Dissonance”: This theme explored how people can feel conflicted about suicide and can be fearful of the consequences of their suicidal behaviour. Conclusion: Participants’ accounts were dominated by experience of significant adversity and psychological suffering. These accounts provided valuable insights into the suicidal process, highlighting implications for clinical practice and future research.

Negative symptoms of schizophrenia and psychosocial treatment: thematic analysis of stakeholders’ perspectives

Objectives. Recent literature indicates variance in psychosocial treatment preferences for negative symptoms of schizophrenia. Attempts at defining therapeutic aims and outcomes for negative symptoms to date have not included major stakeholder groups. The aim of the present study was to address this gap through qualitative methods. Design. Thematic Analysis was applied to qualitative semi-structured interview data to gather the opinions of people who experience negative symptoms, carers, and healthcare professionals. Participants were recruited from two mental health sites (inpatient/community) to increase generalisability of results. Ten people participated in the research. Methods. Semi-structured interview scripts were designed utilising evidence from the review in Chapter 1 of effective psychosocial intervention components for specific negative symptoms. Interviews were audio recorded and transcribed verbatim. Thematic analysis was employed to analyse data. Results. A common theme across groups was the need for a personalised approach to intervention for negative symptoms. Other themes indicated different opinions in relation to treatment targets and the need for a sensitive and graded approach to all aspects of therapy. This approach needs to be supported across systemic levels of organisation with specific training needs for staff addressed. Conclusions. There is disparity in treatment preferences for negative symptoms across major stakeholders. The findings suggest an individualised approach to intervention of negative symptoms that is consistent with recovery. Implementation barriers and facilitators were identified and discussed. There remains a need to develop a better understanding of treatment preferences for patients.

Experiences of COPD patients with existing smoking cessation programs and their preferences for improvement - a qualitative analysis

BACKGROUND: Smoking is a major risk factor for chronic obstructive pulmonary disease (COPD). For current smokers who are diagnosed with COPD, their first treatment option is to stop smoking. Motivation is necessary for long-term smoking cessation; therefore, when designing smoking cessation programs, the patients' needs and preferences should be considered. We focused on COPD patients' experiences with existing smoking cessation programs and evaluated their preferences for the improvement of these programs. METHODS: We conducted 18 guideline-based interviews with COPD patients between April and June 2014 in Germany. Each patient with COPD, who was a current or past smoker and had made at least one attempt to quit smoking in the past 5 years, was included in the study. We audiotaped, verbatim transcribed, and evaluated the interviews, using content analysis. RESULTS: The patients had broad and different experiences with pharmaceutical, behavioral, and alternative approaches that supported or negatively influenced the smoking cessation process. Pharmaceuticals were viewed as an expensive alternative with many side effects although they helped to stop cravings for a few moments. Furthermore, the bad structure and impersonal content of the seminars for smoking cessation negatively influenced group cohesion, and therefore degrading the patients' motivation to stop smoking. Alternative methods, such as acupuncture and hypnosis were mostly ineffective in smoking cessation, but in some cases, served as motivational strategies. CONCLUSION: Negative experiences with smoking cessation were explained by the patients' lack of motivation or resolution. Other negative experiences, such as the structure of seminars for smoking cessation and the high price of pharmaceuticals should be addressed through policy changes to increase the patients' motivation to quit smoking.

