Peer-mentoring for first-time mothers from areas of socio-economic disadvantage: a qualitative study within a randomised controlled trial

Objective: To explore the difficulties experienced by lay-workers, women and health professionals involved in a peer-mentoring programme for first-time mothers living in socially disadvantaged areas. Design: Qualitative study; semi-structured interviews with lay-worker peer-mentoring programme participants at two separate stages of the programme (antenatal and postnatal). Setting: Community based. Participants: 11 women receiving peer-mentoring support (from first hospital antenatal visit to one year postnatal); 11 lay-workers; 2 research midwives. Results: Lay-workers had difficulty initiating contact with women and failure to establish contact affected their morale adversely. They felt that women understood their intended role poorly and attempted to develop relationships with them by sharing personal experiences and offering friendship; women who participated in the programme appreciated this. Developing a peer-mentor relationship was difficult if women lacked interest in the programme or in continuing contact. External influences on peer-mentoring uptake and delivery included family and friends who could prevent or encourage women’s participation and cause difficulties for the lay-worker both in delivering support and arranging follow-up. Lay-workers providing support to women from a different ethnic background experienced difficulties relating to both language and culture: these were perceived to affect peer-mentor relationships adversely. Major personal difficulties for lay-workers related to time constraints in reconciling mentoring requirements with demands of family and other work. Informing midwives of these difficulties helped identify solutions through training and ongoing professional support for the lay-workers. Conclusions: Lay-worker peer support is appreciated by first time mothers but difficulties in initiating contact, developing peer-mentor relationships and external influences such as family, ethnicity and time constraints are relevant to poor uptake and high staff turnover. In developing peer support programmes, awareness of potential difficulties and of how professional support can help resolve these should improve uptake and thus optimise the evaluations of their effectiveness.

Beyond the shadow space: architecture as a professional and creative process; during and post-conflict.

Introduction

Much has been written about the impact of conflict on the physical nature of cities; most obviously perhaps the damage, destruction, defensive construction and spatial reconfigurations that evolve in times of conflict. Set within the context of Belfast, Northern Ireland, this paper will focus on three areas. First, a closer reading of the long-term physical impact of conflict, in particular, the spatial forms and practices that persist conceptually and culturally, and/or resist re-conceptualisation. Secondly, the effect of conflict on the nature of architectural practice itself, considering whether issues such as appointment and procurement impacted on architectural expectation and the context of operation. Thirdly, the effect of conflict on people, in particular in relation to creativity and hence the psyche of practice itself. This section will also identify the conditions that undermine or support design quality and creativity not only within times of conflict but also as society evolves out of the shadow space. 1
Twelve years on from the Peace Agreement,2 it may seem remarkable from an external perspective that Northern Ireland still needs to be reflecting on its troubled past. But the immediate post-conflict phase offered the communities of Northern Ireland place and time to experience ‘normal life’, begin to reconcile themselves to the hurt they experienced and start to reconfigure their relationships to one another. Indeed, it has often been expressed that probing the issues too much, at too early a phase, might in fact ‘Open old wounds without resolving anything’ and/or ‘Destabilise the already fragile political system.’3 This tendency not to deliberate or be too probing is therefore understandable and might be the reason why, for example, Northern Ireland's first Architecture and Built Environment policy, published in June, 2006, contains only one routine reference to ‘the Troubles’.

Clearly, however, there is a time in the development of a healthy, functioning society, when in order effectively to plan its future, it must also carry out a closer reading and deeper understanding of its past. As Maya Angelou puts it, ‘History, despite its wrenching pain/ Cannot be unlived, and if faced/ With courage, need not be lived again.’4

Increasingly, those within the creative arts sector and the built environment professions are showing interest in carrying out that closer reading, teasing out issues around conflict. This was led in part by the recent publication of the Troubles Archive by the Arts Council of Northern Ireland.5 Those involved in the academic or professional development of future generations of architects are also concerned about the relevance of a post-conflict condition. As a profession, if architects purport to be concerned with context, then the almost tangible socio-political circumstances and legacy of Northern Ireland does inevitably require direct eye contact. This paper therefore aims to bring the relationship between conflict and architectural practice in Northern Ireland into sharp focus, not to constrain or dull creative practice but to heighten its potential.

