An exploration of how domains of quality of care relate to overall care experience

Purpose: To determine the relative influence of the different domains of healthcare quality from the Care Experience Feedback Improvement Tool and identify key predictors of healthcare quality from the patients’ perspective. Measurement is necessary to determine whether quality of healthcare is improving. The Care Experience Feedback Improvement Tool was developed as a brief measure of patient experience. It is important to determine the relative influence of the different domains of healthcare quality to further clarify how the Care Experience Feedback Improvement Tool can be used and identify key predictors of healthcare quality from the patients’ perspective. Methods: 802 people with a healthcare experience during the previous 12 months were telephoned to complete the Care Experience Feedback Improvement Tool questions and an additional eleven-point global rating of patient experience. To estimate the influence of different domains of healthcare quality on patient overall ratings of quality of healthcare experience, we regressed the overall rating of patient experience with each component of quality (safety, effectiveness, timely, caring, enables system navigation and person-centred). Findings: We found that all of the domains of the Care Experience Feedback Improvement Tool, influenced patient experience ratings of healthcare quality. Specifically, results show the degree of influence, the impact of demographics and how high scores for overall rating of patient experience can be predicted. Originality: Our findings suggest that all of the Care Experience Feedback Improvement Tool domains are important in terms of capturing the wholeness of the patient experience of healthcare quality to direct local quality improvement

“BARBIE IS AS MUCH ABOUT FASHION AS SHE IS ABOUT CULTURE AND EMPOWERMENT”: FEMINISM IN BARBIE THE MOVIE AND ITS POSTFEMINIST MARKETING

The Barbie movie has been celebrated by fans for its feminist narrative. Although the film garnered appreciation from fans across the world, my thesis illustrates that it ultimately serves as a vehicle to promote a product, leading to question its feminist narrative. This mixed method study, which combines feminist textual analysis and feminist political economy analysis, investigates feminism and postfeminism within the Barbie movie and the marketing for the movie. The feminist textual analysis identified both feminist and postfeminist ideologies that are present within the film. The feminist political economy analysis identified the marketing for the Barbie movie as postfeminist. The results of the analysis indicate that Mattel turns female empowerment into a commodity that perpetuates gendered consumption and reinforces a patriarchal society

Patient and community nurse perspectives on recruitment to a randomized controlled trial of urinary catheter washout solutions

Aims To provide evidence around the acceptability of a proposed randomised controlled trial (RCT) of catheter washout solutions. Design: A sample of senior community nursing staff (n=7) were interviewed and four focus groups with a sample of community nurses were conducted. Eleven semi-structured face-to-face interviews were undertaken with patients using a long-term catheter. Methods: An in-depth qualitative study using a phenomenological approach was employed. This approach was suitable to explore the lived experiences of subjects and gain their viewpoints and experiences. Results: Nurse participants raised concerns regarding the removal of treatment or increased risk of infection in relation to which arm of the trial patients were randomised to. There was concern that patients could get used to the increased contact with nursing staff. Six patients who agreed to participate cited personal benefit, benefiting others, and a sense of indifference. Four patients were unsure about taking part and one declined

An Evaluation of the Impact of Sight and Hearing Support Services: Western Isles Sensory Project

This report presents an evaluation of the Western Isles Sensory Centre (WISC). The Centre provides advice, assessment, referrals and practical interventions to people with sensory impairments who live in the Western Isles. The report details the evaluation findings from a survey and in-depth interviews carried out with WISC clients and their carers. The views of clients and experience of the service offered by the WISC was explored initially by the use of a postal survey (n=49). Following this, a number of in-depth interviews (n=12) were conducted with clients that further explored the impact that attending the Centre had on their impairment. The views of WISC staff who support service provision for people with sensory impairments were also sought. Additionally, perspectives about the service were sought from health, social care and third sector professionals who are involved in the care and support of people with sensory impairments

Working in partnership: the application of shared decision making to health visitor practice

Aim and objectives To explore the processes which support shared decision making when health visitors and parents are creating plans to improve the wellbeing of babies and children.  Background  Worldwide, there is a focus on promoting children's wellbeing in order to enhance population health. Within the United Kingdom, health visitors have a key responsibility for working in partnership with parents to support this agenda. Despite evidence that the application of ‘shared decision making’ frameworks can increase patient participation, improve patient satisfaction, and improve health outcomes, there is limited research linking shared decision making with health visitor practice.  Design  A qualitative, descriptive study.  Methods  The study was undertaken in two phases: in Phase 1, two parent: health visitor dyads, who were planning together as part of usual care, were audio-recorded and then the participants’ experiences were sought through individual questionnaires. In Phase 2 semi-structured interviews were conducted with nine health visitors and nine parents in relation to their recent experiences of planning care.  Results  Evidence of supportive processes included having a shared understanding around the issue needing to be addressed; being able to identify interventions which were accessible for the family; engaging in decision making through deep, meaningful conversations using sensitive and responsive approaches; and establishing positive relationships between health visitors and parents, significant others within the family, and other professionals.  Conclusion  Despite evidence of strong, trusting relationships between parents and health visitors, there were times when shared decision making was unable to take place due to the absence of supportive processes

An evaluation of methods used to teach quality improvement to undergraduate healthcare students to inform curriculum development within preregistration nurse education: a protocol for systematic review and narrative synthesis

