The impact of nurse-directed protocolised-weaning from mechanical ventilation on nursing practice: A quasi-experimental study

Background:
Internationally, nurse-directed protocolised-weaning has been evaluated by measuring its impact on patient outcomes. The impact on nurses’ views and perceptions has been largely ignored.

Aim:
To determine the change in intensive care nurses’ perceptions, satisfaction, knowledge and attitudes following the introduction of nurse-directed weaning. Additionally, views were obtained on how useful protocolised-weaning was to practice.

Methods:
The sample comprised nurses working in general intensive care units in three university-affiliated hospitals. Nurse-directed protocolised-weaning was implemented in one unit (intervention group); two ICUs continued with usual doctor-led practice (control group). Nurses’ perceptions, satisfaction, knowledge and attitudes were measured by self-completed questionnaires before (Phase I) and after the implementation of nurse-directed weaning (Phase II) in all units.

Results:
Response rates were 79% (n=140n=140) for Phase 1 and 62% (n=132n=132) for Phase II. Regression-based analyses showed that changes from Phase I to Phase II were not significantly different between the intervention and control groups. Sixty-nine nurses responded to both Phase I and II questionnaires. In the intervention group, these nurses scored their mean perceived level of knowledge higher in Phase II (6.39 vs 7.17, p=0.01p=0.01). In the control group, role perception (4.41 vs 4.22, p=0.01p=0.01) was lower and, perceived knowledge (6.03 vs 6.63, p=0.04p=0.04), awareness of weaning plans (6.09 vs 7.06, p=0.01p=0.01) and satisfaction with communication (5.28 vs 6.19, p=0.01p=0.01) were higher in Phase II. The intervention group found protocolised weaning useful in their practice (75%): this was scored significantly higher by junior and senior nurses than middle grade nurses (p=0.02p=0.02).

Conclusion

We conclude that nurse-directed protocolised-weaning had no effect on nurses’ views and perceptions due to the high level of satisfaction which encouraged nurses’ participation in weaning throughout. Control group changes are attributed to a ‘reactive effect’ from being study participants. Weaning protocols provide a uniform method of weaning practice and are particularly beneficial in providing safe guidance for junior staff.

A methodological framework for studying policy coherence for development

The purpose of this article is to develop a methodological framework for analyzing Policy Coherence for Development (PCD). With this goal, we analyze different views of PCD in order to establish a comprehensive approach of Coherence adapted to globalization process. In this context, the article proposes a methodological framework based on four dimensions of analysis in CPD. In each dimen-sion, we set the areas and actors to investigate and we put forward research questions that could be use as a guide for a comprehensive approach to study PCD.

Factors affecting adherence to use of hip protectors amongst residents of nursing homes - A correlation study

Background: Hip protectors are protective pads designed to cover the greater trochanter and attenuate or disperse the force of a fall sufficiently to prevent a hip fracture. Promising results from randomised controlled trials in nursing homes have resulted in hip protectors being widely recommended in the health care literature and in national guidelines. Objectives: The objectives of the study were to identify characteristics of individual residents, and the organisational features of the homes in which they live, which may affect adherence to wearing hip protectors. Design: An observational, correlation study designed to identify factors related to adherence. Setting: Forty nursing and residential homes in the UK. Participants: 1346 residents of the homes who were not confined to bed and with no pressure sore on the hip. Methods: The introduction of an evidence-based policy to offer Safehips hip protectors to residents free of charge and with support from a nurse facilitator. Adherence to wearing the hip protectors was observed over 72 weeks. Results: Initial acceptance of the hip protectors was 37.2%. Continued adherence was 23.9% at 24 weeks; 23.2% at 48 weeks; and 19.9% at 72 weeks. Greater adherence was associated with the following individual resident characteristics: a greater degree of dependency (95% CI 1.39 - m3.78) and cognitive impairment (95% CI 1.01 - 2.98); being male rather than female (95% CI 1.06 - 2.48). Greater adherence was also associated with the following organisational characteristics of homes: fewer changes of senior manager during the study period (95% CI 1.01 - 8.51), and being resident in a home with a resident profile showing a greater proportion of residents with a higher degree of dependency (95% CI 1.04 - 1.27). There was wide a variation in the degree of success in implementation between homes (adherence of 0 - 100% at 24 weeks). Conclusions: Those implementing a policy of introducing hip protectors into nursing and residential homes should consider targeting residents with cognitive impairment. Such residents are at greater risk of hip fracture and appear to be more likely to continue wearing hip protectors. Those charged with implementing changes inpractice or policy should consider how the context for implementation can be optimised to increase the likelihood of success.