The level playing field: the impact of assessment practice on professional development

Context: The effects of assessment practice on students’ learning are unclear, particularly regarding professional development. Corralling in objective structured clinical examinations (OSCEs) is designed to reduce illicit passing of examination information. Candidates completing an examination are kept secluded until the next cohort of examinees has begun. We used the introduction of corralling as a context in which to explore social influences on examination misconduct, with the aims of improving understanding of the hidden effects of assessment, and evaluating the acceptability of corralling from the student perspective.

Methods: A questionnaire was administered to students corralled post-OSCE for the first time. Eleven semi-structured interviews were subsequently conducted. Questionnaire data were analysed for descriptive statistics and thematic analysis of interview transcripts was carried out.

Results: The questionnaire response rate was 95.4% (251/263). Before corralling, 80.9% (203/251) of students were aware of the sharing of information among peers and 78.5% (197/251) agreed that such misconduct was unprofessional. The majority were in favour of corralling (90.8%, 228/251). Four themes emerged from the semi-structured interviews: the student network versus the individual; assessment-driven culture; the deferring of professionalism, and the ‘level playing field’. Students saw interaction within the student network, on a background of assessment-driven culture, as the key driver in examination misconduct. Conforming to the rules of the social network was prioritised over individual agency, although the mismatch between the rules of the network and the dominant professional discourse caused some conflict for individuals. Deferred professionalism (described as the practice of taking on the norms of professional behaviour only when qualified) was a rationalisation used to minimise this conflict. Corralling provided a ‘level playing field’ in which the influences of the network were minimised.

Conclusions: Examination misconduct is thus a complex social construction with implications for individual learners in terms of professional development. Corralling is one mechanism for addressing misconduct that is acceptable to students, but assessment processes have important hidden effects which educators should acknowledge.

Hip protectors to prevent hip fractures - a waste of time and money?

Abstract:
Background: An estimated 30-60% of older
adults fall every year and about 1% of falls result in a hip fracture. Hip fracture is a serious and growing problem, with a 3-10 fold rise in worldwide incidence predicted by 2050 (Gullberg, et al 1997). Hip protectors are underwear with built in protection for the greater trochanter. They are designed to prevent hip fractures by dispersing or absorbing the force of a fall. Trials
published to 2001 were broadly supportive of
the effectiveness of hip protectors, and this
was reflected in a Cochrane review in 2000.
However, earlier trials were methodologically
flawed and subsequent trials have not demonstrated effectiveness. The most recent Cochrane review describes only a marginal benefit (Parker et al, 2005).
Review and Discussion: This presentation
evaluates the current evidence for the use
of hip protectors and discusses the use of
that evidence by manufacturers, suppliers,
professional groups and guideline developers.
Interestingly, despite the limitations of the
evidence base, most advice has been broadly
supportive. Reasons for this are proposed
and discussed in the context of a critique of
evidence-based healthcare. protectors. However, the available evidence can be used in different ways and for different purposes by those with an interest in promoting
the use of hip protectors. A conservative
approach is warranted, where, if we cannot
demonstrate that hip protectors work, we
presume that they do not. This presentation will be of use to practitioners wanting to evaluate the evidence base for hip protectors (and other recommended interventions) on behalf of clients. It will also be of interest to policy makers who must assess the claims made for health care technologies as part of the decisionmaking process.
Recommended reading:
Gullberg B, Johnell O, Kanis JA (1997) Worldwide
projections for hip fracture. Osteoporos
Int. 7(5):407-13 .
Parker MJ, Gillespie WJ, Gillespie LD (2005) Hip
protectors for preventing hip fractures in older
people. The Cochrane Database of Systematic
Reviews Issue 3. Art. No.: CD001255.pub3. DOI:
10.1002/14651858.CD001255.pub3.

(Re)-Introducing Themes of Religion and Spirituality to Professional Social Work Training in the Land of ‘Saints and Scholars’.

