A cross-sectional survey of general practice health workers' perceptions of their provision of culturally competent services to ethnic minority people with diabetes

Aims To explore General Practice teams cultural-competence, in particular, ethnicity, linguistic skillset and cultural awareness. The practice teams’ access to diabetes-training, and overall perception of cultural-competence were also assessed. Methods A cross-sectional single-city-survey with one in three people with diabetes from an ethnic minority group, using 35 semi-structured questions was completed. Self-reported data analysed using descriptive statistics, interpreted with reference to the Culturally-Competent-Assessment-Tool. Results Thirty-four (52%) of all 66 practices in Coventry responded between November 2011 and January 2012. Key findings: (1) One in five practice staff was from a minority group in contrast with one in ten of Coventry’s population, (2) 164 practice staff (32%) spoke a second language relevant to the practice's minority population, (3) 56% of practices were highly culturally-competent at providing diabetes services for minority populations, (4) 94% of practices reported the ethnicity of their populations, and (5) the most frequently stated barriers to culturally-competent service delivery were language and knowledge of nutritional habits. Conclusions Culturally-competent diabetes care is widespread across the city. Language barriers are being addressed, cultural knowledge of diabetes-related-nutrition requires further improvement. Further studies should investigate if structured cultural-competence training for diabetes service providers produces positive effects in diabetes-related outcome-measures in minority populations

Attracting and retaining nurses through a clinical fellowship programme

Shortages in nursing are the single biggest and most urgent workforce issue that the NHS needs to address. This article sets out the early success of the Nurse Clinical Fellowship Programme established by The Royal Wolverhampton NHS Trust. The unique programme aims to attract and retain nurses by offering a staff nurse post with supported access to academia, fully funded by the NHS Trust. To date, the Trust has attracted 90 nurses (both UK and international registered nurses) to the programme. The programme is also offered internally and the Trust has a cohort of 10 internal nursing staff enrolled onto the programme completing either their BSc (top-up) or Masters, with a second cohort of 60 internal nurses due to start in September 2019. To support international registered nurses with demonstrating their competence to meet Nursing and Midwifery Council requirements the Trust has also established an objective structured clinical examination preparation course designed to embrace and enhance the existing knowledge and skills, while guiding staff in transferring these in line with UK and Trust policies and practices

The educational preparation of nurses in a developing economy and patient mortality

Background: Most studies have reported that higher levels (baccalaureate degree) of educational attainment by nurses is associated with lower levels of patient mortality. Researchers working in developed economies (e.g. North America and Europe) have almost exclusively conducted these studies. The value of baccalaureate nurse education has not been tested in countries with a developing economy. Method: A retrospective observational study conducted in seven hospitals. Patient mortality was the main outcome of interest. Anonymised data were extracted on nurses and patients from two different administrative sources and linked using the staff identification number that exists in both systems. We used bivariate logistic regression models to test the association between mortality and the educational attainment of the admitting nurse (responsible for assessment and care planning). Results: Data were extracted for 11,918 patients and 7,415 nurses over the first six months of 2015. The majority of nurses were educated in South Asia and just over half were educated to at least bachelor degree level. After adjusting for confounding and clustering, nurse education was not found to be associated with mortality (OR=1·34, 95% confidence interval=·569, 3·156). Implications for nursing and health policy: Our observations may suggest that in a developing economy the academic level of nurses’ education is not associated with a reduction in patient mortality. Findings should be interpreted with considerable caution but do challenge widely held assumptions about the value of baccalaureate prepared nurses. Further research focused on nursing education in developing economies is required to inform health policy and planning

Managing the surgical ward

Leading a clinical care environment is both a rewarding and challenging role that requires clinical expertise, experience, and leadership capability. A ward leader is required to understand a range of management techniques and principles to ensure that safe and effective care is delivered to the patients. This chapter outlines key requirements, including establishment creation, managing of rotas aligned to patient acuity and dependency, and financial management. In addition, this chapter also discusses the development of clinical governance processes to ensure robust management of incidents, issues, and care audit.</p

