The lived experience of final year student nurses of learning through reflective processes.

This scientific phenomenological study aims to explore and better understand the lived experience of learning through reflective processes, the nature, meaning and purpose of reflective learning, what is learned and the triggers and processes that enable meaningful reflective activity. Ten final year nursing students who felt that they had experienced learning through reflective processes were invited to describe their lived experiences of the phenomenon during taped phenomenological interviews. The rich and contextualised data was analysed using the four steps for descriptive phenomenological analysis proposed by Giorgi (1985). The findings essentially differentiate between authentic reflective learning which enables the emergence of 'own knowing', and the academically driven activities often perceived as 'doing reflection'. Authentic and significant personal 'own knowing' is derived from reflective activity prompted by unpredictable, arbitrary occurrences experienced in everyday encounters in the professional and personal worlds of the participants, which stimulate meaningful existential questions that, in turn, demand attention and drive the commitment to ongoing reflection. Engagement with authentic reflective activity is often triggered by an insistent and personal 'felt' sense of a need to understand and know 'something more for the self, and this activity demands far more privacy than the contemporary literature acknowledges. On the cusp of registered practice, the participants described how the maturation of reflective activity had enabled them to engage with the struggle to locate themselves personally and professionally in the context of care, to establish and refine personal and professional values and beliefs and to consider the realities of their nursing practice. Reflection enabled the participants to recognise and affirm that they had become nurses and could fulfil the role to their own and others expectations. Their reflective knowing and understanding was active and embodied in the way they lived their nursing practice. Analysis of the lived experience of learning through reflective processes has raised a number of issues for nurse education, in particular how student nurses may be supported in coming to know themselves and to become reflective, the importance of supportive mentorship and the significance of role modelling in professional development, the psychological safety of the 'practicum' and the need for privacy for authentic reflective learning

The Northern Ireland Section 75 equality duty: an international perspective

‘Mainstreaming’ equality came to international prominence in the mid-1980s. This approach of promoting equality contrasts with anti-discrimination laws designed to protect the rights of individuals in that it is concerned with transforming public decision-making processes and resource allocation. It requires making the concerns and experiences of hitherto marginalised and discriminated groups an integral dimension of the design, implementation, monitoring and evaluation of all policies and programmes. This holistic approach has developed rapidl y and has been endorsed and adopted by countries and supranational organisations around the world. However, despite its widespread acceptance, in the two decades since mainstreaming came to international prominence, there have been very few detailed evaluations of the various approaches developed in different countries. A survey of the published literature reveals that some countries and organisations have favoured a 'light-touch' approach to mainstreaming - based upon enabling legal and institutional mechanisms, whereas others have adopted a more regulatory approach with an emphasis on monitoring, compliance and legal enforcement. This paper is concerned with an example of the latter approach. The 'Section 75' statutory equality duty, as set out in the Northern Ireland Act (1998) has been described as 'unique and world leading'. It requires strategic practice that compels public sector agencies to mainstream equality. It is singular in both its broad scope and its use of strong regulatory and monitoring mechanisms. Here we contrast the N.I. duty with an extensive range of international approaches to mainstreaming, and examine the way in which the S.75 duty has been implemented. Our discussion reveals that whilst the initial operationalisation of the pioneering N.I. equality duty has impacted upon its overall effectiveness, it nevertheless has great utility. Important lessons can be learned from the Northern Ireland experience, lessons that can inform the contemporary approach to promoting equality in a variety of national and international contexts. Moreover, the evidence set out in this paper indicates that in several respects, the N.I. duty reflects the future trajectory of international approaches to promoting equality

Can nurses rise to the public health challenge? How a novel solution in nurse education can address this contemporary question.

This paper raises the problem of how improvements in health outcomes, a key component in many governments' strategies, can be achieved. The work highlights a novel undergraduate educational approach which offers solutions to public health challenges within nursing. Against the backdrop of one UK university institution it discusses approaches that can guide nursing students towards a deeper understanding and engagement within the principles of public health. It then proposes how nurses can use their learning to become leaders of health improvement

The Northern Ireland Section 75 equality duty: an international perspective

‘Mainstreaming’ equality came to international prominence in the mid-1980s. This approach of promoting equality contrasts with anti-discrimination laws designed to protect the rights of individuals in that it is concerned with transforming public decision-making processes and resource allocation. It requires making the concerns and experiences of hitherto marginalised and discriminated groups an integral dimension of the design, implementation, monitoring and evaluation of all policies and programmes. This holistic approach has developed rapidl y and has been endorsed and adopted by countries and supranational organisations around the world. However, despite its widespread acceptance, in the two decades since mainstreaming came to international prominence, there have been very few detailed evaluations of the various approaches developed in different countries. A survey of the published literature reveals that some countries and organisations have favoured a 'light-touch' approach to mainstreaming - based upon enabling legal and institutional mechanisms, whereas others have adopted a more regulatory approach with an emphasis on monitoring, compliance and legal enforcement. This paper is concerned with an example of the latter approach. The 'Section 75' statutory equality duty, as set out in the Northern Ireland Act (1998) has been described as 'unique and world leading'. It requires strategic practice that compels public sector agencies to mainstream equality. It is singular in both its broad scope and its use of strong regulatory and monitoring mechanisms. Here we contrast the N.I. duty with an extensive range of international approaches to mainstreaming, and examine the way in which the S.75 duty has been implemented. Our discussion reveals that whilst the initial operationalisation of the pioneering N.I. equality duty has impacted upon its overall effectiveness, it nevertheless has great utility. Important lessons can be learned from the Northern Ireland experience, lessons that can inform the contemporary approach to promoting equality in a variety of national and international contexts. Moreover, the evidence set out in this paper indicates that in several respects, the N.I. duty reflects the future trajectory of international approaches to promoting equality

