Search

Purpose This paper describes a case study of a developmental program evaluation on the Autism Community Toolkit, a collaborative skills training program for parents and school professionals. The purpose of this study was to examine the influence of the training on participants’ knowledge, competence and perceived collaboration; and potential improvements to the training program. Design/methodology/approach The program included multiple training sessions for families and school professionals, designed to educate participants on autism, evidence-based interventions and to increase home-school communication and collaboration. Data collection methods included pre- and post-measures and feedback forms. Findings Results indicated that the training program was beneficial for participants overall. Pre- and posttest measures indicated growth in knowledge and competency in autism interventions. While there were no statistically significant differences in the quantitative measure of collaboration, qualitative results suggest that participants reported increased collaboration posttraining. Practical implications Overall, the training program was effective, and the ongoing implementation assessment was conducive to continuous improvement. The authors also discuss difficulties with implementation and recommendations for future intervention implementation. Originality/value This case study provides practical information about creating, evaluating and improving a unique intervention designed to support school–home collaboration.

This chapter considers the works of poets Gavin Douglas, Alexander Barclay, Stephen Hawes, and Robert Copland, placing them in the context of the political, cultural, religious, and technological changes of the late fifteenth and early sixteenth centuries. It suggests that their works witness a variety of experiments with poetic form and voice in response to these changes. It argues that each engages with overlapping questions about how to formulate the position of the poet at court, the position of the poet in the text, and the potential of print to reshape the way the poet envisages both his work as writer and the physical manifestations of that work. It further demonstrates that their shared vernacular poetic heritage is central to their thinking about these questions.

AimsTo explore barriers to, and facilitators of, adherence to compression therapy, from the perspective of people with venous leg ulcers.DesignAn interpretive, qualitative, descriptive study involving interviews with patients.MethodsParticipants were purposively sampled from respondents to a survey exploring attitudes to compression therapy in people with venous leg ulcers. Sampling continued until data saturation: 25 interviews between December 2019 and July 2020. Inductive thematic analysis of interview transcripts was undertaken to create a framework for the data, followed by deductive analysis informed by the Common-Sense Model of Self-Regulation.ResultsA range of knowledge and understanding about the cause of venous leg ulcers and the mechanisms of compression therapy was demonstrated, which was not particularly related to adherence. Participants talked about their experience with different compression methods and their concerns about the length of time healing could take. They also spoke about aspects of the organization of services which affected their care.ConclusionIdentifying specific, individual barriers/facilitators to compression therapy is not simple, rather factors combine to make adherence more or less likely or possible. There was no clear relationship between an understanding of the cause of VLUs or the mechanism of compression therapy and adherence; different compression therapies presented different challenges for patients; unintentional non-adherence was frequently mentioned; and the organization of services could impact on adherence. Ways in which people could be supported to adhere to compression therapy are indicated. Implications for practice include issues relating to communication with patients; taking into account patients' lifestyles and ensuring that they know about useful ‘aids’; providing services that are accessible and provide continuity of appropriately trained staff; minimizing unintentional non-adherence; and acknowledging that healthcare professionals will always need to support/advise those who cannot tolerate compression.ImpactCompression therapy is a cost-effective, evidence-based treatment for venous leg ulcers. However, there is evidence that patients do not always adhere to this therapy and there is limited research investigating reasons why patients do not wear compression. The study found no clear relationship between an understanding of the cause of VLUs or the mechanism of compression therapy and adherence; that different compression therapies presented different challenges for patients; that unintentional non-adherence was frequently mentioned and that the organization of services could impact on adherence. Attending to these findings offers the opportunity to increase the proportion of people undergoing appropriate compression therapy and achieving complete wound healing, the main outcome desired by this group.Patient/Public ContributionA patient representative sits on the Study Steering Group, contributing to the work from developing the study protocol and interview schedule to interpretation and discussion of findings. Members of a Wounds Research Patient and Public Involvement Forum were consulted about interview questions.

We conducted a prospective environmental surveillance study to investigate the air, surface, dust and water contamination of a room occupied by a patient infected with Monkeypox virus (MPXV) at various stages of his illness. The patient tested positive for MPXV from a throat swab and skin lesions. Environmental sampling was conducted in a negative pressure room with 12 unidirectional HEPA air changes per hour and daily cleaning of the surfaces. A total of 179 environmental samples were collected on days 7, 8, 13, and 21 of his illness. Air, surface, and dust contamination was highest during the first eight days of the illness, with a gradual decline to the lowest contamination level by day 21. Viable MPXV was isolated from surfaces and dust samples and no viable virus was isolated from the air and water samples.SynopsisInadequate research prevail on the mode of transmission for monkeypox virus. This study reports the findings of viable monkeypox virus from the patient environment, highlighting its implications for human health and impact on infection and prevention control measures.

