The diffusion and dissemination of a suicide prevention training programme across three sites in the North West of EnglandGreen, Gillian Diana January 2010 (has links)
Aim: The purpose of this study was to explore the processes involved in the dissemination of a suicide prevention training programme (STORM) and, to add context to these processes in terms of its Workability, its ability to become Normalized (sustained) into practice. In addition, this study was interested in the part policy played in the dissemination of suicide prevention training. Background: The National Health Service needs to build capacity and capability to deliver high quality equitable care. Learning and professional development are key to this endeavour and yet there is a lack of apparent support within healthcare organizations to facilitate this. Programme evaluation is also needed to ensure that the training delivered is of good quality, applicable to practice and is sustainable. Whilst dissemination studies tell us that certain processes are important to the successful adoption of innovations, what is less clear is how these innovations are then sustained and routinized into practice. Method: Facilitators within three study sites were trained by the researcher to deliver the STORM programme. Participants directly involved in the dissemination of the STORM programme, or with policy implementation, were recruited to a multiple case study. Semistructured telephone interviews were conducted over a 12-month penoo. Findings: A culture of training was found that understood the processes needed to support a training programme. Suicide prevention policy was found to influence suicide prevention training to some degree. The Normalization Process Theory was found to have practical utility when applied to the work of training. Reflexive evaluation informed decisions to continue, adapt or cease the work of training. The work was fluid and dynamic with the ability to project itself into future work; it was normalized into practice. Conclusions: A culture of training can be identified that supports training. The Normalization Process Theory can identify the processes involved that help normalize (sustain) training into practice, and it can provide an evaluative tool. However, if organizations are to benefit from this research they must integrate sustainability and programme evaluation into their systems as continuing processes and not as outcomes. Further research is needed to explore how well organizations can benefit from this work.
Family caregiving : telling stories about the journey between becoming a carer and placing an elderly relative into a care homeGregory, Sheila Ann January 2009 (has links)
The demographics of a rapidly ageing population and the shift towards community care have placed greater reliance on families to meet the care needs of elderly relatives at home. Supporting carers is vital for carers, those they care for and is cost effective because of the potential burden on public services. Using narrative analysis, ten caregivers were invited to tell their stories about placing an elderly relative into residential care. What would they choose to say about how, when and why they had reached the decision not to carry on caring? Their narratives are represented poetically, using their words and phrases from the interview transcripts. The poems capture the wholeness of their stories in condensed form and magnify how they had reached their individual 'breaking points'. My intention was to share their evocative accounts in an alternative, powerful and emotionally engaging way. I problematise my own identity as a caregiver, discussing how the methodology embraces my subjectivity; inter-subjectivity, the co-construction of data; the performative nature of narrative interviewing, representational and interpretational practices. There was a temporal structure to their stories; a series of transitions in their caregiving and the rhythm of the poetry mirrored the rhythmical counting down of their survival time as carers. A relationship was found between the passage of time; changes in the identities of the caregivers/cared for; the availability and quality of formal support and the decision to place their relatives into care. By attending in more empathic ways to the detail of their stories, the research contributes to an embodied understanding of the caregiver experience. As well as supporting comprehensive research undertaken by Carers UK, the findings also enabled a detailed examination of the extent to which the latest national strategy for carers (DOH 2008) addresses the gaps in support identified by the caregivers.
This thesis is an analysis of interactional practices through which the work of a mental health information line is carried out, utilising discursive psychology and conversation analysis in the analysis of a corpus of calls to MIND Infoline. The aim of MIND Infoline is to provide information on mental illness, and the services in England and Wales which support those affected by mental illness. In negotiating access to the data, the call-takers of the line were encouraged to suggest topics for analysis such that the work of this thesis would be of benefit to them. Three of these topics are the foci of the analytic chapters; how callers are asked what it is they want from the line, how courses of action are proffered to callers, and how crying callers are responded to. In the analysis of these topics, institutional restrictions are discussed as consequential for the actions engaged in by the call-takers, who are encouraged to refrain from giving advice, 'chatting' with callers, and providing emotional support. In the analytic chapters, empirically grounded observations are made about four recurrent practices engaged in by the call-takers; • The use of interrogatives which constrain callers' responses and make relevant a request for information .• The use of modal verbs and' If / Then Constructions' in the proffering of courses of action to callers • The use of ' Yes / No' interrogatives in the proffering of courses of action to callers • Empathetic formulations which are deployed following occurrences of caller crying The reporting of the findings back to the helpline staff and the application of these findings for their work are also discussed. The thesis as a whole contributes to the literature on the analysis of institutional interactions, particularly to the literature on the management of restricted practices in institutional settings.
Hakaml, Bader A.
