An enactive and dynamical systems theory account of dyadic relationships

Many social relationships are a locus of struggle and suffering, either at the individual or interactional level. In this paper we explore why this is the case and suggest a modeling approach for dyadic interactions and the well-being of the participants. To this end we bring together an enactive approach to self with dynamical systems theory. Our basic assumption is that the quality of any social interaction or relationship fundamentally depends on the nature and constitution of the individuals engaged in these interactions. From an enactive perspective the self is conceived as an embodied and socially enacted autonomous system striving to maintain an identity. This striving involves a basic two-fold goal: the ability to exist as an individual in one's own right, while also being open to and affected by others. In terms of dynamical systems theory one can thus consider the individual self as a self-other organized system represented by a phase space spanned by the dimensions of distinction and participation, where attractors can be defined. Based on two everyday examples of dyadic relationship we propose a simple model of relationship dynamics, in which struggle or well-being in the dyad is analyzed in terms of movements of dyadic states that are in tension or in harmony with individually developed attractors. Our model predicts that relationships can be sustained when the dyad develops a new joint attractor toward which dyadic states tend to move, and well-being when this attractor is in balance with the individuals' attractors. We outline how this can inspire research on psychotherapy. The psychotherapy process itself provides a setting that supports clients to become aware how they fare with regards to the two-fold norm of distinction and participation and develop, through active engagement between client (or couple) and therapist, strategies to co-negotiate their self-organization.

Unity in diversity: electronic patient record use in multidisciplinary practice

In this paper we examine the use of electronic patient records (EPR) by clinical specialists in their development of multidisciplinary care for diagnosis and treatment of breast cancer. We develop a practice theory lens to investigate EPR use across multidisciplinary team practice. Our findings suggest that there are oppositional tendencies towards diversity in EPR use and unity which emerges across multidisciplinary work, and this influences the outcomes of EPR use. The value of this perspective is illustrated through the analysis of a year-long, longitudinal case study of a multidisciplinary team of surgeons, oncologists, pathologists, radiologists, and nurse specialists adopting a new EPR. Each group adapted their use of the EPR to their diverse specialist practices, but they nonetheless orientated their use of the EPR to each others' practices sufficiently to support unity in multidisciplinary teamwork. Multidisciplinary practice elements were also reconfigured in an episode of explicit negotiations, resulting in significant changes in EPR use within team meetings. Our study contributes to the growing literature that questions the feasibility and necessity of achieving high levels of standardized, uniform health information technology use in healthcare.

Graduate Education for Leadership in Sustainable Development Innovation , Practice and Research

This paper reflects on the motivation, method and effectiveness of teaching leadership and organisational change to graduate engineers. Delivering progress towards sustainable development requires engineers who are aware of pressing global issues (such as resource depletion, climate change, social inequity and an interdependent economy) since it is they who deliver the goods and services that underpin society within these constraints. In recognition of this fact the Cambridge University MPhil in Engineering for Sustainable Development has focussed on educating engineers to become effective change agents in their professional field with the confidence to challenge orthodoxy in adopting traditional engineering solutions. This paper reflects on ten years of delivering this course to review how teaching change management and leadership aspects of the programme have evolved and progressed over that time. As the students on this professional practice have often extensive experience as practising engineers and scientists, they have learned the limitations of their technical background when solving complex problems. Students often join the course recognising their need to broaden their knowledge of relevant cross-disciplinary skills. The course offers an opportunity for these early to mid-career engineers to explore an ethical and value-based approach to bringing about effective change in their particular sectors and organisations. This is achieved through action learning assignments in combination with reflections on the theory of change to enable students to equip themselves with tools that help them to be effective in making their professional and personal life choices. This paper draws on feedback gathered from students during their participation on the course and augments this with alumni reflections gathered some years after their graduation. These professionals are able to look back on their experience of the taught components and reflect on how they have been able to apply this key learning in their subsequent careers.

A review of TRIZ, and its benefits and challenges in practice

TRIZ (the theory of inventive problem solving) has been promoted by several enthusiasts as a systematic methodology or toolkit that provides a logical approach to developing creativity for innovation and inventive problem solving. The methodology, which emerged from Russia in the 1960s, has spread to over 35 countries across the world. It is now being taught in several universities and it has been applied by a number of global organisations who have found it particularly useful for spurring new product development. However, while its popularity and attractiveness appear to be on a steady increase, there are practical issues which make the use of TRIZ in practice particularly challenging. These practical difficulties have largely been neglected by TRIZ literature. This paper takes a step away from conventional TRIZ literature, by exploring not just the benefits associated with TRIZ knowledge, but the challenges associated with its acquisition and application based on practical experience. Through a survey, first-hand information is collected from people who have tried (successfully and unsuccessfully) to understand and apply the methodology. The challenges recorded cut across a number of issues, ranging from the complex nature of the methodology to underlying organisational and cultural issues which hinder its understanding and application. Another contribution of this paper, potentially useful for TRIZ beginners, is the indication of what tools among the several contained in the TRIZ toolkit would be most useful to learn first, based on their observed degree of usage by the survey respondents. © 2012 Elsevier Ltd. All rights reserved.