This chapter begins by alluding to Ireland’s historical reputation as the land of “Saints and Scholars” and then briefly charts its demise from this position. A parallel process in relation to religiously motivated provision of health and social care is outlined. The inclusion of themes of religion and spirituality within the current professional social work codes in the USA and Britain and the framework for social work training in Northern Ireland is noted. In this context the lack of any substantive inclusion of themes of religion and/or spirituality within the Bachelor of Social Work (BSW) degree at Queens University Belfast will be situated. A series of intersecting reasons for this lack of inclusion are proposed in terms of the experience of living through the recent troubled history of Northern Ireland and a variety of biases in academic thought.
A rationale for the re-introduction of inputs on religion and spirituality is articulated in terms of the widespread resurgence of these themes within health and social care and psychotherapy literature and the new emphasis on practicing in culturally sensitive ways in Britain. The first steps to re-introduce these themes under the higher context marker of “culturally competent practice” are described and an analysis of data from the students’ feedback presented along with illustrative quotations. The dissonance between the initial misgivings of staff and the overwhelmingly positive responses of students are highlighted. The chapter concludes with a discussion of lessons learned through the process with an emphasis on how the inclusion of these themes can result in better practice for service users, including those impacted by “the Troubles” in Northern Ireland.

Medication use review in Qatar: Are community pharmacists prepared for the extended professional role?

Background
The incidence of chronic illnesses is increasing globally. Non-adherence to medications and other medication-related problems are common among patients receiving long-term medications. Medication use review (MUR) is a service provision with an accredited pharmacist undertaking structured, adherence-centered reviews with patients receiving multiple medications. MUR services are not yet available in community pharmacies in Qatar.

Objective
The current study aims to evaluate community pharmacists' knowledge, attitudes, and perception towards establishing MUR as an extended role in patient care.

Setting
Private community pharmacies in Qatar including chains and independent pharmacies.

Methodology
A cross-sectional survey using a self-administered questionnaire was conducted among licensed community pharmacists from December 2012 to January 2013. Data analysis was conducted using descriptive and inferential statistics.

Main outcome measures
Knowledge, attitudes, and practices related to MUR concept and services.

Results A total of 123 participants responded to the survey (response rate 56 %). The mean total knowledge score was 71.4 ± 14.7 %. An overwhelming proportion of the participants (97 %) were able to identify the scope of MUR in relation to chronic illnesses and at enhancing the quality of pharmaceutical care. Furthermore, 80 % of the respondents were able to identify patients of priority for inclusion in an MUR program. However, only 43 % of the participants knew that acute medical conditions were not the principal focus of an MUR service, while at least 97 % acknowledged that the provision of MUR services is a great opportunity for an extended role of community pharmacists and that MUR makes excellent use of the pharmacist's professional skills in the community. The participants generally reported concerns about time, dedicated consultation area, and support staff as significant barriers towards MUR implementation.

Conclusion
This study suggests that community pharmacists in Qatar had sufficient knowledge about the concept of MUR and its scope, but there were still important deficiencies that warrant further education. The findings have important implications on policy and practice pertaining to the implementation of MUR as an extended role of pharmacists and as part of Qatar's National Health Strategy to move primary health care forward.

Empathy in UK pharmacy students: assessing differences by gender, level in the degree programme, part-time employment and medical status

Background: Empathy is an important aspect of patient–healthcare professional interactions.Aims: To investigate whether gender, level in the degree programme, employment and health status affected empathy scores of undergraduate pharmacy students.Method: All undergraduate pharmacy students (n=529) at Queen’s University Belfast were invited via email to completean online validated empathy questionnaire. Empathy scores were calculated and non-parametric tests used to determine associations between factors.Results: Response rate was 60.1% (318/529) and the mean empathy score was 106.19. Scores can range from 20 to 140,with higher scores representing a greater degree of empathy. There was no significant difference between genders (p=0.211). There was a significant difference in scores across the four levels of the programme (p<0.001); scores were lowest at Level 1 and greatest at Level 4 (final year). There were no significant differences in scores for respondents who had a part-time job, a chronic condition, or took regular medication in comparison to those who did not (p=0.028,p=0.880, p=0.456, respectively).Conclusion: A reasonable level of empathy was found relative to other studies; this could be further enhanced at lower levels of the degree pathway.

Professional development for professional learners: teachers’ experiences in Norway, Germany and England

Proposals made by the European Commission in 2007 led to the Education Council adopting, for the first time, a European agenda for improving the quality of teaching and teacher education. This article reports on a small-scale longitudinal interview-based study with teachers in England, Norway and Germany demonstrating that while opportunities for professional development are increasing in all three countries, dissatisfaction is expressed by most teachers in relation to its quality and outcomes.

