Flight Nurses’ Narratives of Traumatic Patient Care Events: Why Do They Stay?

As frontline providers of care, flight nurses are continuously exposed to traumatic patient care events; they are, accordingly, highly vulnerable to the injurious effects of compassion fatigue. Flight nursing is an exclusive nursing specialty in which highly trained registered nurses provide comprehensive pre-hospital, emergency, and critical care to patients with urgent or life-threatening conditions aboard helicopter or fixed wing aircraft or, when necessary due to unfavorable weather conditions, by ground ambulance. The purpose of this study was to explore the lived experiences of five flight nurses; to better understand the factors they perceived to be contributors or barriers to compassion fatigue resilience in the medical flight environment. The descriptive phenomenology of Husserl and the methodological interpretation of Colaizzi supported the discovery of abundant narrative data that offered a rare view of flight nursing practice including characteristics and values of flight nurses, coping strategies flight nurses employed to resist compassion fatigue, and barriers to job satisfaction in the medical flight environment. Purposeful sampling was utilized to select participants employed in a Level Two trauma facility in the mid-Atlantic region of the United States. Face-to-face interviews provided rich description of the flight nurse role including multiple variables that influenced flight nurses’ capacity to stay. Twenty-three cluster themes and seven emergent themes emerged from the narrative dataset as the flight nurse participants described their experiences with traumatic patient care events and the strategies they employed to manage secondary stress. Emergent themes included Self-Efficacy, Self-Determination, Traumatic Caring, Forbearance, Professional Isolation, Heart, and Finding Meaning

Management in practice : analysing the impact of policy change on managers and doctors in general medical practice

This thesis explores the impact of changes in health policy introduced by Conservative administrations in the period 1987 to 1995 on the definition, management and control of professional work within general medical practice. The research underpinning this work combined secondary analysis, large-scale primary fieldwork and qualitative research with clinicians and managers. The first stage of primary fieldwork was conducted during the period September 1994 to June 1995 and consisted of a postal survey of 750 practices across England and Wales. This was followed up with a second phase of research involving depth interviews with managers and clinicians, delivered in the period July to November 1995. This pluralist methodology sought to connect micro and macro levels of analysis in exploring the relationship between the state, professions and managers in primary care. The research explores the extent to which a number of professional freedoms have been challenged by policy change including political, economic and technical autonomy and the extent to which this had changed the position and rewards of managers in general practice. Employing a multi-dimensional approach to the analysis of power this thesis suggests that prevailing theories of a decline in professional power, based primarily on economic relations at the macro level cannot account for the complexity of relations found in UK general practice. Further, studies focusing at the collective level of bargaining between the state and the medical profession in the UK have over-estimated the impact of policy change due to a neglect of study at the micro level. Rather this study has revealed a complex picture of both continuity and change in which general practitioners have lost, retained and in some cases extended their power as a result of policy initiatives. Whilst professional freedoms have remained relatively intact, the impact of policy change on the occupation of Practice Management has been more significant, with prevailing discourses of `managerialism' creating gendered struggles over the definition and meaning of management in primary care. This work therefore calls for a multi-dimensional account of social life which can explain the complex interaction of differing sites of power, within which a wide range of power resources are deployed. Further this work would endorse a dynamic concept of power in which 'patterns of interaction' (Bradley 1999) are fluid and changeable rather than fixed and self-sustaining systems. It is argued here that constraints on social action are created by the history of past agency, embedded in institutions and social practices that both shape, and are shaped by the agency of individuals.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Management in practice : analysing the impact of policy change on managers and doctors in general medical practice

This thesis explores the impact of changes in health policy introduced by Conservative administrations in the period 1987 to 1995 on the definition, management and control of professional work within general medical practice. The research underpinning this work combined secondary analysis, large-scale primary fieldwork and qualitative research with clinicians and managers. The first stage of primary fieldwork was conducted during the period September 1994 to June 1995 and consisted of a postal survey of 750 practices across England and Wales. This was followed up with a second phase of research involving depth interviews with managers and clinicians, delivered in the period July to November 1995. This pluralist methodology sought to connect micro and macro levels of analysis in exploring the relationship between the state, professions and managers in primary care. The research explores the extent to which a number of professional freedoms have been challenged by policy change including political, economic and technical autonomy and the extent to which this had changed the position and rewards of managers in general practice. Employing a multi-dimensional approach to the analysis of power this thesis suggests that prevailing theories of a decline in professional power, based primarily on economic relations at the macro level cannot account for the complexity of relations found in UK general practice. Further, studies focusing at the collective level of bargaining between the state and the medical profession in the UK have over-estimated the impact of policy change due to a neglect of study at the micro level. Rather this study has revealed a complex picture of both continuity and change in which general practitioners have lost, retained and in some cases extended their power as a result of policy initiatives. Whilst professional freedoms have remained relatively intact, the impact of policy change on the occupation of Practice Management has been more significant, with prevailing discourses of `managerialism' creating gendered struggles over the definition and meaning of management in primary care. This work therefore calls for a multi-dimensional account of social life which can explain the complex interaction of differing sites of power, within which a wide range of power resources are deployed. Further this work would endorse a dynamic concept of power in which 'patterns of interaction' (Bradley 1999) are fluid and changeable rather than fixed and self-sustaining systems. It is argued here that constraints on social action are created by the history of past agency, embedded in institutions and social practices that both shape, and are shaped by the agency of individuals.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Commercially important species associated with horse mussel (Modiolus modiolus) biogenic reefs: a priority habitat for nature conservation and fisheries benefits

