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1 – 10 of 878Hesham Metwalli Mousli, Iman El Sayed, Adel Zaki and Sherif Abdelmonem
This study intends to improve the quality of venous thromboembolism (VTE) prophylaxis practices including proper VTE risk assessment and the appropriate prophylaxis measures for…
Abstract
Purpose
This study intends to improve the quality of venous thromboembolism (VTE) prophylaxis practices including proper VTE risk assessment and the appropriate prophylaxis measures for surgical urology patients.
Design/methodology/approach
The authors applied the Six-Sigma define, measure, analyze, improve and control (DMAIC) improvement methodology in a pre–post interventional study that involved all adult patients above 18 years old indicated and scheduled for urology surgical interventions including endoscopic urological surgeries in a urology specialized 60-bed hospital. The pre-intervention sample included all patients meeting the inclusion criteria over a period of six months. Post-intervention sample included all patients meeting the inclusion criteria over a period of six months. The improvement areas included both the VTE risk assessment as well as the VTE prophylaxis prescription.
Findings
DMAIC methodology has achieved a substantial sustained improvement in surgical urology VTE prophylaxis practices with an average of 70% on both levels; VTE risk assessment practices and VTE prophylaxis prescribing practices were statistically significant. The post-intervention results also showed a statistically controlled process with no special cause variations. Based on the study results, the Six-Sigma DMAIC methodology can be considered of high value when applied in healthcare clinical practice improvement projects.
Research limitations/implications
The project study includes some pitfalls that can be addressed as follows: 1. The lack of VTE rate incidence tracking. This limitation can be partly refuted when the authors conduct a literature review and explore that the VTE prophylaxis effectiveness had been proven with sufficient evidence to an extent that pushed several scientific societies to develop their own guidelines to support VTE prophylaxis. (Algattas et al., 2018). 2. Another limitation of this study can be that it handled only surgical patients and more specifically surgical urology patients. Of course, VTE prophylaxis is a crucial life-threatening problem not only for the surgical admitted patients but also for all the medical admitted patients either in hospital wards or ICUs. However, the prediction that surgical patients especially surgical urology patients are more prone to VTE development risk as they have -in several cases-two or three main additive risk factors which are age, procedure duration and malignancy in elderly men. (Tikkinen et al., 2014). So, the authors consider the study project to be a prototype that hopefully can be utilized for future study projects that will manage both other surgical specialty patients and medical patients on the national level and can track accurately and effectively report the VTE incidence rates.
Practical implications
Several recommendations can be extracted from the research project that is summarized in the following points: Paying focused attention to continuous healthcare quality improvement initiatives and projects as a main approach for healthcare improvement especially for the public health-related problems. This might be achieved through periodic region-specific or specialty-specific focus groups from which public health problems could be addressed and prioritized to be considered as a part of country healthcare campaigns regarding cost-utility and feasibility studies. The adoption of a system thinking approach in dealing with the improvement strategies; all efforts and resources are to be employed to achieve a common objective. This includes the generation of a national-wide electronic health information system that can aid in healthcare resource allocation and direct the healthcare efforts towards the most important, high-priority public health problems. Electronic national-wide health record is really an effort, and resources consuming activity, but actually, it's worth exerting efforts, and its valuable outcomes may be seen several years later. 3. Development of unified national specialized VTE prophylaxis pathways to standardize the patient-specific VTE prophylaxis plans. Standardization of healthcare pathways enables healthcare professionals to follow an evidence-based practice which will be reflected on the improvement of healthcare quality level, cost-effectiveness enhancement, and timely patient care on all levels especially in high critical areas like ER and ICU. 4. Incorporation of VTE prophylaxis costs in the universal health insurance diagnosis-related group (DRG) insurance packages and service pricing. Universal health insurance is a nationwide strategy that is aiming to cover all Egypt residents by the year 2030. Universal health insurance is being following the DRG reimbursement policy that is thought to control all the healthcare-associated costs so, the VTE prophylaxis costs shall be added as the main cost item to encourage all healthcare facilities to follow an evidence-based VTE prophylaxis pathway taking into consideration the high-risk patient categories who will definitely represent a high-cost burden on the long run if they suffer a VTE event.
