Infection prevention as "a show": a qualitative study of nurses' infection prevention behaviours

Background: Control of infection and prevention of healthcare associated infections is an ongoing issue worldwide. Yet despite initiatives and strategies to reduce the burden that these infections cause, healthcare workers' practice is still reported as suboptimal and these infections persist. Much of the research to date has primarily focused on predicting infection prevention behaviours and factors associated with guideline compliance. While this has given valuable insight, an investigation aiming to understand and explain behaviours that occur in everyday practice from the perspective of the actors themselves may hold the key to the challenges of effecting behaviour change. This study questioned "How can nurses' infection prevention behaviour be explained?" This paper presents one of three identified themes 'Rationalising dirt-related behaviour'. Design: This interpretative qualitative study uses vignettes, developed from nurses' accounts of practice, to explore nurses' reported infection prevention behaviours. Participants: Registered nurses working in an acute hospital setting and had been qualified for over a year. They were recruited while studying part-time at a London University. Methods: Twenty semi-structured interviews were undertaken using a topic guide and vignettes. Interviews were transcribed verbatim and analysed using the framework method. Results: The findings demonstrate that participants were keen to give a good impression and present themselves as knowledgeable practitioners, although it was evident that they did not always follow procedure and policy. They rationalised their own behaviour and logically justified any deviations from policy. Deviations in others were criticised as irrational and explained as superficial and part of a 'show' or display. However, participants also gave a presentation of themselves: a show or display that was influenced by the desire to protect self and satisfy patient scrutiny. Conclusions: This study contributes to the identification and explanation of nurses' infection prevention behaviours which are considered inappropriate or harmful. Behaviour is multifaceted and complex, stemming from a response to factors that are outside a purely 'scientific' understanding of infection and not simply understood as a deficit in knowledge. This calls for educational interventions that consider beliefs, values and social understanding of dirt and infection. © 2013 Elsevier Ltd

Evaluation of some scale effects in the response and failure of composite beams

The feasibility of using scale model testing for predicting full-scale behavior of composite beams loaded in tension and flexure was investigated. Classical laws of similitude were applied to fabricate and test replica model beams to identify scaling effects in the load response, strength, and mode of failure. Experiments were conducted using graphite-epoxy composite beams having different laminate stacking sequences and a range of scaled sizes. Results indicated that the elastic response of scaled composite beams was independent of specimen size. However, a significant scale effect in strength was observed. In addition, a transition in failure mode was observed among scaled beams of certain laminate stacking sequences. Weibull statistical and fracture mechanics based models were applied to predict the strength scale effect since standard failure criteria cannot account for the influence of absolute specimen size in failure

The Adolescent Girls Empowerment Program: Lessons learned from the pilot test program

This document presents an evaluation of the Adolescent Girls Empowerment Program (AGEP), which is comprised of three major components: 1) safe spaces groups in which girls meet once a week over the course of two years for training on sexual and reproductive health, life skills and financial education. Groups are facilitated by a mentor, a young female from the same community as the girls; 2) a health voucher that girls can use at contracted private and public facilities for general wellness and sexual and reproductive health services; and 3) a saving account that has been designed to be girl-friendly. A randomized control trial (RCT) using a cluster design is being used to evaluate the impact of AGEP. The research aims to identify the impact of the intervention on the following key indicators: HIV prevalence, HSV-2 prevalence, age at first sex, age at first birth, contraceptive use, experience of gender-based violence, and educational attainment

Predicting the Dynamic Crushing Response of a Composite Honeycomb Energy Absorber Using Solid-Element-Based Models in LS-DYNA

This paper describes an analytical study that was performed as part of the development of an externally deployable energy absorber (DEA) concept. The concept consists of a composite honeycomb structure that can be stowed until needed to provide energy attenuation during a crash event, much like an external airbag system. One goal of the DEA development project was to generate a robust and reliable Finite Element Model (FEM) of the DEA that could be used to accurately predict its crush response under dynamic loading. The results of dynamic crush tests of 50-, 104-, and 68-cell DEA components are presented, and compared with simulation results from a solid-element FEM. Simulations of the FEM were performed in LS-DYNA(Registered TradeMark) to compare the capabilities of three different material models: MAT 63 (crushable foam), MAT 26 (honeycomb), and MAT 126 (modified honeycomb). These material models are evaluated to determine if they can be used to accurately predict both the uniform crushing and final compaction phases of the DEA for normal and off-axis loading condition

Opportunities and Obstacles in Adoption of Biodiversity-Enhancing Features on California Farms