'Surfacing' Micropolitics as a Potential Management Change Frame

This paper considers the findings of a small-scale survey undertaken in a university department. Against a background of massification and commodification, the the increased level of responsibility and accountability has intensified political activity in general but at the micro level in particular. The conclusions of this research demonstrate that staff perceived power in the form of workload, appointment's and promotions were all contingent on the micro politics within the department and the affiliation to senior staff.

Uso problemático de las redes sociales en estudiantes universitarios

Los avances que están produciéndose en el ámbito académico con el surgimiento de herramientas de la Web 2.0 y el empleo masivo por parte de los estudiantes de la redes sociales para comunicarse entre ellos, está haciendo que el panorama educativo se encuentre ante unos desafíos a los que tiene que dar respuesta. La investigación que aquí se presenta tuvo como objetivo principal analizar el estado del empleo de la redes sociales por parte alumnado universitario, así como los posibles malos hábitos y usos problemáticos de las mismas. Se utilizó como instrumento de recogida de información un cuestionario “ad hoc” con un total de 23 ítems. Se concluye que el alumnado en general no posee malos hábitos en el empleo de las redes sociales, igualmente los resultados obtenidos ponen de manifiesto que su utilización no está plenamente integrada en las instituciones universitarias de educación superior, así como que los estudiantes no las emplean/usan como herramienta fundamental para las resolución de cuestiones académicas.

Host-based P2P flow identification and use in real-time

Data identification is a key task for any Internet Service Provider (ISP) or network administrator. As port fluctuation and encryption become more common in P2P traffic wishing to avoid identification, new strategies must be developed to detect and classify such flows. This paper introduces a new method of separating P2P and standard web traffic that can be applied as part of a data mining process, based on the activity of the hosts on the network. Unlike other research, our method is aimed at classifying individual flows rather than just identifying P2P hosts or ports. Heuristics are analysed and a classification system proposed. The accuracy of the system is then tested using real network traffic from a core internet router showing over 99% accuracy in some cases. We expand on this proposed strategy to investigate its application to real-time, early classification problems. New proposals are made and the results of real-time experiments compared to those obtained in the data mining research. To the best of our knowledge this is the first research to use host based flow identification to determine a flows application within the early stages of the connection.

Hillsborough: The Truth

Hillsborough: The Truth was first published in 1999 to universal acclaim. Established as the definitive, unique account of the disaster, in which 96 men, women and children died, hundreds were injured and thousands traumatised, it details the appalling treatment endured by the bereaved and survivors in the immediate aftermath and the inhumanity of the identification process. It reveals the inadequacies of the police investigations, official inquiries and inquests, uncovering the systematic review and alteration of South Yorkshire police statements conducted with the approval of police investigators and Lord Justice Taylor’s inquiry. It examines in depth the subsequent private prosecution and trial of two senior police officers in 2000. Using verbatim accounts, Scraton's detailed analysis demonstrates the inadequacy of legal processes and the remarkable breadth of judicial discretion, undermining and inhibiting such cases.

Powerful, disturbing and harrowing, Hillsborough: The Truth exposes the institutional complacency that made a tragedy on this scale inevitable. It shows the law’s failure to provide appropriate means of access, disclosure and redress for those facing the consequences of institutional neglect and personal negligence. And it tells how ordinary people suffer when those in authority sacrifice truth and accountability to protect their reputations. In this new edition Scraton reflects critically on two decades of policy and legal reform including crowd safety and inquest procedure and on the continuing struggles of the bereaved and survivors who have campaigned relentlessly for truth, acknowledgment and justice.

