The role of boundary spanners in delivering collaborative care: a process evaluation

BACKGROUND: On average, people with schizophrenia and psychosis die 13–30 years sooner than the general population (World Psychiatry 10 (1):52–77, 2011). Mental and physical health care is often provided by different organisations, different practitioners and in different settings which makes collaborative care difficult. Research is needed to understand and map the impact of new collaborative ways of working at the primary/secondary care interface (PloS One 7 (5); e36468). The evaluation presented in this paper was designed to explore the potential of a Community and Physical Health Co-ordinator role (CPHC) (CPHCs were previously Care Co-ordinators within the Community Mental Health Team, Community in the title CPHC refers to Community Mental Health) and Multi-Disciplinary Team (MDT) meetings across primary and community care, with the aim of improving collaboration of mental and physical health care for service users with Severe Mental Illness (SMI). METHODS: Data collection took place across five general practices (GPs) and a Community Mental Health Team (CMHT) in the Northwest of England, as part of a process evaluation. Semi-structured interviews were conducted with a purposive sample of GP staff (n= 18) and CMHT staff (n=4), a focus group with CMHT staff (n=8) and a survey completed by 13 CMHT staff, alongside cardiovascular risk data and MDT actions. Framework analysis was used to manage and interpret data. RESULTS: The results from the evaluation demonstrate that a CPHC role and MDT meetings are effective mechanisms for improving the collaboration and co-ordination of physical health care for SMI service users. The findings highlight the importance of embedding and supporting the CPHC role, with an emphasis on protected time and continuing professional roles and integrating multiple perspectives through MDT meetings. Considering the importance of physical health care for SMI service users and the complex environment, these are important findings for practitioners, researchers and policy makers in the field of primary care and mental health. CONCLUSION: There is an increasing focus on integration and collaborative working to ensure the delivery of quality care across the whole patient pathway, with a growing need for professionals to work together across service and professional boundaries. The introduction of a two pronged approach to collaboration has shown some important improvements in the management of physical health care for service users with SMI

A Longitudinal Investigation of the Glass Ceiling in Nursing

Purpose: This paper presents a longitudinal, qualitative study exploring changes in the attributional constructions of sense-making in the perceptions and lived experiences of the glass-ceiling among a cohort of female mental health nurses in the National Health Service (NHS) who participated in a 12-month multi-faceted career and leadership development pilot programme compared to a matched control group. Design/methodology/approach: The authors interviewed 27 female mental health nurses in the UK who participated in a multi-faceted development programme specifically designed to support female nurses secure career advancement and 27 members of a matched control group who did not experience the programme. Participants engaged in semi-structured telephone interviews at three separate time points (six months apart) over a 12-month period. Findings: Programme participants differed in their attributional constructions of sense-making in relation to the glass-ceiling over time compared to the matched control group. e.g. triggering understandings and awakenings and re-evaluating the glass-ceiling above when promoted. Findings are used to theorise about the glass-ceiling as a concept that shifts and changes over time as a function of experience. Practical implications: Practical implications include important organisational outcomes in relation to fostering the career advancement and retention of talented female leaders at all career stages. Originality/value: The authors present the first known longitudinal, qualitative study to explore changes in attributional constructions of sense-making in perceptions and experiences of the glass-ceiling among female nurses over time compared to a matched control group

