Predictive Factors of Successful Outcomes for Occupational Therapy Students

Objective: The purpose of this study was to investigate the extent to which pre-admission factors and program grades predict FWII performance and first time pass status on the NBCOT exam for occupational therapy students at the University of Puget Sound. Method: The sample included 242 students from cohorts 2002 to 2011. Multiple regression was used to predict FWII performance. Logistical regression predicted first time (P1) or second time pass (P2) on the NBCOT. One-sample t-test mean comparisons were calculated between students who passed or failed FWII, and between P1 and P2 students. Results: Prediction of FWII scores was not statistically significant. In contrast, GRE and program grades may predict P1 students. Logistical regression identified 26% of P2 students and 99.1% of P1 students. Pre-admission factors and program grades yielded numerous statistically significant differences in means between P1 and P2 students. Conclusion: Identifying P2 students may be beneficial during the selection process, and for faculty members during the program so they may intervene to assist students at risk

Embedding compassionate care in local NHS practice: a realistic evaluation of the Leadership in Compassionate Care Programme

This thesis offers an original contribution to knowledge through providing a rigorous longitudinal examination of a complex intervention known as the ‘Leadership in Compassionate Care Programme’ (LCC) which was designed to embed compassionate care within local NHS practice in a large Health Board in Scotland. To date there has been little research into the impact of dedicated programmes aimed at enhancing compassionate care on an organisational basis. Through the use of Pawson and Tilley’s (1997) realistic evaluation framework this study takes the form of a critical exploration of what did and did not support a sustained focus on compassionate care within the participating settings. The findings have important implications for both policy and practice, and the thesis culminates in a series of recommendations for healthcare organisations at macro, meso and micro levels.Concern about the delivery of compassionate care in the NHS has become a major focus of political, public and professional debate during the last ten years. There has been long standing recognition of the clinical and financial pressures within the NHS; however, the scandal of poor care in Mid Staffordshire NHS Trust brought the issue of compassionate nursing practice into sharp focus. This study makes reference to the findings of the original Francis Inquiry (2010) and subsequent recommendations (Francis 2013) and there is no doubt that the current and future landscape of compassionate care is very different to the one encountered at the outset of this inquiry in 2007.This longitudinal qualitative study provides insight into nurses’ experiences as they engaged with the LCC Programme and it provides an important understanding of how best to recognise and support existing good practice and achieve sustainable improvements. Data collection was conducted over three years and primarily involved 46 semi-structured interviews with 33 key participants. This led to the development of eight detailed case studies of participating wards and the generation of an analytic framework based on ‘level of adoption’ of the LCC Programme. The eventual synthesis of findings across all eight study sites permitted the development of a conceptual model for strengthening organisational capacity for the delivery of compassionate care. The ‘compassionate core’ of this model recognises compassionate care as focussed on meeting the needs of patients, of relatives and of staff. My findings point to the fact that embedding and sustaining compassionate care demands a strategic vision and investment in a local infrastructure that supports relationship-centred care, practice development, and effective leadership at all levels

Midwifery continuity of carer: Developing a realist evaluation framework to evaluate the implementation of strategic change in Scotland

Midwifery continuity of carer (MCC) models result in better clinical outcomes for women and offer midwives a superior way of working when compared to other models of maternity care. Implementing a MCC model, a key recommendation of the Scottish Government Maternity and Neonatal Strategy Best Start, requires significant restructuring of maternity services and changes to midwives' roles. Careful evaluation is therefore required to monitor and understand how the policy affects care providers and users. Realist evaluation is an appropriate methodology for evaluating programmes of change set within complex social organisations, such as health services, and can help to understand variations in outcomes and experiences. This paper presents the approach taken using the principles of realist evaluation to identify key programme theories, which then informed an evaluation framework and a midwives' evaluation tool. The comprehensive survey-tool developed for midwives has the potential to be used more widely to evaluate comparable strategic change in this area

Gender equality approaches in water, sanitation, and hygiene programs: Towards gender-transformative practice

The recent (re-)emergence of gender-transformative approaches in the development sector has focused on transforming the gender norms, dynamics, and structures which perpetuate inequalities. Yet, the application of gender-transformative approaches within water, sanitation, and hygiene (WASH) programing remains nascent as compared with other sectors. Adopting a feminist sensemaking approach drawing on literature and practice, this inquiry sought to document and critically reflect on the conceptualization and innovation of gender-transformative thinking in the Australian Government's Water for Women Fund. Through three sensemaking workshops and associated analysis, participants developed a conceptual framework and set of illustrative case examples to support WASH practitioners to integrate strengthened gender-transformative practice. The multi-layered framework contains varied entry points to support multi-disciplinary WASH teams integrating gender equality, as skills and resources permit. Initiatives can be categorized as insensitive, sensitive, responsive or transformative, and prompted by five common motivators (welfare, efficiency, equity, empowerment, and transformative requality). The framework has at its foundation two diverging tendencies: toward instrumental gender potential and toward transformative gender potential. The article draws on historical and recent WASH literature to illustrate the conceptual framework in relation to: (i) community mobilization, (ii) governance, service provision, and oversight, and (iii) enterprise development. The illustrative examples provide practical guidance for WASH practitioners integrating gendered thinking into programs, projects, and policies. We offer a working definition for gender-transformative WASH and reflect on how the acknowledgment, consideration, and transformation of gender inequalities can lead to simultaneously strengthened WASH outcomes and improved gender equality

Midwives’ views of changing to a Continuity of Midwifery Care (CMC) model in Scotland: a baseline survey

