GPs’ and community pharmacists’ opinions on medication management at transitions of care in Ireland

Objective. The aim of this study was to survey GPs and community pharmacists (CPs) in Ireland regarding current practices of medication management, specifically medication reconciliation, communication between health care providers and medication errors as patients transition in care.
Methods. A national cross-sectional survey was distributed electronically to 2364 GPs, 311 GP Registrars and 2382 CPs. Multivariable associations comparing GPs to CPs were generated and content analysis of free text responses was undertaken.
Results. There was an overall response rate of 17.7% (897 respondents—554 GPs/Registrars and 343 CPs). More than 90% of GPs and CPs were positive about the effects of medication reconciliation on medication safety and adherence. Sixty per cent of GPs reported having no formal system of medication reconciliation. Communication between GPs and CPs was identified as good/very good by >90% of GPs and CPs. The majority (>80%) of both groups could clearly recall prescribing errors, following a transition of care, they had witnessed in the previous 6 months. Free text content analysis corroborated the positive relationship between GPs and CPs, a frustration with secondary care communication, with many examples given of prescribing errors.
Conclusions. While there is enthusiasm for the benefits of medication reconciliation there are limited formal structures in primary care to support it. Challenges in relation to systems that support inter-professional communication and reduce medication errors are features of the primary/secondary care transition. There is a need for an improved medication management system. Future research should focus on the identified barriers in implementing medication reconciliation and systems that can improve it.

DESCRIBING SLEEP AND SEDATION PRACTICES IN THE ICU: A MULTINATIONAL SURVEY

Introduction Sleep disturbances are common in critically ill patients treated in the intensive care unit (ICU) with the potential for serious consequences and long-term effects on health outcomes and patient morbidity.
Objectives Our aim was to describe sleep management and sedation practices of adult ICUs in ten countries and to evaluate roles and responsibilities of the ICU staff in relation to key sleep and sedation decisions.
Methods A multicenter, self-administered survey sent to nurse managers of adult ICUs across 10 countries. The questionnaire comprised four domains: sleep characteristics of the critically ill; sleep and sedation practices; non-pharmacological and pharmacological interventions used to improve sleep; and the autonomy and influence of nurses on sleeping practices in the ICU.
Results Overall response rate was 66% (range 32% UK to 100% Cyprus), providing data from 522 ICUs. In all countries, the most frequent patient characteristic perceived to identify sleep was lying quietly with closed eyes (N=409, 78%) (range 92% Denmark to 36% Italy). The most commonly used sedation scale was the Richmond Agitation-Sedation Score (RASS) (N=220, 42%) (range 81% UK to 0% Denmark, Cyprus where most ICUs used the Ramsay score). In most ICUs, selection of sleep medication (N=265, 51%) and assessment of effect (N=309, 59%) was performed by physicians and nurses based on collaborative discussion. In a minority of ICUs (N=161, 31%), decisions and assessments were made by physicians alone. The most commonly used (in all countries) non-pharmacological intervention to promote sleep was reducing ICU staff noise (N=473, 91%) (range 100% Denmark, Norway to 78% Canada). Only 95 ICUs (18%) used earplugs on a frequent basis (range 0% Greece, Cyprus, Denmark to 57% Sweden). Propofol was the drug used most commonly for sedation (N=359, 69%) (range 96% Sweden to 29% Canada). Chloral hydrate was used by only 63 (12%) ICUs (range 0% Greece, Cyprus, Denmark, Italy to 56% Germany). Sedation scales were used on a routine basis by 77% of the 522 ICUs. Participants scored nursing autonomy for sleep and sedation management as moderate; median score of 5 (scale of 0 to 10), range 7 (Canada, Greece, Sweden) to 4 (Norway, Poland). Nursing influence on sleep and sedation decisions was perceived considerable; median score 8, range 9 (Denmark) to 5 (Poland).
Conclusions We found considerable across country variation in sleep promotion and sedation management practices though most have adopted a sedation scale as recommended in professional society guidelines. Most ICUs in all countries used a range of pharmacological and non-pharmacological interventions to promote sleep. Most units reported inter-professional decision-making with nurses perceived to have substantial influence on sleep/sedation decisions.

Using Social Worlds Theory to Explore Influences on Community Nurses’ Experiences of Providing Out of Hours Paediatric Palliative Care

Abstract Background: Paediatric oncology palliative care in the community is rare and nationally there is a lack of standardisation of out of hours nursing service provision. Objectives: This paper seeks to explore influences on the experiences of paediatric nurses providing out of hours palliative care within the family home to children with cancer. The study used social worlds theory to aid identification and demonstration of the findings. Methods: Twelve community-based palliative cases were purposively selected from children with cancer treated at one regional centre. Tape-recorded interviews were undertaken with 54 health professionals (general practitioners, community nurses and allied health professionals) involved in providing their palliative care and five facilitated case discussions completed. Data analysis followed a grounded theory approach; chronological comparative data analysis identifying generated themes. Social worlds theory was used as a framework to examine the data. Results: Nurses’ experiences are shaped by their social world and those of the nursing team,child and family and the inter-professional team providing the care. The lack of a formalised service, sub-optimal inter-professional working and impact of social worlds influence the experience of the nurse. Conclusions: Social worlds theory provided a new perspective in understanding these experiences based within a paediatric palliative care setting, knowledge that can be used to inform service provision.

