Characteristics and experiences of past participants in the Texas Peer Assistance Program for Nurses

There are nearly 200,000 licensed practicing nurses in the state of Texas, representing one-tenth of the nations' workforce. The prevalence of substance abuse among nurses is estimated to range between six and 20 percent in this professional group.^ Since March 1987, the Texas Peer Assistance Program for Nurses (TPAPN) has offered intervention, education, support and monitoring to nurses in Texas whose practice has become impaired due to substance abuse and/or mental illness. Since then approximately 44 percent of nurses who voluntarily signed participation agreements successfully completed the program; fifty-six percent have not. One determinant of completion for those nurses identified as chemically dependent is abstinence from mood altering substances. Other helping professions report higher rates of abstinence two years following treatment.^ The purpose of this study was to investigate the relationship between relapse, demographics, treatment variables, work setting, "stress" indicators and support factors for nurses who participated in TPAPN. A questionnaire was mailed to 1000 randomly selected nurses who had signed agreements since 1987 and were no longer active in the program. More than 41% of the questionnaires were returned undeliverable.^ Recipients of the questionnaire were known only to TPAPN, never to the investigator. All information was received anonymously except when the participant chose to sign the questionnaire. A cover letter explaining the study and inviting participation was enclosed. Completion and return of the questionnaire was considered consent to participate.^ Findings demonstrated a significant relationship between relapse and opiates as the drug of choice for past participants in the Texas Peer Assistance Program for Nurses. Significant associations were found among factors such as control at work, support, physical complaints, job security, self-esteem and employment in this sample. Respondents shared copious written comments about their experiences in TPAPN. These data were analyzed using qualitative methods and compared with similar studies of recovering nurses. Further research with nurses whose practice has been affected by abuse of chemical and mental illness is warranted. ^

Urban Archaeology in Madrid. Experiences and Opportunities to Understand Historical City

In 2015, it will be thirty years since Spanish Historic Heritage Law from 1985 was approved. The results after three decades under this law are necessarily positive and witness how the complex autonomous regional legislation has been promoted, guided and organized in this Heritage field. In addition, the law enforcement has brought into the scene how the numerous public and private initiatives involved in caring, managing, protecting and restoring our cultural heritage have been channeled and regulated, as well as monitoring the impact these initiatives produce on urban archaeology. During this long period of Spanish recent history, cultural heritage -understood as an important development tool, especially when related to cultural tourism- has succeeded in channeling resources for developing the historical research projects, both documental and archaeological, that the Spanish monumental urban ensembles were requiring. In this context, the case of the city of Madrid is a clear example of the significant development that urban Historical Archaeology has experienced in Spain over the last thirty years, especially when dealing with the study of the Middle Ages (8th to 15th centuries) and the Modern Age (16th to 18th centuries). Given the number of interventions and the important results obtained by many of them, Madrid urban archaeology is an extraordinary example of the consequences of implementing new management models, changing criteria and operating procedures, and also, of course, of the conflicts and debates raised regarding heritage, as well as the importance these interventions have implied, which is the main aim of this work.

A quantitative assessment of students’ experiences of studying music: a Spanish perspective on the European credit transfer system (ECTS)

The purpose of this investigation is to evaluate whether or not the allocation of time proposed in the Music Study Guide, adapted from the European Higher Education Area (EHEA) guidelines, is consistent and adequate for students with minimal musical knowledge. The report takes into account the importance of students’ previous knowledge and the relation this has to the time and effort expended by students in acquiring appropriate knowledge and skills. This is related also to the adequacy of the course specification to meet the demands of university study and the labour market. Results show that those students who enrolled at university without any previous musical knowledge are likely to experience significant difficulty in the acquisition of certain musical and professional competences. This highlights a need to reinforce the music curriculum, or establish zero-level courses, in order to enable such students to succeed in the subject.

