We outline three areas where AR is implicitly political, and three areas where it is ethically problematic. We recommend that researchers and participants recognize, discuss and negotiate these problematic areas before starting their work.
This project was initiated to improve the quality of identification and response practices of Emergency Department (ED) nursing staff dealing with possible victims of domestic violence (DV). Nursing staff were trained to identify three key actions in the pathway for domestic violence presentations in the ED. A survey of ED staff was taken pre-training to determine a base-line measure of self-reported knowledge regarding domestic violence policies and practices. The survey was re-administered 1 month and 6 months post-training. A file audit was also undertaken prior to and following the training. Results show the training improved the nurses' confidence, practice and skills in the identification of, and response to, domestic violence, particularly in relation to children. ED nurses are well placed to identify and respond to domestic violence as the ED provides a gateway into health services for women and their children. This paper reports on a participatory action research project which aimed to improve quality and practice around DV for ED staff. The dissemination of the results in this paper are considered to be essential to health services due to dearth of information and research about best practice initiatives for responding to and recognizing domestic violence in the ED.
BackgroundThere is a tension in many health-care services between the expertise and efficiency that comes with centralising services and the ease of access for patients. Neonatal care is further complicated by the organisation of care into networks where different hospitals offer different levels of care and where capacity across, or between, networks may be used when local capacity is exhausted.ObjectivesTo develop a computer model that could mimic the performance of a neonatal network and predict the effect of altering network configuration on neonatal unit workloads, ability to meet nurse staffing guidelines, and distance from the parents’ home location to the point of care. The aim is to provide a model to assist in planning of capacity, location and type of neonatal services.DesignDescriptive analysis of a current network, economic analysis and discrete event simulation. During the course of the project, two meetings with parents were held to allow parent input.SettingThe Peninsula neonatal network (Devon and Cornwall) with additional work extending to the Western network.Main outcome measuresAbility to meet nurse staffing guidelines, cost of service provision, number and distance of transfers, average travel distances for parents, and numbers of parents with an infant over 50 km from home.Data sourcesAnonymised neonatal data for 7629 infants admitted into a neonatal unit between January 2011 and June 2013 were accessed from Badger patient care records. Nurse staffing data were obtained from a daily ring-around audit. Further background data were accessed from NHS England general practitioner (GP) Practice Profiles, Hospital Episode Statistics, Office for National Statistics and NHS Connecting for Health. Access to patient care records was approved by the Research Ethics Committee and the local Caldicott Guardian at the point of access to the data.ResultsWhen the model was tested against a period of data not used for building the model, the model was able to predict the occupancy of each hospital and care level with good precision (R2 > 0.85 for all comparisons). The average distance from the parents’ home location (GP location used as a surrogate) was predicted to within 2 km. The number of transfers was predicted to within 2%. The model was used to forecast the effect of centralisation. Centralisation led to reduced nurse requirements but was accompanied by a significant increase in parent travel distances. Costs of nursing depend on how much of the time nursing guidelines are to be met, rising from £4500 per infant to meet guidelines 80% of the time, to £5500 per infant to meet guidelines 95% of the time. Using network capacity, rather than local spare capacity, to meet local peaks in workloads can reduce the number of nurses required, but the number of transfers and the travel distance for parents start to rise significantly above ≈ 70% network capacity utilisation.ConclusionsWe have developed a model that predicts performance of a neonatal network from the perspectives of both the service provider and the parents of infants in care.Future workApplication of the model at a national level.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
MSF discusses its response to tackling mental health problems in Aceh, Indonesia, and explores some of the main concerns in responding effectively to mental health problems in an emergency setting.
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