Rethinking presence: a grounded theory of nurses and teleconsultation

Aims and objectives: To develop a theory that offered an evidence-based insight into the use of teleconsultation by nurses. Background: Teleconsultation is the use of video to facilitate real-time, remote interaction between healthcare practitioners and patients. Although its popularity is growing, there is little understanding of how teleconsultation impacts on the role of nurses. Design: The study adopted a constructivist grounded theory method, supplemented by the use of Straussian analytical approaches. Methods: Using selective and theoretical approaches, registered nurses with experience of using video in health care were sampled. Data were collected using semi-structured interviews exploring experiences, knowledge and feelings surrounding teleconsultation. Interviews were recorded, transcribed and subjected to three-stage, nonlinear manual analysis (open, axial and selective coding). Results: Theoretical saturation occurred after 17 interviews. The core category identified from the data was ‘nursing presence’ Four subcategories of nursing presence were identified: operational, clinical, therapeutic and social. The degree to which presence could be achieved was dependent upon three influencing factors – enablers, constraints and compensation. Conclusions: Nurses provide different types of presence during teleconsultation, with the degree of presence dependent on specific characteristics of video-mediated communication. Where the use of video constrains the delivery of presence, nurses use a range of compensatory mechanisms to enhance patient care. Relevance to clinical practice: Teleconsultation provides an innovative approach to enhancing the delivery of health care. This study provides nurses with insight into the impact of teleconsultation on their professional role, and an understanding of how best to use video-mediated communication to support patient care

Holistic, Ethical Leadership for the 21st Century

The New Oxford American Dictionary (2001) delineates two definitions for a leader: “1) The person who leads or commands a group, organization, or country; a person followed by others. 2) A short strip of nonfunctioning material at each end of a reel of film or recording tape for connection to the spool.” How often does the latter definition seem more applicable for many of our educational leaders than the former? What are the philosophical foundations of leadership? What does a modern, ethical leader look like? These are just a few questions that will be explored in this article. The challenge beset for the educational leaders of the present and the future is one that will require a bridging and blending of old and new paradigms. A mere paradigm shift may not be sufficient–the term shift is still too mechanistic and linear to adequately describe this new approach. Rather, the modern ethical leader must create a paradigm blend. In the circular way of knowing, akin to the epistemology of the Lakota Sioux (Stolzman, 1986), this article will explore four aspects of modern educational leadership. First, the criticisms and attacks on the educational system will be addressed. Second, the aim of education will be analyzed through three lenses: axiology, epistemology, and ontology. Third, systemic education will be discussed. Fourth, the role of the modern/future educational leader will be explored: specifically regarding the need for him/her to address the concerns of the critics and bridge the divide between two paradigms of education. This essay is a brief exploration that delves into the shortcomings of the modern educational system, the core purposes of education, systemic educational paradigms, and the role of the 21st century ethical leader. The author’s goal is not to provide answers, nor propose a prescription for ethical leadership. Rather, the intent is to aid in focusing the direction which leaders must follow in order to be effective in this millennium. Similar to the manner in which Descartes shared his method of inquiry, the author will share part of his experience in learning and growing as an educational leader. “Thus my purpose here is not to teach the method that everyone should follow in order to conduct his reason correctly, but merely to show how I have tried to conduct mine” (Descartes, 1637/1980, p. 2)

Corruption in UK local government: the mounting risks

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Cabs for hire? Fixing the revolving door between government and business

A report due to be launched on 17th May by Transparency International UK reveals that the system for regulating the ‘revolving door’ between government and business is broken and needs a radical overhaul

The state-private interface in public service provision

Political theory sets out a strong case for the state to play a major role in public service provision. Yet services are often provided by a range of state and non-state actors as well as by collaborative partnerships. This paper surveys the literature, seeking to map arrangements in developing countries and to understand the politics of different types of service provision

Irregularity of the Bergman projection on worm domains in C^n

We construct higher-dimensional versions of the Diederich-Fornaess worm domains and show that the Bergman projection operators for these domains are not bounded on high-order $L^p$-Sobolev spaces for $1\leq p<\infty.$Comment: some typos are corrected, to appear in Michigan Math.