Nurses' experiences of pain management for people with advanced dementia approaching the end of life: a qualitative study

AIMS AND OBJECTIVES: To explore hospice, acute care and nursing home nurses' experiences of pain management for people with advanced dementia in the final month of life. To identify the challenges, facilitators and practice areas requiring further support.

BACKGROUND: Pain management in end-stage dementia is a fundamental aspect of end of life care; however, it is unclear what challenges and facilitators nurses experience in practice, whether these differ across care settings, and whether training needs to be tailored to the context of care.

DESIGN: A qualitative study using semi-structured interviews and thematic analysis to examine data.

METHODS: 24 registered nurses caring for people dying with advanced dementia were recruited from ten nursing homes, three hospices, and two acute hospitals across a region of the United Kingdom. Interviews were conducted between June 2014 and September 2015.

RESULTS: Three core themes were identified: challenges administering analgesia, the nurse-physician relationship, and interactive learning and practice development. Patient-related challenges to pain management were universal across care settings; nurse- and organisation-related barriers differed between settings. A need for interactive learning and practice development, particularly in pharmacology, was identified.

CONCLUSIONS: Achieving pain management in practice was highly challenging. A number of barriers were identified; however, the manner and extent to which these impacted on nurses differed across hospice, nursing home and acute care settings. Needs-based training to support and promote practice development in pain management in end-stage dementia is required.

RELEVANCE TO CLINICAL PRACTICE: Nurses considered pain management fundamental to end of life care provision; however, nurses working in acute care and nursing home settings may be under-supported and under-resourced to adequately manage pain in people dying with advanced dementia. Nurse-to-nurse mentoring and ongoing needs-assessed interactive case-based learning could help promote practice development in this area. Nurses require continuing professional development in pharmacology. This article is protected by copyright. All rights reserved.

Point of view filming and the elicitation interview

Face-to-face interviews are a fundamental research tool in qualitative research. Whilst this form of data collection can provide many valuable insights, it can often fall short of providing a complete picture of a research subject's experiences. Point of view (PoV) interviewing is an elicitation technique used in the social sciences as a means of enriching data obtained from research interviews. Recording research subjects' first person perspectives, for example by wearing digital video glasses, can afford deeper insights into their experiences. PoV interviewing can promote making visible the unverbalizable and does not rely as much on memory as the traditional interview. The use of such relatively inexpensive technology is gaining interest in health profession educational research and pedagogy, such as dynamic simulation-based learning and research activities. In this interview, Dr Gerry Gormley (a medical education researcher) talks to Dr Jonathan Skinner (an anthropologist with an interest in PoV interviewing), exploring some of the many crossover implications with PoV interviewing for medical education research and practice.

Joint Information and Jamming Beamforming for Secrecy Rate Maximization in Cognitive Radio Networks

In this paper, we consider the secure beamforming design for an underlay cognitive radio multiple-input singleoutput broadcast channel in the presence of multiple passive eavesdroppers. Our goal is to design a jamming noise (JN) transmit strategy to maximize the secrecy rate of the secondary system. By utilizing the zero-forcing method to eliminate the interference caused by JN to the secondary user, we study the joint optimization of the information and JN beamforming for secrecy rate maximization of the secondary system while satisfying all the interference power constraints at the primary users, as well as the per-antenna power constraint at the secondary transmitter. For an optimal beamforming design, the original problem is a nonconvex program, which can be reformulated as a convex program by applying the rank relaxation method. To this end, we prove that the rank relaxation is tight and propose a barrier interior-point method to solve the resulting saddle point problem based on a duality result. To find the global optimal solution, we transform the considered problem into an unconstrained optimization problem. We then employ Broyden-Fletcher-Goldfarb-Shanno (BFGS) method to solve the resulting unconstrained problem which helps reduce the complexity significantly, compared to conventional methods. Simulation results show the fast convergence of the proposed algorithm and substantial performance improvements over existing approaches.

Ethical reasoning through simulation: a phenomenological analysis of student experience

Background
Medical students transitioning into professional practice feel underprepared to deal with the emotional complexities of real-life ethical situations. Simulation-based learning (SBL) may provide a safe environment for students to probe the boundaries of ethical encounters. Published studies of ethics simulation have not generated sufficiently deep accounts of student experience to inform pedagogy. The aim of this study was to understand students’ lived experiences as they engaged with the emotional challenges of managing clinical ethical dilemmas within a SBL environment.

Methods
This qualitative study was underpinned by an interpretivist epistemology. Eight senior medical students participated in an interprofessional ward-based SBL activity incorporating a series of ethically challenging encounters. Each student wore digital video glasses to capture point-of-view (PoV) film footage. Students were interviewed immediately after the simulation and the PoV footage played back to them. Interviews were transcribed verbatim. An interpretative phenomenological approach, using an established template analysis approach, was used to iteratively analyse the data.