Pressure ulcer management in Oman: nurses’ knowledge and views

Background: Pressure ulcers (PrUs) have a significant impact on health system expenditure and patient’s quality of life. It is a global problem. Many studies were undertaken in regard to PrU prevention and management. In Oman, no studies have been conducted to investigate nurses’ knowledge on prevention and management of PrUs. The purpose of this descriptive sequential explanatory mixed-method study was to explore the nurses’ level of knowledge in relation to prevention and management of PrUs in Oman. Methods: A mixed method design was used and the study was conducted over two Phases. In Phase I, a questionnaire was developed to explore nurses’ knowledge on PrU, policy, and resources. The main section of the questionnaire was the Pieper-Zulkowski Pressure Ulcer knowledge test (PZ-PUKT) which tests the knowledge on PrU. Another two sections were developed including questions about wound policy and resources available for PrU prevention and management in Oman. The questionnaire was distributed to nurses who were working in surgical, medical, orthopaedic, CCU, and ICU wards/units in seven hospitals. In Phase II study, semi-structured qualitative interviews were conducted with 16 of the questionnaire respondents. Interviews took approximately 30 minutes, were recorded and transcribed verbatim. Qualitative data were analysed using the Knowledge, Attitudes and Practice (KAP) model as the a priori framework. Results: In Phase I, 478 questionnaires were analysed. The knowledge test results showed the overall mean percent score for correctly answered questions was 51% suggesting a low level of knowledge. There was a significant relationship between nurses’ knowledge and age (P=0.001) and between knowledge and years of experience (P=0.001) with knowledge increasing with age and years of experience. In Phase II, four themes were identified from the interviews: knowledge, attitude, and practice (framework themes) and perception of role. Findings indicated positive and negative attitudes towards the care of PrUs. Some nurses stated feeling rewarded when they see wounds improving while others said they could not work with patients independently because they lacked the knowledge and the skills needed. There was variation in the management of PrU between hospitals. Both studies indicated that the wound management policy did not include enough information to guide nurses. Conclusion: Overall the nurses’ level of knowledge on PrU was relatively low. Most nurses were not familiar with wound management policy or different PrU prevention and management strategies. Nurses are aware of the risk of PrUs and try their best to manage them with the available resources however more training is required.

Should female health providers be involved in medical male circumcision? Narratives of newly circumcised men in Malawi

Background The Malawi government has endorsed voluntary medical male circumcision (VMMC) as a biomedical strategy for HIV prevention after a decade of debating its effectiveness in the local setting. The “policy” recommends that male circumcision (MC) should be clinically based, as opposed to the alternative of traditional male circumcision (TMC). Limited finances, acceptability concerns, and the health system’s limited capacity to meet demand are among the challenges threatening the mass rollout of VMMC. In terms of acceptability, the gender of clinicians conducting the operations may particularly influence health facility-based circumcision. This study explored the acceptability, by male clients, of female clinicians taking part in the circumcision procedure. Methods Six focus group discussions (FGDs) were conducted, with a total of 47 newly circumcised men from non-circumcising ethnic groups in Malawi participating in this study. The men had been circumcised at three health facilities in Lilongwe District in 2010. Data were audio recorded and transcribed verbatim. Data were analysed using narrative analysis. Results Participants in the FGDs indicated that they were not comfortable with women clinicians being part of the circumcising team. While few mentioned that they were not entirely opposed to female health providers’ participation, arguing that their involvement was similar to male clinicians’ involvement in child delivery, most of them opposed to female involvement, arguing that MC was not an illness that necessitates the involvement of clinicians regardless of their gender. Most of the participants said that it was not negotiable for females to be involved, as they could wait until an all-male clinician team could be available. Thematically, the arguments against female clinicians’ involvement include sexual undertones and the influences of traditional male circumcision practices, among others. Conclusion Men preferred that VMMC should be conducted by male health providers only. Traditionally, male circumcision has been a male-only affair shrouded in secrecy and rituals. Although being medical, this study strongly suggested that it may be difficult for VMMC to immediately move to a public space where female health providers can participate, even for men coming from traditionally non-circumcising backgrounds.

