In response to calls to improve the efficacy of health care services, there is an increasing focus on the processes of achieving a continuous improvement of services and practices. One specific response is that of the NHS Modernization Agency and National Health Service University in relation to the Discipline of Improvement in Health and Social Care. This paper draws on a study that explored the underpinning knowledge base of the Discipline of Improvement and focuses on describing the framework that was developed. The two-dimensional framework is composed of five primary categories, which cross-link to 11 competencies. The study concludes that the Discipline of Improvement draws together a group of ideas that together cohere to form a distinctive model to aid the improvement of health care. While some of these ideas are well-established, the way in which the Discipline of Improvement makes connections between them offers something new to our understanding of change in the complex world of health care provision, and to nursing management.
Menarche is a significant milestone for young women, representing an important juncture between girlhood and maturation. The limited literature that exists suggests that a mother's reaction to her daughter's first periods can shape her experiences and perceptions of menstruation which, in turn, may impact on her self-image and, consequently, sexual risk taking. However, very little is known about UK mothers' attitudes towards their daughters' menarche. This paper aims to add to the body of knowledge by applying a postmodern critique, a Derridian deconstructive analysis, to a discussion thread found on mumsnet.com – a UK parenting website. The thread is concerned with a mother's response to her daughter's menarche to which other mothers respond. The deconstruction revealed a number of meta-narratives and themes within the text: secrecy, sorrow, a lack of competency and knowledge, power, gender and motherhood. Unwittingly, the women appear to be socialising their daughters to comply with and perpetuate the menstrual taboo that they endured themselves, thus repeating the cycles of shame associated with menstruation. The findings of this critique suggest that menstrual education is an area that requires more attention, particularly in the context of perceived menstrual shame and its impact on sexual decision-making.
SPItech (Standard Performance monitoring Instrumentation technology), a new multicomputer performance monitoring system, employs portable instrumentation technology and bridges the gap between emerging standard interfaces. Facilities support application-specific trace events, breakpoint-style debugging, online transmission of selected data, and dynamic acquisition-rate control. SPItech includes the SuperMSparc multicomputer and its associated performance monitoring hardware and software.< >
This paper describes a cooperative experiential learning activity to develop embedded systems design skills. Student teams design, build, and troubleshoot a microcontroller-based project composed of common embedded systems peripherals, including input/output and electromechanical devices, industry standard communication networks, and complex digital integrated circuits. The design experience is progressive, requiring each successive subsystem to be incorporated without disturbing previously completed subsystems. Furthermore, the design experience is based on a problem-based learning approach that motivates student learning and develops skills required by the student in a future professional capacity. These skills include designing to specification, use of third-party intellectual property, teamwork, communication, and lifelong learning skills. The design experience was offered to a cohort in conjunction with lectures using active learning techniques. Course evaluations were obtained from students and external reviewers, and the results show that the course was well received and achieved its educational objectives.
The MSPARC multicomputer uses processor-based monitoring hardware and probe acquisition software for instrumentation purposes. The authors give an overview of the monitor system and design considerations regarding the probe software. Each node of the mesh connected MSPARC consists of a numerical element and a communications board used to pass messages via custom routers located on a backplane. In addition to the message-passing circuitry, the communications board also contains the instrumentation and monitoring hardware. The monitor and its separate interconnection network are used to assist in application performance monitoring, program design, hardware and software debugging, and hardware analysis. Performance data are transferred from an application program to the monitor system in the form of software probes. The software provides initialization, probe processing, communications, and debug capabilities for a monitor node.< >
This system generates a description of a cellular wafer-scale design including the cell locations and the interconnections between the cells. The functional interdependency of each cell is also defined in terms of necessary lists. From this description, a database that contains the circuit descriptions is created. The system then determines (according to statistical algorithms) which circuit cells are defective and reports the effective wafer-scale yield of the circuit.< >
Men can play a significant role in teaching their children about sexuality but fathers' practices and perceptions in this domain remain under explored. This study presents an Interpretative Phenomenological Analysis of eight fathers' perceptions and practices in educating their ten-year-old children about physical maturation, reproduction and relationships. A Foucauldian analysis with a focus on governmentality and biopower revealed tensions and contradictions between the fathers' aspirations and their realities, which appeared to be underpinned by the dynamic, contradictory, shifting, plural nature of fatherhood identities. Whilst fathers wished to adhere to the cultural imperative for father–child emotional closeness, a disparity between their ambitions and their conduct emerged. Care appeared to be a deeply gendered concept for the fathers and despite their aspirations for an intimate relationship with their children, gendered norms for motherhood and fatherhood prevailed resulting in passivity in their role as sexuality educators. The study concludes by arguing that challenges to structures and subcultural contexts, which may deter fathers from fully engaging with their sons and daughters in this aspect of communication are required.