Many countries around the world are currently trying to find new solutions to the growing problems related to household waste management. Landfilling is no longer being accepted as a sustainable method for waste disposal. Instead, the view has shifted to consider waste as a resource rather than rubbish. Simultaneously, all the environmental concerns related to landfilling have meant that an immediate response to the growing waste crisis needs to be urgently considered. In Europe, the EU has responded by launching a set of Directives which aim to limit the adverse impacts of land filling and increase diversion rates through recycling and responsible treatment of waste. These directives bound all EU countries and threaten significant fines against those which do not comply with the regulations. Performance wise, the UK is behind most of its other fellow EU countries, sending more than 75% of its municipal waste to landfill. As part of the UK, England is also burying most of its waste in landfill despite the concern over the availability of sufficient space for landfill in the future. Current statistics suggests that England's performance has improved since the implementation ofthe Waste Strategy for England and Wales in 2000. However, there continue to be growing fears that it might fail to achieve the 2013 and 2020 Landfill Directive targets. This study sought to evaluate the current household waste management system in the East of England which is one of the nine English regions. The evaluation aimed to identify the strengths and weaknesses of the system prior to recommending ways for further improvements. Three methods were applied in the evaluation; a statistical analysis, semi-structured face-to-face interviews with waste managers from local authorities and private waste contractors and a SWOT analysis. The outcomes indicated that several problems existed with the current household waste management system in the region. Some require immediate attention and need to be addressed before the system can be enhanced and future targets achieved. The study was also able to offer suggestions for alternative strategies which can be applied to improve the current system. Furthermore, suggestions made in this research can potentially be considered to improve the system in other regions provided that they share similar waste management, demographic and socio-economic characteristics with the East of England.
The evolution of customs valuation in the developing world : From Deregulation to Developing State CapapcityMikuriya, Kunio January 2009 (has links)
An accurate assessment of the value of imported goods by customs is an essential precondition of an accurate determination of an importer's tax liability. However, customs au thori ties in many developing coun trie s exp erie nce considera ble difficulty in discharging this function. Poor compliance of importers, weak administrative capacity in customs, and pervasive corruption are often identified as the major problems. Beginning in the 1980's neo-liberal approaches to customs modernization encouraged states to adopt "market solutions" to customs problems. As a result, core customs functions including revenue determination were contracted out to private inspection companies with the support of international financial institutions. These companies proposed to examine documents and carry out physical inspection of consignments (in exporting countries) and to provide information on quantity, quality, value, and tariff classification of the goods for the benefit of the importing jurisdiction before the actual shipment of the goods. Today some 30 governments have adopted this partial privatization, called Preshipment Inspection (PSI), to address the weakness of customs. Based on a realization that unregulated privatization did not bring about the expected efficiency enhancements, states have recently moved to re-regulate these private companies. This movement has been observed in assessment discussions held at the WTO and in other forums, as well as in improved contracts with PSI firms. States and international financial institutions have also become more focused on directly enhancing the capacity of customs authorities. The inspection industry has responded to this trend. It has begun to offer services that support the business model of customs, rather than replace customs functions. Case studies of four countries that have adopted the PSI service show that benefits have been mixed in terms of both their ability to enhance revenue and improve the integrity of customs administration. There is little evidence of transfer of skills and technology to customs authorities. In fact, the use of the private sector has often resulted in a long-term dependence on expensive PSI contracts. Only governments that made serious efforts in direct customs reform have demonstrated an ability to improve customs operations and exit from the PSI program.
Lever, John B.
This thesis examines the emergence, use and future potential of community based partnership working in the field of community safety. Based on a case study of partnership working in Bristol in South West England, it examines the ongoing process of institutional change through which partnership working and community safety have become central features ofUK public policy. Drawing attention to the ways in which community groups and organizatio~ are being drawn . into the policy-making process in order to find solutions to the problems excluded communities face, it argues that community safety has become a central feature of New Labour's wider attempt to reconfigure the state apparatus in its own terms. Highlighting the ways in which managerial pressures emerging from the Government's wider governance agenda compel mainstream agencies to change the ways they operate in order to improve the provision of public services, ~he thesis highlights the emergence of an approach to community safety that prioritizes short-term reductions in crime and disorder over and above long-term community concerns. This approach is seen to be problematical for a nurriber of reasons and it is argued that partnerships'will only be successful in the long-term if they direct resources towards initiatives that allow mainstream agencies and community groups to articulate their experiences and expectations of each other in an open and inclusive way. Building on the governmentality account ,of developments in governance it makes use of insights from the work of Norbert Elias and argues that figurational sociology provides compelling insights into the nature of contemporary change processes. The thesis leans strongly towards theory and places partnership working in a long term socio-historical perspective that illustrates the extent to which, how, and why mainstream resources are being realigned through partnership working. Although it draws attention to the current limitations of community based partnership working under New Labour, the thesis concludes that the community governance model is laying the institutional foundations on which a more civilized approach to community safety may one day stand.