Collaboration between school staff, families, and community partners is vital for ensuring all students’ success, particularly those with disabilities. In this case study, we will discuss a community-university partnership involving a university school psychology graduate program, several local school districts, and a specialized medical facility for children with autism and related neurodevelopmental disorders. These partners came together to create the Families and Schools Partnership Program (FSPP). Facilitated by School Psychology faculty and graduate students, FSPP offers support to families and schools through a cohesive multidisciplinary approach to intervention. In this study, we examined the experiences of 700 families referred to the FSPP consultation team and evaluated the reasons for referral, levels of intervention required by each family, and case outcomes. As a result, we offer a series of steps and tips for developing collaborative interagency relationships, an outline of the consultation framework and processes developed, and lessons learned throughout implementation.

John Skelton (c 1460-1529) has long been recognised as a poetic innovator, most notably for his invention of the verse-form that bears his name, the Skeltonic. Its origins have been traced to a wide variety of poetic genres and even prose forms; this chapter, however, argues that it also owes a great deal to Skelton’s own earlier writing in the well-established verse-form of rhyme royal. The chapter first traces connections between the ostentatiously experimental Skeltonic and Skelton’s less conspicuous experiments with sound pattern in rhyme royal; it then argues that formal experimentation shapes Skelton’s understanding of poetic authority as something derived from the poet’s own technical skill rather than from external sources.

Effective collaboration is associated with positive outcomes for students and is a key component of equitable educational opportunities. There are challenges to effective collaboration, however, as our understanding of it differs based on the various definitions in the literature. The purpose of this systematic review is to identify the common constructs across definitions of collaboration as a means to develop a universal model that can be used in the schools. Through the development of a “building blocks” framework, we provide a common definition and identify the steps that must be taken before true collaboration can occur. This model highlights the iterative nature of the collaborative process and the importance of revisiting the foundational aspects of collaborative development. The systematic review focuses on using a common definition for research and the practice of collaboration.

Science, technology, engineering, and math (STEM) related fields comprise the top 30 occupations expected to grow the fastest by 2026. This increase in job opportunities, coupled with the evolution of technology, is creating higher demands for diversity in the labor market. Currently all student require innovative training and support from a young age to pursue STEM careers successfully. However, women and girls with disabilities face unique barriers along the STEM education pipeline. In this paper, we report the current and projected labor market trends inthe United States. We then consider how this labor market information can be used by elementary educators to engage girls with disabilities in STEM-related learning effectively. Finally, through our analysis of labor market needs and the available assessment and intervention literature, we present a science-informed framework for intervention.

Promoting health and preventing ill health are key standards of proficiency for pre-registration nursing education in the UK. The knowledge and skills required to fulfil this role is dependent on students developing a clear understanding of population health during their educational experience. The websites of the 60 undergraduate adult nursing programmes in England that lead to registration were explored, to see how the population health agenda is presented in the information for future candidates. It was found that only 26% of universities promote a population health agenda in the general description of the adult nursing programme, emphasising clinical skills teaching and partnerships with hospital trusts for placement provision. To embrace the breadth of 21st century nursing practice, universities should be marketing nursing proficiencies and raising awareness of the wider context in which care is delivered during recruitment. This approach to branding has the potential to challenge stereotypes and widen participation.

BackgroundLittle is known about mental health problems of children and young people (CYP) involved with public and private law family court proceedings, and how these CYP fare compared to those not involved in these significant disruptions to family life.AimsThis study examined records of depression/anxiety in CYP involved in public and private law proceedings using linked population-level data across Wales.MethodRetrospective e-cohort study. We calculated the incidence of primary-care-recorded depression/anxiety among CYP involved in these proceedings and in a comparison group, using Poisson regression. Depression/anxiety outcomes following proceedings were evaluated using pairwise Cox regression, with age- and gender-matched controls of CYP who had no involvement with the courts.ResultsCYP in the public group had twice the risk of depression (adjusted incidence rate ratio aIRR = 2.2; 95% CI 1.9–2.6) and 20% higher risk of anxiety (aIRR = 1.2; 95% CI 1.0–1.5) relative to the comparison group. The private group had 60% higher risk of depression (aIRR = 1.6; 95% CI 1.4–1.7) and 30% higher risk of anxiety (aIRR = 1.3; 95% CI 1.2–1.4). Following private law proceedings, CYP were more likely to have depression (hazard ratio HR = 1.9; 95% CI 1.7–2.1), and anxiety (HR = 1.4; 95% CI 1.2–1.6) than the control group. Following public proceedings, CYP were more likely to have depression (HR = 2.1; 95% CI 1.7–2.5). Incidence of anxiety or depression following court proceedings was around 4%.ConclusionsFindings highlight the vulnerability of CYP involved in family court proceedings and increased risk of depression and anxiety. Schools, health professionals, social and family support workers have a role to play in identifying needs and ensuring CYP receive appropriate support before, during and after proceedings.