The potential of online coaching to develop female entrepreneurial self-efficacy

Purpose – The purpose of this study is to explore the potential of coaching to develop female entrepreneurship by overcoming potential barriers. It sought to understand how entrepreneurial self-efficacy can be applied to development relationships, through on-line coaching, examining changes in the four key elements of entrepreneurial self-efficacy enactive mastery, vicarious experiences, social persuasion and psychological arousal. The study examines the impact of coaching relationships on female entrepreneurial self-efficacy compared to a control group. The participant group was matched with coaches and undertook a structured six months’ coaching programme. Design/methodology/approach – This was a longitudinal study using a mixed methods approach. Questionnaires investigating entrepreneurial self-efficacy were collected at two time points for both the coaching and control group. After the first time point, the coaching group was supported through a six months coaching development programme. At the second time point, questionnaires were again completed by both groups and qualitative data gather via interviews with the coaching group. Findings – The findings from this study showed that coaching relationships had a positive impact on coachees’ entrepreneurial self-efficacy, compared to the control group in terms of enactive mastery, vicarious experience, social persuasion and psychological arousal. This suggests that coaching is a development intervention which can be used to enhance self-efficacy beliefs of female entrepreneurs, thereby increasing their chances of engaging in successful business creation and operation. Research limitations/implications – The group size was a problem, with four of the coaching group and ten of the control group dropping out. The coaching participants left the intervention due to personal reasons but no reason could be established for the control group participants leaving the study. The problem of ‘Type II’ was considered and in an attempt to overcome this problem, data were shown at below 10% (p <0.10). It would also have been useful to collect more qualitative data from the control group. Practical implications – An online coaching programme provided by women for women, which is tailored to the individual, can support female entrepreneurs through the difficult stages of start-up and development phases of business development. Creating more successful women owned businesses will not only provide financial benefits, but should help provide additional entrepreneurial networks for women, as well as more positive female role models. Exposure to positive role models has been found to have a direct effect on entrepreneurial self-efficacy. This circular affect should in theory keep on increasing, if female entrepreneurs have access to the tailored support provided by coaching programmes such as the one used here. Social implications – Considering the current global economic climate, it is increasingly important for women to be supported in small business ownership (Denis, 2012). Countries which actively promote women entering into business ownership will ultimately share the gains in terms of wider issues, i.e. improving education and health, and economic growth (Harding, 2007). If female entrepreneurship is to be encouraged and supported, provision needs to be designed and developed based on female entrepreneurs’ needs and requirements, rather than simply conforming to traditional business support models. Originality/value – This study contributes to learning and theoretical debates by providing an understanding of female entrepreneurs’ needs with regard to business support and how this can be related to and supported by coaching. It also adds to the literature on entrepreneurial self-efficacy, coaching and learning by providing empirical evidence to illustrate how coaching interventions, including the use of online methods, can have a positive impact on female entrepreneurial self-efficacy

Implementation of clinical decision support to manage acute kidney injury in secondary care: an ethnographic study

Background: Over the past decade, acute kidney injury (AKI) has become a global priority for improving patient safety and health outcomes. In the UK, a confidential inquiry into AKI led to the publication of clinical guidance and a range of policy initiatives. National patient safety directives have focused on the mandatory establishment of clinical decision support systems (CDSSs) within all acute National Health Service (NHS) trusts to improve the detection, alerting and response to AKI. We studied the organisational work of implementing the AKI CDSSs within routine hospital care. Methods: An ethnographic study comprising non-participant observation and interviews was conducted in two NHS hospitals, delivering AKI quality improvement programmes, located in one region of England. Three researchers conducted a total of 49 interviews and 150 hours of observation over an 18-month period. Analysis was conducted collaboratively and iteratively around emergent themes, relating to the organisational work of technology adoption. Results: The two hospitals developed and implemented AKI CDSSs using very different approaches. Nevertheless, both resulted in adaptive work and trade-offs relating to the technology, the users, the organisation, and the wider system of care. A common tension was associated with attempts to maximise benefit whilst minimise additional burden. In both hospitals, resource pressures exacerbated the tensions of translating AKI recommendations into routine practice. Conclusions Our analysis highlights a conflicted relationship between external context (policy and resources), and organisational structure and culture (e.g. digital capability, attitudes to quality improvement). Greater consideration is required to the long-term effectiveness of the approaches taken, particularly in light of the ongoing need for adaptation to incorporate new practices into routine work

Virtual Reality, Ultrasound-guided Liver Biopsy Simulator: Development and Performance Discrimination