Design of a fibre-optic disc accelerometer: theory and experiment

Mechanical principles of fibre-optic disc accelerometers (FODA) different from those assumed in previous calculation methods are presented. An FODA with a high sensitivity of 82 rad/ g and a resonance frequency of 360 Hz is designed and tested. In this system, the minimum measurable demodulation phase of the phase-generated carrier (PGC) is 10(-5) rad, and the minimum acceleration reaches 120 ng theoretically. This kind of FODA, with its high responsivity, all-optic-fibre configuration, small size, light weight and stiff shell housing, ensures effective performance in practice.

Reconceptualising moderation in asynchronous online discussions using grounded theory.

This paper reports a grounded theory study of e-moderation of asynchronous online discussions, to explore the processes by which tutors in higher education decide when and how to e-moderate. It aims to construct a theory of e-moderation based on some key factors which appear to influence e-moderation. It discusses previous research on the definition and practice of e-moderation, and then describes the study, which involved four e-moderators working in two different university contexts. Key themes on e-moderation, which emerged using a grounded theory approach, are discussed. It proposes a paradigm framework for e-moderation and suggests that as a facilitative activity, it should be sufficiently contained within ‘a ring-fenced learning arena’. Factors outwith and inside the ring-fence which appear to influence e-moderation and their implications for future theory development and validation are discussed. Keywords: e-moderation; grounded theory; online learning; asynchronous discussions; ring-fence

The Practice and Understanding of the Eucharist in the United Church of Christ: A Practical Theological Study

This dissertation explores the complexity of the understanding and practice of the Eucharist in the United Church of Christ as revealed in a textual analysis of the UCC Book of Worship (1986) and a qualitative study of five representative UCC congregations. Little has been written on this topic, save for several brief articles on the history of the theology of the sacrament in the two bodies that merged to form the UCC in 1957: the Congregational Christian Churches (CC) and the Evangelical and Reformed Church (E&R). This dissertation advances the topic through a practical-theological study that brings into critical conversation contemporary eucharistic practices in five congregations and a historical theological analysis of liturgical traditions in the UCC and antecedent denominations. Through this conversation, the study articulates common themes of a UCC eucharistic theology and explores implications for ongoing theology and practice in the denomination. The introduction explicates the methodology employed in this study, guided by Don Browning's work. The first two chapters present the findings of the focus group interviews and an interpretation of those results respectively. Chapter three analyzes the eucharistic liturgies in three historic books of worship used in the E&R heritage. In chapter four, two of the antecedent resources utilized in the CC tradition are analyzed. The short-lived Hymnal of the United Church of Christ, published in 1974, includes liturgies that would find fuller expression in the 1986 Book of Worship. That hymnal is examined in chapter five. Chapter six interprets the two services of "Word and Sacrament" found in the Book of Worship. Chapter seven offers a comparative analysis of the focus group findings and the theology inherent in the Book of Worship. The final chapter offers strategic recommendations for revised theory and practice. The conclusion points toward areas for further research: it propels a critical conversation around the notion of covenant, Christ's presence in the meal, and who can receive and officiate at the Eucharist. This dissertation concludes that the UCC lives within a balance of multiple, complementary theologies and challenges the denomination to make stronger connections between the meal and mission, reconciliation, and tradition.

