Now showing 1 - 10 of 19
  • Publication
    Non-Technical Skills (NTS) for enhancing patient safety: achievements and future directions
    (Japanese Society for Quality and Safety in Healthcare, 2012-11) ; ; ;
    Problems in team communication and decision making have been implicated in accidents in high risk industries such as aviation, off shore oil processing, nuclear power generation. Recognition of the role that breakdowns in communication and teamwork play in patient safety incidents has led to a plethora of studies in the area of what has come to be widely known as non-technical skills (NTS); a term initially used in European aviation (1). This has led to increasing interest in identifying, assessing, training and measuring non-technical skills. Nontechnical skills are defined as the cognitive and social skills that complement workers’ technical skills (1). Technical skills are the procedural and clinical skills that healthcare professionals apply when diagnosing, monitoring and treating patients. Non-technical skills refer to the general cognitive and social skills that allow them to, among other things, monitor the situation, make decisions, take a leadership role, communicate and co-ordinate their actions within a team, in order to achieve high levels of safety and efficiency.
  • Publication
    Scottish Devolution: A Slippery Path towards Consensus Democracy?
    (International Center for Comparative Law and Politics, Graduate School of Law and Politics, University of Tokyo, 2002)
    The aim of this paper is to show how constitutional change has come to realisation in Britain by focusing on Scottish devolution and also to point out that, in spite of many changes occurring in the British party system and structures, as well as regional government framework, the British political system will not alter until consensus on majoritarian decision-making is further eroded. This paper is divided into three parts: the first part will discuss the merits and demerits of consensus democracy. The second part will examine the progress of Scottish devolution historically and critically review conventional hypotheses about devolution. The last part will highlight one of these hypotheses that focuses on social cleavage and party system change in Britain in order to elucidate the constitutional constraint the British political system has on a much stronger impact on reforms. In this paper, Scottish devolution is focused on because it sheds light on a process of how the majoritarian system operates and has led to a constitutional change, primarily by the active roles played by the two major parties. Scottish devolution and yet unaccomplished electoral reforms for parliament in Westminster are in sharp contrast. Both arguments for fairer representation and more direct democracy started to come to political fore in the 1960s and only the latter has been seriously taken up by the Labour party, since post-war consensus1 between Conservative and Labour party about constitutional frameworks and economic management was broken down in the late 1970s and only when the party got back to power in 1997, devolution scheme was eventually implemented. It has taken almost twenty years to fulfill this goal. However, this still does not automatically result in consolidating the way towards consensus democracy. In conclusion, Britain still constitutes the majoritarian model even today, although there is some scope for change.
  • Publication
    What are the mechanisms that enable the reciprocal involvement of seldom heard groups in health and social care research? A rapid realist review protocol
    Background: The University College Dublin (UCD) PPI Ignite Connect Network will fundamentally embed public and patient involvement (PPI) in health-related research, education and training, professional practice and administration in UCD’s institutional structures and procedures. A significant focus of the programme of work is on actively engaging and developing long-term reciprocal relationships with seldom heard groups, via our ten inaugural partners. Methods: This rapid realist review will explore what are the mechanisms that are important in actively engaging seldom heard groups in health and social care research. The review process will follow five iterative steps: (1) clarify scope, (2) search for evidence, (3) appraise primary studies and extract data, (4) synthesise evidence and draw conclusions, and (5) disseminate findings. The reviewers will consult with expert and reference panels to focus the review, provide local contextual insights and develop a programme theory consisting of context–mechanism–outcome configurations. The expert panel will oversee the review process and agree, via consensus, the final programme theory. Review findings will follow the adopted RAMESES guideline and will be disseminated via a report, presentations and peer-reviewed publication. Discussion: The review will update and consolidate evidence on the mechanisms that enable the reciprocal engagement and participation of ‘seldom heard’ groups in health and social care research. Via the expert and reference process, we will draw from a sizeable body of published and unpublished research and grey literature. The local contextual insights provided will aid the development of our programme theories. This new evidence will inform the design and development of the UCD PPI Ignite program focused on ensuring sustained reciprocal partnerships.