The perceived experience of supervision within the PACE trial

This study was set within the UK inter-professional multi-centre randomized controlled PACE trial of manual based therapy (White et al 2007). The aim of supervision within “the trial” was to maintain specificity, sustain retention, manage quality control and assurance, monitor competence in delivering therapy and enhance professional development. The rationale for the ancillary study was that the approach to supervision within the trial appeared to be different from the previous experience of supervision for many of the therapists (Clouder & Sellars 2004, Sellars 2004, Sweeney et al 2001). A review of the literature on supervision and reflective practice highlighted that there are many models, methods, approaches and factors that influence the effectiveness of supervision (Edwards et al 2005, van Ooijen 2000).

La transition vers la vie adulte : les besoins des jeunes adultes présentant une déficience intellectuelle profonde et de leur famille, les facteurs qui l'influencent et les pistes de solutions pour la faciliter

Résumé : Introduction : Au Québec, jusqu’à l’âge de 21 ans, les enfants et adolescents ayant une déficience intellectuelle (DI) profonde ont des services de pédiatrie adaptés et l’opportunité de fréquenter des écoles spécialisées publiques. Toutefois, au-delà de cet âge, l’accès à ces services spécialisés est plus limité : le financement pour la fréquentation scolaire cesse et les jeunes adultes transfèrent des services de santé pédiatriques vers le secteur adulte. Malgré la mise en place de solutions visant à faciliter cette transition, des difficultés tendent à persister, une situation pouvant avoir des effets négatifs considérables au niveau de la personne ayant un handicap et de sa famille. Cependant, peu d’études se sont intéressées aux facteurs qui influencent le vécu de la transition vers la vie adulte des familles de jeunes personnes présentant une DI profonde, rendant difficile l’adaptation des programmes déjà existants de planification de la transition à la réalité de ces familles. Objectif : Ce projet vise à décrire les besoins des personnes présentant une DI profonde et de leur famille lors de la transition vers la vie adulte, en décrivant le vécu des parents lors de cette période et les facteurs qui l’influencent, ainsi qu’en explorant les pistes de solution à mettre en place. Méthodologie : Afin de réaliser cette étude qualitative, un devis descriptif interprétatif a été choisi. Deux entrevues semi-dirigées individuelles ont été réalisées auprès de quatorze parents, la deuxième entrevue permettant de valider et d’approfondir les résultats à l’aide d’un résumé de la première rencontre. Résultats : Plusieurs facteurs multisystémiques de l’ordre du soutien matériel, informatif, cognitif et affectif semblent influencer la transition vers la vie adulte. Ces différents facteurs contribuent au vécu particulièrement difficile des familles, qui vivent beaucoup d’anxiété et de frustration face au peu de soutien qui leur est offert. Plusieurs idées intéressantes ont été proposées par les parents pour répondre à ce manque de soutien, autant au plan du partage des connaissances, de l’amélioration de la collaboration inter-établissement que du soutien psychologique. Conclusion : Cette étude souligne l’importance d’impliquer l’ensemble des acteurs œuvrant auprès du jeune adulte et de sa famille dans la planification de la transition. La compréhension de la réalité des personnes avec une DI profonde et de leur famille devrait permettre de développer des interventions concrètes leur étant destinées dans de futurs projets.

French good practice guidelines for medical and occupational surveillance of the low back pain risk among workers exposed to manual handling of loads

International audience

Towards Automated Business Process Deduction through a Social and Collaborative Platform

Part 12: Collaboration Platforms

The impact of outcomes-driven curriculum reform on teacher perspectives of professional practice