Learning and organization in the knowledge-based information economy: Initial findings from a participatory action research case study

This paper reports on an ongoing, multiphase, project-based action learning and research project. In particular, it summarizes some aspects of the learning climate and outcomes for a case study company In the software industry, Using a participatory action research approach, the learning company framework developed by Pedler et al, (1997) is used to initiate critical reflection in the company at three levels: managing director, senior management team and technical and professional staff. As such, this is one of the first systematic attempts to apply this framework to the entire organization and to a company in the knowledge-based learning economy. Two sets of issues are of general concern to the company: internal issues surrounding the company's reward and recognition policies and practices and the provision of accounting and control information in a business relevant way to all levels of staff; and external issues concerning the extent to which the company and its members actively learn from other companies and effectively capture, disseminate and use information accessed by staff in boundary-spanning roles. The paper concludes with some illustrations of changes being introduced by the company as a result of the feedback on and discussion of these issues.

Advanced educational parallel DSP system based on TMS320C25 processors

This paper describes the design, application, and evaluation of a user friendly, flexible, scalable and inexpensive Advanced Educational Parallel (AdEPar) digital signal processing (DSP) system based on TMS320C25 digital processors to implement DSP algorithms. This system will be used in the DSP laboratory by graduate students to work on advanced topics such as developing parallel DSP algorithms. The graduating senior students who have gained some experience in DSP can also use the system. The DSP laboratory has proved to be a useful tool in the hands of the instructor to teach the mathematically oriented topics of DSP that are often difficult for students to grasp. The DSP laboratory with assigned projects has greatly improved the ability of the students to understand such complex topics as the fast Fourier transform algorithm, linear and circular convolution, the theory and design of infinite impulse response (IIR) and finite impulse response (FIR) filters. The user friendly PC software support of the AdEPar system makes it easy to develop DSP programs for students. This paper gives the architecture of the AdEPar DSP system. The communication between processors and the PC-DSP processor communication are explained. The parallel debugger kernels and the restrictions of the system are described. The programming in the AdEPar is explained, and two benchmarks (parallel FFT and DES) are presented to show the system performance.

Risks and the financing of PPP: Perspectives from the financiers

Public private partnerships (PPP) are an established model for most governments internationally to provide infrastructure-based services, using private finance. Typically the public authority will sign a contract with a special purpose vehicle (SPV), which, because of the holistic nature of PPP, in turn sub-contracts the finance, design, construction, maintenance and soft services to companies that are often related to its shareholders. Thus there is a considerable network of linked organisations that together procure and provide the PPP project. While there is an increasing body of research that examines these PPP projects, much of it is interview or case study based so that the evidence is drawn from a small number of interviews or cases in specific sectors. It also focuses on the public sector procurer and the private sector contractor in the network of organisations. Although it has been recognised that the perceptions of the financiers may vary from those of other key PPP players there is much less research that focuses on the financiers. In this paper we report the results of a postal questionnaire survey, administered to 109 providers of senior debt and equity, from which the response rate was just less than 40%. We supplement these findings with a small number of illustrative quotes from interviewees, where the cited quote represents a commonly held view. We used SPSS and Nvivo to analyse the data. The findings show that when assessing PPPs financiers perceive a very wide range of risks as important, and that it is important to them that many of these risks are either insured or allocated to sub-contractors. When considering participating in PPPs, financiers agree that working with familiar partners on familiar projects and in familiar sectors is important, which may raise barriers to entry and undermine competitive processes.