Background Open visiting refers to the principle of unrestricted visiting hours in the hospital setting to enable relatives, families and carers to visit at any time. There has been recognition that open visiting supports the principle of patient and family supported care and improves communication. Despite this there has been difficulty in implementing open visiting and barriers identified. The aims of this study were therefore to evaluate the implementation of open visiting, the barriers to implementation, sustainability and the impact of open visiting on communication between health care professionals, families and carers. Methods The study was conducted on two large acute wards for the older person. Realist evaluation methods were used to understand ‘what works well, how, for whom and to what extent.’ Mixed methods were employed including qualitative interviews and descriptive analyses of routine data sets. Following the methodology of realist evaluation, programme theories were identified a long with the context, mechanisms and outcomes of implementation, to better understand the implementation process. Results The results of this study identified some key findings, demonstrating that open visiting does improve communication and can help to build trusting relationships between families/carers and health care professionals (HCP). Barriers to implementation were based on the belief that it would impinge on routines within the ward setting. To achieve the principles of patient and family/carer centred care, the key mechanisms are the confidence and skills of individual nurses and health care assistants to engage with relatives/carers, whilst retaining a sense of control, particularly when care is being delivered to other patients. Conclusion In summary, open visiting creates a positive culture which fosters better relationships between families/carers and HCPs. Involving families/carers as partners in care does not happen automatically in an environment where open visiting is the policy, but requires engagement with staff to encourage and support relatives/carers.

Objective The purpose of this study is to explore the self-care support provision for patients with type 2 diabetes by diabetes educators and to explore the challenges that they encountered in providing the intended services. Methods Single embedded qualitative case study design using in-depth individual face to face interviews were adopted. Twelve diabetes educators from three diabetes clinics in urban areas in Malaysia were purposively selected and interviewed within the period of eight months (November 2012–June 2013). The data were transcribed verbatim and analyzed using Framework technique. Result The practice of diabetes educators revolved around the traditional paternalistic approach but emphasize on individualized support. However, their practice was restricted by several factors, including patients’ acceptance and interest in self-care, lack of confidence and opportunity to practice, and fragmented health care system. Conclusion The current practice of diabetes educators is very limited to knowledge provision and rather a generalist. Considering a more specialized role would increase opportunities for diabetes educators to provide high-quality self-care support provision.

BackgroundThe international literature has largely conceptualised transition to university as a process of adjustment to both the social and the academic demands of university life. Several factors influence this process including: student, parent and university staff expectations; student preparedness; and student belongingness. Moreover, some student groups (groups well-represented in nursing) appear to have particular difficulty in successfully transitioning to university life.Study AimsTo explore first year nursing students' experiences of the transition to university; to compare nursing students' experiences with those of other disciplines and identify ways of easing the transition for nursing students.MethodologyAs part of their coursework, first year nursing students at an English University submitted a 500-word, formative reflection on the transition to university. Anonymised reflections from 161 students were available to the researchers for thematic content analysis; 50 reflections, however, proved sufficient for ‘information power’.ResultsTwo main themes emerged from the data: (i) ‘managing expectations’, an overarching theme that permeated most of the reflections; and (ii) ‘practical tools and support aids’, the practical, concrete actions that either the university took, or the students developed themselves, to ease the transition. Both themes embraced inter-related academic, social and personal domains.ConclusionsNursing students' transition experiences are similar to those of other university students. However, the particular demographics of nursing student cohorts amplifies certain aspects of the transition experience: more students who are likely to struggle with transition but also more students who embrace the developmental aspects of going to university. Transition requires joint enterprise between students and university staff, especially in terms of expectations and the support required to become independent learners. Transitions can be eased by tapping into student resourcefulness and seeing transition as a gradual process that cuts across academic, social and personal dimensions rather than as a short, one-off event.

This research examined the risk and protective factors of responders and nonresponders to a schoolwide implementation of positive behavioral interventions and supports (SW-PBIS) within an alternati...