This thesis is the result of an investigation of a Queensland example of curriculum reform based on outcomes, a type of reform common to many parts of the world during the last decade. The purpose of the investigation was to determine the impact of outcomes on teacher perspectives of professional practice. The focus was chosen to permit investigation not only of changes in behaviour resulting from the reform but also of teachers' attitudes and beliefs developed during implementation. The study is based on qualitative methodology, chosen because of its suitability for the investigation of attitudes and perspectives. The study exploits the researcher's opportunities for prolonged, direct contact with groups of teachers through the selection of an over-arching ethnography approach, an approach designed to capture the holistic nature of the reform and to contextualise the data within a broad perspective. The selection of grounded theory as a basis for data analysis reflects the open nature of this inquiry and demonstrates the study's constructivist assumptions about the production of knowledge. The study also constitutes a multi-site case study by virtue of the choice of three individual school sites as objects to be studied and to form the basis of the report. Three primary school sites administered by Brisbane Catholic Education were chosen as the focus of data collection. Data were collected from three school sites as teachers engaged in the first year of implementation of Student Performance Standards, the Queensland version of English outcomes based on the current English syllabus. Teachers' experience of outcomes-driven curriculum reform was studied by means of group interviews conducted at individual school sites over a period of fourteen months, researcher observations and the collection of artefacts such as report cards. Analysis of data followed grounded theory guidelines based on a system of coding. Though classification systems were not generated prior to data analysis, the labelling of categories called on standard, non-idiosyncratic terminology and analytic frames and concepts from existing literature wherever practicable in order to permit possible comparisons with other related research. Data from school sites were examined individually and then combined to determine teacher understandings of the reform, changes that have been made to practice and teacher responses to these changes in terms of their perspectives of professionalism. Teachers in the study understood the reform as primarily an accountability mechanism. Though teachers demonstrated some acceptance of the intentions of the reform, their responses to its conceptualisation, supporting documentation and implications for changing work practices were generally characterised by reduced confidence, anger and frustration. Though the impact of outcomes-based curriculum reform must be interpreted through the inter-relationships of a broad range of elements which comprise teachers' work and their attitudes towards their work, it is proposed that the substantive findings of the study can be understood in terms of four broad themes. First, when the conceptual design of outcomes did not serve teachers' accountability requirements and outcomes were perceived to be expressed in unfamiliar technical language, most teachers in the study lost faith in the value of the reform and lost confidence in their own abilities to understand or implement it. Second, this reduction of confidence was intensified when the scope of outcomes was outside the scope of the teachers' existing curriculum and assessment planning and teachers were confronted with the necessity to include aspects of syllabuses or school programs which they had previously omitted because of a lack of understanding or appreciation. The corollary was that outcomes promoted greater syllabus fidelity when frameworks were closely aligned. Third, other benefits the teachers associated with outcomes included the development of whole school curriculum resources and greater opportunity for teacher collaboration, particularly among schools. The teachers, however, considered a wide range of factors when determining the overall impact of the reform, and perceived a number of them in terms of the costs of implementation. These included the emergence of ethical dilemmas concerning relationships with students, colleagues and parents, reduced individual autonomy, particularly with regard to the selection of valued curriculum content and intensification of workload with the capacity to erode the relationships with students which teachers strongly associated with the rewards of their profession. Finally, in banding together at the school level to resist aspects of implementation, some teachers showed growing awareness of a collective authority capable of being exercised in response to top-down reform. These findings imply that Student Performance Standards require review and, additional implementation resourcing to support teachers through times of reduced confidence in their own abilities. Outcomes prove an effective means of high-fidelity syllabus implementation, and, provided they are expressed in an accessible way and aligned with syllabus frameworks and terminology, should be considered for inclusion in future syllabuses across a range of learning areas. The study also identifies a range of unintended consequences of outcomes-based curriculum and acknowledges the complexity of relationships among all the aspects of teachers' work. It also notes that the impact of reform on teacher perspectives of professional practice may alter teacher-teacher and school-system relationships in ways that have the potential to influence the effectiveness of future curriculum reform.

Caught in the act of collaboration: Students’ experiences of collective learning within a real-world design studio context

This study is an evaluation of design students’ perceptions of the benefits of collective learning in a real-world collaborative design studio. Third year students worked in inter-disciplinary teams representing architecture, interior design, landscape architecture, and industrial design. Responding to a real-world brief and in consultation with an industry partner client and early childhood education pre-service teachers, the teams were required to collectively propose a design response for a community-based child and family centre, on an iconic koala sanctuary site. Data were collected using several methods including a participatory action research method, through the form of a large analogue, collaborative jigsaw puzzle. Using a grounded theory methodology, qualitative data were thematically analysed to reveal six distinct aspects of collaboration, which positively impacted the students’ learning experience. The results of this study include recommendations for improving real world collaboration in the design studio in preparation for students’ transition into professional practice.

Understanding teacher collaboration in disadvantaged urban primary schools: uncovering practices that foster professional learning communities

This study is set in the context of disadvantaged urban primary schools in Ireland. It inquires into the collaborative practices of primary teachers exploring how class teachers and support teachers develop ways of working together in an effort to improve the literacy and numeracy levels of their student. Traditionally teachers have worked in isolation and therefore ‘collaboration’ as a practice has been slow to permeate the historically embedded assumption of how a teacher should work. This study aims to answer the following questions. 1). What are the dynamics of teacher collaboration in disadvantaged urban primary schools? 2). In what ways are teacher collaboration and teacher learning related? 3). In what ways does teacher collaboration influence students’ opportunities for learning? In answering these research questions, this study aims to contribute to the body of knowledge pertaining to teacher learning through collaboration. Though current policy and literature advocate and make a case for the development of collaborative teaching practices, key studies have identified gaps in the research literature in relation to the impact of teacher collaboration in schools. This study seeks to address some of those gaps by establishing how schools develop a collaborative environment and how teaching practices are enacted in such a setting. It seeks to determine what skills, relationships, structures and conditions are most important in developing collaborative environments that foster the development of professional learning communities (PLCs). This study uses a mixed method research design involving a postal survey, four snap-shot case studies and one in depth case study in an effort to establish if collaborative practice is a feasible practice resulting in worthwhile benefits for both teachers and students.