Abstract Background: Adverse drug reactions (ADRs) can occur due to ecstasy use, and the number of people dying due to drug-related deaths has increased in the past 10 years. Harm reduction strategies could help prevent ADRs or decrease the incidence of life-threatening health consequences due to ecstasy use. However, no reviews have explored the breadth of evidence available on ecstasy harm reduction strategies. Methods: A rapid scoping review was conducted using adapted JBI methodology to identify the prevalence and nature of harm reduction strategies that ecstasy users employ in recreational settings, with both peer-reviewed research and user-oriented drug information websites explored. Five databases (CINAHL, EMBASE, Medline, PsycINFO, CENTRAL) were searched for English language records from database inception to August 2022. User-oriented websites were identified via the project’s stakeholder group and Google searches. Results: Twenty reports representing 19 studies (one randomised control trial, nine quantitative descriptive studies and nine qualitative studies) were included. A wide variety of harm reduction strategies were reported, including drug-specific strategies (for example, limiting the amount of ecstasy consumed, buying from trusted sources, drug checking (pill testing)); behavioural strategies (for example, monitoring fluid (water) consumption, taking a rest break to regulate temperature, avoiding alcohol and mixing with other drugs; preloading and post-loading); and peer-related strategies (for example not using alone, looking out for friends). Ecstasy users obtain information on ecstasy’s effects and/or harm reduction practices from a variety of sources including friends, nightclubs, TV news, drug leaflets, music magazines and user-oriented information websites. Fourteen user-oriented websites providing ecstasy-specific harm reduction information were identified, and strategies focused on dosage and frequency of use, interaction with other substances and prevention of health consequences, such as heatstroke, or dehydration among others. However, only two webpages provided citations to the evidence used for the content. Conclusions: While numerous harm reduction strategies exist, employing them can depend on the users’ overall goal/s which might also encompass avoiding comedown or increasing their high. Moreover, users’ previous experience can influence how and when they adhere to harm reduction. More efficient ways of communicating harms and harm reduction strategies might be needed.
Continuing professional education (CPE) for nurses is deemed an essential component to develop, maintain and update professional skills. However, there is little empirical evidence of its effectiveness or factors which may influence its application into practice. This paper explores a continuing professional education programme on the safe administration of medication and how new knowledge and skills are transferred into clinical practice. Realist evaluation provided the framework for this study. Realist evaluation stresses the need to evaluate programmes within "context," and to ask what "mechanisms" are acting to produce which "outcomes." This realist evaluation had four distinct stages. Firstly, theories were built as conjectured CMO configurations (Stage 1 and 2), then these cCMO were tested (Stage 3) and they were then refined (Stage 4). Data was collected through document analysis and interviews (9) to build and refine CMOs. The conjectured CMOs were tested by clinical observation, interview (7), analysis of further documents and analysis of data from reported critical incidents and nursing care metric measurements. This study has shown the significant role of the ward manager in the application of new learning from the education programme to practice. Local leadership was found to enable a patient safety culture and the adoption of a quality improvement approach. The multi-disciplinary team at both organisation and local level was also found to be a significant context for the application of the education programme into practice. Reasoning skills and receptivity to change were identified to be key mechanisms which were enabled within the described contexts. The findings from this study should inform policy and practice on the factors required to ensure learning from CPE is applied in practice. The realist evaluation framework should be applied when evaluating CPE programmes as the rationale for such programmes is to maintain and improve patient care.
Abstract Background: Adverse drug reactions (ADRs) can occur due to ecstasy use, and the number of people dying due to drug-related deaths has increased in the past 10 years. Harm reduction strategies could help prevent ADRs or decrease the incidence of life-threatening health consequences due to ecstasy use. However, no reviews have explored the breadth of evidence available on ecstasy harm reduction strategies. Methods: A rapid scoping review was conducted using adapted JBI methodology to identify the prevalence and nature of harm reduction strategies that ecstasy users employ in recreational settings, with both peer-reviewed research and user-oriented drug information websites explored. Five databases (CINAHL, EMBASE, Medline, PsycINFO, CENTRAL) were searched for English language records from database inception to August 2022. User-oriented websites were identified via the project’s stakeholder group and Google searches. Results: Twenty reports representing 19 studies (one randomised control trial, nine quantitative descriptive studies and nine qualitative studies) were included. A wide variety of harm reduction strategies were reported, including drug-specific strategies (for example, limiting the amount of ecstasy consumed, buying from trusted sources, drug checking (pill testing)); behavioural strategies (for example, monitoring fluid (water) consumption, taking a rest break to regulate temperature, avoiding alcohol and mixing with other drugs; preloading and post-loading); and peer-related strategies (for example not using alone, looking out for friends). Ecstasy users obtain information on ecstasy’s effects and/or harm reduction practices from a variety of sources including friends, nightclubs, TV news, drug leaflets, music magazines and user-oriented information websites. Fourteen user-oriented websites providing ecstasy-specific harm reduction information were identified, and strategies focused on dosage and frequency of use, interaction with other substances and prevention of health consequences, such as heatstroke, or dehydration among others. However, only two webpages provided citations to the evidence used for the content. Conclusions: While numerous harm reduction strategies exist, employing them can depend on the users’ overall goal/s which might also encompass avoiding comedown or increasing their high. Moreover, users’ previous experience can influence how and when they adhere to harm reduction. More efficient ways of communicating harms and harm reduction strategies might be needed.
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