Using Workload Measurement Tools in Diverse Care Contexts: the Experience of Staff in Mental Health and Learning Disability Inpatient Settings

Introduction The critical challenge of determining the correct level and skill-mix of nursing staff required to deliver safe and effective healthcare has become an international concern. It is recommended that evidence-based staffing decisions are central to the development of future workforce plans. Workforce planning in mental health and learning disability nursing is largely under-researched with few tools available to aid the development of evidence-based staffing levels in these environments. Aim It was the aim of this study to explore the experience of staff using the Safer Nursing Care Tool (SNCT) and the Mental Health and Learning Disability Workload Tool (MHLDWT) in mental health and learning disability environments. Method Following a 4-week trial period of both tools a survey was distributed via Qualtrics on-line survey software to staff members who used the tools during this time. Results The results of the survey revealed that the tools were considered a useful resource to aid staffing decisions; however specific criticisms were highlighted regarding their suitability to psychiatric intensive care units (PICU) and learning disability wards. Discussion This study highlights that further development of workload measurement tools is required to support the implementation of effective workforce planning strategies within mental health and learning disability services. Implications for Practice With increasing fiscal pressures the need to provide cost-effective care is paramount within NHS services. Evidence-based workforce planning is therefore necessary to ensure that appropriate levels of staff are determined. This is of particular importance within mental health and learning disability services due to the reduction in the number of available beds and an increasing focus on purposeful admission and discharge.

Liderança transformacional/transacional: que impacto no cinismo organizacional?

Dissertação apresentada à Escola Superior de Comunicação Social como parte dos requisitos para obtenção de grau de mestre em Gestão Estratégica das Relações Públicas.

Alcohol consumption in late adolescence and early adulthood - where is the problem?

Risky single-occasion drinking (RSOD) is more common in late adolescence and early adulthood (approximately between the ages of 16 and 30) than in any other period in life. This is also the age when young people in Switzerland and many other European countries are legally allowed to buy and drink alcohol, but they usually do not yet have adult responsibilities. This paper reviews evidence from the international literature and provides examples of studies conducted in Switzerland demonstrating that (a) RSOD is by far most prevalent on Saturday evenings followed by Friday evenings, usually because young people go out and do not have any work or study responsibilities the next day; (b) RSOD results from drinking in private before going out ("predrinking") and accelerating the pace of drinking (i.e. increasing the number of drinks consumed per hour); (c) RSOD is often not accidental but purposeful,. to seek excitement, to have fun and to feel the effects of alcohol; (d) RSOD occurs predominantly outside the home, mostly in bars, pubs, discos or at special events and festivals; (e) RSOD often results in intended and unintended injuries and other acute consequences, which are leading risk factors for mortality and morbidity in this age group. Effective prevention strategies should include attempts to reduce opportunities to engage in heavy drinking as well as strategies to reduce its harmful consequences.

Educational issues perceived by expectant lesbian couples /

Despite the increasing public profile of lesbian childbearing, public health resources for expectant women often bear heterosexist assumptions and create barriers to accessing information relevant to lesbian mothering experiences. This descriptive, exploratory study examined one lesbian couple's perceived educational needs for effective support, barriers to access, strategies for locating care, and the impact of childbearing on their lives, as well as their reflections on inviting ways to offer supportive practices in a public health context. A case study approach used feminist ethnographic methodology and purposeful convenience sampling. A prenatal and a postnatal open-ended interview were completed with 1 white, middle-class, able, lesbian childbearing couple, each ofwhom has birthed as coparent and biological mother in this couple relationship. Despite this couple's immense situated privilege, they struggled to locate the support they sought for childbearing in a way that offered optimal emotional and physical care from the preconceptual to postpartum stages and which maintained confidentiality or anonymity as desired. They created meaningful care through personal networks. The findings were framed using invitational and feminist theories: how people, places, programs, processes, policies, and politics contributed to educational support. A three part conceptual framework emerged which identified components of access to support: perceived safety of resources, disclosure status, situated privilege, and public or private availability of information. The consequences of lack of public access to comprehensive childbearing care for lesbian women and their communities are described. Educational possibilities addressed systemic heterosexism through the development of sensitive educators, meaningful curriculum, program planning, explicit policies, community partnerships, and political leadership with respect to both institutional and research venues.