Results
Four main themes emerged from the analysis: (1) ‘Authentic on all levels?’, (2)‘Letting the emotions flow’, (3) ‘Ethical alarm bells’ and (4) ‘Voices of children and ghosts’. Students recognised many explicit ethical dilemmas during the SBL activity but had difficulty navigating more subtle ethical and professional boundaries. In emotionally complex situations, instances of moral compromise were observed (such as telling an untruth). Some participants felt unable to raise concerns or challenge unethical behaviour within the scenarios due to prior negative undergraduate experiences.

Conclusions
This study provided deep insights into medical students’ immersive and embodied experiences of ethical reasoning during an authentic SBL activity. By layering on the human dimensions of ethical decision-making, students can understand their personal responses to emotion, complexity and interprofessional working. This could assist them in framing and observing appropriate ethical and professional boundaries and help smooth the transition into clinical practice.

An Efficient Precoder Design for Multiuser MIMO Cognitive Radio Networks with Interference Constraints

We consider a linear precoder design for an underlay cognitive radio multiple-input multiple-output broadcast channel, where the secondary system consisting of a secondary base-station (BS) and a group of secondary users (SUs) is allowed to share the same spectrum with the primary system. All the transceivers are equipped with multiple antennas, each of which has its own maximum power constraint. Assuming zero-forcing method to eliminate the multiuser interference, we study the sum rate maximization problem for the secondary system subject to both per-antenna power constraints at the secondary BS and the interference power constraints at the primary users. The problem of interest differs from the ones studied previously that often assumed a sum power constraint and/or single antenna employed at either both the primary and secondary receivers or the primary receivers. To develop an efficient numerical algorithm, we first invoke the rank relaxation method to transform the considered problem into a convex-concave problem based on a downlink-uplink result. We then propose a barrier interior-point method to solve the resulting saddle point problem. In particular, in each iteration of the proposed method we find the Newton step by solving a system of discrete-time Sylvester equations, which help reduce the complexity significantly, compared to the conventional method. Simulation results are provided to demonstrate fast convergence and effectiveness of the proposed algorithm. 

Real Estate Case Competitions

Real Estate is by nature a hands-on business in which real-world experience and new challenges are the best teacher. With this in mind, graduate real estate education has embraced case competitions as a way to apply education-based learning to real world project simulation. In recent years, teams from Cornell have consistently stood out in these competitions, making impressions and forming relationships that they will carry with them over their careers. In this issue of the Review, we recognize a composite of previous winners of the four major real estate-focused case competitions, and look back on what was a very successful year for case competition teams at Cornell. The case competitions draw students from all the constituent programs of Real Estate at Cornell, including the Baker Program, Johnson Graduate School of Management, City and Regional Planning, Architecture, and Landscape Architecture.

The Design and Development of Educational Immersive Environments: From Theory to Classroom Deployment

Computer game technology is poised to make a significant impact on the way our youngsters will learn. Our youngsters are ‘Digital Natives’, immersed in digital technologies, especially computer games. They expect to utilize these technologies in learning contexts. This expectation, and our response as educators, may change classroom practice and inform curriculum developments. This chapter approaches these issues ‘head on’. Starting from a review of the current educational issues, an evaluation of educational theory and instructional design principles, a new theoretical approach to the construction of “Educational Immersive Environments” (EIEs) is proposed. Elements of this approach are applied to development of an EIE to support Literacy Education in UK Primary Schools. An evaluation of a trial within a UK Primary School is discussed. Conclusions from both the theoretical development and the evaluation suggest how future teacher-practitioners may embrace both the technology and our approach to develop their own learning resources.

The Path between Pedagogy and Technology: Establishing a Theoretical Basis for the Development of Educational Game Environments

The power of computer game technology is currently being harnessed to produce “serious games”. These “games” are targeted at the education and training marketplace, and employ various key game-engine components such as the graphics and physics engines to produce realistic “digital-world” simulations of the real “physical world”. Many approaches are driven by the technology and often lack a consideration of a firm pedagogical underpinning. The authors believe that an analysis and deployment of both the technological and pedagogical dimensions should occur together, with the pedagogical dimension providing the lead. This chapter explores the relationship between these two dimensions, and explores how “pedagogy may inform the use of technology”, how various learning theories may be mapped onto the use of the affordances of computer game engines. Autonomous and collaborative learning approaches are discussed. The design of a serious game is broken down into spatial and temporal elements. The spatial dimension is related to the theories of knowledge structures, especially “concept maps”. The temporal dimension is related to “experiential learning”, especially the approach of Kolb. The multi-player aspect of serious games is related to theories of “collaborative learning” which is broken down into a discussion of “discourse” versus “dialogue”. Several general guiding principles are explored, such as the use of “metaphor” (including metaphors of space, embodiment, systems thinking, the internet and emergence). The topological design of a serious game is also highlighted. The discussion of pedagogy is related to various serious games we have recently produced and researched, and is presented in the hope of informing the “serious game community”.