International audienceObjectives: Identify and prospectively investigate simulated ultrasound-guided targeted liver biopsy performance metrics as differentiators between levels of expertise in interventional radiology. Methods: Task analysis produced detailed procedural step documentation allowing identification of critical procedure steps and performance metrics for use in a virtual reality ultrasound-guided targeted liver biopsy procedure. Consultant (n 5 14, male 5 11, female 5 3) and trainee (n 5 26, male 5 19, female 5 7) scores on the performance metrics were compared. Ethical approval was granted by the Liverpool Research Ethics Committee (UK). Independent t-tests and analysis of variance (ANOVA) investigated differences between groups. Results: Independent t-tests revealed significant differences between trainees and consultants on 3 performance metrics: targeting, p 5 0.018, t 5 22.487 (22.040 to 20.207); probe usage time, p 5 0.040, t 5 2.132 (11.064 to 427.983); mean needle length in beam, p 5 0.029, t 5 22.272 (20.028 to 20.002). ANOVA reported significant differences across years of experience (0-1, 1-2, 3+ years) on seven performance metrics: no-go area touched, p 5 0.012; targeting, p 5 0.025; length of session, p 5 0.024; probe usage time, p 5 0.025; total needle distance moved, p 5 0.038; number of skin contacts, p , 0.001; total time in no-go area, p 5 0.008. More experienced participants consistently received better performance scores on all 19 performance metrics. Conclusion: It is possible to measure and monitor performance using simulation, with performance metrics providing feedback on skill level and differentiating levels of expertise. However, a transfer of training study is required

The Role of Simulation in Medical Training and Assessment

An overview to medical simulation has been provided. In the context of procedural interventional radiology training, we start with the definition and history of simulation, address its increasing importance in medicine reflect on its theoretical basis and current evidence and finally review its advantages/ limitations and prospects for the future

A longitudinal study to explore and examine the potential and impact of an e-coaching programme on the learning and self-efficacy of female entrepreneurs in the north west of England

The aim of this longitudinal study was to examine the potential of coaching to develop female entrepreneurs' self-efficacy through learning and development. This was achieved by firstly conducting a needs analysis, which explored the potential of an e-coaching programme for female entrepreneurs in the North West of England. Secondly, implementing an e-coaching programme called TEC (Tailored E-Coaching) for female entrepreneurs in the North West of England and exploring the impact of the programme, specifically examining female entrepreneurs' learning development with regard to entrepreneurial self efficacy, general entrepreneurial attitudes and locus of control, compared to a control group who did not receive the coaching intervention. The study consisted of two stages, with two time points in stage two (pre and post programme). A mixed method approach was used, whereby qualitative and quantitative data were collected. The main barriers faced by female entrepreneurs appear to be based on access to funding and finance, balancing domestic responsibilities and work, a lack of human capital, a lack of social capital and lack of confidence. Women often dismiss entrepreneurial endeavours because they believe that they do not have the required skills (Wilson, Kickul and Marlino, 2007). In addition, they do not appear to be accessing the support that is currently available, particularly when compared with male entrepreneurs (Stranger, 2004; Fielden et al, 2003). However, there is limited empirical research examining female entrepreneurs' requirement regarding business support provision. One form of professional one-to-one support that may have the potential to overcome these barriers to entrepreneurial activity is coaching. Longitudinal empirical research examining the effectiveness of coaching and the learning processes in coaching relationships is scarce, with an absence of research using control groups (Smither and London, 2003). Thirty women were involved in stage one of the study. In stage two of the study, sixty female entrepreneurs (coachees and coaches) commenced a coaching relationship for six months and twenty six female entrepreneurs signed up to a control group (those not receiving the coaching intervention). The aim of the coaching programme was primarily to use instant messaging for the majority of coaching meetings. The relationship lasted approximately six months (2006-2007). Qualitative data was analysed using content analysis and quantitative questionnaire data was analysed using paired sample t-tests. The study found that coachees' learning development resulted in increased levels of entrepreneurial self-efficacy and general entrepreneurial attitudes in a range ofkey areas and increased internality regarding locus of control. In contrast, the control group did not show any increase in entrepreneurial self-efficacy and showed a decrease in general entrepreneurial attitudes. Coaches developed their coachees through a range of learning processes, for example, enactive mastery and the clarification of business goals, vicarious experience through shared experiences and verbal persuasion through validation. The study found that online coaching has a variety of advantages, e.g. convenience, ease of access, and time to reflect on information.EThOS - Electronic Theses Online ServiceGBUnited Kingdo