  • Publication
    Adult Safeguarding Legislation and Policy Rapid Realist Literature Review
    The investigation of, and intervention into the alleged abuse of older people has become a dominant feature of social work in Ireland. The international definition of elder mistreatment adopted in most western countries including Ireland, is: ‘Elder abuse is a single or repeated act or lack of appropriate action occurring within any relationship where there is an expectation of trust which causes harm to an older person’ (WHO, 2008; WHO/INPEA, 2002). Operationalising this abstract definition is to describe types or categories of abuse that older people can be subjected to - physical, sexual, psychological, financial and neglect. Although valuable, the limitations of these narrow and mutually exclusive categories are increasingly recognised (Anand et al., 2013; O’Brien et al., 2011; Naughton et al., 2012). There is a major lack of understanding of the voice and experiences of older people in relation to abuse (Anand et al., 2013; Charpentier and Souliéres, 2013; WHO, 2002b). Irish research has demonstrated that older people conceptualise elder abuse as the loss of voice and agency, diminishing status in society, violation of rights and wider societal influences that undermine a sense of individualism and ‘personhood’ (O’Brien et al., 2011; Naughton et al., 2013).
  • Publication
    The attitudes and awareness of London based emergency department physicians towards the management of common dentofacial emergencies
    Background Dentofacial emergencies which are a common presentation to the emergency department (ED) and there is little data on how they are managed by non-dentally trained clinicians in the ED. Aims: To investigate the attitudes and awareness of ED physicians towards four common aspects of dentofacial emergencies and to explore potential barriers ED physicians may face in treating these emergencies. Methods A questionnaire survey involving 103 ED physicians largely from around the London region was employed. Results: The cohort included ED consultants (n=33), ED registrars (n=33) and ED juniors (n=37). 76.5% reported as not having any formal training in managing these emergencies. The study found that the percentage of participants who were confident in managing dental trauma was 20.4%, major facial trauma (40.6%), interpreting facial x-rays (69.3%) and facial suturing (86.3%). A subgroup of the cohort (n=58) were questioned on who they felt should manage maxillofacial and dental emergencies. 51.7% felt that dentists should manage dental emergencies and 67.2% thought that maxillofacial surgeons should manage maxillofacial emergencies in the ED. Only 12.1% and 22.4% felt that ED doctors should treat dental emergencies and maxillofacial emergencies respectively. When asked who they would like to be treated by in the event they presented to the ED with a traumatic dental injury (n=102) only 3.9% favoured ED as treating speciality compared to 23.5% treatment by a dentist and 72.5% by a maxillofacial surgeon. None of the participants opted treatment by an ENP. Discussion: Although based on a limited study sample the data suggests that ED doctors do not feel confident in managing some dentofacial emergencies. This may be attributed to a lack of training in this area as well as exposure to these types of emergencies. Furthermore the confidence level reported may not reflect actual competence and there is a need for greater awareness, validated guidelines and training resources for ED clinicians to treat dentofacial emergencies as well more research in this field of emergency medicine.
      408Scopus© Citations 48
  • Publication
    Understanding clinical risk decision making regarding development of depression during interferon-alpha treatment for hepatitis-C: A qualitative interview study
    Background: Hepatitis C virus (HCV) affects 170 million worldwide. Currently, around 30% of patients receiving interferon-alpha (IFN-α) treatment for HCV experience clinically significant depression. Effective and timely detection of depression is crucial to ensuring appropriate treatment and support. However, little is known about how clinical nurse specialists identify patients at risk of developing interferon-alpha-induced depression, and monitor those receiving antiviral treatment for the occurrence of depression.
      477Scopus© Citations 7
  • Publication
    Learning from patient safety incidents in incident review meetings: Organisational factors and indicators of analytic process effectiveness
    Learning from patient safety incidents is difficult; information is often incomplete, and it is not clear which incidents are preventable or which intervention strategies are optimal. Effective group processes are vital for learning but few studies in healthcare have examined in depth the processes involved and whether they are effective. The aims of this study were to identify factors that facilitated and hindered the process of analysing incidents in teams and to develop and apply a framework of indicators of effective analytic processes. Incident review meetings in acute care and mental health care were observed. Full field notes were analysed thematically. A framework of process measures was developed and used to rate each meeting using the field notes. Reliability was analysed. Factors hindering analysis were lack of organisational support, high workload and a managerial, autocratic leadership style. Facilitating factors were participatory interactions and strong safety leadership. Process measures showed deficits in critiquing the causes of incidents, seeking further information, critiquing potential solutions and solving problems that crossed organisational boundaries, supporting observational data on the importance of effective leadership. Organisational legitimacy, administrative support, training, tools for incident analysis, effective well trained leaders who empower the team and sufficient resources to manage the high workload were all identified in this study as necessary changes to improve learning. Future studies could develop and validate the proposed framework of process indicators to provide a tool for teams to use as an aid to improve the analysis of incidents.