The keys to citizenship : a case study of Local Authority responses to the needs of children in careErskine, S. C. January 2004 (has links)
This Case Study examines the educational problems facing young people in the care system in Scotland during a period of significant legislative change. The role of literacy as a determining factor and key to better quality of life for children in the care of Local Authorities has long been acknowledged. The aim of the study was to examine how young people experience the policies put in place to support them. Two major areas are identified and addressed; firstly, the absence of a theoretical and conceptual framework sufficiently robust to permit analysis of how the needs of children are identified and met by Social Work Services and Education. The resulting framework allows the systems of Social Work and Education and their interrelationship to be interrogated together. Secondly, the need to define quality and effectiveness within services for children is addressed. Criteria of effectiveness that reflect principles and intention of public policy in Social Work, Education and Legislation are drawn up and their critical points of effectiveness established. These reflect significant changes contained in the Children (Scotland) Act 1995. Key elements of both Education and Social Work systems are analysed and key inter-relationships mapped to create a General Model of Provision. Data was collected from young people leaving the care system, young people currently in school, parents, carers, Social Work and Education staff and Senior Managers in 93 interviews. The study, of mixed design, explores how young people experience support for their learning in school and in different care settings in three Local Authorities. The findings indicate that young people view literacy as an important key to a better future. They remain reasonably optimistic about the promise of Further Education. Of concern, however, is their relationship to society. These young people experienced an overly powerful system which tended to undermine their sense of individual agency rather than facilitate their attempts to establish themselves independently in the community. Reasons for this were primarily withdrawal of support at critical junctures compounded by lack of financial and social support which resulted in threat to their security.
The introduction of clinical governance requires that community nurses participate in the development of corporate accountability for clinical performance, accounting for normality as well as exceptional events in practice. The ability to deal with change has become a necessary part of the community nursing role, a factor complicated by the geographical spread and stratification of community nursing teams. If the development of clinical governance is to avoid domination by medical or managerial perspectives, each staff group is required to represent their standpoint. This is a study of the enacted narrative in the community context, to understand how nurses narrate and justify their involvement in these reforms and, to examine the development of a negotiated consensus by community nursing teams. A research approach within the social constructionist tradition informed by Burke’s (1969) dramatist pentad was used to explore and interpret the respondents’ accounts. Narratives of clinical governance were obtained from unstructured interviews with twenty staff, including district nurses and managers in two NHS trusts. The study findings suggested the continuing penetration of nursing practice by management systems, and associated hybridisation of nursing and management roles. Nursing governance is enacted through clinical audit and standard setting systems, building on the history of nursing involvement in these initiatives to develop a nursing consensus on the governance of nursing practice. The majority of nurses are presented as disengaged from these events, with the resultant nursing governance systems underpinned by an apparent rather than actual consensus. The uncertainty of the community nursing knowledge base in the face of clinical governance is illustrated, with practitioners reliant on rationalities drawn from managerial and evidence based logics. It is argued that the marginalisation of the nursing perspective by nursing governance systems, may result in a failure of the profession to develop the dialectical skills and articulacy required to present the nursing perspective in this and future developments. Difficulties arising from the way in which clinical governance is being developed are identified. The findings suggest the requirement of a revised approach to the management of nurses, enabling the explicit inclusion of the nursing majority in future policy implementation.
Shared decision-making : an evidence-based approach for supporting children, parents and practitioners to manage chronic conditionsSutcliffe, Katy January 2010 (has links)
No description available.
This thesis explores the strategies of ignorance and uncertainty employed by UK regulators, practitioners and policymakers during the controversy over whether selective serotonin reuptake inhibitor (SSRI) antidepressants such as Prozac contribute to suicidal and homicidal reactions in some users. Empirically, the thesis is based on archival research, textual analysis, and interviews with UK policymakers and clinicians involved with efforts to determine the safety of SSRIs. By analyzing these materials with methodological and conceptual tools from the fields of science studies and the sociology of reason and objectivity, the thesis demonstrates the following four findings. First, drawing on the case of SSRIs, I demonstrate that many policymakers within the UK's National Health Service are frustrated with their inability to access clinical trial data necessary for developing treatment guidelines. Second, I argue that problems surrounding access to clinical trial data illustrate weaknesses within evidence-based medicine, a model of medicine that has become dominant in the UK and internationally over the past three decades. Third, I argue that when practitioners and policymakers wish to criticize the socio-political factors that make it difficult to access clinical trial data, their dissent must be limited to the universe of numbers, a phenomena which I term the "moral authority of objectivity" in medicine. Fourth, drawing on interviews with expert advisors to the MHRA, I argue that, in the case of SSRIs, regulators employed a strategic use of ignorance in order to absolve themselves of liability in not disclosing the knowledge of adverse effects when they first learned of them. This final finding has theoretical implications for recent studies of uncertainty and ignorance. I suggest that the SSRI controversy illuminates the regulatory value of inconsistent, uncertain and contradictory facts. The usefulness of uncertainty lies in its performative nature: uncertainty creates a demand for solutions to the ambiguity which it perpetuates, often consolidating the authority of those who have advanced a position of uncertainty to begin with.
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