The Theory of Interhybridity: Socio-political Dimensions and Migration Experiences of Post-communist Western Balkan States

The Western Balkans integration within the EU has started a legal process which is the rejection of former communist legal/political approaches and the transformation of former communist institutions. Indeed, the EU agenda has brought vertical/horizontal integration and Europeanization of national institutions (i.e. shifting power to the EU institutions and international authorities). At this point, it is very crucial to emphasize the fact that the Western Balkans as a whole region has currently an image that includes characteristics of both the Soviet socialism and the European democracy. The EU foreign policies and enlargement strategy for Western Balkans have significant effects on four core factors (i.e. Schengen visa regulations, remittances, asylum and migration as an aggregate process). The convergence/divergence of EU member states’ priorities for migration policies regulate and even shape directly the migration dynamics in migrant sender countries. From this standpoint, the research explores how main migration factors are influenced by political and judicial factors such as; rule of law and democracy score, the economic liberation score, political and human rights, civil society score and citizenship rights in Western Balkan countries. The proposal of interhybridity explores how the hybridization of state and non-state actors within home and host countries can solve labor migration-related problems. The economical and sociopolitical labor-migration model of Basu (2009) is overlapping with the multidimensional empirical framework of interhybridity. Indisputably, hybrid model (i.e. collaboration state and non-state actors) has a catalyst role in terms of balancing social problems and civil society needs. Paradigmatically, it is better to perceive the hybrid model as a combination of communicative and strategic action that means the reciprocal recognition within the model is precondition for significant functionality. This will shape social and industrial relations with moral meanings of communication.

Ambivalent 'selves': Japanese women's diasporic experiences in Australian higher education

In an age of globalisation and internationalisation, how women learn to represent themselves in terms of their cultural, social and gender identities in the wider world is significant. A group of 17 Japanese women studying in postgraduate courses in three Australian universities were interviewed for part of this longitudinal project, and their case studies are presented in this paper to portray the women's lived experiences and interpret how higher education overseas affects their reconstruction of their 'selves' and traditional Japanese femininity. I set my analytic framework through a discussion of the forceful globalisation of higher education and discourses of identity and 'self', and then analyse the present status of Japanese women in contemporary Japan. I then provide excerpts of the women's narratives which indicate ambivalent 'selves' in transition. Two possibilities have arisen from their narratives to illuminate this ambivalence - one possibility is that women's positive experiences in Australia and their increased and diverse exposure to and experience of other cultures may influence cultural change such as the transformation of constructs of women at home, and challenge existing identity and femininity discourses in Japan. The second possibility is that negative aspects of their 'diasporic experiences' can also articulate other complex identity politics, such as Japanese women's 'double marginalisation' which means being both a woman and a member of an ethnic minority group, conflicts between the homogenisation of 'Asian women' and representations of 'new Japanese women', and their sense of belongingness to their original culture. These contradictory phenomena of identity formations within Japanese women have the potential to shift the debate and challenge current essentialist views of hegemonic homogenisation of regional identities.

Inequalities in retail choice: exploring consumer experiences in suburban neighbourhoods

Focuses on deprived neighbourhoods where instances of “food deserts” have been found and explores, through focus groups, consumer experiences of food store choices. Focusing on suburban neighbourhoods in Portsmouth, identifies significant differences in experiences of choice both between and within neighbourhoods. In some localities, the research also finds dissatisfaction with the (supposedly-coveted) “small local store”. Shows that choice is very different from provision, and conceptualises how consumers’ circumstances, situation and individual characteristics can significantly reduce a broad theoretical provision of food stores to a limited set of perceived real choices.

Patient anxiety and experiences associated with an outpatient "one-stop" "see and treat" hysteroscopy clinic

BACKGROUND: "One-stop" outpatient hysteroscopy clinics have become well established for the investigation and treatment of women with abnormal uterine bleeding. However, the advantages of these clinics may be offset by patient factors such as anxiety, pain, and dissatisfaction. This study aimed to establish patients' views and experiences of outpatient service delivery in the context of a one-stop diagnostic and therapeutic hysteroscopy clinic, to determine the amount of anxiety experienced by these women and compare this with other settings, and to determine any predictors for patient preferences. METHODS: The 20-item State-Trait Anxiety Inventory was given to 240 women attending a one-stop hysteroscopy clinic: to 73 consecutive women before their appointment in a general gynecology clinic and to 36 consecutive women attending a chronic pelvic pain clinic. The results were compared with published data for the normal female population, for women awaiting major surgery, and for women awaiting a colposcopy clinic appointment. In addition, a questionnaire designed to ascertain patients' views and experiences was used. Logistic regression analysis was used to delineate the predictive values of diagnostic or therapeutic hysteroscopy, and to determine their effect on the preference of patients to have the procedure performed under general anesthesia in the future. RESULTS: Women attending the hysteroscopy clinic in this study reported significantly higher levels of anxiety than those attending the general gynecology clinic (median, 45 vs 39; p = 0.004), but the levels of anxiety were comparable with those of women attending the chronic pelvic pain clinic (median, 45 vs 46; p = 0.8). As compared with the data from the normal female population (mean, 35.7) and those reported for women awaiting major surgery (mean, 41.2), the levels of anxiety experienced before outpatient hysteroscopy clinic treatment were found to be higher (mean, 45.7). Only women awaiting colposcopy (6-item mean score, 51.1 +/- 13.3) experienced significantly higher anxiety scores than the women awaiting outpatient hysteroscopy (6-item mean score, 47.3 +/- 13.9; p = 0.002). Despite their anxiety, most women are satisfied with the outpatient hysteroscopy "see and treat" service. High levels of anxiety, particularly concerning pain but not operative intervention, were significant predictors of patients desiring a future procedure to be performed under general anesthesia. CONCLUSIONS: Outpatient hysteroscopy is associated with significant anxiety, which increases the likelihood of intolerance for the outpatient procedure. However, among those undergoing operative therapeutic procedures, dissatisfaction was not associated with the outpatient setting.

