Precaution, governance and the failure of medical implants: the ASR(TM) hip in the UK

Hip implants have provided life-changing treatment, reducing pain and improving the mobility and independence of patients. Success has encouraged manufacturers to innovate and amend designs, engendering patient hopes in these devices. However, failures of medical implants do occur. The failure rate of the Articular Surface Replacement metal-on-metal hip system, implanted almost 100,000 times world-wide, has re-opened debate about appropriate and timely implant governance. As commercial interests, patient hopes, and devices’ governance converge in a socio-technical crisis, we analyse the responses of relevant governance stakeholders in the United Kingdom between 2007 and 2014. We argue that there has been a systemic failure of the governance system entrusted with the safety of patients fitted with medical implants. Commercial considerations of medical implants and the status quo of medical implant governance have been given priority over patient safety despite the availability of significant failure data in an example of uncertainty about what constitutes appropriate precautionary action

Crossing the threshold into reflective practice.

Encouraging reflective practice across postgraduate programmes for health professionals is challenging. Assessing reflections and determining the level of reflective practice reached can be difficult. Understanding reflection as a threshold concept may be useful to help meet the pedagogical challenges of such a valuable skill

Leadership and organisational effectiveness – lessons to be drawn from education?

Aim  The aim of this paper is to present findings of a case study on organisational effectiveness in an education setting and draw similarities with a healthcare setting, focusing on the school principal and nurse leader. Background  The study was carried out in a primary school setting and focuses on a principal (as leader). The school, which will be named St Senan’s for the case study, is a typical tall structure has a staff of 30 (teachers and special needs’ assistants) and a student number of 117. Methods  A case study methodology was used. Data was collected by interviewing the principal, two teachers, two students and a parent, in this order. In addition, a Parents’ Council meeting was observed and document analysis was carried out on measurements which reflected some critical success factors for the school. Results  Interviews from students and teachers in addition to observation notes indicate that the principal’s leadership impacts on organisational effectiveness in the school. Conclusions  The findings are located in the context of education with similarities being drawn from nursing. It is how the leader leads in the context of the organisation setting which is paramount. In other words it is not possible to take a set of general critical success factors for a school or healthcare setting and apply these widely. The paper concludes by proposing the use of a quality framework to contextualise the findings of the case and promote further discussion in the context of nurse leaders. Implications  The paper suggests that comparisons can be made between school principals and nurse leaders

Leading and leadership: Reflections on a case study.

Aim: The aim of this case study was to explore if observing leaders in the context of their day-to-day work can provide an insight into how they lead in particular circumstances. Background: The study was carried out in small organisation which was set up five years ago. Methods: A case study methodology was used. Data was collected by field notes of non-participant and participant observations. Follow-up interviews were transcribed and analysed to contextualise the observations. A reflective diary was used by the researcher to add to the richness of the data. Results: The data demonstrates how the leader responded in key circumstances during scheduled meetings with staff, interactions in the office and during coffee time. These responses are linked to literature on leadership in the areas of power, personal development, coaching and delegation. Conclusions: The findings suggest that observing a leader in the context of their day-to-day work can provide evidence to validate what leaders do in particular circumstances Implications for Nursing Management: The implications of the findings for nursing management are the opportunities to use observation as a tool to understand what managers/leaders do, how they manage or lead and why others respond as they do, and with what outcomes

Action Learning- a process which supports organisational change initiatives.

This paper reflects on how action learning sets were used to support organisational change initiatives. It sets the scene with contextualising the inclusion of change projects in a masters programme. Action learning is understood to be a dynamic process where a team meets regularly to help individual members address issues through a highly structured, facilitated team process of reflection and action. The key findings from evaluation of the students and facilitators’ experiences are reflected on, together with plans for improving the experience for all stakeholders for the next academic year. In sharing this experience the purpose of the paper is to highlight the most significant learning from the evaluation. Good preparation for action learning is vital to ensure a positive experience for all involved. From the student perspective, an appropriate learning set mix is needed to ensure a balance of support and challenge for the action learning set. In addition to a preparatory workshop for action learning facilitators regular meetings with the action learning facilitators in the form of action learning sets could be scheduled as a support especially for those new to the process. Finally it is hoped that this account will encourage readers to use action learning for supporting and engaging students in organisational change initiatives