Managing Cultural Diversity in Healthcare Partnerships: The Case of LIFT

Purpose: The National Health Service (NHS) Local Improvement Finance Trust (LIFT) programme was launched in 2001 as an innovative public-private partnership to address the historical under-investment in local primary care facilities in England. The organisations from the public and private sector that comprise a local LIFT partnership each have their own distinctive norms of behaviour and acceptable working practices - ultimately different organisational cultures. The purpose of this article is to assess the role of organisational culture in facilitating (or impeding) LIFT partnerships and to contribute to an understanding of how cultural diversity in public-private partnerships is managed at the local level. Design/methodology/approach: The approach taken was qualitative case studies, with data gathering comprising interviews and a review of background documentation in three LIFT companies purposefully sampled to represent a range of background factors. Elite interviews were also conducted with senior policy makers responsible for implementing LIFT policy at the national level. Findings: Interpreting the data against a conceptual framework designed to assess approaches to managing strategic alliances, the authors identified a number of key differences in the values, working practices and cultures in public and private organisations that influenced the quality of joint working. On the whole, however, partners in the three LIFT companies appeared to be working well together, with neither side dominating the development of strategy. Differences in culture were being managed and accommodated as partnerships matured. Research limitations/implications: As LIFT develops and becomes the primary source of investment for managing, developing and channelling funding into regenerating the primary care infrastructure, further longitudinal work might examine how ongoing partnerships are working, and how changes in the cultures of public and private partners impact upon wider relationships within local health economies and shape the delivery of patient care. Originality/value: To the authors' knowledge this is the first study of the role of culture in mediating LIFT partnerships and the findings add to the evidence on public-private partnerships in the NHS

The Development of Corporate Identity: A Political Perspective

A corporate identity denotes a set of attributes that senior managers ascribe to their organization. It is therefore an organizational identity articulated by a powerful interest group. It can constitute a claim which serves inter alia to justify the authority vested in top managers and to further their interests. The academic literature on organizational identity, and on corporate identity in particular, pays little attention to these political considerations. It focuses in an apolitical manner on shared meanings when corporate identity works, or on cognitive dissonance when it breaks down. In response to this analytical void, we develop a political analysis of corporate identity and its development, using as illustration a longitudinal study of successive changes in the corporate identity of a Brazilian telecommunications company. This suggests a cyclical model in which corporate identity definition and redefinition involve power relations, resource mobilization and struggles for legitimacy. © Blackwell Publishing Ltd 2007.

Research ethics committees: values and power in higher education

The rise of research governance structures in universities has created huge disquiet amongst academic researchers. The unquestioning adoption of a medical model of ethical review based upon positivist methodological assumptions has created for many a mismatch between their own ongoing ethical research practice and the process of obtaining clearance from Research Ethics Committees (REC). This paper examines the issues that have contributed to dissatisfaction with the ethical review model that is prevalent within the modern university. Using examples from the authors’ own experiences, the dynamics of values, interests and power in research governance is examined from multiple perspectives including that of REC member and applicant; lecturer/student supervisor; researcher; and
university administrator. The paper reveals a rift between the values and objectives of the key players in research governance within the modern university and concludes by asking whether differences can be resolved so that a collaborative approach to ethical review may be incorporated into a renewed academic research culture. It is suggested that the alternative is increasing alienation from anything to do with ‘ethics’, with potentially serious consequences for the ethical standards of social research.

Management of Barrett's esophagus in the UK: Overtreated and underbiopsied but improved by the introduction of a national randomized trial

OBJECTIVES: To assess the variation in practice of Barrett's esophagus (BE) management in comparison with accepted international guidelines before and after the introduction of a large BE randomized controlled trial (RCT) with protocols including those of tissue sampling.
DESIGN: A validated anonymized questionnaire was sent to 401 senior attending gastroenterologists asking for details of their current management of BE, especially histological sampling. Of the 228 respondents, 57 individuals (each from a different center) were in the first group to enter the ASPirin Esomeprazole (BE) Chemoprevention Trial (AspECT), and we assessed change in practice in these centers.
RESULTS: Ninety percent of specialists did not take adequate biopsies for histological diagnosis. Furthermore, 74% would consider aggressive surgical resection for prevalent cases of high-grade dysplasia in BE as their first-line choice despite the associated perioperative mortality. Ninety-two percent claim their lack of adherence to guidelines is because there is a need for stronger evidence for surveillance and medical interventions. Effect of the AspECT trial: Those clinicians in centers where the AspECT trial has started have improved adherence to ACG guidelines compared with their previous practice (P < 0.05). BE patients now get 18.8% more biopsies compared with previous practice, and 37.7% if the patient is entered into the AspECT trial (P < 0.01).
CONCLUSIONS: This large study indicates both wide variation in practice and poor compliance with guidelines. Because optimal histology is arguably the most important facet of BE management, the improvement in practice in centers taking part in the AspECT trial indicates an additional value of large international RCTs.