      372Scopus© Citations 24
  • Publication
    Paving the way and passing the torch: mentors' motivation and experience of supporting women in optical engineering
    (Taylor & Francis, 2014-03-20) ; ;
    The phenomenon of women's underrepresentation in engineering is well known. However, the slow progress in achieving better gender equality here compared with other domains has accentuated the 'numbers' issue, while the quality aspects have been largely ignored. This study aims to shed light on both these aspects via the lens of mentors, who are at the coalface of guiding female engineers through their education and subsequent careers. Based on data collected from 25 mentors (8 men and 17 women from 8 countries), the paper explores their experiences of being mentors, as well as their views on recommended actions for nurturing female engineers. The findings reveal that the primary motivation for becoming a mentor was personal for men and women. Many mentors from countries with relatively lower female labour participation rates perceive their roles as guarantors of their mentees' successful future career paths, and a similar trend can be found in mentors in academia. The study underscores the need for invigorating mentors’ roles in order to secure a more equitable future for engineering education.
      391Scopus© Citations 5
  • Publication
    Bringing the family in through the back door: the stealthy expansion of family care in Asian and European long-term care policy
    (Springer, 2017-09) ;
    In the era of global ageing, amid political concerns about increasing care needs and long-term sustainability of current care regimes, most high-income economies are seeking to minimise the use of institutional care and to expand formal home care for their older populations. In long-term care reforms, concerns about public funding, formal providers and the paid care workforce are foremost. However, an integral yet hidden part of all these reforms is the stealthily growing role of family carers. This article aims to identify and spell out how developments in formal home care bring about different modes of increasing, encouraging and necessitating family care inputs, across welfare states. Using secondary sources, three different modes were identified, and the article outlines the logic of each mechanism, drawing on illustrative examples of policy dynamics in both European and Asian countries. Family care inputs have increased through policy changes that are not explicitly or primarily about family care, but rather about expansion or changes in formal care. In some cases, this is explicit, in other cases something that happens 'through the back door'. Nonetheless, in all cases there are implications for the family caregivers' time, health and employment options. Future studies are needed to examine longitudinal trends from a comparative perspective to confirm our findings and elucidate how government commitments to formal home care provision and financing interact with the changing nature and volume of family caregiving.
      536Scopus© Citations 25
  • Publication
    Can connected technologies improve sleep quality and safety of older adults and care-givers? An evaluation study of sleep monitors and communicative robots at a residential care home in Japan
    A sheet-shaped body vibrometer (SBV) is a type of assistive technology which offers a constant and noninvasive method of recording and monitoring the physical condition and sleep patterns of care recipients. With the aim of creating a safer environment for both care recipients and caregivers, we connected the SBV to a communicative robot (com-robot), to function as an integrated system. The robot has a sensor which activates when a care recipient tries to stand up, whereupon it sends an alert to care staff and speaks to the care recipient. The combined technologies offer an enhanced sense of security, as they watch over older people during the night, visualise sleep patterns and alert care staff. As proof of concept, this study examines the usefulness of this connected system by testing its effectiveness among two types of users (care recipients and professionals) in a residential care home in Japan. For the former, sleep parameters were investigated to see if there was any change over time in and impact on an older person's quality of life. As a measurement of quality of life, the interRAI method was used as a comprehensive assessment tool, based on which a care plan was also created for each care recipient. The interRAI is a nursing care evaluation and nursing care plan creation guideline package that provides unbroken care that can be used at home, in facilities or in the community For the latter, the study tests the level of fatigue among care professionals during night shifts before and after the intervention. For triangulation of data, semi-structured interviews and usability tests were carried out. Despite a few points for improvement, the results highlight multiple benefits for care recipients and professionals of using the SBV and com-robot integrated system in a residential care home.
      84Scopus© Citations 11