A Review of the Nurse Consultant Role

Background This paper reports the results of a review of the Nurse Consultant role at Nottinghamshire Healthcare NHS Trust the aim of which was to provide a clear picture of the current role remit and impact of each Nurse Consultant to inform recommendations for [any] required revision and ensure that Nurse Consultant’s roles and responsibilities are aligned to the evidence on best practice, reflect the Trusts business priorities, and that there is a well understood model in operation. Methods Using multiple methods of data collection, we investigated perceptions of the impact of Nurse Consultants among general managers and clinical directors, service users and carers, and selected other colleagues using semi-structured interviews and a focus group, as well as exploring with Nurse Consultants their view of the impact of their role via semi-structured interviews. In addition, we evaluated the leadership skills of Nurse Consultants using a 360 degree evaluation. Finally, we examined the activities of Nurse Consultants by analysing their diaries during a three month period. Results Nurse Consultants spend 38% of their activity on expert practice, 26% on professional leadership and practice, 19% on education, training and supervision and 15% on practice development, research and evaluation; 2% is spent on other activities. On the 360 degree evaluations, Nurse Consultants scored highest on enabling others (median 52/60), followed by modelling, encouraging and inspiring others (51/60). They scored lowest on challenging others (47/60). General Managers and Clinical Directors reported the positive impact Nurse Consultants have on clinical leadership and their contribution to improving clinical strategies and service developments. Service users and carers reported that they value the role, but were critical of the absence of Nurse Consultants in acute mental health wards. Conclusions The practices of Nurse Consultants at Nottinghamshire Healthcare Trust reflect the suggested domains of the role, but they fall short of national expectations of the percentage time NC should spend on expert clinical practice. There is widespread recognition of the positive impact of the role on service development and evidence of the positive impact of Nurse Consultants on practice. In general, colleagues recognise that Nurse Consultants are positive role models, who inspire, challenge, encourage and enable others. There is a widespread belief in the untapped potential for Nurse Consultants to play a more strategic leadership role in the Trust. Recommendations are made for the future development of the Nurse Consultant role

Clinician experiences on training and awareness of sexual orientation in NHS Talking Therapies Services for Anxiety and Depression

Previous research that explored sexual minority service users’ experiences of accessing NHS Talking Therapies for Anxiety and Depression Services highlighted the need for specific sexual orientation training. Inconsistent or lack of training may contribute to disparities in treatment outcomes between sexual minority service users and heterosexual service users. The aim of the study was to explore clinicians’ competencies working with sexual minority service users, their experiences of sexual orientation training, their view of current gaps intraining provision, and ways to improve training. Self-reported sexual orientation competency scales and open ended questions were used to address the aims of the study. Participants (n=83) included Psychological Wellbeing Practitioners (PWPs) and high-intensity CBT therapists (HITs). Responses on competency scales were analysed using Kruskal–Wallis tests and thematic analysis was used to analyse qualitative responses. Participants who identified as 25–29 years old had higher scores on the knowledge scale than 45+-year-olds.Bisexual participants also had higher scores on the knowledge subscale than heterosexual participants. Threeover-arching themes were identified: (a) training received on sexual minority issues by Talking Therapies clinicians, (b) clinicians’ experiences of accessing and receiving sexual minority training, and (c) perceived gaps in current sexual minority training and ways to improve training. Findings were linked to previous literature and recommendations to stakeholders are made throughout the Discussion section with the view of improving sexual orientation training

Evaluating and Quantifying User and Carer Involvement in Mental Health Care Planning (EQUIP): Co-Development of a New Patient-Reported Outcome Measure

International and national health policy seeks to increase service user and carer involvement in mental health care planning, but suitable user-centred tools to assess the success of these initiatives are not yet available. The current study describes the development of a new reliable and valid, interval-scaled service-user and carer reported outcome measure for quantifying user/carer involvement in mental health care planning. Psychometric development reduced a 70-item item bank to a short form questionnaire using a combination of Classical Test, Mokken and Rasch Analyses. Test-retest reliability was calculated using t-tests of interval level scores between baseline and 2–4 week follow-up. Items were worded to be relevant to both service users and carers. Nine items were removed following cognitive debriefing with a service user and carer advisory group. An iterative process of item removal reduced the remaining 61 items to a final 14-item scale. The final scale has acceptable scalability (Ho = .69), reliability (alpha = .92), fit to the Rasch model (χ2(70) = 97.25, p = .02), and no differential item functioning or locally dependent items. Scores remained stable over the 4 week follow-up period, indicating good test-retest reliability. The ‘Evaluating the Quality of User and Carer Involvement in Care Planning (EQUIP)’ scale displays excellent psychometric properties and is capable of unidimensional linear measurement. The scale is short, user and carer-centred and will be of direct benefit to clinicians, services, auditors and researchers wishing to quantify levels of user and carer involvement in care planning

A Template for a New Generic Geographically Weighted R Package gwverse

GWR is a popular approach for investigating the spatial variation in relationships between response and predictor variables, and critically for investigating and understanding process spatial heterogeneity. The geographically weighted (GW) framework is increasingly used to accommodate different types of models and analyses, reflecting a wider desire to explore spatial variation in model parameters and outputs. However, the growth in the use of GWR and different GW models has only been partially supported by package development in both R and Python, the major coding environments for spatial analysis. The result is that refinements have been inconsistently included within GWR and GW functions in any given package. This paper outlines the structure of a new gwverse package, that may over time replace GW model, that takes advantage of recent developments in the composition of complex, integrated packages. It conceptualizes gwverse as having a modular structure, that separates core GW functionality and applications such as GWR. It adopts a function factory approach, in which bespoke functions are created and returned to the user based on user-defined parameters. The paper introduces two demonstrator modules that can be used to undertake GWR and identifies a number of key considerations and next steps