The Development of Educational Materials for the Study of Architecture using Computer Game Technology

Computer game technology provides us with the tools to create web-based educational materials for autonomous and collaborative learning. At Worcester, we have researched the use of this technology in various educational contexts. This paper reports one such study; the use of the commercial game engine “Unreal Tournament 2004” (UT2004) to produce materials suitable for education of Architects. We map the concepts and principles of Architectural Design onto the affordances (development tools) provided by UT2004, leading to a systematic procedure for the realization of buildings and urban environments using this game engine. A theory for the production of web-based learning materials which supports both autonomous and collaborative learning is developed. A heuristic evaluation of our materials, used with second-year students is presented. Associated web-pages provide on-line materials for delegates.

Global Trade Governance and ASEAN: Studies of Trade-Related Aspects of Labor, Environment and Culture in Southeast Asia

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

Evolution of an Interactive Online Magazine for Students, Academics and Expert Practitioners to Engage Students in ESD

Urgency to embed awareness of sustainability principles and practice across society, and need for digital literacy and advocacy for sustainability are reshaping ESD. These, together with developments in learning and teaching, demand new tools to support implementation of project-based learning and more interactive approaches. This investigation explores the evolution of susthingsout.com, an online magazine for students, academics and expert practitioners, developed by the University of Worcester. This comprises two parts; the first, a private site specifically for students involved in sustainability learning on-campus; the second, an open-access site developed to deliver sustainability information and good practice across campus, community and not-for-profit and commercial organisations. This paper involves only the private site i.e. the equivalent of an in-house VLE specifically designed to support the teaching of sustainability to multi-disciplinary first and second year undergraduate students. It reports on the progress of the VLE, following three years of use and initial improvements, in terms of the student support and engagement, as well as considering the practical issues affecting these. The results fall into four categories of pedagogical, operational, cultural and external factors, which are synthesised to capture and share emerging knowledge of good practice offering insights to other developers of online sustainability materials.

Developing Innovative TEL Practice in Teacher Education

This interactive symposium will focus on the use of different technologies in developing innovative practice in teacher education at one university in England. Technology Enhanced Learning (TEL) is a field of educational policy and practice that has the power to ignite diametrically opposing views and reactions amongst teachers and teacher educators, ranging across a spectrum from immense enthusiasm to untold terror. In a field where the skills and experience of individuals vary from those of digital natives (Prensky 2001) to lags and lurkers in digital spaces, the challenges of harnessing the potential of TEL are complex. The challenges include developing the IT skills of trainees and educators and the creative application of these skills to pedagogy in all areas of the curriculum. The symposium draws on examples from primary, secondary and post-compulsory teacher education to discuss issues and approaches to developing research capacity and innovative practice using different etools, many of which are freely available. The first paper offers theoretical and policy perspectives on finding spaces in busy professional lives to engage in research and develop research-informed practice. It draws on notions of teachers as researchers, practitioner research and evidenc-ebased practice to argue that engagement in research is integral to teacher education and an empowering source of creative professional learning for teachers and teacher educators. Whilst acknowledging the challenges of this stance, examples from our own research practice illustrate how e-tools can assist us in building the capacity and confidence of staff and students in researching and enhancing teaching, learning and assessment practice. The second paper discusses IT skills development through the TEL pathway for trainee teachers in secondary education across different curriculum subjects. The lead tutor for the TEL pathway will use examples of activities developed with trainee teachers and university subject tutors to enhance their skills in using e-tools, such as QR codes, Kahoot, Padlet, Pinterest and cloud based learning. The paper will also focus on how these skills and tools can be used for action Discussant - the wider use of technologies in a university centre for teacher education; course management, recruitment and mentor training. research, evaluation and feedback and for marking and administrative tasks. The discussion will finish with thoughts on widening trainee teachers’ horizons into the future direction of educational technology. The third paper considers institutional policies and strategies for promoting and embedding TEL, including an initiative called ‘The Learning Conversation’, which aims ‘to share, highlight, celebrate, discuss, problematise, find things out...’ about TEL through an online space. The lead for ‘The Learning Conversation’ will offer reflections on this and other initiatives across the institution involving trainee teachers, university subject tutors, librarians and staff in student support services who are using TEL to engage, enthuse and support students on campus and during placements in schools. The fourth paper reflects on the use of TEL to engage with trainee teachers in post-compulsory education. This sector of education and training is more fragmented than primary and secondary schools sectors and so the challenges of building a community of practice that can support the development of innovative practice are greater.

Conceção e pré-teste de comunicação de uma campanha publicitária para a revista "Courrier Internacional"

Trabalho de projeto apresentado à Escola Superior de Comunicação Social como parte dos requisitos para obtenção de grau de mestre em Publicidade e Marketing.