Alison Edgley

The social and political thought of Noam Chomsky

Introduction. Chomsky: critic or theorist? 1. Political theory 2. The good society 3. State capitalism 4. State theory 5. Nationalism 6. Politics and the media Conclusion. Chomsky: militant optimist

Investigating the safety of medication administration in adult critical care settings

BACKGROUND Medication errors are recognized causes of patient morbidity and mortality in hospital settings, and can occur at any stage of the medication management process. Medication administration errors are reported to occur more frequently in critical care settings, and can be associated with severe consequences. However, patient safety research tends to focus on accident causations rather than organizational factors which enhance patient safety and health care resilience to unsafe practice. The Organizational Safety Space Model was developed for high-risk industries to investigate factors that influence organizational safety. Its application in health care settings may offer a unique approach to understand organizational safety in the health care context, particularly in investigating the safety of medication administration in adult critical care settings. PURPOSE This literature review explores the development and use of the Organizational Safety Space Model in the industrial context, and considers its application in investigating the safety of medication administration in adult critical care settings. SEARCH STRATEGIES (INCLUSION AND EXCLUSION CRITERIA): CINAHL, Medline, British Nursing Index (BNI) and PsychInfo databases were searched for peer-reviewed papers, published in English, from 1970 to 2011 with relevance to organizational safety and medication administration in critical care, using the key words: organization, safety, nurse, critical care and medication administration. Archaeological searching, including grey literature and governmental documents, was also carried out. From the identified 766 articles, 51 studies were considered relevant. CONCLUSION The Organizational Safety Space Model offers a productive, conceptual system framework to critically analyse the wider organizational issues, which may influence the safety of medication administration and organizational resilience to accidents. However, the model needs to be evaluated for its application in health care settings in general and critical care in particular. Nurses would offer a valuable insight in explaining how the Organizational Safety Space Model can be used to analyse the organizational contributions towards medication administration in adult critical care settings.

The attitudes of neonatal nurses towards extremely preterm infants.

AIM The paper is a report of a study of the attitudes of neonatal nurses towards extremely preterm infants. BACKGROUND Alongside advancing survival at extremely preterm gestational ages, ethical debates concerning the provision of invasive care have proliferated in light of the high morbidity. Despite nurses being the healthcare professionals who work closest with the infant and their family, their potential influence is usually ignored when determining how parents come to decisions about future care for their extremely premature infant. METHODS A Q methodology was employed to explore the attitudes of neonatal nurses towards caring for extremely preterm infants. Data were collected between 2007 and 2008 and analysed using PQMethod and Card Content Analysis. RESULTS Thirty-six nurses from six neonatal units in the United Kingdom participated. Although there was consensus around the professional role of the nurse, when faced with the complexities of neonatal nursing three distinguishing factors emerged: the importance of parental choice in decision-making, the belief that technology should be used to assess response to treatment, and the belief that healthcare professionals should undertake difficult decisions. CONCLUSION Neonatal nurses report unexpected difficulties in upholding their professionally defined role through highly complex and ever varied decision-making processes. Recognition of individual attitudes to the care of extremely preterm infants and the role of the family in the face of difficult decisions should facilitate more open communication between the nurse and the parents and improve the experience of both the nurse and the family during these emotional situations.

Interprofessional collaboration: Sure start, uncertain futures

We report on a study that examines the structural constraints to successful interprofessional collaboration, rather than organizational (Hart & Fletcher, 1999) or management (Bateman, Bailey, & McLellan, 2003) processes. These constraints are derived from differences in service ethos between professionals. This study involved investigating the perceptions of mainstream professionals about their experience of working with Sure Start professionals in a Nottinghamshire Sure Start programme. Sure Start is a United Kingdom (UK) Government initiative designed to tackle child poverty and social exclusion. It does this by targeting extra provision for families with preschool children in specified geographical areas identified as deprived. It is anticipated that Sure Start will facilitate interprofessional collaboration with other agencies working with pre-school children through recognition of a shared agenda. Unlike statutory services, Sure Start provision is demand-led, in that services are identified and monitored in partnership with the community. Implicitly it is hoped that Sure Start will bring about innovation in service provision and challenge accepted ways of doing things. Although interprofessional collaboration is fundamental to Sure Start, there are examples that it has not been achieved in other settings, e.g., Bateman et al., 2003; Freeman, Miller, & Ross 2000; McLaughlin, 2004. It is recognized that effective collaboration requires recognition of shared interests and agenda (Lawson, 2004), although Morrow, Malin, & Jennings (2005) and Bateman et al. (2003) argue that the experience of interprofessional collaboration can generate considerable uncertainty, in particular about where individual or collective responsibility lies. A series of semi-structured interviews with 18 local professionals were conducted to collect data on the impact of Sure Start on their work, and the extent to which they worked with a shared agenda. The professional groups included Social Services, Nursery Nurses, Special Need Educationalists, Midwifery, Librarians, Clinical Psychologists, Health Visitors, Speech Therapists, and Children’s Resource Workers. All interviewees gave informed consent. Overwhelmingly, local professionals viewed Sure Start positively. They saw it as a welcome adjunct to statutory services in areas with a high proportion of families with complex needs. It was seen as a programme with a high level of financial support attached to it, compared to statutory services that were seen as under-resourced. Examples of how Sure Start was thought to add to existing services were found in each professional grouping. For Social Services, Clinical Psychologists and Speech Therapists, Journal of Interprofessional Care, August 2006; 20(4): 433 – 435

Critical realist review: exploring the real, beyond the empirical

This article defines the ‘critical realist review’, a literature-based methodological approach to critical analysis of health care studies (or any discipline charged with social interventions) that is robust, insightful and essential for the complexities of twenty-first century evidence-based health and social care. We argue that this approach, underpinned by a critical realist philosophy and methodology, will facilitate students and researchers to employ relevant theoretical insights from a range of disciplines that have necessary contributions to make to our understanding of health and social care practice and provision. We explore the limitations of randomised controlled trials (RCTs) and the systematic review for informing evidence-based health and social care. The article also offers some suggestions on method, although, as we argue, the approach deliberately eschews a ‘cookbook’ approach. A glossary of terms is provided in the Appendix.