Background To effectively realise their role in health promotion nurses need a clear understanding of the social determinants of health. In 1987 the WHO recommended that students participate in meaningful community based problem-solving to prepare them for health promotion practice, including actual or simulated community health projects. Objective To explore the use of community problem-solving in undergraduate nurse education and its impact on students' understanding of population health. Method This literature review used a five-stage iterative method, to explore the following research question; how is community problem-solving being used in undergraduate nurse education and to what effect? Following a systematic database search (CINAHL, MEDLINE, ERIC and ProQuest BNI), forward citation and snowballing, 82 studies were screened against the inclusion and exclusion criteria. A critical appraisal of the studies was conducted using COREQ and data was extracted using a summary table. Thematic analysis was used to identify major themes from the literature. Results Ten studies were identified which explore the use of community problem-solving these provide some useful insight into the design, application and the apparent benefits of the approach in undergraduate nurse education. Three key themes emerge: students develop a broader vison of their future role in health promotion, a deeper understanding of community and social determinants, as well as identifying the role of community assets for health. Only one of the studies included in the review evaluated the impact of community problem-solving on health promotion practice after graduation. Conclusion The concept of CPS in undergraduate nurse education has been around for many years, but there has never been a comprehensive review of its implementation or effectiveness. Research into its impact is needed to examine whether it increases students' understanding of their future role in health promotion. If nurses are expected to play a key role in public health, nurse educators need research evidence to support the design and delivery of CPS to implement a population health approach to undergraduate nurse education.

ObjectivesTo investigate factors that promote and prevent the use of compression therapy in people with venous leg ulcers.DesignQualitative interview study with nurses using the Theoretical Domains Framework (TDF).SettingThree National Health Service Trusts in England.ParticipantsPurposive sample of 15 nurses delivering wound care.ResultsNurses described factors which made provision of compression therapy challenging. Organisational barriers (TDF domains environmental context and resources/knowledge, skills/behavioural regulation) included heavy/increasing caseloads; lack of knowledge/skills and the provision of training; and prescribing issues (variations in bandaging systems/whether nurses could prescribe). Absence of specialist leg ulcer services to refer patients into was perceived as a barrier to providing optimal care by some community-based nurses. Compression use was perceived to be facilitated by clinics for timely initial assessment; continuity of staff and good liaison between vascular/leg ulcer clinics and community teams; clear local policies and care pathways; and opportunities for training such as ‘shadowing’ in vascular/leg ulcer clinics. Patient engagement barriers (TDF domains goals/beliefs about consequences) focused on getting patients ‘on board’ with compression, and supporting them in using it. Clear explanations were seen as key in promoting compression use.ConclusionsRising workload pressures present significant challenges to enhancing leg ulcer services. There may be opportunities to develop facilitated approaches to enable community nursing teams to make changes to practice, enhancing quality of patient care. The majority of venous leg ulcers could be managed in the community without referral to specialist community services if issues relating to workloads/skills/training are addressed. Barriers to promoting compression use could also be targeted, for example, through the development of clear patient information leaflets. While the patient engagement barriers may be easier/quicker to address than organisational barriers, unless organisational barriers are addressed it seems unlikely that all people who would benefit from compression therapy will receive it.

Background and aims Patients with short bowel syndrome and type 3 intestinal failure (SBS-IF) are dependent on parenteral nutrition (PN), a lifesaving treatment but inconvenient and with risks. Glucagon-like peptide 2 analogue (teduglutide) can reduce patients’ need for PN. However, it comes with the risk of a number of side effects. This qualitative study investigated patients’ decision making process to start teduglutide and how family members contributed to the decision. MethodsIn-depth semi-structured interviews were conducted with nine participants, six patients with SBS-IF and three family members about the decision to take teduglutide. Interviews were transcribed verbatim and analysed using framework analysis. ResultsThe prominent motivation for taking teduglutide (Revestive® Takeda Pharmaceuticals Limited) was reducing or stopping PN. Other motivations were to help others by assisting in developing the knowledge base around teduglutide, patients felt that they had nothing to lose by trying the drug and the support of relatives. The reasons patients considered not taking the drug were that they had accepted being on PN, the potential side effects of teduglutide and undergoing extra monitoring. However, the monitoring programme also acted as a motivator providing reassurance that patients would be observed and supported with side effects. Family members were happy to support patients’ decision to try teduglutide, although they had more reservations, indicating a higher risk threshold. ConclusionPatients considered potential benefits of teduglutide outweighed any disadvantages. Relatives, although supportive, had more reservations.

