UNDERSTANDING AND ENCOURAGING CLIMATE FRIENDLY ACTION: A STUDY OF INDIVIDUALS\u27 PERSONAL ENERGY AND TRANSPORTATION DECISIONS AND BELIEFS ABOUT CLIMATE CHANGE

There is a strong scientific consensus that climate change is happening, is caused by human activities, and will have significant negative consequences. Avoiding the most severe consequences will require significant reductions in carbon dioxide emissions, including changes in individuals\u27 personal energy and transportation choices, which can contribute significantly to climate change. Past research has identified a wide range of factors that may influence perceptions of climate change and willingness to act to reduce it. However, there are still considerable gaps in our knowledge. There is limited understanding of how different factors interact in people\u27s decisions about personal energy and transportation. Additionally, most previous research has focused on behavioral intentions rather than actual behavior, and there tends to be a considerable gap between intentions and actions. Therefore, the goal of this study was to gain a more holistic and in-depth understanding of how different influences interact in people\u27s decision processes to motivate their personal energy and transportation choices. This study used interview data and a qualitative analysis approach to gain this in-depth understanding and complement past research, which has used mainly psychometric, survey-based research methods. I found that individuals\u27 decisions about personal energy and transportation actions occurred in (at least) two stages. First, people had a preferred approach to energy and transportation use. This was most often based on key values and social factors. A preferred approach to personal energy and transportation actions that included climate friendly actions was frequently motivated by pro environmental values. However, values about consumption and social justice were also important motivators. Membership in a social network that supported climate friendly actions was also important. However, people\u27s actual personal energy and transportation actions were the results of an `in the moment\u27 decision making process in which their preferred approach was often mediated by other factors including their lifestage - such as requirements of having a family, conflicting desires, or failure to keep their more-values based preferences top of mind. Interestingly, climate change itself was not an important reason for climate friendly actions; mainly because people felt that their ability to reduce climate change through individual action was very limited

Can a mobile app improve the quality of patient care provided by trainee doctors? Analysis of trainees case reports

OBJECTIVES: To explore how a medical textbook app (‘iDoc’) supports newly qualified doctors in providing high-quality patient care. DESIGN: The iDoc project, funded by the Wales Deanery, provides new doctors with an app which gives access to key medical textbooks. Participants’ submitted case reports describing self-reported accounts of specific instances of app use. The size of the data set enabled analysis of a subsample of ‘complex’ case reports. Of the 568 case reports submitted by Foundation Year 1s (F1s)/Year 2s (F2s), 142 (25%) detailed instances of diagnostic decision-making and were identified as ‘complex’. We analysed these data against the Quality Improvement (QI) Framework using thematic content analysis. SETTING: Clinical settings across Wales, UK. PARTICIPANTS: Newly qualified doctors (2012–2014; n=114), F1 and F2. INTERVENTIONS: The iDoc app, powered by Dr Companion software, provided newly qualified doctors in Wales with a selection of key medical textbooks via individuals’ personal smartphone. RESULTS: Doctors’ use of the iDoc app supported 5 of the 6 QI elements: efficiency, timeliness, effectiveness, safety and patient-centredness. None of the case reports were coded to the equity element. Efficiency was the element which attracted the highest number of case report references. We propose that the QI Framework should be expanding to include ‘learning’ as a 7th element. CONCLUSIONS: Access to key medical textbooks via an app provides trusted and valuable support to newly qualified doctors during a period of transition. On the basis of these doctors’ self-reported accounts, our evidence indicates that the use of the app enhances efficiency, effectiveness and timeliness of patient-care in addition consolidating a safe, patient-centred approach. We propose that there is scope to extend the QI Framework by incorporating ‘learning’ as a 7th element in recognition of the relationship between providing high-quality care through educational engagement

Mobile learning devices in the workplace: 'as much a part of the junior doctors' kit as a stethoscope'?

Background Smartphones are ubiquitous and commonly used as a learning and information resource. They have potential to revolutionize medical education and medical practice. The iDoc project provides a medical textbook smartphone app to newly-qualified doctors working in Wales. The project was designed to assist doctors in their transition from medical school to workplace, a period associated with high levels of cognitive demand and stress. Methods Newly qualified doctors submitted case reports (n = 293) which detail specific instances of how the textbook app was used. Case reports were submitted via a structured online form (using Bristol Online Surveys - BOS) which gave participants headings to elicit a description of: the setting/context; the problem/issue addressed; what happened; any obstacles involved; and their reflections on the event. Case reports were categorised by the purpose of use, and by elements of the quality improvement framework (IoM 2001). They were then analysed thematically to identify challenges of use. Results Analysis of the case reports revealed how smartphones are a viable tool to address clinical questions and support mobile learning. They contribute to novice doctors’ provision of safe, effective, timely, efficient and patient-centred care. The case reports also revealed considerable challenges for doctors using mobile technology within the workplace. Participants reported concern that using a mobile phone in front of patients and staff might appear unprofessional. Conclusion Mobile phones blur boundaries between the public and private, and the personal and professional. In contrast to using a mobile as a communication device, using a smartphone as an information resource in the workplace requires different rituals. Uncertain etiquette of mobile use may reduce the capacity of smartphone technology to improve the learning experience of newly qualified doctors

