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This article reviews the Montessori literature through the lens of leadership, using Maria Montessori’s writings for a perspective on leadership aligned with her principles and practices. Dr. Montessori was a strong leader who argued that adults, as leaders, should take direction from children as the spiritual builders of human beings. Her concept of the prepared environment, including the prepared adult, supports this foundation for leadership and has applications beyond the classroom context. Leadership in the Montessori context has a biological base but incorporates elements of service and morality that guide social reform with a peaceful telos. While there are overlaps with existing models of leadership, this review suggests that a distinct perspective on leadership does begin to emerge from Dr. Montessori’s legacy.

OBJECTIVE:Limited evidence concerning the burden and predictors of omitted medication doses within mental health hospitals could severely limit improvement efforts in this specialist setting. This study aimed to determine the prevalence, nature and predictors of omitted medication doses affecting hospital inpatients in two English National Health Service (NHS) mental health trusts. METHODS:Over 6 data collection days trained pharmacy teams screened inpatient prescription charts for scheduled and omitted medication doses within 27 adult and elderly wards across 9 psychiatric hospitals. Data were collected for inpatients admitted up to two weeks prior to each data collection day. Omitted doses were classified as 'time critical' and 'preventable' based on established criteria. Omitted dose frequencies were presented with 95% confidence intervals (CI). Multilevel logistic regression analyses determined the predictors of omitted dose occurrence, with omission risks presented as adjusted odds ratios (OR) with 95% CI. RESULTS:18,664 scheduled medication doses were screened for 444 inpatients and 2,717 omissions were identified, resulting in a rate of 14.6% (95% CI 14.1-15.1). The rate of 'time critical' omitted doses was 19.3% (95% CI 16.3-22.6%). 'Preventable' omitted doses comprised one third of all omissions (34.5%, 930/2694). Logistic regression analysis revealed that medicines affecting the central nervous system were 55% less likely to be omitted compared to all other medication classes (9.9% vs. 18.8%, OR 0.45 (0.40-0.52)) and that scheduled doses administered using non-oral routes were more likely to be omitted compared the oral route (inhaled OR 3.47 (2.64-4.57), topical 2.71 (2.11-3.46), 'other' 2.15 (1.19-3.90)). 'Preventable' dose omissions were more than twice as likely to occur for 'time critical' medications than non-time critical medications (50.4% vs. 33.8%, OR 2.24 (1.22-4.11)). CONCLUSIONS:Omitted medication doses occur commonly in mental health hospitals with 'preventable' omissions a key contributor to this burden. Important targets for remedial intervention have been identified.

OBJECTIVE:Medication administration errors (MAEs) are a common risk to patient safety in mental health hospitals, but an absence of in-depth studies to understand the underlying causes of these errors limits the development of effective remedial interventions. This study aimed to investigate the causes of MAEs affecting inpatients in a mental health National Health Service (NHS) hospital in the North West of England. METHODS:Registered and student mental health nurses working in inpatient psychiatric units were identified using a combination of direct advertisement and incident reports and invited to participate in semi-structured interviews utilising the critical incident technique. Interviews were designed to capture the participants' experiences of inpatient MAEs. All interviews were transcribed verbatim and subject to framework analysis to illuminate the underlying active failures, error/violation-provoking conditions and latent failures according to Reason's model of accident causation. RESULTS:A total of 20 participants described 26 MAEs (including 5 near misses) during the interviews. The majority of MAEs were skill-based slips and lapses (n = 16) or mistakes (n = 5), and were caused by a variety of interconnecting error/violation-provoking conditions relating to the patient, medicines used, medicines administration task, health care team, individual nurse and working environment. Some of these local conditions had origins in wider organisational latent failures. Recurrent and influential themes included inadequate staffing levels, unbalanced staff skill mix, interruptions/distractions, concerns with how the medicines administration task was approached and problems with communication. CONCLUSIONS:To our knowledge this is the first published in-depth qualitative study to investigate the underlying causes of specific MAEs in a mental health hospital. Our findings revealed that MAEs may arise due to multiple interacting error and violation provoking conditions and latent 'system' failures, which emphasises the complexity of this everyday task facing practitioners in clinical practice. Future research should focus on developing and testing interventions which address key local and wider organisational 'systems' failures to reduce error.

Today, English Academic Discourse (EAD) is the hegemonic vehicle of knowledge in the modern world, and researchers from all language backgrounds are under a great deal of pressure to publish in it. However, there exist other academic discourses in Europe that are based upon quite different epistemological paradigms and which are being increasingly eclipsed with the expansion of English in academic and research settings. This paper examines some of the cultural disjunctions that manifest themselves when the Anglo-Saxon academic model comes into contact with different knowledge traditions, and looks at the various language industries that have sprung up to help bridge the gap. The paper ends with a brief discussion of the ideological implications of the expansion of English as a lingua franca for the communication of knowledge.

Today, English Academic Discourse (EAD) is the hegemonic vehicle of knowledge in the modern world, and researchers from all language backgrounds are under a great deal of pressure to publish in it. However, there exist other academic discourses in Europe that are based upon quite different epistemological paradigms and which are being increasingly eclipsed with the expansion of English in academic and research settings. This paper examines some of the cultural disjunctions that manifest themselves when the Anglo- Saxon academic model comes into contact with different knowledge traditions, and looks at the various language industries that have sprung up to help bridge the gap. The paper ends with a brief discussion of the ideological implications of the expansion of English as a lingua franca for the communication of knowledge.