Horse mussel reefs (Modiolus modiolus) are biodiversity hotspots afforded protection by Marine Protected Areas (MPAs) in the NE Atlantic. In this study, horse mussel reefs, cobble habitats and sandy habitats were assessed using underwater visual census and drop-down video techniques in three UK regions. Megafauna were enumerated, differences in community composition and individual species abundances were analysed. Samples of conspicuous megafauna were also collected from horse mussel reefs in Orkney for stable isotope analysis.Communities of conspicuous megafauna were different between horse mussel habitats and other habitats throughout their range. Three commercially important species: whelks (Buccinum undatum), queen scallops (Aequipecten opercularis) and spider crabs (Maja brachydactyla) were significantly more abundant (by as much as 20 times) on horse mussel reefs than elsewhere. Isotopic analysis provided insights into their trophic relationship with the horse mussel reef. Protection of M. modiolus habitat can achieve biodiversity conservation objectives whilst benefiting fisheries also

Freedom from equine infectious anaemia virus infection in Spanish Purebred horses

Introduction: No cases of equine infectious anaemia (EIA) have been reported in Spain since 1983. Factors that could increase the risk of reintroducing equine infectious anaemia virus (EIAV) into Spain include the recent occurrence of the disease in Europe and the absence of compulsory serological testing before importation into Spain. Aims and objectives: Given the importance of the Spanish Purebred (SP) horse breeding industry in Spain, the aim of this cross-sectional study was to provide evidence of freedom from EIAV in SP stud farms in Central Spain. Materials and methods: Serum samples from 555 SP horses, collected between September 2011 and November 2013, were tested using a commercially available EIAV ELISA with a published sensitivity of 100 per cent. Results: All 555 samples were negative for antibody to EIAV, providing evidence of a true EIAV seroprevalence between 0 per cent and 0.53 per cent (95% CIs of the sensitivity and specificity of the ELISA technique used Q10 were 100 per cent and 99.3 per cent, respectively) among the SP breeding population in Central Spain. Conclusions: These findings should serve to increase confidence when exporting SP horses to other countries

Healthy universities: an example of a whole-system health-promoting setting

The health-promoting settings approach is well established in health promotion, with organisational settings being understood as complex systems able to support human wellbeing and flourishing. Despite the reach and evident importance of higher education as a sector, ‘healthy universities’ has not received high-level international leadership comparable to many other settings programmes. This study explores how the concept of a healthy university is operationalised in two case study universities. Data collection methods included documentary analysis, observation field notes and semi-structured interviews with staff and students. Staff and students understood the characteristics of a healthy university to pertain to management processes relating to communication and to a respectful organisational ethos. Enhancers of health and wellbeing were feeling valued, being listened to, having skilled and supportive line managers and having a positive physical environment. Inhibitors of health and wellbeing were having a sense of powerlessness and a lack of care and concern. The concept of the healthy university has been slow to be adopted in contrast to initiatives such as healthy schools. In addition to challenges relating to lack of theorisation, paucity of evidence and difficulties in capturing the added value of whole-system working, this study suggests that this may be due to both their complex organisational structure and the diverse goals of higher education, which do not automatically privilege health and wellbeing. It also points to the need for a wholeuniversity approach that pays attention to the complex interactions and interconnections between component parts and highlights how the organisation can function effectively as a social system

Capturing the short-term variability of carbon dioxide emissions from sedimentary rock weathering in a remote mountainous catchment, New Zealand