Background There is increasing evidence that patients with incurable cancer approaching the end-of-life, their carers and clinicians want to know how much time is left to live. Prognostic models can help with planning for the end of life and sorting out affairs, but we know very little about the acceptability of the models to patients, carers and clinicians.Method Semi-structured interviews were conducted with a purposive sample of 29 patients, 20 carers and 32 clinicians who took part in a large validation study of prognostic models, to find out how acceptable they are. Interview data were entered into NVivo 10 and analysed using the five stages of Framework Analysis: (i) familiarisation, (ii) developing a thematic framework, (iii) indexing, (iv) charting, and (v) mapping and interpretation.Findings The use of prognostic models was acceptable to patients and carers, and largely acceptable to clinicians. There was marked discrepancy however between the wishes of patients and carers for prognostic discussions, and the willingness of clinicians to initiate and conduct these conversations. Clinicians’ reluctance was founded on the dual principles of working in patients’ best interests and doing no harm, but was at odds with what patients and carers actually wanted. Conclusion Prognostic models such as PiPS may be a useful adjunct to clinical decision making, but also a helpful tool for initiating difficult conversations at the end of life. In order to conduct these conversations skilfully, communication skills training tailored to end of life prognostic conversations is needed.

Background The Prognosis in Palliative care Study (PiPS) prognostic survival models predict survival in patients with incurable cancer. PiPS-A (Prognosis in Palliative care Study – All), which involved clinical observations only, and PiPS-B (Prognosis in Palliative care Study – Blood), which additionally required blood test results, consist of 14- and 56-day models that combine to create survival risk categories: ‘days’, ‘weeks’ and ‘months+’. Objectives The primary objectives were to compare PIPS-B risk categories against agreed multiprofessional estimates of survival and to validate PiPS-A and PiPS-B. The secondary objectives were to validate other prognostic models, to assess the acceptability of the models to patients, carers and health-care professionals and to identify barriers to and facilitators of clinical use. Design This was a national, multicentre, prospective, observational, cohort study with a nested qualitative substudy using interviews with patients, carers and health-care professionals. Setting Community, hospital and hospice palliative care services across England and Wales. Participants For the validation study, the participants were adults with incurable cancer, with or without capacity to consent, who had been recently referred to palliative care services and had sufficient English language. For the qualitative substudy, a subset of participants in the validation study took part, along with informal carers, patients who declined to participate in the main study and health-care professionals. Main outcome measures For the validation study, the primary outcomes were survival, clinical prediction of survival and PiPS-B risk category predictions. The secondary outcomes were predictions of PiPS-A and other prognostic models. For the qualitative substudy, the main outcomes were participants’ views about prognostication and the use of prognostic models. Results For the validation study, 1833 participants were recruited. PiPS-B risk categories were as accurate as agreed multiprofessional estimates of survival (61%; p = 0.851). Discrimination of the PiPS-B 14-day model (c-statistic 0.837, 95% confidence interval 0.810 to 0.863) and the PiPS-B 56-day model (c-statistic 0.810, 95% confidence interval 0.788 to 0.832) was excellent. The PiPS-B 14-day model showed some overfitting (calibration in the large –0.202, 95% confidence interval –0.364 to –0.039; calibration slope 0.840, 95% confidence interval 0.730 to 0.950). The PiPS-B 56-day model was well-calibrated (calibration in the large 0.152, 95% confidence interval 0.030 to 0.273; calibration slope 0.914, 95% confidence interval 0.808 to 1.02). PiPS-A risk categories were less accurate than agreed multiprofessional estimates of survival (p c-statistic 0.825, 95% confidence interval 0.803 to 0.848; calibration in the large –0.037, 95% confidence interval –0.168 to 0.095; calibration slope 0.981, 95% confidence interval 0.872 to 1.09) and the PiPS-A 56-day model (c-statistic 0.776, 95% confidence interval 0.755 to 0.797; calibration in the large 0.109, 95% confidence interval 0.002 to 0.215; calibration slope 0.946, 95% confidence interval 0.842 to 1.05) had excellent or reasonably good discrimination and calibration. Other prognostic models were also validated. Where comparisons were possible, the other prognostic models performed less well than PiPS-B. For the qualitative substudy, 32 health-care professionals, 29 patients and 20 carers were interviewed. The majority of patients and carers expressed a desire for prognostic information and said that PiPS could be helpful. Health-care professionals said that PiPS was user friendly and may be helpful for decision-making and care-planning. The need for a blood test for PiPS-B was considered a limitation. Limitations The results may not be generalisable to other populations. Conclusions PiPS-B risk categories are as accurate as agreed multiprofessional estimates of survival. PiPS-A categories are less accurate. Patients, carers and health-care professionals regard PiPS as potentially helpful in clinical practice. Future work A study to evaluate the impact of introducing PiPS into routine clinical practice is needed. Trial registration Current Controlled Trials ISRCTN13688211. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 28. See the NIHR Journals Library website for further project information.