No description available.

No description available.

Patient monitoring is a complex task, particularly during childbirth, where assessment of the baby's condition is inferred from the continuous electronic recording of the baby's heart rate pattern and maternal uterine contractions (CTG). Computerised decision support has long been advocated, as difficulties in the interpretation of the CTG have led to failure to intervene and unnecessary intervention. The problem is large, for obstetric litigation now accounts for 80% of the UK National Health Service litigation bill. The Plymouth Perinatal Research Group has developed a computerised decision support system for patient monitoring during childbirth and the UK Medical Research Council has agreed to fund a multicentre randomised trial. The work of this thesis was an investigation of the labour ward care system to inform the human-centred design of the decision support system for patient monitoring in childbirth, prior to the clinical trial. It was recognised that many decision support systems have failed to gain clinical acceptance, as conventional design models were inadequate. Lack of attention to the organisational context of the care system and the process of the direct patient care led to the design of inflexible 'expert' systems, which constrained working practices. A pilot ethnographic study of an existing decision support system, used for the analysis of umbilical cord blood samples, was undertaken to clarify the research approach required for the main study. It was found that barriers to effective use within the wider work system included inadequate implementation and lack of organisational support. A case study approach produced a more comprehensive account of the context and process of the use of the computer system. The main study combined qualitative with quantitative techniques to investigate the system of care in childbirth, both outside and within the delivery room, to provide a unique, holistic perspective. The organisational context of the labour ward was investigated by direct observation of clinicians over the course of their work for 220 hours. Observations were documented and transcribed to computer text files. Patterns of actions and events were coded using ATLAS(ti) data analysis software. The codes were counted and tabulated to model the main features of this labour ward care system, which was expressed in the form of a rich picture diagram. These findings were confirmed by a limited study of five other UK labour wards. The core qualitative categories, derived from the observation data, found a complex and problematic relationship between communication, decision making and accountability. Decisions were often made outside the delivery room and were subject to misinterpretation and bias. The organisational hierarchy made it difficult for junior staff to question clinical management decisions. A system of tacit practice, external demands upon clinicians and transient allocation of junior midwives to labour ward militated against teamwork. This increased the vulnerability of the care of mothers to error. The process of direct patient care, within the individual delivery room, of 20 mothers in labour was captured in a novel audio-video observation study. The 111 hours of first stage labour and 12 hours of second stage labour were recorded and digitised to computer files. Recurrent actions and patterns of behaviour were coded both quantitatively and qualitatively using ATLAS(ti) data analysis software. Midwives left the room on average every 15 minutes to be absent for 27% of the first stage of labour. Record keeping occurred on average every 10 minutes and accounted for 19% of midwives' time. Midwives had little time to talk with mothers and only sat down at the bedside for 15% of the time. Psychosocial support was not given priority. Parents were generally excluded from communication between clinicians yet 108 clinicians took part in the care of the 20 women. Pressures from medicolegal directives and task-orientated imperatives overshadowed meaningful interaction with parents and caused spurious care priorities. This work has revealed the need for a critical reassessment of the type of support that is required for monitoring situations in all areas of medicine. A range of functions, such as shared information displays and models, have been suggested to augment roles and relationships between clinicians and parents to support patient-centred care. The present work has revealed that a combination of computer-based technology and changes to working practice can support the parents, their individual carers and their various roles. In this way the system of care can be more aligned to the objective of a safe and emotionally satisfying birth experience for parents and staff. A further programme of research is required to follow-up the existing studies, develop these new forms of interaction between technology and clinicians, and evaluate their effectiveness. The research methods employed in the present work will provide a more comprehensive evaluation of the decision support system in the forthcoming multicentre trial. The methods of investigation have also been shown to be of relevance to patient safety research, service delivery and training.

Abstract Respect is a concept crucial to nursing but one which has not been explored adequately. Respect may mean different things to different people, depending on age or culture. It has been determined that disrespect is closely linked with abusive behaviour. Lack of respect may be seen not only as a form of abuse, but also as the cause from which all other forms of abuse develop. In order to truly understand the development of abuse in long-term care, we must have an understanding of the key concepts that contribute to it. Respect is one of these concepts. The goal of this practicum was to develop a strategy that would promote the development of policies and the reinforcement of behaviours that reflect “respect”. The key words used to define respect and specific comments related to respect were identified by residents, family members and staff of a long-term care facility. The meaning of respect from the perspective of the resident, family members and staff of Deer Lodge Centre was explored through a questionnaire. Results of the questionnaire were tabulated and shared through presentations to all participant groups. Recommendations on policy change based on the results were identified and shared. / October 2006

Abstract Respect is a concept crucial to nursing but one which has not been explored adequately. Respect may mean different things to different people, depending on age or culture. It has been determined that disrespect is closely linked with abusive behaviour. Lack of respect may be seen not only as a form of abuse, but also as the cause from which all other forms of abuse develop. In order to truly understand the development of abuse in long-term care, we must have an understanding of the key concepts that contribute to it. Respect is one of these concepts. The goal of this practicum was to develop a strategy that would promote the development of policies and the reinforcement of behaviours that reflect “respect”. The key words used to define respect and specific comments related to respect were identified by residents, family members and staff of a long-term care facility. The meaning of respect from the perspective of the resident, family members and staff of Deer Lodge Centre was explored through a questionnaire. Results of the questionnaire were tabulated and shared through presentations to all participant groups. Recommendations on policy change based on the results were identified and shared.