‘The air still wasn’t good … everywhere I went I was surrounded’: Lay perceptions of air quality and health

Abstract The study, designed as a pilot, aimed to explore lay perceptions of air quality from participants who were selected to represent three different social categories: age; health status; and geographical location. We compared responses from younger with older participants who held memories of about air quality prior to the Clean Air Act (1956)1. We also explored possible differences in perception due to health status by including some participants who identified themselves as having asthma. Finally, we compared possible differences in perception between two economically and geographically distinct areas of Greater Nottingham in England. Semi-structured interviews were carried out with 22 participants recruited through schools, church groups and residential homes. Our findings suggest that no air (apart from the seaside) is perceived as automatically safe and therefore healthy. We found that perceptions of ‘good’ air seem to vary with age and health whereas experiences of air quality are associated with socio-economic status. Perceptions of air are shown to be suffused with historical significance, as well as embodying projections embedded from within the local environment and material context.

The perspectives of people who use mental health services engaging with arts and cultural activities

Purpose – The purpose of this paper is to present a study of arts engagement for mental health service users in Denmark. Design/methodology/approach – The study was completed at Hans Knudsen Instituttet, Denmark. It involved analysis of emerging themes from semi-structured interviews with six participants who had participated in a structured visit to the National Gallery (Statens Museum for Kunst) in Denmark. Findings – Multiple benefits for people who use mental health services engaging in arts activities are reported. Arts activities are described as a central component of everyday life; a way of life and a significant factor in getting through the day. Barriers are identified in the interdisciplinary working between the museum educator and participants. Social implications – This study identifies that the participants benefited from taking part in the arts/cultural activity. Findings also suggest that if museums are offering activities to people who use mental health services they should equip staff wi...

Being human: Transdisciplinarity in nursing

Nursing as an academic discipline typically draws on a wide range of other disciplines. There is debate about whether this is a sound basis for the discipline, or whether nursing needs to develop a distinctive body of knowledge. The concept of transdisciplinarity, though little discussed in nursing, is of considerable value in understanding nursing as an academic discipline, and provides a possible resolution to the debate above. In order to get a better understanding of what transdisciplinarity might mean in a nursing context, we conducted a qualitative interview-based study of faculty in a UK school of nursing. The debate about nursing’s status as a discipline was reproduced by the interviewees. Despite these differences, a degree of consensus emerged about the concept of nursing as a transdisciplinary discipline. Transdisciplinarity in nursing offers an overarching approach that is applicable to a broader range of disciplines. This approach offers the possibility of moving beyond some of the major debates in nursing as an academic discipline. This broad and pragmatic approach grounds nursing knowledge in nursing practice, which means that as a transdisciplinary discipline it does not overstate its claims to knowledge, but instead explicitly acknowledges tacit and ‘craftsmanship’-type forms of knowledge.

Method, methodology and politics

In this chapter I seek to explore how and in what ways Chomsky’s voluminous works on American foreign policy provide practical examples of a critical realist research approach in social science. The purpose for doing this is two-fold. First, Chomsky’s political analysis has been systematically sidelined and dismissed within the academy as being of extremist nature, and therefore worthy only of being treated as polemic rather than works with social scientific pedigree. Chomsky himself does not go out of his way to lay claim to a consistent and consistently applied political philosophy, confining his thoughts on the subject to a number of interviews published by Otero (1988) and Barsamian (1992). However, these rarely appear alongside his analysis of political events, which may go some way to explaining the apparent ease with which he has been so summarily dismissed. Second, as Carter and New (2004) observe, critical realist approaches to social science are a comparatively recent development, and much writing about realism and social science has been directed towards philosophical concerns rather than demonstrating what critical realist research might look like. Situating Chomsky’s political writing within a critical realist framework, therefore, makes it possible to gain a greater appreciation of the intellectual depth of Chomsky’s extensive body of social science work, as well as examine how we might ‘do’ critical realist social science.

MRSA care in the community: why patient education matters

In primary care, patients are prescribed decolonisation treatment to eradicate meticillin-resistant Staphylococcus aureus (MRSA). This complex treatment process requires the patient to apply a topical antimicrobial treatment as well as adhering to rigorous cleaning regimens to ensure the environment is effectively managed. A pilot study was carried out that involved developing an enhanced, nurse-delivered education tool, training a community nurse to use it, then testing its use with a patient. Three interviews were carried out: one with a patient who received usual care, one with a patient who received the enhanced education and one with the community nurse who delivered the enhanced education tool. The patient who received the enhanced education reported better knowledge and understanding of the application of treatment than the patient who did not. These results are interesting and point the way forward for larger research studies to build on the learning from this limited exploration and develop more effective management of MRSA in primary care.