A case study evaluation of implementation of a care pathway to support normal birth in one English birth centre: anticipated benefits and unintended consequences

Background: The policy drive for the UK National Health Service (NHS) has focused on the need for high quality services informed by evidence of best practice. The introduction of care pathways and protocols to standardise care and support implementation of evidence into practice has taken place across the NHS with limited evaluation of their impact. A multi-site case study evaluation was undertaken to assess the impact of use of care pathways and protocols on clinicians, service users and service delivery. One of the five sites was a midwifery-led Birth Centre, where an adapted version of the All Wales Clinical Pathway for Normal Birth had been implemented. Methods: The overarching framework was realistic evaluation. A case study design enabled the capture of data on use of the pathway in the clinical setting, use of multiple methods of data collection and opportunity to study and understand the experiences of clinicians and service users whose care was informed by the pathway. Women attending the Birth Centre were recruited at their 36 week antenatal visit. Episodes of care during labour were observed, following which the woman and the midwife who cared for her were interviewed about use of the pathway. Interviews were also held with other key stakeholders from the study site. Qualitative data were content analysed. Results: Observations were undertaken of four women during labour. Eighteen interviews were conducted with clinicians and women, including the women whose care was observed and the midwives who cared for them, senior midwifery managers and obstetricians. The implementation of the pathway resulted in a number of anticipated benefits, including increased midwifery confidence in skills to support normal birth and promotion of team working. There were also unintended consequences, including concerns about a lack of documentation of labour care and negative impact on working relationships with obstetric and other midwifery colleagues. Women were unaware their care was informed by a care pathway. Conclusion: Care pathways are complex interventions which generate a number of consequences for practice. Those considering introduction of pathways need to ensure all relevant stakeholders are engaged with this and develop robust evaluation strategies to accompany implementation

A quantitative analysis of the impact of a computerised information system on nurses' clinical practice using a realistic evaluation framework

Objective: To explore nurses' perceptions of the impact on clinical practice of the use of a computerised hospital information system. Design: A realistic evaluation design based on Pawson and Tilley's work has been used across all the phases of the study. This is a theory-driven approach and focuses evaluation on the study of what works, for whom and in what circumstances. These relationships are constructed as context-mechanisms-outcomes (CMO) configurations. Measurements: A questionnaire was distributed to all nurses working in in-patient units of a university hospital in Spain (n = 227). Quantitative data were analysed using SPSS 13.0. Descriptive statistics were used for an overall overview of nurses' perception. Inferential analysis, including both bivariate and multivariate methods (path analysis), was used for cross-tabulation of variables searching for CMO relationships. Results: Nurses (n = 179) participated in the study (78.8% response rate). Overall satisfaction with the IT system was positive. Comparisons with context variables show how nursing units' context had greater influence on perceptions than users' characteristics. Path analysis illustrated that the influence of unit context variables are on outcomes and not on mechanisms. Conclusion: Results from the study looking at subtle variations in users and units provide insight into how important professional culture and working practices could be in IT (information technology) implementation. The socio-technical approach on IT systems evaluation suggested in the recent literature appears to be an adequate theoretical underpinning for IT evaluation research. Realistic evaluation has proven to be an adequate method for IT evaluation. (C) 2009 Elsevier Ireland Ltd. All rights reserved

Software Engineers' Information Seeking Behavior in Change Impact Analysis - An Interview Study

Software engineers working in large projects must navigate complex information landscapes. Change Impact Analysis (CIA) is a task that relies on engineers' successful information seeking in databases storing, e.g., source code, requirements, design descriptions, and test case specifications. Several previous approaches to support information seeking are task-specific, thus understanding engineers' seeking behavior in specific tasks is fundamental. We present an industrial case study on how engineers seek information in CIA, with a particular focus on traceability and development artifacts that are not source code. We show that engineers have different information seeking behavior, and that some do not consider traceability particularly useful when conducting CIA. Furthermore, we observe a tendency for engineers to prefer less rigid types of support rather than formal approaches, i.e., engineers value support that allows flexibility in how to practically conduct CIA. Finally, due to diverse information seeking behavior, we argue that future CIA support should embrace individual preferences to identify change impact by empowering several seeking alternatives, including searching, browsing, and tracing.Comment: Accepted for publication in the proceedings of the 25th International Conference on Program Comprehensio

Patients as researchers - innovative experiences in UK National Health Service research

Consumer involvement is an established priority in UK health and social care service development and research. To date, little has been published describing the process of consumer involvement and assessing ‘consumers’ contributions to research. This paper provides a practical account of the effective incorporation of consumers into a research team, and outlines the extent to which they can enhance the research cycle; from project development and conduct, through data analysis and interpretation, to dissemination. Salient points are illustrated using the example of their collaboration in a research project. Of particular note were consumers’ contributions to the development of an ethically enhanced, more robust project design, and enriched data interpretation, which may not have resulted had consumers not been an integral part of the research team