Background: Despite criticism, quality improvement (QI) continues to drive political and educational priorities within health care. Until recently, QI educational interventions have varied, targeting mainly postgraduates, middle management and the medical profession. However, there is now consensus within the UK, USA and beyond to integrate QI explicitly into nurse education, and faculties may require redesign of their QI curriculum to achieve this. Whilst growth in QI preregistration nurse education is emerging, little empirical evidence exists to determine such effects. Furthermore, previous healthcare studies evaluating QI educational interventions lend little in the way of support and have instead been subject to criticism. They reveal methodological weakness such as no reporting of theoretical underpinnings, insufficient intervention description, poor evaluation methods, little clinical or patient impact and lack of sustainability. This study aims therefore to identify, evaluate and synthesise teaching methods used within the undergraduate population to aid development of QI curriculum within preregistration nurse education. Methods/design: A systematic review of the literature will be conducted. Electronic databases, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychological Information (PsychINFO), Education Resources Information Centre (ERIC), Medical Literature Analysis and Retrieval System Online (MEDLINE) and Applied Social Sciences Index and Abstracts (ASSIA), will be searched alongside reference list scanning and a grey literature search. Peer-reviewed studies from 2000-2014 will be identified using key terms quality improvement, education, curriculum, training, undergraduate, teaching methods, students and evaluation. Studies describing a QI themed educational intervention aimed at undergraduate healthcare students will be included and data extracted using a modified version of the Reporting of Primary Studies in Education (REPOSE) Guidelines. Studies will be judged for quality and relevance using the Evidence for Policy and Practice Information and Co-ordinating Centre's (EPPI) Weight of Evidence framework and a narrative synthesis of the findings provided. Discussion: This study aims to identify, evaluate and synthesise the teaching methods used in quality improvement education for undergraduate healthcare students where currently this is lacking. This will enable nursing faculty to adopt the most effective methods when developing QI education within their curriculum

Achieving quantum supremacy with sparse and noisy commuting quantum computations

The class of commuting quantum circuits known as IQP (instantaneous quantum polynomial-time) has been shown to be hard to simulate classically, assuming certain complexity-theoretic conjectures. Here we study the power of IQP circuits in the presence of physically motivated constraints. First, we show that there is a family of sparse IQP circuits that can be implemented on a square lattice of n qubits in depth O(sqrt(n) log n), and which is likely hard to simulate classically. Next, we show that, if an arbitrarily small constant amount of noise is applied to each qubit at the end of any IQP circuit whose output probability distribution is sufficiently anticoncentrated, there is a polynomial-time classical algorithm that simulates sampling from the resulting distribution, up to constant accuracy in total variation distance. However, we show that purely classical error-correction techniques can be used to design IQP circuits which remain hard to simulate classically, even in the presence of arbitrary amounts of noise of this form. These results demonstrate the challenges faced by experiments designed to demonstrate quantum supremacy over classical computation, and how these challenges can be overcome

An evaluation of approaches used to teach quality improvement to preregistration healthcare professionals: an integrative review

Background  Improving the quality of healthcare remains central to UK and international policy, practice and research. In 2003, The Institute of Medicine's ‘Health Professions Education: A Bridge to Quality’, advocated quality improvement as a core competency for all healthcare professionals. As a result, developing capacity and capability of those applying improvement methodologies in the pre-registration population has risen, yet, little is known about the teaching approaches employed for this purpose.  Objectives To describe and analyse educational approaches used to teach quality improvement to pre-registration healthcare professionals and identify enabling and impeding factors.  Design  Integrative review.  Data sources  CINAHL, PsychINFO, MEDLINE, ERIC, ASSIA, SCOPUS and Google Scholar were accessed for papers published between 2000 and 2016.  Review methods  Publications where quality improvement education was delivered to pre-registration healthcare professionals were eligible. One author independently screened papers, extracted data using a modified version of the Reporting of Primary Studies in Education Guideline and evaluated methodological quality using the Weight of Evidence Framework. The Kirkpatrick Education Evaluation Model was used to explore the impact of teaching approaches. Enabling and impeding factors were thematically analysed. A narrative synthesis of findings is presented.  Results  Ten papers were included, representing nursing, pharmacy and medicine from UK, Norway and USA. Studies comprised four quantitative, four mixed method, one qualitative and one cluster randomised trial, all allocated medium Weight of Evidence. Teaching approaches included experiential learning cited in all studies, didactics in seven, group work in four, seminars in three, self-directed learning in three and simulation in one. Most studies measured Level 1 of the Kirkpatrick Model (reaction), all but one measured Level 2 (skills, knowledge or attitudes), none measured Level 3 (behaviour) and one measured Level 4 (patient outcomes). Enabling and impeding themes included: Teaching Approaches, Clinical/Faculty support, Information Provision, Curriculum Balance and Data.  Conclusions  Evaluating quality improvement education is complex. Experiential learning combined with didactics is the favoured approach; however, attributing causality to educational intervention proves difficult in light of poor methodological rigour, lack of validated tools and complex clinical settings. Clarity regarding which quality improvement competencies are priority for this population would be useful to streamline future educational development and evaluation. Stronger collaboration between educators and clinicians is recommended to explore the multiple components and contextual factors associated with quality improvement education in practice. Ethnographic enquiry may be a logical next step to advance knowledge within the field

Risk Perceptions of Environmental Hazards and Human Reproduction: A Community Based Survey

Objectives: We have investigated the Australian public’s perceived risks on human reproductive health from a number of identified environmental hazards. Methods: A sample of 1261 subjects were interviewed. This interview included specific questions related to perceived risks of certain environmental hazards to human reproductive health. Results: Women were almost twice as likely to rank all hazards as harmful or very harmful to human reproduction than men. Age also influenced perceived risk with those in the 35 and older age groups more likely to rank lead as a harmful hazard when compared with the 18-34 group. Pesticides were identified by 84.5% of the sample as the most harmful environmental hazard to human reproduction. Conclusions: Similar to other environmental hazards, different groups of people in the general population perceive hazards relating to reproductive health differently. This information is important for both policy makers and health professionals dealing with reproductive environmental health issues