Originality/value
DMAIC improvement methodology applications in healthcare are still relatively limited, especially on the clinical level. The study can be considered one of a kind in Egypt dealing with a comprehensive DMAIC methodology application on the clinical level.
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Benjamin Buck Blankenship and Jon Lee
This study was intended to investigate a small-scale School-based Motivational Interviewing (SBMI) pilot with first-year college students. This approach honors student autonomy…
Abstract
Purpose
This study was intended to investigate a small-scale School-based Motivational Interviewing (SBMI) pilot with first-year college students. This approach honors student autonomy, supports self-determination and has the potential to impact educational outcomes in higher education. Motivational Interviewing (MI) is an evidence based conversational skill set, defined as “a collaborative conversational style for strengthening a person's own motivation and commitment to change” (Miller and Rollnick, 2013, p. 12). Student perceptions of satisfaction with the faculty-student mentoring intervention were sought. Relational aspects of MI (partnership, empathy and alliance) were also explored.
Design/methodology/approach
A mixed-method approach was used for the SBMI study, focused on college students with recent academic setbacks (N = 19).
Findings
The intervention was deployed with high levels of MI technical fidelity and relational quality. Participants reported high satisfaction with the intervention. The relational aspects and participant perceived alliance with their faculty were highly correlated across the intervention, adding to the discussion of the mechanisms of MI that contribute to its effectiveness.
Research limitations/implications
This work is formative, yet at this point is not generalizable given the scope of the study.
Practical implications
Findings are encouraging for further development of this innovative pedagogical approach. Possible future applications of research are provided.
Social implications
Discussed herein, SBMI has the potential to meet the needs of traditionally underrepresented student groups.
Originality/value
The reported study is the initial portion of a larger intervention development project.
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Barrie Green and Jake Stanworth
This paper aims to critically compare the impact and preparedness for practice of two types of mental health nurse training in the UK. One being a hospital-based apprenticeship…
Abstract
Purpose
This paper aims to critically compare the impact and preparedness for practice of two types of mental health nurse training in the UK. One being a hospital-based apprenticeship model from the 1980s; the other a university-based and more academically focussed approach from this millennium.
Design/methodology/approach
This autoethnographic reflective commentary describes and reviews the effectiveness of two training curricula for Registered Mental Nurse (RMN) training. The first being the certificate-level 1983 syllabus of the UK Central Council for Nursing, Midwifery and Health Visiting, which was replaced in the late 1990s by diploma and degree-level Project 2000 training of the General Nursing Council. Using a reflective narrative approach to describe the lived experience of two qualified nurses, it compares, reviews and critiques both initiatives.
Findings
The author/researchers found both benefits and negatives inherent in each model. These were grouped into five key headings, which are a sense of belonging/identity; exposure to clinical practice; differences in training modality; development of clinical management skills and clinical preparedness; and academic merit. The older curriculum lacked an academic or research base, whereas the more recent approach encouraged and enhanced this element. However, with regard to preparing the clinician/registered nurse to feel confident in addressing a range of clinical and managerial challenges, the older style training seems to deliver better outcomes. They conclude that a move towards a “middle ground” between the two models may be of benefit to future RMN preparation.
Research limitations/implications
This study reports on the experience of two registered nurses. Therefore, the sample size is small. However, autoethnography is acknowledged as an effective means of delivering qualitative research; in addition, the authors access and use material from the wider literature to triangulate and critique their approach. This paper adds to the literature but also allows for duplication by others to further test the findings.
Practical implications
This type of study provides an opportunity for others to review, compare and contrast nursing or other multi-discipline changes in training/curriculum. The research method is one that is transferable and can be used within areas of practice, which have resource limitations. It provides an opportunity to replicate it in other services or jurisdictions.
Social implications
Nursing in the UK has experienced significant change over the past four decades. For RMNs, the move from hospitals into the community has been transformational. In addition, the influence of higher academic standards and the influence of the recent pandemic have challenged the profession and individuals within it. This study demonstrates positive and negative elements of the dilemma faced by nurses and offers a further contribution to this area.
Originality/value
There are a number of academic papers, media stories, statutory reports and guidance that explore the impact of changes within nurse training. This paper uses a first person autoethnographic study of the impact and effectiveness of these changes at a human level, the nurse on the ground. It uses the ward medicine keys as the vehicle to represent the huge responsibility that newly qualified nurses must face; this is not widely represented elsewhere in the literature!