The quality of diabetes care in the community: practice, policy and culture

Aim: Diabetes is an important barometer of health system performance. This chronic condition is a source of significant morbidity, premature mortality and a major contributor to health care costs. There is an increasing focus internationally, and more recently nationally, on system, practice and professional-level initiatives to promote the quality of care. The aim of this thesis was to investigate the ‘quality chasm’ around the organisation and delivery of diabetes care in general practice, to explore GPs’ attitudes to engaging in quality improvement activities and to examine efforts to improve the quality of diabetes care in Ireland from practice to policy. Methods: Quantitative and qualitative methods were used. As part of a mixed methods sequential design, a postal survey of 600 GPs was conducted to assess the organization of care. This was followed by an in-depth qualitative study using semi-structured interviews with a purposive sample of 31 GPs from urban and rural areas. The qualitative methodology was also used to examine GPs’ attitudes to engaging in quality improvement. Data were analysed using a Framework approach. A 2nd observation study was used to assess the quality of care in 63 practices with a special interest in diabetes. Data on 3010 adults with Type 2 diabetes from 3 primary care initiatives were analysed and the results were benchmarked against national guidelines and standards of care in the UK. The final study was an instrumental case study of policy formulation. Semi-structured interviews were conducted with 15 members of the Expert Advisory Group (EAG) for Diabetes. Thematic analysis was applied to the data using 3 theories of the policy process as analytical tools. Results: The survey response rate was 44% (n=262). Results suggested care delivery was largely unstructured; 45% of GPs had a diabetes register (n=157), 53% reported using guidelines (n=140), 30% had formal call recall system (n=78) and 24% had none of these organizational features (n=62). Only 10% of GPs had a formal shared protocol with the local hospital specialist diabetes team (n=26). The lack of coordination between settings was identified as a major barrier to providing optimal care leading to waiting times, overburdened hospitals and avoidable duplication. The lack of remuneration for chronic disease management had a ripple effect also creating costs for patients and apathy among GPs. There was also a sense of inertia around quality improvement activities particularly at a national level. This attitude was strongly influenced by previous experiences of change in the health system. In contrast GP’s spoke positively about change at a local level which was facilitated by a practice ethos, leadership and special interest in diabetes. The 2nd quantitative study found that practices with a special interest in diabetes achieved a standard of care comparable to the UK in terms of the recording of clinical processes of care and the achievement of clinical targets; 35% of patients reached the HbA1c target of <6.5% compared to 26% in England and Wales. With regard to diabetes policy formulation, the evolving process of action and inaction was best described by the Multiple Streams Theory. Within the EAG, the formulation of recommendations was facilitated by overarching agreement on the “obvious” priorities while the details of proposals were influenced by personal preferences and local capacity. In contrast the national decision-making process was protracted and ambiguous. The lack of impetus from senior management coupled with the lack of power conferred on the EAG impeded progress. Conclusions: The findings highlight the inconsistency of diabetes care in Ireland. The main barriers to optimal diabetes management center on the organization and coordination of care at the systems level with consequences for practice, providers and patients. Quality improvement initiatives need to stimulate a sense of ownership and interest among frontline service providers to address the local sense of inertia to national change. To date quality improvement in diabetes care has been largely dependent the “special interest” of professionals. The challenge for the Irish health system is to embed this activity as part of routine practice, professional responsibility and the underlying health care culture.

Anticipatory vigilance: A classic grounded theory of risk reduction and management in the perioperative setting

This research aimed to investigate the main concern facing nurses in minimising risk within the perioperative setting and to generate an explanatory substantive theory of how they resolve this through anticipatory vigilance. In the context of the perioperative setting, nurses encounter challenges in minimising risks for their patients on a continuous basis. Current explanations of minimising risk in the perioperative setting offers insights into how perioperative nurses undertake their work. Currently research in minimising risk is broadly related to dealing with errors as opposed to preventing them. To date, little is known about how perioperative nurses practice and maintain safety. This study was guided by the principles of classic grounded theory as described by Glaser (1978, 1998, 2001). Data was collected through individual unstructured interviews with thirty seven perioperative nurses (with varying lengths of experiences of working in the area) and thirty three hours of non-participant observation within eight different perioperative settings in the Republic of Ireland. Data was simultaneously collected and analysed. The theory of anticipatory vigilance emerged as the pattern of behaviour through which nurse’s deal with their main concern of minimising risk in a high risk setting. Anticipatory vigilance is enacted through orchestrating, routinising and momentary adapting within a spirit of trusting relations within the substantive area of the perioperative setting. This theory of offers an explanation on how nurses resolve their main concern of minimising risk within the perioperative setting. The theory of anticipatory vigilance will be useful to nurses in providing a comprehensive framework of explanation and understanding on how nurses deal with minimising risk in the perioperative setting. The theory links perioperative nursing, risk and vigilance together. Clinical improvements through understanding and awareness of the theory of anticipatory vigilance will result in an improved quality environment, leading to safe patient outcomes.