The essence of a tacit intersection : a heuristic inquiry into nature-based leisure and personal transformation

There are a considerable number of programs and agencies that count on the existence of a unique relationship between nature and human development. In addition, there are significant bodies of literature dedicated to understanding developmentally focused nature-based experiences. This research project was designed to flirther the understanding of this phenomenon. Consequently, the purpose of this research endeavour was to discover the essence ofthe intersection ofpersonal transformation and nature-based leisure, culminating in a rich and detailed account of this otherwise tacit phenomenon. As such, this research built on the assumption of this beneficial intersection of nature and personal transformation and contributes to the understanding ofhow this context is supporting or generating of selfactualization and positive development. Heuristic methods were employed because heuristics is concerned with the quality and essence of an experience, not causal relationships (Moustakas, 1990). Heuristic inquiry begins with the primary researcher and her personal experience and knowledge of the phenomenon. This study also involved four other coresearchers who had also experienced this phenomenon intensely. Co-researchers were found through purposeful and snowball sampling. Rich narrative descriptions of their experiences were gathered through in-depth, semi-structured interviews, and artifact elicitation was employed as a means to get at co-researchers' tacit knowledge. Each coresearcher was interviewed twice (the first interview focused on personal transformation, the second on nature) for approximately four and a half hours in total. Transcripts were read repeatedly to discern patterns that emerged from the study of the narratives and were coded accordingly. Individual narratives were consolidated to create a composite narrative of the experience. Finally, a creative synthesis was developed to represent the essence of this tacit experience. In conclusion the essence of the intersection of nature-based leisure and personal transformation was found to lie in the convergence of the lived experience of authenticity. The physical environment of nature was perceived and experienced to be a space and context of authenticity, leisure experiences were experienced as an engagement of authenticity, and individuals themselves encountered a true or authentic self that emanated from within. The implications of these findings are many, offering suggestions, considerations and implications from reconsidered approaches to environmental education to support for selfdirected human development.

Teamwork and leadership : competitive youth soccer as a context for positive youth development

The purpose of this study was to examine processes and interactions that characterized positive developmental experiences in sport. A highly competitive and reputable U-17 girls' soccer team was chosen for the study through purposeful sampling, providing an information rich case from which data could be derived (Patton, 2002). Seventeen players and three coaches participated in this study. Based on an ethnographic methodology data were collected via observations and both informal and formal semi-structured interviews. Tlie data were coded according to the three procedures outlined by Seidel and Kelle (1995): a) noticing relevant phenomena, b) collecting examples of those phenomena, and c) analyzing those phenomena in order to find commonalities, differences, patterns and structures. Significant events and underlying themes were recounted chronologically through a collection of vignettes, aimed to provide a contextual lens for the reader. Results revolved around two prominent themes: Teamwork and leadership. These were closely related concepts that required players to demonstrate a wide range of developmental skills for the team to move collectively towards their end goal. Furthermore, teamwork and leadership experiences took both desirable and undesirable forms. For example, at the beginning of the season competition existed amongst the players at the expense of teamwork and leadership. As the season progressed the pursuit of a shared goal allowed the players to view each other as collaborators and teamwork and leadership skills became increasingly evident. At times, however, success on the field was prioritized above maintaining relationships off the field, requiring the coaches to intervene and re-establish equilibrium.

Are there transformative indicators for motivation to learn?

Fourteen nursing s tudents enrolled in a community coll ege were chosen by purposeful se lection to be i nterviewed in a qualitative survey. A proposed mode l of Learner Motivation Development was examined . The mode l describes four stages of motivati on development progression across the lifespan: I Survival (infancy to childhood), I I Expl oration (childhood to adolescence), III Identification (pre- adulthood), and IV Reflection ( adulthood ). This r esearch examined the last two stages. The criteria used to categorize the students within the fr amework were bas ed on human development theories as described by Maslow (1954) and Erikson (1950). The concept of critica l thinking proposed by Brookfield (1987) and the ideas of transformative learning expressed by Mezirow (1991) were also incorporated. The researcher' s criteria , antici pated behaviours and characteri stics, were used to ana lyze the students' responses to open-ended questions. The central theme of the research was based on the assumption that motivation to learn is intrinsic and inherent in pre-adult and adult learners. Six pre-adults and two adults met the descriptors set for stage III Identification. Five adults and one pre-adult met the criteria for stage IV Reflection. The impact of life e xperiences and maturation were clearly demonstrated.