Leading through the COVID-19 pandemic: Experiences of UK Executive Nurse Directors

Aim To explore the challenges experienced by Executive Nurse Directors during the COVID-19 pandemic, and to inform future nursing leadership strategies. Design A qualitative research project involving interviews with 21 Executive Nurse Directors from England and Wales. Methods Participants were purposively sampled and recruited through Chief Nursing Officers and nursing leadership networks. Semi-structured interviews were conducted and recorded online via Teams. Braun and Clarke's approach to thematic reflexive analysis was applied to data analysis. Results Executive Nurse Directors played a critical role during the COVID-19 pandemic. Six themes are explored: tensions, and adaptive response to personal leadership styles; uncertainty and support at the board level; responding to national political decision-making; the personal and emotional impact of the role and the sources of effective support; the voice and public profile of nursing; lessons learnt and strategies for future leadership development. Enablers of decision-making included effective multidisciplinary working, freedom from normal organizational constraints, support for innovation, and the development of stronger bonds with colleagues. Barriers to decision-making included limited knowledge of the virus and its impact and lack of guidance, particularly at a national level. Priorities, strategies and actions for recovery include recognizing the emotional impact of being in a high-level decision-making role, protecting staff from burnout and understanding the long-term implications of pandemic work for nurse leaders. Conclusion Future strategies for nursing leadership during public health, national and global emergencies are recommended. Impact This study contributes to the literature exploring the Executive Nurse Director role and their experiences of leading through the COVID-19 pandemic, and identifies priorities, strategies and actions for recovery and learning for the future of senior leadership

How a mobile app supports the learning and practice of newly qualified doctors in the UK: an intervention study

Background The transition from medical school to the workplace can be demanding, with high expectations placed on newly qualified doctors. The provision of up-to-date and accurate information is essential to support doctors at a time when they are managing increased responsibility for patient care. In August 2012, the Wales Deanery issued the Dr.Companion© software with five key medical textbooks (the iDoc app) to newly qualified doctors (the intervention). The aim of the study was to examine how a smartphone app with key medical texts was used in clinical workplace settings by newly qualified doctors in relation to other information sources and to report changes over time. Methods Participants (newly qualified - Foundation Year 1 - doctors) completed a baseline questionnaire before downloading the iDoc app to their own personal smartphone device. At the end of Foundation Year 1 participants (n = 125) completed exit questionnaires one year later. We used Wilcoxon Signed Rank test to analyse matched quantitative data. Results We report significant changes in our participants’ use of workplace information resources over the year. Respondents reduced their use of hard-copy and electronic versions of texts on PCs but made more use of senior medical staff. There was no significant difference in the use of peers and other staff as information sources. We found a significant difference in how doctors felt about using a mobile device containing textbooks in front of patients and senior medical staff in the workplace. Conclusions Our study indicates that a mobile app enabling timely, internet-free access to key textbooks supports the learning and practice of newly qualified doctors. Although participants changed their use of other resources in the workplace, they continued to consult with seniors. Rather than over-reliance on technology, these findings suggest that the app was used strategically to complement, not replace discussion with members of the medical team. Participants’ uncertainty about using a mobile device with textbook app in front of others eased over time

Financing environmentally sensitive residential development

Master of ScienceLandscape ArchitectureUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/101653/1/39015056308383.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/101653/2/39015056308383.pd

Leading through the COVID-19 pandemic

AIM: To explore the challenges experienced by Executive Nurse Directors during the COVID-19 pandemic, and to inform future nursing leadership strategies. DESIGN: A qualitative research project involving interviews with 21 Executive Nurse Directors from England and Wales. METHODS: Participants were purposively sampled and recruited through Chief Nursing Officers and nursing leadership networks. Semi-structured interviews were conducted and recorded online via Teams. Braun and Clarke\u27s approach to thematic reflexive analysis was applied to data analysis. RESULTS: Executive Nurse Directors played a critical role during the COVID-19 pandemic. Six themes are explored: tensions, and adaptive response to personal leadership styles; uncertainty and support at the board level; responding to national political decision-making; the personal and emotional impact of the role and the sources of effective support; the voice and public profile of nursing; lessons learnt and strategies for future leadership development. Enablers of decision-making included effective multidisciplinary working, freedom from normal organizational constraints, support for innovation, and the development of stronger bonds with colleagues. Barriers to decision-making included limited knowledge of the virus and its impact and lack of guidance, particularly at a national level. Priorities, strategies and actions for recovery include recognizing the emotional impact of being in a high-level decision-making role, protecting staff from burnout and understanding the long-term implications of pandemic work for nurse leaders. CONCLUSION: Future strategies for nursing leadership during public health, national and global emergencies are recommended. IMPACT: This study contributes to the literature exploring the Executive Nurse Director role and their experiences of leading through the COVID-19 pandemic, and identifies priorities, strategies and actions for recovery and learning for the future of senior leadership. REPORTING METHOD: The study adhered to the Consolidated Criteria for Reporting Qualitative Research. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution