Engaging denial through spirituality: An ethnographic study of caregivers of the elderly and implications for pastoral care

The paper examines a number of studies conducted on caregivers of the institutionalized elderly, including a large qualitative research project conducted by the author and a hospital administrator. Finding that many professional caregivers of the aged continue to deny their own aging and death to some degree, this paper seeks to chart the relationship between such denial and spiritual wholeness. The facets of denial, both positive and negative, are examined in the light of the dual nature of spirituality. Midlife is viewed as being the crucial time for growth and well-being for oneself and for the wider community, including the earth. Theological and practical considerations are offered

The Effects of an Exercise Programme on Health-Related Variables and Mood in Sedentary Women

This study reports on the effects of a thrice weekly exercise programme over a 12 week period on health-related fitness variables, blood lipids and mood in previously sedentary women. Each exercise session consisted of 20 minutes of aerobic exercise at 80% of predicted maximum heart rate, 5 minutes of strength and local muscular endurance and 5 minutes of flexibility exercise. Twenty two exercisers, age 36.6+/-9.3 years (range 21-48) and 16 controls age 36.4+/-8.6 years (range 21-50) took part in the study. All subjects were assessed, before and after 12 weeks of training, on physiological variables and mood state. A sub-sample of 8 exercise and 9 control subjects had total cholesterol and plasma triglycerides assessed before and after the 12 week training period. T-tests on baseline measures showed that the two groups were not significantly different in any of the variables tested. Paired t-tests were carried out to assess if either group showed an improvement in any of the variables from Test 1 to Test 2. The exercise group significantly improved in all of the physiological variables except resting (pre-exercise) heart rate which was only of borderline significance and systolic blood pressure, which did not change significantly. The control group showed a significant reduction in diastolic blood pressure and abdominal endurance. The exercise group significantly improved in all mood factors except clearheaded-confused. Neither group significantly improved total cholesterol or triglycerides. Two sample t-tests were carried out to determine if the exercise group showed a greater average improvement over the controls in any of the variables tested. The average range of improvement is indicated by 95% Confidence Intervals (CI). The exercise group showed greater average improvement in the following variables: Steady State Heart Rate during 2nd workload, 95% CI (-3.1, -14.8) beats per minute; Steady State Heart Rate during final workload, 95% CI (-5.3, -15.5) beats per minute; Estimated VO2 max, 95% CI (0.15, 0.41) Litres/minute) and (2.10, 6.16) ml/kg/minute; Low back/Hamstrings Flexibility 95% CI (2.85, 6.09) cm; Abdomianal Endurance, 95% CI (2.54, 6.72) repetitions per minute ; Sum of Skinfolds, 95% CI (-2.5, -9.3) mm; Estimated Percentage Body fat, 95% CI (-1.39, -2.55)%; Elated-Depressed Mood factor, 95% CI (1.9, 16.4) T score and Energetic-Tired Mood factor, 95% CI (1.6, 14.8) T score. Previous research has consistently reported that aerobic training can favourably influence resting heart rate, submaximal heart rate and oxygen uptake. The present study found a significantly decrease in submaximal heart rate and an increase in predicted VO2 max which is consistent with previous findings which conclude that regular aerobic exercise improves the oxygen transport system. In addition, the exercise programme resulted in significant improvements in abdominal muscular endurance and lower back/hamstrings flexibility which may result in improved posture and a decreased risk of low back pain. Increases in elation and perceived energy were evident in exercise subjects. These findings are consistent with previous research. Two sample t-tests at Test 2 revealed that the exercise group had significantly lower heart rate during submaximal exercise during the ergometer test, higher predicted VO2 max and higher mean T scores for elated-depressed and energertic-tired mood factors than the control group. These variables show the greatest differences between the groups. Paired t-tests revealed other differences, since there there is more power in within subject tests. In summary, a 12 week University exercise programme was effective in improving several physiological variables and psychological mood factors related to health and well-being in previously sedentary women

Autonomous robotic exploration of unknown environments

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The development and evaluation of a computer based e-learning tool to enhance knowledge of workplace wellness