The USDA National Organic Program requires the conservation of biodiversity and the maintenance or improvement of natural resources on organic farms. On-farm biodiversity-enhancing features such as border plantings can provide many of these ecosystem services. However, which practices farmers currently use to manage non-cropped edges, why and how they use these practices, and how subsidies and technical assistance affect farmers’ ability and willingness to manage farm edges for biodiversity are little studied topics. Our study set out to identify the range of practices currently used to manage non-cropped field edges, roadsides, pond edges, and banks of permanent watercourses (sloughs, canals, ditches) in a case study area in California. Secondary objectives were to gauge local farmers’ awareness of planted hedgerows and vegetated waterways and to gather preliminary information about the range of incentives and constraints to installing such features

Examining Nurse Practitioners\u27 Perceptions and Beliefs Regarding Hospice Referrals for African Americans

Terminally ill patients often have difficult choices at the end-of-life, and electing to receive hospice services is one of them. Hospice has been linked to improved quality of life and death and is accessible to terminally ill patients. Despite the accessibility, African American patients often make the decision to forgo hospice services. The purpose of this descriptive study was to explore perceptions and beliefs of nurse practitioners (NPs) regarding the lack of utilization of hospice for African American patients and the feasibility of NPs for initial referral for terminally ill African American patients. The research questions addressed whether an NP\u27s perception, beliefs, and past experiences with hospice influence their decision to refer terminally ill African American patients to hospice. This project was guided by the theory of planned behavior to identify perceptions and beliefs of NPs about referrals for African American patients as well as knowledge to develop an awareness education program. Data were collected using a modified online survey administered to 8 NPs who practiced in Georgia or were members of a NPs\u27 Facebook social group. Descriptive statistics demonstrated that the 8 NPs viewed hospice as a valuable service and cost-effective. Microsoft Excel was used to manage qualitative content, which demonstrated that NPs felt education was important for increasing African American patients\u27 use of hospice. The implementation of an awareness education program can benefit NPs by educating them on the possible connection between their beliefs and perceptions about African American terminally ill patients and their decision to refer African American patients to hospice. Additionally, this project has the potential to improve end-of-life care

Effects of Water Chemistry and Watershed Characteristics on Populations of Trout in the Great Smoky Mountains National Park

The purpose of this study was to combine fish, water quality, and watershed data- bases in order to determine what relationships exist between trout biomass and base flow water quality in the Great Smoky Mountains National Park (GRSM). Quarterly base flow water quality data collected from 1993 to 2003 at 31 stream sites in the GRSM were used in step-wise multiple linear regression models to analyze brook and rainbow trout biomass (kg/ha). Stream samples were analyzed for pH, acid neutralizing capacity (ANC), conductivity, major cations, and major anions. The potential predictor variables included seasonality, basin characteristics, USGS stream flow data as surrogate hydrologic data, precipitation data, e.g. cumulative inches of rain on preceding days, and water quality data. Each of the predictor variables were found to be statistically significant (p\u3c0.05) influencing factors to trout biomass, particularly elevation, basin area, sulfate concentration, maximum stream flow, conductivity, ANC and percent anakeesta geology. Final correlation analysis, where zeros were assumed for biomass when there were no trout present, revealed that pH, ANC, conductivity, and sulfate are important predictors of trout biomass. Brook trout biomass was not significantly correlated with median pH or log (ANC). However, rainbow trout young-of-year and adult biomass had correlation coefficients of 0.514 and 0.504 respectively with median pH. Furthermore, rainbow trout young-of-year and adult biomass had correlation coefficients of 0.635 and 0.544 respectively with log (ANC). Brook trout young-of-year and adult biomass had correlation coefficients of –0.237 and –0.239 respectively with log (conductivity). Rainbow trout young-of-year and adult biomass had correlation coefficients of 0.613 and 0.368 respectively with log (conductivity). Lastly, both brook and adult rainbow trout biomass had significant negative correlations with sulfate concentrations. Brook trout young-of-year and adult biomass had correlation coefficients of –0.346 and –0.303 respectively with sulfate. Rainbow trout adult biomass had a correlation coefficient of -0.190. Rainbow trout young-of-year biomass was not significantly correlated with sulfate concentrations. Modeling revealed that brook trout biomass is most strongly related to elevation while rainbow trout biomass is related more to basin area. Elevation is positively correlated with brook trout biomass and accounts for 31% and 40% of the variability in brook trout young-of-year and adult biomass respectively. Similarly, basin area is positively correlated with rainbow trout biomass and accounts for 68% and 40% of the variability in rainbow trout young-of-year and adult biomass respectively. It is thought that basin area and elevation are possible surrogates for stream size. Elevation and basin area have a correlation coefficient of –0.4794, meaning that large basin areas occur at lower elevations and higher elevations have smaller basin areas. Results also showed that young-of-year trout were negatively affected by increases in maximum stream flow and cumulative precipitation for the previous 90 days. Also results for adult trout biomass show a negative relationship with biomass of a competing trout species. Both trout species were negatively affected by increases in sulfate concentrations and percent anakeesta geology. The overall models for biomass produced r-squared values of 0.54 and 0.63 for brook trout young-of-year and adult respectively and values of 0.73 and 0.49 for rainbow trout young-of-year and adult respectively. Based on the regression results, trout biomass decreases with increases in sulfate concentrations and percent anakeesta. Both of these variables can be linked to acidic stream conditions. Sites along Shutts Prong, Porters Creek, and Walker Camp Prong are at risk because total trout biomass at these locations is either zero or very small and they have greater than 90% anakeesta geology and/or elevated sulfate concentrations. Brook trout biomass showed a significant positive relationship with elevation. This was expected since results from Baldigo and Lawrence (2001) showed that brook trout seem to be present in streams at high elevations with cold water, steep gradients, small channels, and fast water velocities. Furthermore, brook trout are most often found in small lakes and streams at high elevations which are most susceptible to acidic deposition (Turner et al. 1992). In the GRSM, brook trout are relegated to high elevation streams by historic logging and competition from exotic rainbow trout. Apparently due to competition, brook trout biomass was adversely affected by increases in rainbow trout biomass. Rainbow trout are larger than brook and therefore able to out-compete them for feeding territories. Larson and Moore (1985) found that in GRSM stream segments with similar physical characteristics rainbow trout have biomasses about 1.8 times greater than that of brook trout. Rainbow trout biomass showed a significant positive relationship with basin area, which is consistent with King’s (1943) observation that rainbow trout are relatively larger and more active and therefore choose larger streams, other conditions being the same, than brook trout. Rainbow trout biomass also increases with increasing stream conductivity and ANC. Conductivity is related to the amount of ions (including calcium, magnesium, sodium, and potassium) found in a stream’s water which should benefit fish. The negative relationships between young-of-year biomass and hydrologic conditions can be explained by young-of-year trout being washed away by high flows and/or high flows often corresponding to decreases in stream pH and ANC (Latterell et al. 1998; Driscoll et al. 2001). Final correlation results also indicate that both brook and rainbow trout biomass decrease as the cumulative precipitation for the previous 90 and 180 days increases. This is consistent with results from Barnett (2003) that water quality conditions in the GRSM were adversely affected by increased stream flows, acid deposition and precipitation. Furthermore, negative correlations between sulfate concentrations and biomass give possible evidence to the problem of acid deposition. However, sulfate is also strongly correlated with anakeesta geology. Since this analysis does not consider storm event water quality, it is difficult to separate out the affects of acid deposition versus acidic geology in the GRSM