Pregnancy loss in lesbian and bisexual women: An online survey of experiences

Background: Although pregnancy loss is a distressing health event for many women, research typically equates women’s experiences of pregnancy loss to ‘married heterosexual women’s experiences of pregnancy loss’. The objective of this study was to explore lesbian and bisexual women’s experiences of miscarriage, stillbirth and neonatal death. Methods: This study analysed predominantly qualitative online survey data from 60 non-heterosexual, mostly lesbian, women from the UK, USA, Canada and Australia. All but one of the pregnancies was planned. Most respondents had physically experienced one early miscarriage during their first pregnancy, although a third had experienced multiple losses. Results: The analysis highlights three themes: processes and practices for conception; amplification of loss; and health care and heterosexism. Of the respondents, 84% conceived using donor sperm; most used various resources to plan conception and engaged in preconception health care. The experience of loss was amplified due to contextual factors and the investment respondents reported making in impending motherhood. Most felt that their loss(es) had made a ‘significant’/‘very significant’ impact on their lives. Many respondents experienced health care during their loss. Although the majority rated the overall standard of care as ‘good’/‘very good’/‘outstanding’, a minority reported experiencing heterosexism from health professionals. Conclusions: The implications for policy and practice are outlined. The main limitation was that the inflexibility of the methodology did not allow the specificities of women’s experiences to be probed further. It is suggested that both coupled and single non-heterosexual women should be made more visible in reproductive health and pregnancy loss research.

Experiences in using a contingency factor-based validation methodology for spreadsheet DSS

The use of spreadsheets has become routine in all aspects of business with usage growing across a range of functional areas and a continuing trend towards end user spreadsheet development. However, several studies have raised concerns about the accuracy of spreadsheet models in general, and of end user developed applications in particular, raising the risk element for users. High error rates have been discovered, even though the users/developers were confident that their spreadsheets were correct. The lack of an easy to use, context-sensitive validation methodology has been highlighted as a significant contributor to the problems of accuracy. This paper describes experiences in using a practical, contingency factor-based methodology for validation of spreadsheet-based DSS. Because the end user is often both the system developer and a stakeholder, the contingency factor-based validation methodology may need to be used in more than one way. The methodology can also be extended to encompass other DSS.

Managing wireless networks in the healthcare sector:emerging experiences of cultural impacts

The existing body of knowledge has generally supported that organizational culture plays a significant role in shaping group identity, work pattern, communication schemes, and interpersonal relations; all of these cultural elements are important organizational factors that shape workplaces and operational routines. In the context of emerging information technology, it has also been suggested that organizational culture could affect IT implementation and management. However, little is known about how emerging information technology shapes organizational culture, which in turn helps reshape the organization as a whole. The purpose of this paper is thus to build empirical understanding of how IT in general and emerging wireless networks in particular reshapes organizational culture. Case studies conducted in two hospitals situated in southwest U.S.A. illustrated that the implementation of wireless networks indeed helped shape and/or reshape organizational culture in the healthcare sector and in turn enhance healthcare organizations’ competitiveness in the marketplace. For IT managers and practitioners in healthcare institutions, effective strategy to plan and manage emerging ITs such as wireless networks will thus have long-term implications on cultivating organizational culture that could eventually reshape workplace and competitiveness.