Women's perceptions of Nurse-Midwives' caring behaviours during perinatal loss in Lilongwe, Malawi: An Exploratory study

Objective The Objective for this study was to explore women’s perceptions of and satisfaction with nursing care they received following stillbirth and neonatal death in villages around a community hospital in Lilongwe. Methods This qualitative, exploratory study through a mixture of purposive and snowball sampling, recruited 20 women who had lost a child through stillbirth or neonatal death in the past 2 years. Data were collected through semi-structured interviews in the privacy of the homes of the women. All interviews were tape-recorded and transcribed verbatim and were analyzed using thematic analysis. Results Almost half of the respondents expressed satisfaction with the way nurses cared for them after experiencing perinatal loss, although some felt unable to comment on the quality of care received. However, several bereaved women were dissatisfied with how nurses handled their loss. They noted nurses not providing attention or explanations and some even attributed the death of their child to nurses’ neglect. Conclusions Interventions are needed which foster awareness where nurses become more sensitive to the mothers’ emotional needs in an equally sensitive health care system. There is also need for more research into care provided following perinatal deaths in resource-poor settings to increase the evidence-base for informed and improved care for women who have experienced child loss.

Densus et breuis: considerações sobre o estilo de Tucídides

O estilo de Tucídides foi estudado desde a Antiguidade, sendo a obra mais completa, apesar de não elogiosa, a de Dionísio de Halicarnasso. Este artigo foca alguns dos elementos mais característicos da escrita de Tucídides, estruturando-os em pequenas secções que abrangem a «variatio», os paralelismos, os «hapax legomena», as abstrações, as definições de conceitos, as generalizações e o uso de documentos «verbatim».

Teachers' perceptions of virtual worlds as a medium for social inclusion for adults with intellectual disability

PURPOSE: The aim of this research was to explore educators' perceptions of a virtual world Second Life TM as an environment for social interaction and social inclusion for the Norwegian adult students with intellectual disability that they supported.

METHOD: Five educators who supported a total of 10 adult students with intellectual disability in computer classes in community Adult Education Centres participated in individual in-depth interviews. The interviews were transcribed verbatim and analysed using a content analysis.

RESULTS: Participants were positive about Second Life although they did not perceive that it offered a successful context for social interaction or inclusion. They identified a number of benefits to using a virtual world and for students participating in virtual world research. Barriers identified included language, literacy, and technology issues along with the complexity of participating independently in a virtual world.

CONCLUSIONS: Some people with intellectual disability can use virtual worlds but the skills required need additional research. Virtual worlds may provide a stimulating, safe, and exciting context for a range of activities but the level of support required by many people is high and consequently expensive.

An exercise programme for smoking cessation: perceptions of the Fit2quit trial intervention

Introduction: Few trials of exercise interventions for smoking cessation have included a qualitative evaluation of the intervention from the participants' perspective. Aims: To determine the perceptions of participants who received a 6-month telephone counselling exercise intervention to aid smoking cessation. Methods: Participants in the Fit2Quit study intervention group were asked to take part in a semi-structured phone interview. All interviews were digitally recorded and transcribed verbatim, and a general inductive approach to data analysis was followed. Results/Findings: Twenty participants from the intervention group completed an interview. The following themes emerged from the analyses: (1) The support people were genuinely interested in what I was achieving, (2) new awareness, new attitude, new lifestyle: I could see the benefits, (3) lack of time, willpower and money stopped me from changing and (4) I would have preferred a more hands on approach: Recommendations for future programmes. Conclusions: A telephone counselling intervention to enhance exercise for smoking cessation was well received. Aspects of the intervention, particularly the provision of support and encouragement from the participant support person, were beneficial. Suggested improvements were greater tailoring of the call schedule, greater face-to-face contact and provision of a buddy system or support group. Such improvements may increase adherence and, therefore, effectiveness of exercise interventions for smoking cessation.

Nursing care for the families of the dying child/infant in paediatric and neonatal ICU: Nurses’ emotional talk and sources of discomfort. A mixed methods study

BACKGROUND: The majority of in-hospital deaths of children occur in paediatric and neonatal intensive care units. For nurses working in these settings, this can be a source of significant anxiety, discomfort and sense of failure.

OBJECTIVES: The objectives of this study were to explore how NICU/PICU nurses care for families before and after death; to explore the nurses' perspectives on their preparedness/ability to provide family care; and to determine the emotional content of language used by nurse participants.