Evaluation of a professional development curriculum in movement education and adapted physical activity for invisible disabilities : a critical cross-case analysis

Movement education and adapted physical activity are content areas not addressed in pre-service education or in-service training for Ontario practitioners working with individuals with disabilities in physical environments. Consequently, physical activity is often overlooked by service providers in programming and intervention for exceptional young learners. A formative evaluation, multiple-case study design was employed in this research in which a purposeful sample of expert practitioners performed a guided, descriptive evaluation of a three-day professional development workshop curriculum designed to supplement these areas lacking in professional preparation within their respective cohorts. Case-by-case and comparative analyses illustrated the inherent assumptions and societal constraints which prioritize the structure of professional development within the education system and other government organizations providing services for school-aged persons with disabilities in Ontario. Findings, discussed from a critical postmodern perspective, illustrate the paradoxical nature of Western values and prevailing mind/body dichotomy that guide professional practice in these fields.

Mechanisms for sustainable accountability : a case study of a nonprofit educational organization

A qualitative case study of the capacity to be accountable in one nonprofit intennediary educational organization yielded an emergent conceptual framework of four mechanisms: structural, governing, communicative, and educative mechanisms to build and sustain the capacity of accountability. Drawing attention to the purposeful creation of structures that support accountability, purposeful navigation of the complex matrix of accountability relationships, and purposeful transfer of knowledge to infonn future accountability, this study calls for mindfulness in practice in broader educational contexts. Protocols to pass on knowledge gained in building the four capacities reveal a new dimension of accountability: continuity. In this model, the educative mechanism is the life force that feeds the other three mechanisms to increase accountability and sustain it over time.

Writing and science connections : integrated instruction and assessment

Learning to write is a daunting task for many young children. The purpose of this study was to examine the impact of a combined approach to writing instruction and assessment on the writing performance of students in two grade 3 classes. Five forms and traits of writing were purposefully connected during writing lessons while exhibiting links to the four strands of the grade 3 Ontario science curriculum. Students then had opportunities to engage in the writing process and to self-assess their compositions using either student-developed (experimental group/teacher-researcher's class) or teachercreated (control group/teacher-participant's class) rubrics. Paired samples t-tests revealed that both the experimental and control groups exhibited statistically significant growth from pretest to posttest on all five integrated writing units. Independent samples t-tests showed that the experimental group outperformed the control group on the persuasive + sentence fluency and procedure + word choice writing tasks. Pearson product-moment correlation r tests revealed significant correlations between the experimental group and the teacher-researcher on the recount + ideas and report + organization tasks, while students in the control group showed significant correlations with the teacher-researcher on the narrative + voice and procedure + word choice tasks. Significant correlations between the control group and the teacher-participant were evident on the persuasive + sentence fluency and procedure + word choice tasks. Qualitative analyses revealed five themes that highlighted how students' self-assessments and reflections can be used to guide teachers in their instructional decision making. These findings suggest that educators should adopt an integrated writing program in their classrooms, while working with students to create and utilize purposeful writing assessment tools.

Back to Basics: Exploring gestural habits as cues for anticipating self-injurious episodes in a child with Autism and Deafness

This research project is a longitudinal qualitative case study. It contributes to an understanding of self-injurious behaviour (SIB) by inviting the reader through the narrative of the lived experience of a fifteen year old child-informant and the network of individuals in his life. The value and importance of a case-study is that it focuses on the authenticity of the experience of living with disability. Through the use of detailed field observations, interviews and photo documents, the study thoroughly explores three main areas: quality of movements, potential cues as pre-cursors to episodes of self-injury, and purposeful communication. The research begins with a review of literature on Autism, Deafness and Self-injury, formulates the research design and orientation of Physical Education, Phenomenology and Semiotics, and then systematically explores four distinct phases in the analytical process. The aim was to explore self-injurious episodes in the child informant in hopes to translate the meaning of the behaviour and potentially utilize this to provide more opportunities for adapted physical activity. The findings reveal distinct patterns of movement cues utilized for different purposes. The implications of the findings are self-injurious episodes in the child informant are preceded by distinct patterns of movement that are potentially communicative. Suggested future direction of the research is expanding the scope to other disabilities for which verbal communication is challenging, and standardizing the translating tools to assist in understanding the communication of movement.