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Melissa Newberry and Phil Riley
Although the emotion work of teaching has been part of the conversation for more than 30 years, it remains a side conversation, as sort of an afterthought to academics and the…
Abstract
Although the emotion work of teaching has been part of the conversation for more than 30 years, it remains a side conversation, as sort of an afterthought to academics and the accepted mainstream point of teaching and learning. In this chapter, we reflect on what has occurred in the field in the decade since our book Emotion in school: Understanding how the hidden curriculum influences relationships, leadership, teaching and learning was published. We approach the topic through a lens of tensions that we perceive occurring in the field. Emotions in schools, for the most part, remain the hidden curriculum in that in many ways emotions are still downplayed in the classroom and have no space in teacher preparation programs. Teachers, students, administrators, and teacher educators alike are left to deal with the tensions that confront them that educational researchers have yet to resolve – tensions related to measurement (what are we measuring and why), related to how we define emotion and tensions related to practice. In this short chapter we do not have the space to address all tensions that might arise; we have chosen a few to provoke conversation and thoughts about where the field may go from here. Suggestions for beginning teachers and research for teacher preparation are offered.
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Xue Zhang, Yezheng Liu, Xin Li and Jianshan Sun
Leveraging information technology (IT) to improve the treatment and support of patients is a widely studied topic in healthcare. For chronic diseases, such as diabetes, the use of…
Abstract
Purpose
Leveraging information technology (IT) to improve the treatment and support of patients is a widely studied topic in healthcare. For chronic diseases, such as diabetes, the use of information technology is even more important since its effect extends from a clinic environment to patients’ daily life. The purpose of this paper is to investigate the impacts of one widely adopted information technology, the mobile phone, on diabetes treatment, specifically on the complicated process of patients’ health, emotions and compliance.
Design/methodology/approach
We leverage a unique longitudinal dataset on diabetes patients’ health status in rural areas of China to study the problem. We also cross-link the dataset with mobile carrier data to further differentiate mobile phone use to phone calls and network use. To address the endogeneity concerns, we apply PSM and a series of instrument variables.
Findings
We identify clear evidence that mobile phone use can significantly improve patients’ emotions and compliance, where the effect is generally larger on patients in worse health conditions. While mobile phone calls clearly benefit diabetes patients, we do notice that mobile phone network use has a negative moderating effect with patients’ health condition on improving compliance.
Originality/value
This study not only enriches our theoretical understanding of the role of mobile phones in diabetes management, it also shows the economic benefit of promoting patients’ use of mobile phones, which should be considered by medical care providers and medical policymakers.
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Serious case reviews remind us that there is much to learn about inter-agency activity. Professional identity is a key phenomenon influencing work behaviour, especially during…
Abstract
Purpose
Serious case reviews remind us that there is much to learn about inter-agency activity. Professional identity is a key phenomenon influencing work behaviour, especially during inter-agency activity. Yet, this link is complex and not well understood within the context of UK children’s services. With an agenda of improving outcomes for children and their families, The purpose of this research paper is to conduct a systematic literature review on this topic to develop a conceptual model aimed at informing how practitioners mobilise their professional identity during inter-agency activity.
Design/methodology/approach
This paper used meta-ethnography to synthesise the available research. This method is suitable for researchers who are interested in conceptual or theoretical understandings of a particular phenomenon as opposed to describing individual accounts or experiences.
Findings
The findings support postmodern accounts of identity and show the construct as fluid, contingent and constituted within interaction. Professional identities are mobilised through the sharing of professional knowledge, which is underpinned by the performative nature of language. Mobilisations can lead to both positive and negative consequences, which can act as a barrier to and facilitator of inter-agency activity.
Originality/value
Inter-agency working is integral to the function of children’s services but remains an undertheorised concept, and this had led to a dearth of guiding theory on inter-agency practice. By drawing on relevant psychological theory, the proposed model provides a unique psycho-social perspective that articulates the important role of identity during inter-agency activity, which would be of interest to professionals working in children’s services.
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Gabriella Tazzini, Brioney Gee, Jon Wilson, Francesca Weber, Alex Brown, Tim Clarke and Eleanor Chatburn
This paper aims to examine the barriers and facilitators of conducting and implementing research in frontline child and youth mental health settings in the UK.