Background: There is good evidence that Continuity of Midwifery Care (CMC) is associated with improved clinical outcomes, greater maternal satisfaction, and improved work experiences for midwives. Changes made to the organisation require careful implementation, with on-going evaluation to monitor progress. Aim: To develop a survey tool that incorporates several validated scales, which was used to collect baseline data prior to implementing a high-quality Continuity of Midwifery Care (CMC) model in Scotland.9 This tool gathered data about midwives’ personal and professional wellbeing prior to service reorganisation, with a longitudinal study intended to measure change in midwives’ reportage across time. This paper reports the baseline data-collection. Methods: An on-line survey was shared with practising midwives (n=321) in Scotland via the NHS intranet, verbally, email, and paper. The survey elicited midwives views about Continuity of Midwifery Care (CMC); values and philosophies of care; attitudes towards their professional role; personal and professional demographics; quality of life and wellbeing. Psychometric attitudinal scales were scored and free text comments themed according to positive/negative opinions of the new Continuity of Midwifery Care (CMC) model to highlight key concerns to be addressed and identify change barriers or facilitators.Findings: The majority of midwives indicated support for philosophies underpinning Continuity of Midwifery Care (CMC), which includes physiological birth and providing autonomous midwifery care. Participants also indicated positive attitudes towards their current role and organisation, with some worrying about how the organisation was going to implement the changes required. Worries included, receiving an overburdening workload, being deskilled in certain areas of midwifery practice, and lack of support were litigation to arise. Conclusion: Midwives support the values and philosophies that underpin Continuity of Midwifery Care (CMC), yet worry about organisational change involved in evolving systems of care. Hence, management require to implement strategies to reduce fears. For example, delivering accurate and honest information, enabling midwives to plan, design and implement changes themselves, and providing emotional and material help

Midwives’ views of changing to a Continuity of Midwifery Care (CMC) model in Scotland: a baseline survey

Background: There is good evidence that Continuity of Midwifery Care (CMC) is associated with improved clinical outcomes, greater maternal satisfaction, and improved work experiences for midwives. Changes made to the organisation require careful implementation, with on-going evaluation to monitor progress. Aim: To develop a survey tool that incorporates several validated scales, which was used to collect baseline data prior to implementing a high-quality Continuity of Midwifery Care (CMC) model in Scotland.9 This tool gathered data about midwives’ personal and professional wellbeing prior to service reorganisation, with a longitudinal study intended to measure change in midwives’ reportage across time. This paper reports the baseline data-collection. Methods: An on-line survey was shared with practising midwives (n=321) in Scotland via the NHS intranet, verbally, email, and paper. The survey elicited midwives views about Continuity of Midwifery Care (CMC); values and philosophies of care; attitudes towards their professional role; personal and professional demographics; quality of life and wellbeing. Psychometric attitudinal scales were scored and free text comments themed according to positive/negative opinions of the new Continuity of Midwifery Care (CMC) model to highlight key concerns to be addressed and identify change barriers or facilitators.Findings: The majority of midwives indicated support for philosophies underpinning Continuity of Midwifery Care (CMC), which includes physiological birth and providing autonomous midwifery care. Participants also indicated positive attitudes towards their current role and organisation, with some worrying about how the organisation was going to implement the changes required. Worries included, receiving an overburdening workload, being deskilled in certain areas of midwifery practice, and lack of support were litigation to arise. Conclusion: Midwives support the values and philosophies that underpin Continuity of Midwifery Care (CMC), yet worry about organisational change involved in evolving systems of care. Hence, management require to implement strategies to reduce fears. For example, delivering accurate and honest information, enabling midwives to plan, design and implement changes themselves, and providing emotional and material help

Implementing continuity of midwife carer – just a friendly face? A realist evaluation

BackgroundGood quality midwifery care saves the lives of women and babies. Continuity of midwife carer (CMC), a key component of good quality midwifery care, results in better clinical outcomes, higher care satisfaction and enhanced caregiver experience. However, CMC uptake has tended to be small scale or transient. We used realist evaluation in one Scottish health board to explore implementation of CMC as part of the Scottish Government 2017 maternity plan.MethodsParticipatory research, quality improvement and iterative data collection methods were used to collect data from a range of sources including facilitated team meetings, local and national meetings, quality improvement and service evaluation surveys, audits, interviews and published literature. Data analysis developed context-mechanism-outcome configurations to explore and inform three initial programme theories, which were refined into an overarching theory of what works for whom and in what context.ResultsTrusting relationships across all organisational levels are the context in which CMC works. However, building these relationships during implementation requires good leadership and effective change management to drive whole system change and foster trust across all practice and organisational boundaries. Trusting relationships between midwives and women were valued and triggered a commitment to provide high quality care; CMC team relationships supported improvements in ways of working and sustained practice, and relationships between midwives and providers in different care models either sustained or constrained implementation. Continuity enabled midwives to work to full skillset and across women’s care journey, which in turn changed their perspective of how they provided care and of women’s care needs. In addition to building positive relationships, visible and supportive leadership encourages engagement by ensuring midwives feel safe, valued and informed.ConclusionLeadership that builds trusting relationships across all practice and organisational boundaries develops the context for successful implementation of CMC. These relationships then become the context that enables CMC to grow and flourish. Trusting relationships, working to full skill set and across women’s care journey trigger changes in midwifery practice. Implementing and sustaining CMC within NHS organisational settings requires significant reconfiguration of services at all levels, which requires effective leadership and cannot rely solely on ground-up change