Patient experiences of serious adverse drug reactions and their attitudes to medicines:a qualitative study of survivors of Stevens-Johnson syndrome and toxic epidermal necrolysis in the UK

Background: Adverse drug reactions (ADRs) cause significant morbidity and mortality and account for around 6.5% of hospital admissions. Patient experiences of serious ADRs and their long-term impact on patients' lives, including their influence on current attitudes towards medicines, have not been previously explored. Objective: The aim of the study was to explore the experiences, beliefs, and attitudes of survivors of serious ADRs, using drug-induced Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) as a paradigm. Methods: A retrospective, qualitative study was undertaken using detailed semi-structured interviews. Fourteen adult survivors of SJS and TEN, admitted to two teaching hospitals in the UK, one the location of a tertiary burns centre, were interviewed. Interview transcripts were independently analysed by three different researchers and themes emerging from the text identified. Results: All 14 patients were aware that their condition was drug induced, and all but one knew the specific drug(s) implicated. Several expressed surprise at the perceived lack of awareness of the ADR amongst healthcare professionals, and described how the ADR was mistaken for another condition. Survivors believed that causes of the ADR included (i) being given too high a dose of the drug; (ii) medical staff ignoring existing allergies; and (iii) failure to monitor blood tests. Only two believed that the reaction was unavoidable. Those who believed that the condition could have been avoided had less trust in healthcare professionals. The ADR had a persisting impact on their current lives physically and psychologically. Many now avoided medicines altogether and were fearful of becoming ill enough to need them. © 2011 Adis Data Information BV. All rights reserved. Conclusions: Life-threatening ADRs continued to affect patients’ lives long after the event. Patients’ beliefs regarding the cause of the ADR differed, and may have influenced their trust in healthcare professionals and medicines. We propose that clear communication during the acute phase of a serious ADR may therefore be important.

Is pregnancy a teachable moment for diet and physical activity behaviour change? An interpretative phenomenological analysis of the experiences of women during their first pregnancy

OBJECTIVES: Pregnancy may provide a 'teachable moment' for positive health behaviour change, as a time when women are both motivated towards health and in regular contact with health care professionals. This study aimed to investigate whether women's experiences of pregnancy indicate that they would be receptive to behaviour change during this period. DESIGN: Qualitative interview study. METHODS: Using interpretative phenomenological analysis, this study details how seven women made decisions about their physical activity and dietary behaviour during their first pregnancy. RESULTS: Two women had required fertility treatment to conceive. Their behaviour was driven by anxiety and a drive to minimize potential risks to the pregnancy. This included detailed information seeking and strict adherence to diet and physical activity recommendations. However, the majority of women described behaviour change as 'automatic', adopting a new lifestyle immediately upon discovering their pregnancy. Diet and physical activity were influenced by what these women perceived to be normal or acceptable during pregnancy (largely based on observations of others) and internal drivers, including bodily signals and a desire to retain some of their pre-pregnancy self-identity. More reasoned assessments regarding benefits for them and their baby were less prevalent and influential. CONCLUSIONS: Findings suggest that for women who conceived relatively easily, diet and physical activity behaviour during pregnancy is primarily based upon a combination of automatic judgements, physical sensations, and perceptions of what pregnant women are supposed to do. Health professionals and other credible sources appear to exert less influence. As such, pregnancy alone may not create a 'teachable moment'. Statement of contribution What is already known on this subject? Significant life events can be cues to action with relation to health behaviour change. However, much of the empirical research in this area has focused on negative health experiences such as receiving a false-positive screening result and hospitalization, and in relation to unequivocally negative behaviours such as smoking. It is often suggested that pregnancy, as a major life event, is a 'teachable moment' (TM) for lifestyle behaviour change due to an increase in motivation towards health and regular contact with health professionals. However, there is limited evidence for the utility of the TM model in predicting or promoting behaviour change. What does this study add? Two groups of women emerged from our study: the women who had experienced difficulties in conceiving and had received fertility treatment, and those who had conceived without intervention. The former group's experience of pregnancy was characterized by a sense of vulnerability and anxiety over sustaining the pregnancy which influenced every choice they made about their diet and physical activity. For the latter group, decisions about diet and physical activity were made immediately upon discovering their pregnancy, based upon a combination of automatic judgements, physical sensations, and perceptions of what is normal or 'good' for pregnancy. Among women with relatively trouble-free conception and pregnancy experiences, the necessary conditions may not be present to create a 'teachable moment'. This is due to a combination of a reliance on non-reflective decision-making, perception of low risk, and little change in affective response or self-concept.