Best Practice for Providing Social Care and Support to People Living with Concurrent Sight Loss and Dementia: Professional Perspectives

Purpose-Approximately 100,000 people in the UK aged 75 and over have concurrent dementia and sight loss, but current understanding of their experiences, needs and preferences is limited. The purpose of this paper is to report on a research project that explored the provision of social care and support for older people with both conditions. Design/methodology/approach-The project was a collaboration between the universities of York, Worcester, Bournemouth and Cambridge, supported by the Thomas Pocklington Trust and the Housing and Dementia Research Consortium. Data for this paper were drawn from focus groups held in 2013 involving 47 professionals across the dementia, sight loss and housing sectors. Findings-Thematic analysis identified five main barriers to providing high-quality, cost-effective social care and support: time constraints; financial limitations; insufficient professional knowledge; a lack of joint working; and inconsistency of services. The requirements of dementia and sight loss often conflict, which can limit the usefulness of equipment, aids and adaptations. Support and information needs to address individual needs and preferences. Research limitations/implications-Unless professionals consider dementia and sight loss together, they are unlikely to think about the impact of both conditions and the potential of their own services to provide effective support for individuals and their informal carers. Failing to consider both conditions together can also limit the availability and accessibility of social care and support services. This paper is based on input from a small sample of self-selecting professionals across three geographical regions of England. More research is needed in this area. Practical implications-There are growing numbers of people living with concurrent dementia and sight loss, many of whom wish to remain living in their own homes. There is limited awareness of the experiences and needs of this group and limited provision of appropriate services aids/adaptations. A range of measures should be implemented in order to support independence and well-being for people living with both conditions and their family carers. These include increased awareness, improved assessment, more training and greater joint working. Social implications-People living with dementia or sight loss are at high risk of social isolation, increasingly so for those with both conditions. Services that take an inclusive approach to both conditions can provide crucial opportunities for social interaction. Extra care housing has the potential to provide a supportive, community-based environment that can help residents to maintain social contact. Originality/value-This paper adds much-needed evidence to the limited existing literature, and reflects the views of diverse professionals across housing, health and social care

E-learners’ experiences of time

This paper explores the experiences of e-learners participating in continuing professional development programmes in three UK universities. Data was collected using questionnaires, discussion group postings and informal telephone interviews. These were analysed using two approaches to content analysis: a coding scheme and metaphors. Findings indicated that: e-learners reconstruct their approaches to time management at an early stage in their programme; the e-learners developed different time management strategies (planned, opportunistic, planned/opportunistic); and metaphors illustrated their underlying experiences of time. These provide the basis of recommendations for e-tutors. Finally, the paper explores methodological issues and outlines some implications for practice.

Teacher educators: proposing new professional development models within an English further education context

At a time of increasing public and government focus on the quality of teacher education, little is known about the professional development needs of those who teach teachers in further education (FE). Yet they are crucial players. Efforts are intensifying across a significant number of countries to promote the professional development of teacher educators, but there is little support for new or experienced practitioners and no substantive professional standards regarding this role in English FE. This has an impact on the professional practice and career trajectories of teacher educators themselves. Based on a series of semi-structured interviews, an online survey and focus groups, this mixed-methods study uses a sequential exploratory design. The study captures the voices of English FE teacher educators who identified mentoring, induction and a choice of continuous professional development sessions as important strategies to improve the effectiveness of their role over time. This article will propose flexible models of professional development, following an analysis of new and experienced teacher educators’ needs in FE in England. The article recommends that new professional standards for teacher educators could be written collaboratively by practitioners, within a policy and institutional framework which supports the scholarship and research requirements of teacher educators.

Exploring the personal and professional lives of teachers in the search for authenticity /

"We teach who we are" (Palmer, 1998, p. 2). This simple, yet profound, statement was the catalyst that began my thesis journey. Using a combination of self-study and participant narratives, Palmer's idea was explored as search for authenticity. The self-study component of this narrative was enhanced by the stories of two other teachers, both women. I chose to use narrative methodology to uncover and discover the relationship between the personal and professional lives of being a teacher. Do teachers express themselves daily in their classrooms? Do any lessons from the classroom translate into teachers' personal lives? The themes of reflection, authenticity, truth, and professional development thread themselves throughout this narrative study. In order to be true to myself as a teacher/researcher, arts-based interpretations accompany my own and each participant's profile. Our conversations about our pasts, our growth as teachers and journeys as individuals were captured in poetry and photographic mosaics. Through rich and detailed stories we explored who we are as teachers and how we became this way. The symbiotic relationship between our personal and professional lives was illustrated by tales of bravery, self-discovery, and reflection. The revelations uncovered illustrate the powerful role our past plays in shaping the present and potentially the friture. It may seem indulgent to spend time exploring who we are as teachers in a time that is increasingly focused on improving student test scores. Yet, the truth remains that, "Knowing myself is as crucial to good teaching as knowing my students and my subject" (Palmer, 1998, p. 2).