No description available.

Abstract Respect is a concept crucial to nursing but one which has not been explored adequately. Respect may mean different things to different people, depending on age or culture. It has been determined that disrespect is closely linked with abusive behaviour. Lack of respect may be seen not only as a form of abuse, but also as the cause from which all other forms of abuse develop. In order to truly understand the development of abuse in long-term care, we must have an understanding of the key concepts that contribute to it. Respect is one of these concepts. The goal of this practicum was to develop a strategy that would promote the development of policies and the reinforcement of behaviours that reflect “respect”. The key words used to define respect and specific comments related to respect were identified by residents, family members and staff of a long-term care facility. The meaning of respect from the perspective of the resident, family members and staff of Deer Lodge Centre was explored through a questionnaire. Results of the questionnaire were tabulated and shared through presentations to all participant groups. Recommendations on policy change based on the results were identified and shared.

Automobile dashboards are evolving into intelligent largely screen-based computer interfaces. Recent evidence suggests unnatural aspects of some secondary systems (including infotainment systems). Naturalness of interaction is a minority discipline not yet applied to the automobile; while automotive interface research is a mainly quantitative discipline that has not yet applied a naturalness approach. To advance the field, a measurement scale based on rigorous qualitative exploration of natural-feeling interaction with secondary controls was required. Study 1 used ethnographic interview with Contextual Inquiry inside 12 ordinary drivers' cars, to investigate natural-feeling aspects of past, present and future driver-car interactions. Thematic analysis suggested a framework of ten characteristics. Half concerned control and physicality; half concerned perceived socio-intelligent behaviours of the car. Study 2 involved intensive exploratory workshops with ten drivers comprising Think Aloud, artefact modelling and focus groups, to explore natural-feeling interaction with secondary controls in different ways. The resulting thematic framework comprised 11 characteristics in four categories: familiarity/control, physical connection, low visual/cognitive demand, and humanlike intelligence and communication. Study 3 comprised two ethnographic participant observations. Eight drivers were observed interacting with their controls during long road journeys. Twenty-two drivers were observed interacting verbally with futuristic 'intelligent' secondary systems while driving on public roads. Design guidelines relating to physicality, usability, automation, and humanlike communication were formulated. Study 4 converted all the qualitative findings into a questionnaire comprising 46 bipolar five-point scales. Eighty-one drivers used it to rate one control in their cars. Correlation and factor analyses revealed three underlying factors and 14 items suitable for the first industrially applicable measurement scale for driver-car naturalness. These items concern perceived helpfulness, politeness, competence, predictability, control, ease, mental demands, intuitiveness, 'realness', instantaneousness, communication, logical location, mapping and 'affordance'. Initial testing found acceptable validity. The conclusion recommends further data collection, expanded validity testing, and potential applications to self-driving cars.

China's open-door policy to the West has created a great demand for Chinese speakers of English. But the existing formal language institutions are far from enough to meet such a great need. Consequently, large numbers of people will have to learn English by themselves, self-directed to different extents, depending on the facilities available to them. There are also large numbers of potential selfdirected learners who do not yet know where to start and how to tackle the task. Self-directed learning, either of English or of other subjects, has always played an important role in China as an alternative form of education. There have been many successful self-directed learners who have made remarkable contributions to the country in different fields. However, self-directed learning of English on a large scale is still a relatively new phenomenon. Some proper guidance and the learners' awareness of the likely difficult areas will make the learning both more effective and more efficient. This study will attempt to examine the gradual change from teacher-centred teaching and learning to learner-centred teaching and learning and the development of self-directed learning. Then the study will try to provide information on some of the self-directed learning programmes of interest to Chinese learners. Afterwards, the study will examine the basic needs and characteristics of Chinese self-directed learners. The greater part of this study will be devoted to the likely areas of difficulty of self-directed learners in China and some possible ways to solve them. The last part will deal with study skills in self-directed learning and use of resources available.

After decades of implementing a teacher-centred curriculum in Botswana, a learner-centred curriculum was introduced into the education system in 1998. The course of this, teachers had to make a paradigm shift that radically affected the manner in which they were expected to assess learners. I utilised a qualitative case study as the basis for this research which sets out to investigate how the release of teachers influence their assessment practices. The following three findings emerged from this study: Firstly, although the curriculum recommended a learner-centred approach, teachers have been inadequately trained and prepared for learner-centred assessment. Secondly, despite their inadequate training, it seems that teachers had developed confidence in their ability to carry out these new assessment practices. Thirdly, despite this radical policy change, many teachers are still utilizing teacher-centred assessment practices. Copyright / Dissertation (MEd)--University of Pretoria, 2010. / Humanities Education / unrestricted