Individual and organisational challenges for personalised care on an inpatient ward: the staff team perspective

Criticism of NHS acute psychiatric care has been high within patient experience research, compounded by critical press coverage of inpatient wards. Government policy requires staff to deliver compassionate, personalised care, but there is little research considering staff’s perspectives and experiences of the work. This study aimed to construct a grounded theory of acute psychiatric staff’s experiences, with particular attention to what might facilitate or block compassionate patient care. Semi-structured interviews were conducted with ten ward staff (three men, seven women) across a range of disciplines. Data were analysed using constructivist grounded theory. The model constructed captures the dynamic interactions between eleven categories: Being in a chaotic environment, Feeling limited, Struggling to improve without support, Building patient relationships, Enjoying the work, Staying vigilant, Taking an emotional toll, Putting up a barrier, Supporting each other, Seeing tensions and differences, and Acting as one team. The study concluded that staff described feeling motivated to engage with patients but restricted by practical and emotional demands. While support was provided by colleagues and formal structures, staff could not always make full use of them. Suggestions for future research and clinical practice include changes to practical demands on staff, as well as attitudes towards reflective practice

Guest editorial: JCAL access to support teaching research methods

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Book Review: 'Enraged, rattled and wronged: Entitlement’s response to social progress' by Kristin J. Anderson

Book review

Integrated helicopter survivability

A high level of survivability is important to protect military personnel and equipment and is central to UK defence policy. Integrated Survivability is the systems engineering methodology to achieve optimum survivability at an affordable cost, enabling a mission to be completed successfully in the face of a hostile environment. “Integrated Helicopter Survivability” is an emerging discipline that is applying this systems engineering approach within the helicopter domain. Philosophically the overall survivability objective is ‘zero attrition’, even though this is unobtainable in practice. The research question was: “How can helicopter survivability be assessed in an integrated way so that the best possible level of survivability can be achieved within the constraints and how will the associated methods support the acquisition process?” The research found that principles from safety management could be applied to the survivability problem, in particular reducing survivability risk to as low as reasonably practicable (ALARP). A survivability assessment process was developed to support this approach and was linked into the military helicopter life cycle. This process positioned the survivability assessment methods and associated input data derivation activities. The system influence diagram method was effective at defining the problem and capturing the wider survivability interactions, including those with the defence lines of development (DLOD). Influence diagrams and Quality Function Deployment (QFD) methods were effective visual tools to elicit stakeholder requirements and improve communication across organisational and domain boundaries. The semi-quantitative nature of the QFD method leads to numbers that are not real. These results are suitable for helping to prioritise requirements early in the helicopter life cycle, but they cannot provide the quantifiable estimate of risk needed to demonstrate ALARP. The probabilistic approach implemented within the Integrated Survivability Assessment Model (ISAM) was developed to provide a quantitative estimate of ‘risk’ to support the approach of reducing survivability risks to ALARP. Limitations in available input data for the rate of encountering threats leads to a probability of survival that is not a real number that can be used to assess actual loss rates. However, the method does support an assessment across platform options, provided that the ‘test environment’ remains consistent throughout the assessment. The survivability assessment process and ISAM have been applied to an acquisition programme, where they have been tested to support the survivability decision making and design process. The survivability ‘test environment’ is an essential element of the survivability assessment process and is required by integrated survivability tools such as ISAM. This test environment, comprising of threatening situations that span the complete spectrum of helicopter operations requires further development. The ‘test environment’ would be used throughout the helicopter life cycle from selection of design concepts through to test and evaluation of delivered solutions. It would be updated as part of the through life capability management (TLCM) process. A framework of survivability analysis tools requires development that can provide probabilistic input data into ISAM and allow derivation of confidence limits. This systems level framework would be capable of informing more detailed survivability design work later in the life cycle and could be enabled through a MATLAB® based approach. Survivability is an emerging system property that influences the whole system capability. There is a need for holistic capability level analysis tools that quantify survivability along with other influencing capabilities such as: mobility (payload / range), lethality, situational awareness, sustainability and other mission capabilities. It is recommended that an investigation of capability level analysis methods across defence should be undertaken to ensure a coherent and compliant approach to systems engineering that adopts best practice from across the domains. Systems dynamics techniques should be considered for further use by Dstl and the wider MOD, particularly within the survivability and operational analysis domains. This would improve understanding of the problem space, promote a more holistic approach and enable a better balance of capability, within which survivability is one essential element. There would be value in considering accidental losses within a more comprehensive ‘survivability’ analysis. This approach would enable a better balance to be struck between safety and survivability risk mitigations and would lead to an improved, more integrated overall design

Two Wide Planetary-mass Companions to Solar-type Stars in Upper Scorpius

At wide separations, planetary-mass and brown dwarf companions to solar-type stars occupy a curious region of parameter space not obviously linked to binary star formation or solar system scale planet formation. These companions provide insight into the extreme case of companion formation (either binary or planetary), and due to their relative ease of observation when compared to close companions, they offer a useful template for our expectations of more typical planets. We present the results from an adaptive optics imaging survey for wide (~50–500 AU) companions to solar-type stars in Upper Scorpius. We report one new discovery of a ~14 M_J companion around GSC 06214−00210and confirm that the candidate planetary-mass companion 1RXS J160929.1−210524 detected by Lafrenière et al. is in fact comoving with its primary star. In our survey, these two detections correspond to ~4% of solar-type stars having companions in the 6–20 M_J mass and ~200–500 AU separation range. This figure is higher than would be expected if brown dwarfs and planetary-mass companions were drawn from an extrapolation of the binary mass function. Finally, we discuss implications for the formation of these objects

Model for resonant photon creation in a cavity with time dependent conductivity

In an electromagnetic cavity, photons can be created from the vacuum state by changing the cavity's properties with time. Using a simple model based on a massless scalar field, we analyze resonant photon creation induced by the time-dependent conductivity of a thin semiconductor film contained in the cavity. This time dependence may be achieved by irradiating periodically the film with short laser pulses. This setup offers several experimental advantages over the case of moving mirrors.Comment: 9 pages, 1 figure. Minor changes. Version to appear in Phys. Rev.

Knowledge building international project (KBIP): a nested network of learning and knowledge creation

Conference Theme: Learning in the DisciplinesThe Knowledge Building International Project (KBIP 2007-2009) operates on the basis of locally based networks of innovation distributed around the globe. Catalunya (Comconèixer), Hong Kong (KBTN), Quebec (RNS), and Toronto (IKIT) are currently the four main sites. This work represents work primarily within a formal, classroom learning context. Nevertheless, while this work is connected with classroom learning, this work is unique in that it reaches beyond activity within individual classrooms or campus communities to build digital bridges between classrooms in different countries.published_or_final_versio