Teacher talk: A community of colleagues that values practical teacher knowledge through sharing experiences

The purpose of this study was to describe the experiences of five educators participating in a teacher-initiated learning community that valued practical teacher knowledge. Connelly and Clandinin (2000) argued that practical teacher knowledge grew out of experience through interaction in the professional knowledge landscape. Collaboration that promoted teacher learning was the foundation to effective school change (Wood, 1997). This teacher-initiated learning community consisted of members who had equal status and collaborated by participating in discourse on curriculum and instruction. The collegiality of the community fostered teacher professionalism that improved practice and benefited the school. This study focused on the following research questions: (1) What was the experience of these five educators in this learning community? (2) What did these five individuals understand about the nature of practical teacher knowledge? (3) According to the participants, what was the relationship between teacher empowerment and effective school change? ^ The participants were chosen because each voluntarily attended this teacher-initiated learning community. Each participant answered questions regarding the experience during three semi-structured tape-recorded interviews. The interviews were transcribed, and significant statements of meaning were extracted. Using a triangulation of ideas that were common to at least three of the participants ensured the trustworthiness of the analysis. These statements were combined to describe what was experienced and how the participants described their experience. The emerging themes were the characteristics of and the relationships, methods, conditions, and environment for the teachers. The teachers described how a knowledge base of practical teacher knowledge was gained as a spirit of camaraderie developed. The freedom that the teachers experienced to collaborate and learn fostered new classroom practice that affected school change as student interaction and productivity increased. ^ The qualitative analysis of this study provided a description of a learning community that valued practical teacher knowledge and fostered professional development. This description was important to educational stakeholders because it demonstrated how practical teacher knowledge was gained during the teachers' daily work. By sharing every day experiences, the teacher talk generated collaboration and accountability that the participants felt improved practice and fostered a safe, productive learning environment for students. ^

Managing small-medium cities in a time of globalization: Experiences and evidence from Florida's public managers

This study examines how public management practitioners in small and medium-sized Florida cities perceive globalization and its impact on public management practice. Using qualitative analysis, descriptive statistics and factor analysis methods, data obtained from a survey and semi-structured interviews were studied to comprehend how public managers view the management and control of their municipalities in a time of globalization. The study shows that the public managers’ perceptions of globalization and its impact on public management in Florida’s small-medium cities are nuanced. Whereas some public managers feel that globalization has significant impacts on municipalities’ viability, others opine that globalization has no local impact. The study further finds that globalization processes are perceived as altering the public management functions of decision-making, economic development and service delivery in some small-medium cities in Florida as a result of transnational shifts, rapidly changing technologies, and municipalities’ heightened involvement in the global economy. The study concludes that the globalization discourse does not resonate among some public managers in Florida’s small-medium cities in ways implied in extant literature.

A comprehensive assessment of self -report experiences of adoptive parents of special needs children in Florida

Adoption of special needs children is now seen as a life long event whereby the adoptive child and family have unique needs. The need for postplacement resources throughout the life cycle of the adoption process is evident. This exploratory-descriptive research employed a random stratified cross-sectional design. The purpose of the study was to describe, identify, examine, and assess the relative influence of identified empirically and conceptually relevant variables of self-report experiences of adoptive parents of special needs children. Primary areas of exploration included: (1) adoptive children and families' characteristics, (2) postplacement service needs, utilization and satisfaction, and (3) adoptive parents' perceptions of their adoption experiences. A proportionate stratified random mail survey was used to obtain 474 families who had adopted special needs children from the 15 geographic districts which make up the state adoption social service agency in Florida. A 144-item survey questionnaire was used to collect basic information on demographic data, service provision, and adoption experiences. Four research questions were analyzed to test the effect the predictor variables had on willingness to adopt another special needs child, successful adoption, satisfying experience, and realism about problems. All four research questions revealed that the full model and the child's antecedent and the adoptive parents' intervening variable blocks were significant in explaining the variance in the dependent variables. The child's intervening variables alone were only significant in explaining the variance for one of the dependent variables. The results of the statistical analysis on the fifth research question and the three hypotheses determined that (1) only one postplacement service, crisis intervention, had a statistically significant impact on the adoptive parents' perceived level of satisfaction with the adoption experience; (2) adoptive parents who rate their adoption as successful are more likely to express a desire to adopt another special needs child; (3) the more adequate information on the child the adoptive parents perceived that they had prior to placement, the more they perceived they were realistic about the problems they would encounter; and (4) six specific postplacement services were found to be significant in predicting successful adoptions--crisis intervention, outpatient drug/alcohol treatment, maintenance subsidy, physical therapy, special medical equipment, and family counseling. Implications for the social work field and future research are discussed. ^