Abstract
Purpose
This paper aims to examine the barriers and facilitators of conducting and implementing research in frontline child and youth mental health settings in the UK.
Design/methodology/approach
Researchers, clinicians and commissioners who attended a workshop at the Big Emerging Minds Summit in October 2022 provided their expert views on the structural barriers and possible solutions to integrating research in clinical practice based on their experiences of child and young people mental health research.
Findings
The identified barriers encompass resource constraints, administrative burdens and misalignment of research priorities, necessitating concerted efforts to foster a research-supportive culture. This paper proposes the potential actionable solutions aimed at overcoming challenges, which are likely applicable across various other health-care systems and frontline NHS services. Solutions include ways to bridge the gap between research and practice, changing perceptions of research, inclusive engagement and collaboration, streamlining ethics processes, empowering observational research and tailored communication strategies. Case examples are outlined to substantiate the themes presented and highlight successful research initiatives within NHS Trusts.
Originality/value
This paper provides an insight into the views of stakeholders in child and youth mental health. The themes will hopefully support and influence clinicians and academics to come together to improve the integration of research into clinical practice with the hope of improving service provision and outcomes for our children and young people.
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B.S. Patil and M.R. Suji Raga Priya
The purpose of this study is to target utilizing Human resources (HRs) data analytics that may enhance strategic business, but little study has examined how it affects components…
Abstract
Purpose
The purpose of this study is to target utilizing Human resources (HRs) data analytics that may enhance strategic business, but little study has examined how it affects components. Data analytics, HRM and strategic business require empirical investigations and how to over come HR data analytics implementation issues.
Design/methodology/approach
A semi-systematic methodology for its evaluation allows for a more complete examination of the literature that emerges theoretical framework and a structured survey questionnaire for quantitative data collection from IT sector personnel. SPSS analyses data.
Findings
Future research is essential for organisations to exploit HR data analytics’ performance-enhancing potential. Data analytics should complement human judgment, not replace it. This paper details these transitions, the important contributions to theory and practice and future research.
Research limitations/implications
Data analytics has grown rapidly and might make HRM practices faster, more efficient and data-driven. HR data analytics may improve strategic business. HR data analytics on employee retention, engagement and organisational success is insufficient. HR data analytics may boost performance, but there is limited proof. The authors do not know how HRM data analytics influences firms and employees.
Originality/value
Data analytics offers HRM new opportunities, along with technical and ethical challenges. This study makes a significant contribution to HR data analytics, evidence-based practice and strategic business literature. In addition to estimating turnover risk, identifying engagement factors and planning interventions to increase retention and engagement, HR data analytics can also estimate the risk of employee attrition.
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Birgitta Schwartz and Karina Tilling
Research and experience show that evidence-based practice (EBP), i.e. using the best available knowledge in daily professional work, is difficult to achieve in social services…
Abstract
Purpose
Research and experience show that evidence-based practice (EBP), i.e. using the best available knowledge in daily professional work, is difficult to achieve in social services. The purpose of this study is to understand the development of organizational EBP learning processes in daily work through workplace education for staff and managers of supported homes for people with cognitive disabilities. The authors examine how the EBP model and new knowledge are understood and made actionable in the workplace, applying theories of organizational learning.
Design/methodology/approach
The authors used empirical material collected from an EBP workplace education pilot in Sweden, as well as documents on national EBP implementation in Swedish social services. Before the pilot, a focus group interview was conducted with regional senior managers. Participating managers and staff were individually interviewed two to three years after the pilot.
Findings
The study illustrates how knowledge-based action emerged from education where EBP was interpreted, understood, reflected on, and tested, supported by codified EBP tools in the work context. The participants, when supervised, and when observing and questioning their own behaviors in practice, contributed to double-loop learning (DLL) processes. Codification of EBP knowledge into useful tools and socialization processes during education and workplace meetings was crucial in developing individual and group DLL and knowledge-based actions.
Originality/value
The bottom-up approach to EBP development and the adaptive contextual learning at the workplace gave new insights into organizational learning in social service workplaces.
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Constantin Bratianu, Alexeis Garcia-Perez, Francesca Dal Mas and Denise Bedford