METHODS: Focus group and individual interviews were conducted with 22 registered nurses from neonatal and paediatric intensive care units of two major metropolitan hospitals in Australia. All data were audio recorded and transcribed verbatim. Transcripts were then analysed thematically and using Linguistic Inquiry to examine emotional content.

RESULTS: Four core themes were identified: preparing for death; communication challenges; the nurse-family relationship and resilience of nurses. Findings suggested that continuing to provide aggressive treatment to a dying child/infant whilst simultaneously caring for the family caused discomfort and frustration for nurses. Nurses sometimes delayed death to allow families to prepare, as evidenced in the Linguistic Inquiry analysis, which enabled differentiation between types of emotional talk such as anger talk, anxiety talk and sadness talk. PICU nurses had significantly more anxiety talk (p=0.018) than NICU nurses.

CONCLUSION: This study provided rich insights into the experiences of nurses who are caring for dying children including the nurses' need to balance the often aggressive treatments with preparation of the family for the possibility of their child's death. There is some room for improvement in nurses' provision of anticipatory guidance, which encompasses effective and open communication, focussed on preparing families for the child's death.

An exploration of the role and scope of the Clinical nurse consultant (CNC) in a metropolitan health service

Introduction

Clinical nurse consultants have been a part of the nursing workforce for some time however a lack of clarity regarding this role has led to significant variations in health service expectations, workloads and scope for the Clinical nurse consultants working within this metropolitan health service.

Aim

The aim of this study was to explore the role of the CNC as it is perceived by them, in the context of this health service.

Method

A qualitative approach was used for this study. Following ethics approval a single audio-taped focus group was undertaken to gather data. Guiding questions were used to elicit responses from the group, moderated by the co-investigators. The focus group was transcribed verbatim. Each researcher independently analysed the narrative data, using coding and clustering the data to develop primary and sub-themes.

Results

Whilst each participant experiences their role individually, there were four themes derived from comments expressed by the participants: ‘Diversity and conflict’, ‘Leaders but powerless’, ‘Support systems’ and ‘The portfolio holder role’.

Conclusion

The role of the Clinical nurse consultant is complex and diverse. The variability in the role suggests that organisational consensus of the role, scope and purpose of the CNC position has not been actualised, resulting in a lack of support systems, and an underutilisation of the Clinical nurse consultants as leaders, where they can challenge existing practice and guide future directions in care delivery.

Reasons and remedies for under-representation of women in medical leadership roles: a qualitative study from Australia

OBJECTIVE: To elicit medical leaders' views on reasons and remedies for the under-representation of women in medical leadership roles.

DESIGN: Qualitative study using semistructured interviews with medical practitioners who work in medical leadership roles. Interviews were transcribed verbatim and transcripts were analysed using thematic analysis.

SETTING: Public hospitals, private healthcare providers, professional colleges and associations and government organisations in Australia.

PARTICIPANTS: 30 medical practitioners who hold formal medical leadership roles.

RESULTS: Despite dramatic increases in the entry of women into medicine in Australia, there remains a gross under-representation of women in formal, high-level medical leadership positions. The male-dominated nature of medical leadership in Australia was widely recognised by interviewees. A small number of interviewees viewed gender disparities in leadership roles as a 'natural' result of women's childrearing responsibilities. However, most interviewees believed that preventable gender-related barriers were impeding women's ability to achieve and thrive in medical leadership roles. Interviewees identified a range of potential barriers across three broad domains-perceptions of capability, capacity and credibility. As a counter to these, interviewees pointed to a range of benefits of women adopting these roles, and proposed a range of interventions that would support more women entering formal medical leadership roles.

CONCLUSIONS: While women make up more than half of medical graduates in Australia today, significant barriers restrict their entry into formal medical leadership roles. These constraints have internalised, interpersonal and structural elements that can be addressed through a range of strategies for advancing the role of women in medical leadership. These findings have implications for individual medical practitioners and health services, as well as professional colleges and associations.