Weathering of organic carbon contained in sedimentary rocks (petrogenic OC, OCpetro) is an important control on the concentrations of carbon dioxide (CO2) and oxygen in the atmosphere. Of particular significance are steep mountainous catchments, where high rates of physical erosion introduce OCpetro to the surface, where oxygen in air and water can help drive oxidative weathering reactions, yet measurements of CO2 emissions from OCpetro oxidation are still scarce. Here, we use in situ gas accumulation chambers and show that CO2 fluxes, and their environmental controls, can be determined during a stand-alone, short-term (8 days) field campaign, applied to a remote setting. In the rapidly eroding Waiapu River catchment, New Zealand, dominated by mudstones, we measured high rates of CO2 release (222–1590 mgC m−2 d−1) in five accumulation chambers in the near-surface of naturally fractured and bedded rock outcrops. The corresponding CO2 concentrations are very high (pCO2 ~4700–27,100 ppmv), and such values could influence acid-hydrolysis reactions during chemical weathering of co-occurring silicate minerals. The CO2 is radiocarbon depleted (fraction modern, F14C = 0.0122–0.0547), confirming it is petrogenic in origin. Stable carbon isotopes suggest a source from OCpetro, but δ13C values of the CO2 are lower by ~3.5–3.7 ± 0.1 ‰ from those of OCpetro (−25.9 ± 0.1 ‰), consistent with isotope fractionation associated with microbial respiration of OCpetro. Over 6 days of measurement, we find that CO2 fluxes respond quickly to changes in temperature and humidity, indicating an environmental regulation that is captured by our short-term installation. The approaches applied here mean that future research can now seek to constrain the climatic, lithological and biological controls on OCpetro oxidation across regional to global scales

Implementation of concussion guidelines in community Australian Football and Rugby League - The experiences and challenges faced by coaches and sports trainers

Objectives: While guidelines outlining the appropriate management of sport-related concussion have been developed and adapted for use within community sport, it remains unknown how they are experienced by those responsible for implementing them.: Design: Longitudinal study.: Methods: 111 coaches and sports trainers from community-level Australian Football and Rugby League teams completed pre- and post-season surveys assessing their attitudes towards using concussion guidelines. Participants also provided post-season feedback regarding their experiences in using the guidelines.: Results: 71% of participants reported using the guidelines in the preceding season. Post-season attitude was related to pre-season attitude (p = 0.002), football code (p = 0.015), and team role (p = 0.045). An interaction between team role and guideline use (p = 0.012) was also found, with coaches who had used the guidelines, and sports trainers who had not, reporting more positive post-season attitudes towards using the concussion guidelines. Implementation challenges included disputing of decisions about return-to-play by players, parents, and coaches, and a perceived lack of time. Recommendations for improved guideline materials included using larger fonts and providing for witnessing of advice given to players.: Conclusions: This is the first study to examine the implementation of concussion guidelines in community sport. Training of coaches/sports trainers needs enhancement. In addition, new education should be developed for parents/players about the importance of the return-to-play advice given to them by those who follow these guidelines. Information provided by those who attempted to use the guidelines will assist the refinement of implementation and dissemination processes around concussion guidelines across sports. © 2015 Sports Medicine Australi

Device assessed activity behaviours in patients with indwelling pleural catheter: A sub-study of the Australasian Malignant PLeural Effusion (AMPLE)-2 randomized trial

Background and Objective: Device-assessed activity behaviours are a novel measure for comparing intervention outcomes in patients with malignant pleural effusion (MPE). Australasian Malignant PLeural Effusion (AMPLE)-2 was a multi-centre clinical trial where participants with MPE treated with an indwelling pleural catheter were randomized to daily (DD) or symptom-guided (SGD) drainage for 60-days. Our aim was to describe activity behaviour patterns in MPE patients, explore the impact of drainage regimen on activity behaviours and examine associations between activity behaviours and quality of life (QoL). Methods: Following randomization to DD or SGD, participants enrolled at the lead site (Perth) completed accelerometry assessment. This was repeated monthly for 5-months. Activity behaviour outcomes were calculated as percent of daily waking-wear time and compared between groups (Mann–Whitney U test; Median [IQR]). Correlations between activity behaviour outcomes and QoL were examined. Results: Forty-one (91%) participants provided ≥ 1 valid accelerometry assessment (DDn = 20, SGD n = 21). Participants spent a large proportion of waking hours sedentary (72%–74% across timepoints), and very little time in moderate-to-vigorous physical activity ( \u3c 1% across timepoints). Compared to SGD group, DD group had a more favourable sedentary-to-light ratio in the week following randomization (2.4 [2.0–3.4] vs. 3.2 [2.4–6.1]; p = 0.047) and at 60-days (2.0 [1.9–2.9] vs. 2.9 [2.8–6.0]; p = 0.016). Sedentary-to-light ratio was correlated with multiple QoL domains at multiple timepoints. Conclusion: Patients with MPE are largely sedentary. Preliminary results suggest that even modest differences in activity behaviours favouring the DD group could be meaningful for this clinical population. Accelerometry reflects QoL and is a useful outcome measure in MPE populations