A framework for portfolio development in postgraduate nursing practice

Aims and objectives.  The aim of this study is to explore the introduction of portfolios into the first year of an MSc in Nursing Programme. Background.  This paper outlines a framework for portfolio development in postgraduate nursing practice. The framework is being piloted, within the Irish context, with students in the first year of a Masters in Nursing programme and has the potential to be developed for other nursing programmes at postgraduate level. Design and method.  An action research approach has been chosen to study the implementation of the portfolio and the development of a framework to guide this initiative. To date the development of the framework is being piloted as part of the ‘taking action’ phase of a first action research cycle. Results.  In its current stage of development the framework is constructed to embrace the core concepts of specialist nursing practice and the nursing management competencies, from current Irish health care documents. In addition the portfolio is anchored around personal development planning and is supported by the use of action learning tutorials and academic and practice facilitators. The first evaluating phase will take place later this year and will involve the collection of data from students, facilitators and lecturers. Conclusion.  The introduction of the portfolio at postgraduate level has highlighted, to date, issues of confidentiality in committing experiences to paper, issues around its assessment, and issues around sharing this document with other students. Relevance to clinical practice.  Portfolio development at postgraduate level emphasizes linking theory and practice and stresses the importance of reflection on practice. The portfolio can also be used by nurses to develop their clinical career pathways and encourage personal development planning

Continuing Professional Development: investment or expectation?

Aim: The aim of this study was to explore the reason for nurses\u27 participation in postregistration education. Background: The study was located in one third level institution in Ireland and prospective candidates who applied to undertake a programme of studies were invited to complete the postal questionnaire and return it to the college anonymously in advance of commencing their studies. Method: A descriptive survey research design was adopted with the use of a questionnaire for data collection. The respondents had an opportunity to make additional comments in a questionnaire, which generated some qualitative data. Results: A total of 243 questionnaires were returned which represented a 46.7% response rate. The major reasons for participating in postregistration education were \u27to obtain promotion to a higher grade/position\u27 (99%) and \u27to enable me extend my clinical role\u27 (98%). Conclusion: Investment in nursing education should take into account the reasons for participation in continuing education and professional development as identified in this study and in other studies so as to focus efforts that improve planning for long-term continuing education and professional development. The adoption of such a strategic approach by employers will ensure more precise targeting of scarce continuing education and professional development resources. Equally, expectation without adequate investment is not realistic if the profession wants to move forward in this era of rapid change in the delivery of health care

Factors Influencing Curricular Reform; an Irish Perspective

There are various influences and obstacles when planning an educational curriculum. However, it is imperative that we overcome these barriers and arm our future doctors with the knowledge and skills to serve the needs of the 21st Century patient. As we will discuss, the imprint of globalisation on the landscape of Irish medicine highlights the importance of delivering a diverse curriculum with international dimensions so that knowledge and skills can transfer across borders. We will also explore how medical emigration has a negative impact on the delivery of services in Ireland and in maintaining a sustainable workforce. In addition, financial constraints will always play a role in the logistics of Medical education and it is important that we try to get the best value for money by adding more cost effective virtual learning modules to the traditional classroom based approach. Further research is needed into career satisfaction within Medicine. If we can begin to understand what motivates doctors to stay within the Irish Medical system, then we can design a curriculum with retention of graduates in mind. We believe that if we foster a culture of education, guidance and support in our universities and hospitals, we will ensure that a strong, competent and resilient breed of doctors emerge to serves future generation

Leading change as a professional: working across boundaries

This paper outlines an initiative, namely a leadership symposium, which developed from a chance meeting of like-minded academics, who were trying to achieve similar outcomes with their student groups; namely, to include the scholarly activity of disseminating graduates\u27 action-oriented projects. One group of graduates were from a mix of healthcare professions, the other group were teachers. Both were leading change projects across their professions. One group was guided by action research and the other by action learning. This paper outlines the graduates’ experiences of their challenges, opportunities and learning from leading these change initiatives. Arising from the symposium exchanges, the authors focus on the unique opportunity of the event as a distinctive space for exchange of learning across professions. Findings from qualitative data collected for the symposium is supported by situated learning and existing literature

Approaches to Learning in the context of an outcomes-based curriculum

How does an outcomes-based curriculum influence approaches to learning in an interprofessional postgraduate programme for healthcare professionals