Patient safety in health care professional educational curricula: examining the learning experience

This study has investigated the formal and informal ways pre-registration students from four healthcare professions learn about patient safety in order to become safe practitioners. The study aims to understand some of the issues which impact upon teaching, learning and practising patient safety in academic, organisational and practice „knowledge? contexts. In Stage 1 we used a convenience sample of 13 educational providers across England and Scotland linked with five universities running traditional and innovative courses for doctors, nurses, pharmacists and physiotherapists. We gathered examples of existing curriculum documents for detailed analysis, and interviewed course directors and similar informants. In Stage 2 we undertook 8 case studies to develop an in-depth investigation of learning and practice by students and newly qualified practitioners in universities and practice settings in relation to patient safety. Data were gathered to explore the planning and implementation of patient safety curricula; the safety culture of the places where learning and working take place; the student teacher interface; and the influence of role models and organisational culture on practice. Data from observation, focus groups and interviews were transcribed and coded independently by more than one of the research team. Analysis was iterative and ongoing throughout the study. NHS policy is being taken seriously by course leaders, and Patient Safety material is being incorporated into both formal and informal curricula. Patient safety in the curriculum is largely implicit rather than explicit. All students very much value the practice context for learning about patient safety. However, resource issues, peer pressure and client factors can influence safe practice. Variations exist in students? experience, in approach between university tutors, different placement locations – the experience each offers – and the quality of the supervision available. Relationships with the mentor or clinical educator are vital to student learning. The role model offered and the relationship established affects how confident students feel to challenge unsafe practice in others. Clinicians are conscious of the tension between their responsibilities as clinicians (keeping patients safe), and as educators (allowing students to learn under supervision). There are some apparent gaps in curricular content where relevant evidence already exists – these include the epidemiology of adverse events and error, root cause analysis and quality assessment. Reference to the organisational context is often absent from course content and exposure limited. For example, incident reporting is not being incorporated to any great extent in undergraduate curricula. Newly qualified staff were aware of the need to be seen to practice in an evidence based way, and, for some at least, the need to modify „the standard? way of doing things to do „what?s best for the patient?. A number of recommendations have been made, some generic and others specific to individual professions. Regulators? expectations of courses in relation to patient 9 safety education should be explicit and regularly reviewed. Educators in all disciplines need to be effective role models who are clear about how to help students to learn about patient safety. All courses should be able to highlight a vertical integrated thread of teaching and learning related to patient safety in their curricula. This should be clear to staff and students. Assessment for this element should also be identifiable as assessment remains important in driving learning. All students need to be enabled to constructively challenge unsafe or non-standard practice. Encounters with patients and learning about their experiences and concerns are helpful in consolidating learning. Further innovative approaches should be developed to make patient safety issues 'real' for students

Some useful sources on harm, abuse, agency and resilience across the lifespan

The URL addresses listed here access websites holding an array of electronic resources relevant to the understanding of harm, abuse, agency and resilience across the lifespan. Many websites include links to additional reports, research papers, reviews and other sources of information. Due to the breadth of subject area and limitations on available space, the websites should be regarded as an indicative sample rather than an exhaustive list of relevant information currently available on the internet. Only English language sites have been included. All website addresses were available on 31 July 2009

Future costs of long-term care for older people - some useful sources

The websites listed here provide electronic resources relevant to different aspects of the costs of long-term care. Many include links to additional reports, research papers, reviews and other sources of information. They should be regarded as a representative sample rather than an exhaustive list of relevant information currently available on the Internet. Only English language sites have been included. All website addresses were available on 30 March 2007

Call centre employment a qualitative study

This study explores aspects of the nature and experience of call centre employment. In 1972 only 42% of UK households had a home-based telephone (BIFU, 1996). By 2000 98% of UK homes had access to either fixed-line or mobile telephone services (Oftel, 2001). The commercial exploitation of this artifact is now being realised through call centres employing sophisticated information and communications technologies. Virtually unheard of a decade ago, UK call centres provided jobs for an estimated 264,000 people in 2001 (Datamonitor, 1999). They have increasingly attracted public and academic attention, much of the latter focused on issues of employee control and surveilance. This study uses analyses of call centre-related newspaper articles, a survey of Scottish recruitment and employment agencies, covert participant observation, and interviews with agency representatives and call centre employees to explore issues such as recruitment and selection, the nature and experience of employment, and employee turnover in call centres. The ethics of using covert methods are discussed. Four main conclusions emerge from the study. First, call centre employment can be differentiated from other occupations on the basis of recruitment and selection practices, employee skils and differences in work environments, performance monitoring and supervision practices and regulation of workplace behaviour. Second, job characteristics may predispose employees to low levels of job-related well-being and burnout. Third, levels of employee turnover may be linked to occupational novelty and the availability of pre-employment realistic job information. Fourth, automated systems are beginning to replace routine, repetitive, low value tasks, resulting in changes in the nature of call centre employment. Those jobs that remain seem likely to be more demanding with complex tasks and an emphasis on quality rather than quantity of interactions. The implications of the study's findings and conclusions for future research and for call centre employers and their employees are considered