Evaluating methodological issues in the tourism literature: UK outgoing tourism and trade links

YesThis paper evaluates the importance of trade in goods when modelling demand for tourism. It is argued that the limited literature testing causality between trade in goods and tourism does not consider the appropriate variables. This study utilises bilateral data for 16 UK tourist destinations in order to test Granger causality between trade in goods and tourism expenditure. UK imports, exports and total trade are tested separately, whilst controlling for real GDP and real bilateral exchange rates. The novelty of this paper is the variable specification, as well as testing the causal relationship for the case of UK outgoing tourists. Our findings suggest a causal relationship between the tourism expenditure of UK residents and trade in goods. These results support the inclusion of a trade in goods variable when estimating tourism demand, as well as adopting appropriate methodologies to account for this causal relationship. Furthermore, there is strong evidence that the trade-tourism link is important for both the UK and host countries

Exploring Dating as an Occupation for Young Heterosexual Women in Ireland

Purpose – Dating is a meaningful occupation for many single people. The occupation of dating has transformed considerably in Ireland due to recent changes in Irish culture and the advent of online dating technology. The purpose of this study was to explore the complexities and intricacies of dating in an Irish context. Design/methodology/approach – A qualitative research approach was used and data were collected using semi-structured interviews with ten heterosexual women (age 24-34) living in urban areas of Ireland. Data were analysed using inductive thematic analysis (Braun and Clarke, 2006). Findings – Dating did not fully resonate with their experience, but they did not have an alternative term. The form of dating was influenced by cultural, temporal, physical and virtual contexts. Beliefs about dating, fluctuating emotions and feelings of mortification because of the stigma of online dating created meaning for participants and influenced their use of strategies to improve resilience. While dating was not a preferred occupation for participants because of its arduous nature and fluctuations in emotion, it was seen as essential to fulfil the function of finding a romantic partner or partner in occupation. Connections between participant experiences and occupational science are discussed to address the lexicon of dating and the form, function and meaning of dating. Originality/value – This study contributes to occupational science knowledge by revealing the occupational understandings of dating as an emerging and dynamic occupation in a rapidly changing culture of Ireland