A Template for a New Generic Geographically Weighted R Package gwverse

GWR is a popular approach for investigating the spatial variation in relationships between response and predictor variables, and critically for investigating and understanding process spatial heterogeneity. The geographically weighted (GW) framework is increasingly used to accommodate different types of models and analyses, reflecting a wider desire to explore spatial variation in model parameters and outputs. However, the growth in the use of GWR and different GW models has only been partially supported by package development in both R and Python, the major coding environments for spatial analysis. The result is that refinements have been inconsistently included within GWR and GW functions in any given package. This paper outlines the structure of a new gwverse package, that may over time replace GW model, that takes advantage of recent developments in the composition of complex, integrated packages. It conceptualizes gwverse as having a modular structure, that separates core GW functionality and applications such as GWR. It adopts a function factory approach, in which bespoke functions are created and returned to the user based on user-defined parameters. The paper introduces two demonstrator modules that can be used to undertake GWR and identifies a number of key considerations and next steps. Volume54, Issue

Measurement of statistical nuclear spin polarization in a nanoscale GaAs sample

We measure the statistical polarization of quadrupolar nuclear spins in a sub-micrometer (0.6 um^3) particle of GaAs using magnetic resonance force microscopy. The crystalline sample is cut out of a GaAs wafer and attached to a micro-mechanical cantilever force sensor using a focused ion beam technique. Nuclear magnetic resonance is demonstrated on ensembles containing less than 5 x 10^8 nuclear spins and occupying a volume of around (300 nm)^3 in GaAs with reduced volumes possible in future experiments. We discuss how the further reduction of this detection volume will bring the spin ensemble into a regime where random spin fluctuations, rather than Boltzmann polarization, dominate its dynamics. The detection of statistical polarization in GaAs therefore represents an important first step toward 3D magnetic resonance imaging of III-V materials on the nanometer-scale.Comment: 20 pages, 6 figures, 1 supplementary fil

Institutional and policy issues in the management of fisheries and coastal resources in Cambodia

Fishery management, Governments, Fishery policies, Resource conservation, Resource management, Cambodia,

The Johnson-Segalman model with a diffusion term in Couette flow

We study the Johnson-Segalman (JS) model as a paradigm for some complex fluids which are observed to phase separate, or ``shear-band'' in flow. We analyze the behavior of this model in cylindrical Couette flow and demonstrate the history dependence inherent in the local JS model. We add a simple gradient term to the stress dynamics and demonstrate how this term breaks the degeneracy of the local model and prescribes a much smaller (discrete, rather than continuous) set of banded steady state solutions. We investigate some of the effects of the curvature of Couette flow on the observable steady state behavior and kinetics, and discuss some of the implications for metastability.Comment: 14 pp, to be published in Journal of Rheolog

Tidal energy machines: A comparative life cycle assessment

Marine energy in the UK is currently undergoing a period of exponential growth in terms of development and implementation. The current installed tidal energy capacity of around 4MW is expected to rise to provide up to 20% of the UK’s electricity demand by 2050 [5]. With this in mind, there is a huge range of energy devices, all seemingly promoted by their developers as the best method of extracting power from the ocean. Embodied energy is an important aspect of any power producing device or process, and is used to describe the amount of energy required to begin and maintain the process of energy generation. Until a device or process has generated this amount of energy it cannot be said to be a net contributor of energy. This work used Life Cycle Assessment to study four tidal energy devices, representing a cross section of the existing designs, and compares their embodied energy and carbon dioxide emissions. In order to ensure a fair comparison, a hypothetical installation site is used, with conditions typical of those found at potential array installation sites in the UK. The designs studied include a multi-blade turbine, two three blade horizontal axis turbine machines, and an Archimedes’ screw device. These machines were chosen to represent a cross section of device, foundation, installation and operation designs. They have all been developed to prototype stage, meaning that actual manufacturing data is available. Embodied energy is considered over the entire lifetime of each device, beginning with extraction of raw materials. Energy use from fabrication, transport, installation, lifetime maintenance, end-of-life decommissioning and recycling are all calculated, and compared to the energy generation from each device at the test site. Finally, the embodied energy; CO2 intensity; and energy payback periods are compared to those of conventional power generating systems as well as other renewable energy sources. A range of data sources are used. Embodied energy of steel has been provided by the World Steel Association. Of the four devices studied, all were found to achieve CO2 and energy payback within the first 12 years of their lifetime, and exhibited CO2 intensity of between 18 and 35 gCO2/kWh. This compares favourably to many current energy sources, and is likely to fall as technology improves, array size increases and industry experience progresses

Structural properties of crumpled cream layers

The cream layer is a complex heterogeneous material of biological origin which forms spontaneously at the air-milk interface. Here, it is studied the crumpling of a single cream layer packing under its own weight at room temperature in three-dimensional space. The structure obtained in these circumstances has low volume fraction and anomalous fractal dimensions. Direct means and noninvasive NMR imaging technique are used to investigate the internal and external structure of these systems.Comment: 9 pages, 4 figures, accepted in J. Phys. D: Appl. Phy