Designing Environments for People with Dementia

The ebook edition of this title is Open Access and is freely available to read online. This review systematically explores and assesses the quality of the evidence base for effective and supportive design of living environments for people living with Dementia. Dementia is a major challenge for all countries, as the population with the condition is growing rapidly. Societies desperately need to identify measures which mean that they can continue to thrive with a large population of people who are cognitively impaired. Medical treatments are poor, and there is little indication of better medications appearing in the coming decades. There is urgent need for non-medical advances which can address the challenge including ensuring environments are conducive to living better with Dementia. Whilst there is a lot of activity in this area of Dementia friendly design, the evidence base remains poorly synthesized and weak. This book pulls evidence together to provide a solid reference point from which further research and further developments in the field of Dementia care and support can proceed

RemoDem: Delivering support for people with dementia in remote areas

RemoDem aimed to develop, test and evaluate services for people with dementia in remote areas of the Faroe Islands, Greenland, Sweden and Scotland. Formative and summative evaluation used a flexible research design including collection of baseline data, interviews and focus groups with key informants and data relating to service users, i.e. people with dementia and their carers. Challenges for service providers included organisational difficulties, lack of clear information about their populations with dementia and lack of knowledge in local communities. Test sites which developed services building on their particular local starting points adopted both specialist and ‘off the shelf’ technologies and found that these were generally helpful for people with significant support needs. The flexible research design was found to be essential in the real world conditions of the service development and evaluation. Services were more successful where more mature and less experimental technologies were used. The new services promised to address effectively challenges of remoteness including distance, communication and workforce deployment issues

Time for care: exploring time use by carers of older people

First paragraph: The contribution of carers, as 'people who provide support, in the context of familial or other prior affective relationships, to a person with long-term care needs, experiencing frailty in old age or with serious illness or disability' (Yeandle et al 2017:10), to the support and care of older people is recognised world wide, and researchers internationally are attempting to develop better understanding of its quantity and quality. This paper focuses on the temporal dimensions of what carers do. We take a critical perspective both on time and temporality, and on prevalent assumptions about care that are reproduced in research literature. We argue that the focus on time can be used to generate novel possibilities for research that learns from carers' experiences. As Milne and Larkin (2015) suggest is necessary, we draw on two traditions in care research: 'gathering and evaluation', which considers the quantity and nature of caring and evaluates policy and practice; and 'conceptualising and theorising' which is concerned with caring in its context, questions prevalent assumptions and critically examines established ideas

Literature review: the cost effectiveness of assistive technology in supporting people with dementia

Despite much emphasis on the potential of assistive technologies of many varieties to deliver cost effective ways of supporting people with dementia, and clear indications of this potential, rigorous cost-effectiveness studies of these technologies for this group remain largely absent. The review includes consideration of the indicative evidence. This report describes the process and results of the literature review. Extensive searches identified a large literature, of which 59 items were systematically reviewed and quality assessed.We are indebted to the Dementia Services Development Trust who funded the study as part of the work of the Dementia Services Development Centre in Northern Ireland. This work is supported by the Atlantic Philanthropies and the Northern Ireland DHSSPH

Design of residential environments for people with dementia and sight loss: a structured literature review

A structured literature review concerning the design of living environments for people with dementia and sight loss was conducted. Following systematic searching, thirty three items were included and quality assessed. Findings are described covering colour and contrast, lighting, fixtures and fittings, entrances and exits, gardens and outdoors. The discussion highlights the poor quality of evidence, combined nevertheless with useful suggestions for design; the tendency for literature to be fragmented; and the need for improvements in terms of study focus, study quality and an emphasis on independence and individual needs. The review was subsequently used to inform the development of design guidelines

Developing best practice guidelines for designing living environments for people with dementia and sight loss

The paper considers a process of developing evidence-based design guidelines to be used in environments where people with dementia and sight loss are living. The research involved a systematically conducted literature review and a series of consultations with people affected by dementia and/or sight loss who lived or worked in care homes or in domestic settings. Findings from the literature and the consultations were used in an iterative process to develop the guidelines. The process is outlined, providing examples from the guidelines about lighting and colour and contrast. In discussing the research findings and the development process, the authors consider implications of the work including the weakness of the evidence base, the challenges of improving this and the need for innovative approaches to understanding the complexities of design for people with dementia and sight loss. They highlight the emphasis in the literature on independence for people with sight loss and the focus on control of people with dementia, arguing that this falls short of a genuinely person-centred approach, which recognises the active participation of people with dementia and sight loss