Abstract Introduction: The study is the first to explore the overall workplace wellness knowledge of healthcare staff and students and the use of e-learning to improve this knowledge. Workplace health promotion is an essential part of improving public health, useful for reducing the burden of noncommunicable diseases. However, this emerging topic is not covered in healthcare staff or student education programmes. As no learning tools are available to improve workplace wellness knowledge, this dissertation describes the development and evaluation of an e-learning tool focussing on six workplace wellness topics; work-related stress, musculoskeletal disorders, diet and nutrition, physical activity, smoking and alcohol consumption. Methods: To develop the e-learning tool the Centre for Excellence in Teaching and Learning in Reusable Learning Objects Agile Development Workflow was followed, using expert peer review and a pilot study to create a high quality learning resource. Once developed, a one-group pre and post-test comparison design was used, testing baseline and post-intervention knowledge of workplace wellness. A knowledge questionnaire was used to collect quantitative accuracy scores and subjective evaluation questions were used to assess participants’ perceptions of usability. Results: Pre-questionnaire results showed a poor baseline knowledge of workplace wellness across all of the study sample (n=194). A statistically significant Emily Gartshore vii MNurSci Dissertation: 21/03/2014 improvement in knowledge was seen post-intervention (t(75)=-14.801, p < 0.0005), which also revealed a large effect size. Question specific analysis identified that the percentage of correct responses improved for all questions, identifying the success of the e-learning tool in improving workplace wellness knowledge. Conclusion: The dissertation gives insight to the poor baseline workplace wellness knowledge of healthcare staff and students. It reveals that the workplace wellness e-learning resource is an effective way to improve knowledge of workplace wellness in healthcare staff and students, with future implications for public health, health education and e-learning

The Consequences of Reperfusion on Cerebral Ischaemic Damage

The aim of this PhD thesis was to investigate the consequences of reperfusion on cerebral ischaemic damage using a new model of transient focal cerebral ischaemia developed at the Wellcome Surgical Institute. The model involves the abluminal application of the potent vasoconstrictor peptide endothelin-1 (ET-1) to the exposed MCA of the anaesthetised rat. Previous studied using the hydrogen clearance CBF technique and quantitative autoradiographic and histopathological procedures, revealed that ET-1 application to the MCA produced a profound ischaemia followed by a gradual, spontaneous reperfusion resulting in a reproducible lesion (within the cortex and caudate nucleus) by 4h post insult. The object of this thesis was to further characterise the pathological mechanisms associated with this model of transient cerebral ischaemia by investigating such parameters as CBF, brain tissue swelling, microvascular permeability, free radical damage and neurotransmitter transduction systems and second messengers

Understanding care homes safety: culture and safety in non-mainstream care settings

Background The care home sector provides 24-hour residential care or nursing care to more than 450,000 vulnerable older people in the UK with complex needs and high levels of dependency. These services face many challenges in relation to funding, increasing demand, staff shortages and relying on an unregistered workforce with almost 40% possessing no qualifications. Care homes present a unique setting that provides care to individuals at significant risk of harm but has received little attention or research. Care homes provide a particularly rich context in which to study safety, as they are inherently complex organisations that have historically suffered many catastrophic failures and scandals and continue to struggle to achieve safety goals. It was widely accepted that organisational culture was important for patient safety. Both the organisational culture and patient safety literature have been dominated by the positivist assumption that organisations are part of an external reality that can be both measured and manipulated. Many scholars now argue that positivist approaches do not reflect the complexity of contemporary organisations as they only capture the very surface of organisational cultures. The deeper levels of organisational culture and its impact upon safety have received little exploration in the patient safety literature and have not before been explored in the context of care homes. Aim The thesis aimed to empirically explore organisational culture and how this related to safety in care homes. The thesis focused on how residents, relatives and staff in this context made sense of their reality by investigating the basic underlying assumptions that underpin human perception and behaviour, specifically in relation to quality and safety. Through this exploration the thesis also captured how different groups contributed to and negotiated quality and safety. Research Question The thesis addressed the central research question: • How do employees, residents and relatives give meaning to and value issues of safety in care homes? Methodology The thesis aligned with the interpretive paradigm and adopted an ethnographic case study approach within the care home sector. Over 200 hours of observations and interviews with 50 participants took place across two care homes between January – December 2018. Inductive thematic analysis was used to analyse both interview and observational data. Research Gaps and Intended Contribution This study adds to the limited evidence base through its interpretive, ethnographic approach, accepted as a method suited to achieving a deeper level of cultural analysis. The approach taken has not previously been used to address safety in the care home sector, which presented a setting that was theoretically and empirically distinguished from mainstream care settings. Due to the under-researched nature of this care setting the study also enabled theoretical contribution to the patient safety literature. The findings from this study make a contribution to current debates around care home policy and practice, which was of particular relevance given the recent impact of the COVID-19 pandemic upon the care home sector. The thesis makes a new contribution to the literature around patient safety by presenting a conceptual understanding of how culture relates to safety in care homes that comprises of Uncertainty, Identity and Role, Responsibility and Relationships. My study argues that within care homes there was a disconnect between the formal culture and approaches, and the informal culture within the care home. The study has highlighted that traditional patient safety orthodox approaches being used within care homes may be inappropriate due to the unpredictability and the assumptions that underpin how people give meaning to and value safety in care homes. Moreover, my study has shown that safety in care homes was achieved through attempts to get to know residents, focusing on their identity, building relationships and the importance of promoting resident autonomy and responsibility for their own safety