Whose Voice Is Present?: An Examination of Power and Privilege in Service-Learning in Ontario Universities

This research paper examines themes of power and privilege that occur within service-learning as described by 3 Ontario universities on their service-learning websites. Due to size and time restrictions, this paper was able to examine only 3 Ontario universities: Brock, Wilfrid Laurier, and Lakehead. The purpose of this study is geared towards service-learning practitioners in order for the universities and students to become more self-aware of their immense place of privilege within the service-learning context. Qualitative narrative analysis research methods were employed in this purposeful sample to examine how each university’s story of service-learning reflected themes of power and privilege. The research found that each university posed a unique narrative of service-learning representing various stakeholders’ voices and presence in different ways on their website. Brock largely focuses on faculty and student voices. Laurier intentionally attempts to include all three stakeholder voices, although still favours students and the university as an audience over the community. Lakehead’s unique program includes a plethora of voices and intends much of their information for the community members, students, and the university. The implications of this research demonstrate that universities have a large amount of power and privilege, which is carried through to the students within the service-learning partnership.

Ties From My Father: Personal Narrative as a Tool for Engaging Teenagers and Social Service Practitioners

The purpose of this project is to provide social service practitioners with tools and perspectives to engage young people in a process of developing and connecting with their own personal narratives, and storytelling with others. This project extensively reviews the literature to explore Why Story, What Is Story, Future Directions of Story, and Challenges of Story. Anchoring this exploration is Freire’s (1970/2000) intentional uncovering and decoding. Taking a phenomenological approach, I draw additionally on Brookfield’s (1995) critical reflection; Delgado (1989) and McLaren (1998) for subversive narrative; and Robin (2008) and Sadik (2008) for digital storytelling. The recommendations provided within this project include a practical model built upon Baxter Magolda and King’s (2004) process towards self-authorship for engaging an exercise of storytelling that is accessible to practitioners and young people alike. A personal narrative that aims to help connect lived experience with the theoretical content underscores this project. I call for social service practitioners to engage their own personal narratives in an inclusive and purposeful storytelling method that enhances their ability to help the young people they serve develop and share their stories.

A Comparative Analysis of Community-Based Service Providers for "Extreme" Case ASD: Exploring Activity Program Options

The purpose of my research was to examine how community-based organizations in the Niagara region provide programs for children with Autism Spectrum Disorder (ASD), who are considered to represent “extreme” or “severe” cases. A qualitative, comparative case study was conducted that focused on three organizations who provide summer recreation and activity programs, in order to examine the issues these organizations face when determining program structure and staff training; and to understand what the threshold for physical activity is in this type of setting, and how the unique needs surrounding these “severe” cases are met while attending the program. Purposeful sampling was employed to select a supervisor and senior staff member from each organization to discuss the training process, program development and implementation, and the resources and strategies used within their organization’s community-based program. A confirming comparative analysis was comparative analysis of a parents survey with six mothers whose children are considered “severe” indicated that camp staffs’ expectations are unrealistic where as the parents and supervisors have more realistic expectations within the “real world” of camp. There is no definition of “severe” or “extreme” and therefore severity is dependent upon the context.

Towards Equitable Access to Postsecondary Education: Learning From the Voices of First Generation Students

This qualitative, phenomenological study investigated first generation students’ perceptions of the challenges they experienced in the process of accessing higher education and the type of school-based support that was received. Particular emphasis was placed on the impact of parental education level on access to postsecondary education (PSE) and how differences in support at the primary and secondary levels of schooling influenced access. Purposeful, homogenous sampling was used to select 6 first generation students attending a postsecondary institution located in Ontario. Analysis of the data revealed that several interrelated factors impact first generation students’ access to postsecondary education. These include familial experiences and expectations, school streaming practices, secondary school teachers’ and guidance counselors’ representations of postsecondary education, and the nature of school-based support that participants received. The implications for theory, research, and practice are discussed and recommendations for enhancing school-based support to ensure equitable access to postsecondary education for first generation students are provided.