The impact of hospital downsizing on registered nurses displaced from full-time employment

This research identified and explored the various responses often women Registered Nurses displaced from full-time elnployment as staff nurses in general hospitals in southern Ontario. These nurses were among the hundreds in Ontario who were displaced between October 1991 and October 1995 as a result of organizational downsizing and other health care reform initiatives. The purpose ofthis research was to document tIle responses of nurses to job displacement, and how that experience impacted on a nurse's professional identity and her understanding of the nature and utilization of nursing labour. This study incorporated techniques consistent with the principles of naturalistic inquiry and the narrative tradition. A purposive sample was drawn from the Health Sector Training and Adjustment Program database. Data collection and analysis was a three-step process wherein the data collection in each step was informed by the data analysis in the preceding step. The main technique used for qualitative data collection was semistructured, individual and group interviews. Emerging from the data was a rich and textured story ofhow job displacement disrupted the meaningful connections nurses had with their work. In making meaning of this change, displaced nurses journeyed along a three-step path toward labour adjustment. Structural analysis was the interpretive lens used to view the historical, sociopolitical and ideological forces which constrained the choices reasonably available to displaced nurses while Kelly's personal construct theory was the lens used to view the process of making choices and reconstruing their professional identity.

The person inside the nurse : the professional socialization of baccalaureate nursing students

The goal ofthis research was to gain an understanding ofthe process ofprofessional socialization by accessing role meaning ofstudents engaged in a BScN program. Students from each ofthe four years and faculty members from the school ofnursing volunteered as participants. G. Kelly's (1955) Personal Construct Theory provided the framework to determine awareness and constructed meanings. A reflective tool, called LifeMapping, was adapted and utilized to relate student experiences within education that have attributed to nurse role meaning. Focus group interviews verified data interpretation. Students are informed oftheir choice to study nursing through part-time and volunteer work, secondary school cooperative placements. Descriptions reveal that choices are tested and both positive and negative aspects ofthe role observed. Bipolar images of good and bad nurses seem to be context-related. These images may establish biases in choices related to learning experiences. The person inside ofeach aspiring nurse interprets, revises and understands experiences to incorporate individual meaning into their value and belief structures. Students are aware ofchanges and descnbe them as developments that occur personally up to Year ill and role-image changes that begin in Year II. The major difficulty that students encountered was descnbed as negative attitudes towards their anticipated role. Humanistic-interactionist philosophies are echoed in student accounts of learning experiences. Growth and role development corresponds to process factors of small group, problem-base learning.

An exploration of the impact of a mandatory quality assurance program on the staff nurse's commitment to professional development /

This study explored experiences in relation to the impact of the College of Nurses of Ontario's (CNO's) mandatory Quality Assurance (QA) program on registered nurses (RNs) working in a clinical setting of an acute care hospital. A qualitative descriptive research design was used and data collection was done in 2 stages. First, a survey with open-ended questions was given to 45 nurses. Second, 8 respondents from the survey were interviewed using a semistructured format. Data were obtained from 2 groups-diploma-prepared and post diploma-prepared RNs. Findings demonstrated that the CNO's QA program had varying influences on the RNs' learning paths, and these differences appeared to be related to the educational background of the individual. The diploma-prepared nurses reported that their commitment to professional development was influenced by their level of internal motivation, the pressures associated with time, and the need for a strong external motivator, namely the obligation of management to conduct formal performance appraisals. They further reported that the QA program played a part in positively altering their commitment to continuing education. The post-diploma baccalaureate nurses reported that the QA program played a positive role in influencing their ongoing learning, along with their level of internal motivation, the work and health care environment, and the element of professionalism. Several implications for nursing practice, theory, and fiirther research also became evident.