Strategies used in the pursuit of achievability during goal setting in rehabilitation

We used conversation analysis of six audio- and video-recorded goal setting meetings that were attended by patients and their respective treating team to explore and describe the interaction of participants during interdisciplinary goal setting, and to identify the strategies used to agree goals. The health care professionals involved in the six sessions included four physiotherapists, four occupational therapists, four nurses, one speech and language therapist, and one neuropsychologist. The participants included 3 patients with multiple sclerosis, 2 patients with spinal cord lesions, and 1 patient with stroke from an inpatient neurological rehabilitation unit. Detailed analysis revealed how the treating team shaped the meetings. The most notable finding was that there was rarely a straightforward translation of patient wishes into agreed-on written goals, with the treating team leading goal modification so that goals were achievable. Despite professional dominance, patients also influenced the course of the interaction, particularly when offering resistance to goals proposed by the treating team

Inviwo -- A Visualization System with Usage Abstraction Levels

The complexity of today's visualization applications demands specific visualization systems tailored for the development of these applications. Frequently, such systems utilize levels of abstraction to improve the application development process, for instance by providing a data flow network editor. Unfortunately, these abstractions result in several issues, which need to be circumvented through an abstraction-centered system design. Often, a high level of abstraction hides low level details, which makes it difficult to directly access the underlying computing platform, which would be important to achieve an optimal performance. Therefore, we propose a layer structure developed for modern and sustainable visualization systems allowing developers to interact with all contained abstraction levels. We refer to this interaction capabilities as usage abstraction levels, since we target application developers with various levels of experience. We formulate the requirements for such a system, derive the desired architecture, and present how the concepts have been exemplary realized within the Inviwo visualization system. Furthermore, we address several specific challenges that arise during the realization of such a layered architecture, such as communication between different computing platforms, performance centered encapsulation, as well as layer-independent development by supporting cross layer documentation and debugging capabilities

A Conceptual Model for Scholarly Research Activity

This paper presents a conceptual model for scholarly research activity, developed as part of the conceptual modelling work within the ???Preparing DARIAH??? European e-Infrastructures project. It is inspired by cultural-historical activity theory, and is expressed in terms of the CIDOC Conceptual Reference Model, extending its notion of activity so as to also account, apart from historical practice, for scholarly research planning. It is intended as a framework for structuring and analyzing the results of empirical research on scholarly practice and information requirements, encompassing the full research lifecycle of information work and involving both primary evidence and scholarly objects; also, as a framework for producing clear and pertinent information requirements, and specifications of digital infrastructures, tools and services for scholarly research. We plan to use the model to tag interview transcripts from an empirical study on scholarly information work, and thus validate its soundness and fitness for purpose

Clinical components and associated behavioural aspects of a complex healthcare intervention : Multi-methods study of selective decontamination of the digestive tract in critical care

Copyright © 2013 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.Peer reviewedPostprin

THE ROLE OF LAND-USE PLANNING FOR ORGANIZE THE BALANCED TERRITORIAL DEVELOPMENT WITHIN THE UNITED TERRITORIAL COMMUNITIES

It is a well-known fact that sustainable land use can contribute the formation and maintenance of balanced territorial development. At the same time in scientific publications too little attention is paid to the consideration of land-use planning as an indispensable elementary component of sustainable land use. The aim of this article is to highlight is the importance of land-use planning for balanced territorial development within united territorial communities, mainly by analyzing existing land use and justification recommendations for optimizing land use on a balanced development basis. Land-use planning involves the creation of documentation, including planning and mapping materials, which regulates of land use process within certain administrative unit. In Ukraine, such materials are first of all, a scheme (plan) of land-use certain territorial community, which is compiled on a scale of 1:10000 and contains the current state of land use within the territory of the village council (united territorial community), environmental measures and information on land-use planning for the appropriate perspective. So, the main direction of implementation the ideas of balanced territorial development for the certain administrative unit is the creating a plan for its land-use planning based on the principles of optimization landscape systems on the balanced development basis. On this basis, let’s analyze the current state of land use the Nedogarkiv United Territorial Community and justify recommendations for optimizing land use on a balanced development basis. On a whole, land-use planning is essential for the organization of balanced (sustainable) development of the territory, since the documental status of all created materials indicates that they are mandatory for all landowners and land users. The only disadvantage is the complete dependence of land-use planning on the legislative framework certain country, which complicates the offering of uniform methods of its application for several states or individual regions of the world