Moral shielding: A grounded theory of integrity maintenance in multidisciplinary teams

Using a classic grounded theory methodology (CGT), this study explores the phenomenon of moral shielding within mental health multidisciplinary teams (MDTS). The study was located within three catchment areas engaged in acute mental health service practice. The main concern identified was the maintenance of a sense of personal integrity during situational binds. Through theoretical sampling thirty two practitioners, including; doctors, nurses, social workers, occupational therapists, counsellors and psychologists, where interviewed face to face. In addition, emergent concepts were identified through observation of MDTs in clinical and research practice. Following a classic grounded theory methodology, data collection and analysis occurred simultaneously. A constant comparative approach was adopted and resulted in the immergence of three sub- core categories; moral abdication, moral hinting and pseudo-compliance. Moral abdication seeks to re-position within an event in order to avoid or deflect the initial obligation to act, it is a strategy used to remove or reduce moral ownership. Moral gauging represents the monitoring of an event with the goal of judging the congruence of personal principles and commitments with that of other practitioners. This strategy is enacted in a bid to seek allies for the support of a given moral position. Pseudo-compliance represents behaviour that hides desired principles and commitments in order to shield them from challenge. This strategy portrays agreement with the dominant position within the MDT, whilst holding a contrary position. It seeks to preserve a reservoir of emotional energy required to maintain a sense of personal integrity. Practitioners who were successful in enacting moral shielding were found to not experience significant emotional distress associated with the phenomenon of moral distress; suggesting that these practitioners had found mechanisms to manage situational binds that threatened their sense of personal integrity.

The Performance Practice of Buddhist Baiqi in Contemporary Taiwan

The baiqi (Buddhist percussive instruments), also known as faqi (dharma instruments), are mentioned in the Chinese Buddhist scriptures under many different terms: jianzhi, jiandi, jianzhui, or jianchi. The original function of baiqi in earlier monastic life was to gather people or to call an assembly. With the completion of monasticism and monastic institutions, baiqi have become multifunctional in monasteries, and many baiqi instruments have been developed for different monastic applications. In contemporary Buddhist monasteries in Taiwan, baiqi are used, on the one hand, to mark the time throughout the day, signal the beginning and end of monastic daily activities, and regulate the monastic order; and on the other hand, baiqi are indispensable to the musical practices of all Buddhist rituals, where they are used to accompany fanbai (Buddhist liturgical chants) and to articulate the whole ritual process. This study investigates multiple facets of Buddhist baiqi in their performance practice, function, application, notation, and transmission, exploring the interaction between baiqi and fanbai, baiqi and the practitioner, baiqi and the monastic space, and baiqi and various Buddhist contexts. I draw upon ideas from performance theory as it concerns different disciplines, but I maintain a sharper focus on the musicological dimension of performance practice when analyzing, interpreting, and explaining the performance and music of baiqi in terms of the monastic lifestyle and its rituals. The study not only uncovers the musical system of baiqi, but also encapsulates various issues of performed identity, social interaction, performer/audience, associated behaviors, the musical construction of space, and transmission.

Implications for the scheduling of theory versus application in learning

This paper presents the findings of an experiment which looked at the effects of performing applied tasks (action learning) prior to the completion of the theoretical learning of these tasks (explanation-based learning), and vice-versa. The applied tasks took the form of laboratories for the Object-Oriented Analysis and Design (OOAD) course, theoretical learning was via lectures.

Foundations for paramedic practice: a theoretical perspective

Written by leading paramedics and academic subject experts, with a foreword by Paul Bates, this is the first foundation level text to introduce the main theoretical subjects studied on the new higher education paramedic science programmes. It underpins practice and links ways of working to the crucial theory base. The numerous examples and case studies focus specifically on pre-hospital and emergency care. Key topics covered include: * NHS and ambulance service history * Ethics and law for the paramedic * Communication and reflective practice * Professional issues, including evidence-based practice, anti-discriminatory practice, clinical governance and clinical audit * Psychological perspectives on health and ill health * Safeguarding children * Sociological perspectives on health and ill health and social policy * Managing change and leadership theory * Continuing professional development The text prompts you to stop and think about what you have just read and relate this to your role. Throughout the book, the author carefully considers how the theory being discussed relates to the role of the ambulance clinician. Foundations for Paramedic Practice: A Theoretical Perspective is a core text for students of paramedic science and will also provide a valuable resource for students of allied health professions. This text provides a stepping stone to further reading and investigation. - Taken from the back cover of: Amanda Blaber - Foundations for paramedic practice: a theoretical perspective

Bridging the gap with teamwork: collaborative leadership for communities of practice in the learning and skills sector