Kasvikuitupohjaisten lämmöneristemateriaalien kosteustekninen toiminta

Opinnäytetyön tarkoituksena oli perehtyä rakenteiden sekä tiettyjen kasvikuitueristemateriaalien lämpö- ja kosteustekniseen toimintaan ja koota aiheesta kirjallisuusselvitys tukemaan opinnäytetyön toisena osana toimivaa laskentaa. Kasvikuitueristeiden toiminnan perustana on materiaalien suuri hygroskooppisuus, minkä avulla rakenne tasaa kosteutta huokosrakenteeseensa ja mukautuu näin ollen vallitseviin ilmaston kosteusrasituksiin. Käytännössä useimmat kasvikuitueristetyt rakenteet on todettu toimiviksi tavanomaisissa kosteusolosuhteissa, kun rakenteista on tehty kosteusmittauksia sekä rakenneavauksia. Laskennallisella tarkastelulla on toisaalta havaittu kosteuden aiheuttamia riskejä, kuten kohtalaisen korkeaa homehtumisriskiä rakenteen ulkokerroksissa. Näin ollen laskentatulokset ovat osittain ristiriitaisia käytännön kokemuksiin sekä kokeellisesti mitattuihin arvoihin verrattaessa. Kirjallisuusselvityksen lisäksi opinnäytetyössä perehdyttiin WUFI Pro 1D -simulointiohjelmalla tuotettuihin laskelmiin kahdesta eri kasvikuitueristeisestä ulkoseinärakenteesta sekä vertailurakenteista. Rakenteiden reunaehtoina simulointilaskennassa käytettiin olemassa olevista rakenteista tuotettuja 7 ja 12 kuukauden mittausdatoja rakenteiden lämpötiloista sekä suhteellisista kosteuksista. Mitatun ilmastotiedon avulla rakenteista selvitettiin mitattujen ja laskennalla tuotettujen arvojen lämpö- ja kosteusteknisiä eroavaisuuksia sekä tutkittiin rakenteiden mahdollista homehtumisriskiä suomalaisen homemallin avulla. Olki- sekä puukuitueristeisen rakenteen toiminta perustuu tarkkaan kosteuden hallintaan rakentamisen aikana ja sen jälkeen. Laskennan mukaan olki- sekä puukuitueristeisen seinän homehtumisriski on olemassa, mitä korkeammat rakenteiden alkuolosuhteiden suhteelliset kosteudet ovat. Tutkittaessa laskennallisesti rakenteiden toimivuutta on kuitenkin huomioitava laskennan ja mittauksen tuomat rajoitteet sekä virhetekijät, jotka vaikuttavat vertailtaviin tuloksiin. Laskennallisen tarkastelun perusteella voidaan varmistua rakenteen kosteusteknisestä toimivuudesta vain, jos rakenteessa käytettyjen materiaalien ominaisuudet ovat riittävän hyvin tiedossa. Laskelmia tuleekin pitää lähinnä suuntaan antavina, joiden avulla pystytään arvioimaan rakenteiden kosteusteknisen toiminnan riskitekijöitä. Laskennalla tulisi varmistaa rakenteiden kosteustekninen toimivuus, etenkin kun rakenne eroaa yleisistä ohjeistuksista, tai kun rakenteen toimivuudesta ei ole käytännön kokemuksia.The purpose of the research was to study and gather existing information about the moisture physical behavior of structures, and investigate moisture condensation and mold growth of two organic thermal insulation structures. The purpose was to find the differences between the measured values and the results of the calculation for the heat and moisture behavior of the structures. The study was commissioned by Vahanen Rakennusfysiikka Oy. In this research, the simulation of heat and moisture transference for the two different structures were made by using WUFI Pro 1 -dimensional transient heat and moisture modeling program and mold growth with Finnish mold index program. The moisture physical behaviors of selected structures were analyzed numerically under the climate conditions of Finland and using typical interior conditions of living spaces. The starting point of the calculation was to find the differences between the measurements result by using a variety of material properties and by changing the initial conditions of the structures. The results of this research show, that structures which thermal insulations has used plant-fibre based materials are sensitive to biological damage by moisture. The use of porous thermal insulation materials is based on moisture equilibrium of the structure. Excess moisture in a structure causes condensation to structural layers, like the inside surface of the air barrier or wind protection if the moisture cannot evaporate out of the structure simultaneously. In order that the moisture content of the porous structure stays in balance, the structure’s water vapor resistance should decrease from the inside out. Calculations can only be used as direction of moisture behavior because of calculation error factors. Computational insurance should be done for the structures that differ from the general instructions and for the structures which have no practical experience

Royal Wolverhampton Trust co-production toolkit template

Toolkit produced by The University of Wolverhampton and The Royal Wolverhampton Trust

Co-designing health care solutions with patient representatives and clinicians in a large acute hospital setting: process and engagement

This is an accepted manuscript of an article due to be published by Gavin Publishers in International Journal of Nursing and Health Care Research. The accepted version of the publication may differ from the final published version.The benefits of involving patients and wider members of the public as partners in care are being increasingly recognised internationally. Co-design is one of the methods reported to promote patient-based health service improvements and offers a participatory approach to engage patients and citizens in solving health care challenges. However, current limitations are levelled at this corpus of work, indicating a lack of sustainability and substantive evidence of any known associated processes that can yield sustainable longer-term patient benefit. This service improvement project was underpinned by a Human Centred Design (HCD) methodology incorporating the Design Council’s process Discover, Define, Develop and Deliver [1]. This assisted in providing a participatory framework of co-produced work over a twelve-month period with three clinical pathway teams, Stroke, Children and Young People (CYP) and Learning and Developmental Disabilities (LD.) Meeting specific project objectives, patientbased projects were developed using a toolkit and Collaborative Action Plans that steered involvement throughout. Evaluative results elicited three themes, generating a product idea together, acknowledging the contribution of all, barriers and challenges. Within this, the clinicians and patient representatives reported the value of having a safe space to carry out experienced based work with their respective patient representatives. Additionally, they reported the chosen HCD framework guided the process of engagement determining co-produced health care solutions to patient derived challenges. Conclusions are drawn that suggest further work and research is required to testbed the ‘how to’ processes associated with successful co-design in health and social care. This could provide an empirical basis for the value and process associated with sustainable human centred design required at both a micro and macro level of healthcare