Economic renewal and the gendered knowledge economy in Wales

The Welsh Assembly Government's Economic Renewal Strategy aims to develop Wales into a 'knowledge economy'. 'Knowledge economies' depend upon close networks and effective collaboration between the members of the 'triple helix' of universities, government and industry. The Assembly Government is obliged, under the Government of Wales Act (2006), to pay due regard to equality of opportunities in all its policies, a commitment underlined by the requirements for equality impact assessments under new British equalities legislation. In this paper, we conduct a political arithmetic of the gender of key players in the 'triple helix' in Wales. Will the Economic Renewal Strategy promote equality or unintentionally reproduce already rigid patterns of gender segregation in the labour market

Multilevel governance, equality and human rights: evaluating the first decade of devolution in Wales

The creation of a ‘regional’ legislature for Wales in 1999 presents the opportunity to evaluate the promotion of equality and human rights in the context of multi-level governance in the UK. A decade on, positive aspects include the political reprioritisation of equalities in policy and law and new forms of representative and discursive politics. However, significant shortcomings are also evident. Overall, the Wales case study suggests that sub-unitary-state legislatures have the potential to tailor equalities policies to meet local needs more effectively, yet progress may be arrested by context-specific factors, as well as those that resonate with the international literature on mainstreaming equalities in the work of government

Delivery of a nutritional prescription by enteral tube feeding in children with chronic kidney disease stages 2-5 and on dialysis-clinical practice recommendations from the Pediatric Renal Nutrition Taskforce

The nutritional prescription (whether in the form of food or liquid formulas) may be taken orally when a child has the capacity for spontaneous intake by mouth, but may need to be administered partially or completely by nasogastric tube or gastrostomy device ("enteral tube feeding"). The relative use of each of these methods varies both within and between countries. The Pediatric Renal Nutrition Taskforce (PRNT), an international team of pediatric renal dietitians and pediatric nephrologists, has developed clinical practice recommendations (CPRs) based on evidence where available, or on the expert opinion of the Taskforce members, using a Delphi process to seek consensus from the wider community of experts in the field. We present CPRs for delivery of the nutritional prescription via enteral tube feeding to children with chronic kidney disease stages 2-5 and on dialysis. We address the types of enteral feeding tubes, when they should be used, placement techniques, recommendations and contraindications for their use, and evidence for their effects on growth parameters. Statements with a low grade of evidence, or based on opinion, must be considered and adapted for the individual patient by the treating physician and dietitian according to their clinical judgement. Research recommendations have been suggested. The CPRs will be regularly audited and updated by the PRNT.Peer reviewe

Using Specialist Screening Practitioners (SSPs) to increase uptake of the Bowel Scope (Flexible Sigmoidoscopy) Screening Programme: a study protocol for a feasibility single-stage phase II trial

Background: The NHS Bowel Scope Screening (BSS) programme offers men and women aged 55 years a onceonly flexible sigmoidoscopy (FS), a test that can help reduce colorectal cancer (CRC) incidence and mortality. However, the benefits of BSS are contingent on uptake. This National Institute for Health Research-funded singlestage phase II trial will test the feasibility of using patient navigation (PN), an intervention that offers support to patients to overcome barriers to healthcare, to increase BSS uptake within a socially deprived area of England. Methods/design: All individuals invited for BSS at South Tyneside NHS Foundation Trust during the 6-month recruitment period will be invited to take part in the study. Consenting participants will be randomised to receive PN or usual care in a 2:1 ratio. PN involves non-attenders receiving a phone call from a Specialist Screening Practitioner (SSP) who will elicit reasons for non-attendance and offer educational, practical, and emotional support as needed. If requested by the patient, another appointment for BSS will then be arranged. We anticipate 30 % of participants will be non-attenders. Using A’Hern single-stage design, with 20 % significance level and 80 % power, at least 35 participants who receive PN need to subsequently attend for PN to be considered worthy of further investigation in a definitive trial. The primary outcome measure will be the number of participants in the PN group who re-book and attend their BSS appointment. A qualitative analysis of the PN transcripts, and interviews with the SSPs, will also be conducted, alongside a quantitative analysis of completed patient-reported experience questionnaires. An economic analysis will calculate the costs of delivering PN. Discussion: This feasibility study will be instrumental in deciding whether to conduct the first definitive trial of PN in BSS in England. If PN is subsequently shown to be cost-effective at increasing uptake of BSS, NHS policies could be modified to implement PN as a standard service. The results will be disseminated in peer-reviewed journals and at scientific conferences. Trial registration: International Standard Randomised Controlled Trial Number, ISRCTN1331475