Collaborative approaches in leadership and management are increasingly acknowledged to play a key role in successful institutions in the learning and skills sector (LSS) (Ofsted, 2004). Such approaches may be important in bridging the potential 'distance' (psychological, cultural, interactional and geographical) (Collinson, 2005) that may exist between 'leaders' and 'followers', fostering more democratic communal solidarity. This paper reports on a 2006-07 research project funded by the Centre for Excellence in Leadership (CEL) that aimed to collect and analyse data on 'collaborative leadership' (CL) in the learning and skills sector. The project investigated collaborative leadership and its potential for benefiting staff through trust and knowledge-sharing in communities of practice (CoPs). The project forms part of longer-term educational research investigating leadership in a collaborative inquiry process (Jameson et al., 2006). The research examined the potential for CL to benefit institutions, analysing respondents' understanding of and resistance to collaborative practices. Quantitative and qualitative data from senior managers and lecturers was analysed using electronic data in SPSS and Tropes Zoom. The project aimed to recommend systems and practices for more inclusive, diverse leadership (Lumby et al., 2005). Collaborative leadership has increasingly gained international prominence as emphasis shifted towards team leadership beyond zero-sum 'leadership'/ 'followership' polarities into more mature conceptions of shared leadership spaces, within which synergistic leadership spaces can be mediated. The relevance of collaboration within the LSS has been highlighted following a spate of recent government-driven policy developments in FE. The promotion of CL addresses concerns about the apparent 'remoteness' of some senior managers, and the 'neo-management' control of professionals which can increase 'distance' between leaders and 'followers' and may de-professionalise staff in an already disempowered sector. Positive benefit from 'collaborative advantage' tends to be assumed in idealistic interpretations of CL, but potential 'collaborative inertia' may be problematic in a sector characterised by rapid top-down policy changes and continuous external audit and surveillance. Constant pressure for achievement against goals leaves little time for democratic group negotiations, despite the desires of leaders to create a more collaborative ethos. Yet prior models of intentional communities of practice potentially offer promise for CL practice to improve group performance despite multiple constraints. The CAMEL CoP model (JISC infoNet, 2006) was linked to the project, providing one practical way of implementing CL within situated professional networks.The project found that a good understanding of CL was demonstrated by most respondents, who thought it could enable staff to share power and work in partnership to build trust and conjoin skills, abilities and experience to achieve common goals for the good of the sector. However, although most respondents expressed agreement with the concept and ideals of CL, many thought this was currently an idealistically democratic, unachievable pipe dream in the LSS. Many respondents expressed concerns with the 'audit culture' and authoritarian management structures in FE. While there was a strong desire to see greater levels of implementation of CL, and 'collaborative advantage' from the 'knowledge sharing benefit potential' of team leadership, respondents also strongly advised against the pitfalls of 'collaborative inertia'. A 'distance' between senior leadership views and those of staff lower down the hierarchy regarding aspects of leadership performance in the sector was reported. Finally, the project found that more research is needed to investigate CL and develop innovative methods of practical implementation within autonomous communities of professional practice.

The eLIDA CAMEL nomadic model of collaborative partnership for a community of practice in design for learning

A nomadic collaborative partnership model for a community of practice (CoP) in Design for Learning (D4L) can facilitate successful innovation and continuing appraisals of effective professional practice, stimulated by a 'critical friend' assigned to the project. This paper reports on e-learning case studies collected by the JISC-funded UK eLIDA CAMEL Design for Learning Project. The project implemented and evaluated learning design (LD) tools in higher and further education within the JISC Design for Learning pedagogic programme (2006-07). Project partners trialled professional user evaluations of innovative e-learning tools with learning design function, collecting D4L case studies and LD sequences in post-16/HE contexts using LAMS and Moodle. The project brought together learning activity sequences within a collaborative e-learning community of practice based on the CAMEL (Collaborative Approaches to the Management of e-Learning) model, contributing to international D4L developments. This paper provides an overview of project outputs in e-learning innovations, including evaluations from teachers and students. The paper explores intentionality in the development of a CoP in design for learning, reporting on trials of LD and social software that bridged tensions between formalised intra-institutional e-learning relationships and inter-institutional professional project team dynamic D4L practitioner interactions. Following a brief report of D4L case studies and feedback, the catalytic role of the 'critical friend' is highlighted and recommended as a key ingredient in the successful development of a nomadic model of communities of practice for managing professional e-learning projects. eLIDA CAMEL Partners included the Association of Learning Technology (ALT), JISC infoNet, three universities and five FE/Sixth Form Colleges. Results reported to JISC demonstrated D4L e-learning innovations by practitioners, illuminated by the role of the 'critical friend'. The project also benefited from formal case study evaluations and the leading work of ALT and JISC infoNet in the development of the CAMEL model.