The development and evaluation of a computer based e-learning tool to enhance knowledge of workplace wellness

Abstract Introduction: The study is the first to explore the overall workplace wellness knowledge of healthcare staff and students and the use of e-learning to improve this knowledge. Workplace health promotion is an essential part of improving public health, useful for reducing the burden of noncommunicable diseases. However, this emerging topic is not covered in healthcare staff or student education programmes. As no learning tools are available to improve workplace wellness knowledge, this dissertation describes the development and evaluation of an e-learning tool focussing on six workplace wellness topics; work-related stress, musculoskeletal disorders, diet and nutrition, physical activity, smoking and alcohol consumption. Methods: To develop the e-learning tool the Centre for Excellence in Teaching and Learning in Reusable Learning Objects Agile Development Workflow was followed, using expert peer review and a pilot study to create a high quality learning resource. Once developed, a one-group pre and post-test comparison design was used, testing baseline and post-intervention knowledge of workplace wellness. A knowledge questionnaire was used to collect quantitative accuracy scores and subjective evaluation questions were used to assess participants’ perceptions of usability. Results: Pre-questionnaire results showed a poor baseline knowledge of workplace wellness across all of the study sample (n=194). A statistically significant Emily Gartshore vii MNurSci Dissertation: 21/03/2014 improvement in knowledge was seen post-intervention (t(75)=-14.801, p < 0.0005), which also revealed a large effect size. Question specific analysis identified that the percentage of correct responses improved for all questions, identifying the success of the e-learning tool in improving workplace wellness knowledge. Conclusion: The dissertation gives insight to the poor baseline workplace wellness knowledge of healthcare staff and students. It reveals that the workplace wellness e-learning resource is an effective way to improve knowledge of workplace wellness in healthcare staff and students, with future implications for public health, health education and e-learning

Understanding care homes safety: culture and safety in non-mainstream care settings

Background The care home sector provides 24-hour residential care or nursing care to more than 450,000 vulnerable older people in the UK with complex needs and high levels of dependency. These services face many challenges in relation to funding, increasing demand, staff shortages and relying on an unregistered workforce with almost 40% possessing no qualifications. Care homes present a unique setting that provides care to individuals at significant risk of harm but has received little attention or research. Care homes provide a particularly rich context in which to study safety, as they are inherently complex organisations that have historically suffered many catastrophic failures and scandals and continue to struggle to achieve safety goals. It was widely accepted that organisational culture was important for patient safety. Both the organisational culture and patient safety literature have been dominated by the positivist assumption that organisations are part of an external reality that can be both measured and manipulated. Many scholars now argue that positivist approaches do not reflect the complexity of contemporary organisations as they only capture the very surface of organisational cultures. The deeper levels of organisational culture and its impact upon safety have received little exploration in the patient safety literature and have not before been explored in the context of care homes. Aim The thesis aimed to empirically explore organisational culture and how this related to safety in care homes. The thesis focused on how residents, relatives and staff in this context made sense of their reality by investigating the basic underlying assumptions that underpin human perception and behaviour, specifically in relation to quality and safety. Through this exploration the thesis also captured how different groups contributed to and negotiated quality and safety. Research Question The thesis addressed the central research question: • How do employees, residents and relatives give meaning to and value issues of safety in care homes? Methodology The thesis aligned with the interpretive paradigm and adopted an ethnographic case study approach within the care home sector. Over 200 hours of observations and interviews with 50 participants took place across two care homes between January – December 2018. Inductive thematic analysis was used to analyse both interview and observational data. Research Gaps and Intended Contribution This study adds to the limited evidence base through its interpretive, ethnographic approach, accepted as a method suited to achieving a deeper level of cultural analysis. The approach taken has not previously been used to address safety in the care home sector, which presented a setting that was theoretically and empirically distinguished from mainstream care settings. Due to the under-researched nature of this care setting the study also enabled theoretical contribution to the patient safety literature. The findings from this study make a contribution to current debates around care home policy and practice, which was of particular relevance given the recent impact of the COVID-19 pandemic upon the care home sector. The thesis makes a new contribution to the literature around patient safety by presenting a conceptual understanding of how culture relates to safety in care homes that comprises of Uncertainty, Identity and Role, Responsibility and Relationships. My study argues that within care homes there was a disconnect between the formal culture and approaches, and the informal culture within the care home. The study has highlighted that traditional patient safety orthodox approaches being used within care homes may be inappropriate due to the unpredictability and the assumptions that underpin how people give meaning to and value safety in care homes. Moreover, my study has shown that safety in care homes was achieved through attempts to get to know residents, focusing on their identity, building relationships and the importance of promoting resident autonomy and responsibility for their own safety