Changing Ideas Research Articles

Increasing joy in work in UK healthcare teams: a national quality improvement collaborative

In 2021, 38 healthcare teams across England and Wales took part in the national enjoying work quality improvement collaborative, which aimed to enhance staff wellbeing and create joy in work. Participating teams were supported to use quality improvement methodology and tools as part of a national learning network. At the end of the programme, 16 teams saw an improvement in at least one outcome measure, while 17 teams saw a sustained deterioration in at least one outcome measure. Aggregate data from all teams demonstrated improvements from baseline in all three outcome measures, with a 51% average improvement in the percentage of people who frequently enjoyed being at work, a 41% average improvement in the percentage of people experiencing no symptoms of burnout and a 42% average improvement in the percentage of people who were extremely likely to recommend their team as a place to work. As the first programme on this topic at a national scale, these findings provide ideas for change that can be adapted or replicated by clinical and non-clinical teams to improve their joy and wellbeing at work, and build their understanding of the barriers they may face and what is needed to overcome them. From the ideas tested and the learning from across the collaborative, a theory of change for enhancing staff wellbeing and joy in work has been created to inform future work in this area.

External Service Providers (ESP) Reach-Out Project: How Can Nurses Assist With Improving Patients’ Social, Economic, and Physical Environments?

This project aimed to improve Capital, Coast and Hutt Valley’s cardiology outpatient “nurses” confidence in connecting patients to community support services (Exercise, Food and Nutrition, Medications, Healthy Homes including Power and Gas, Mobility, Social Isolation and Transport) from 46% to 80% by October 2022. The plan-do-study-act (PDSA) cycle is a methodology for rapidly testing change. A baseline of the “nurses” confidence and identification of the types of services needed by patients was established. Follow-up focus group sessions were held with nurses at two hospitals, covering four geographical locations, within the district. The development of a driver diagram translated the high-level improvement goal and identified various causes to help organise the Change Ideas. Not all ideas could be undertaken in the 3-month timeframe. However, Change Idea One—“Help Directory”—was researched and created by the project manager, which is currently a 37-page resource, with seven categories of services, formatted by region (four) that includes links to service providers, referral forms, and printable handouts for patients. The resource was shared with the “nurses” and an incentivised quiz developed to encourage its review. A second anonymous survey was constructed, allowing for a PDSA cycle, to compare confidence levels after having access to the resource. Cardiology outpatient nurses’ level of confidence (quite confident to extremely confident) connecting patients to community support services increased from 46% to 100%. Since completion, the ESP Reach-Out Resource has proven useful to select nurses and, in turn, their patients. The next steps are to escalate to executives within the hospital to seek budget for the development of the resource, including a more environmentally friendly and dynamic resource that is preferably electronic. Once established, it will be promoted within Capital, Coast and Hutt Valley for internal users.

Learning first-year mathematics fully online: Were students prepared, how did they respond?

This paper reports on empirical results from a study that investigated first-year mathematics students’ preparedness for, and response to, online learning. With the appearance of COVID-19 in 2020, lecturers were forced to make sudden changes to the established face-to-face learning environments, and students were expected to adapt to these changes. The idea of a blended learning environment is not new, and students globally have demanded flexibility in mathematics learning environments for some time. However, the idea of a sudden change in environments, particularly to fully online, was new to most lecturers and students. Key aspects in an online environment are students’ ability to self-regulate their learning, and the availability and accessibility of technological resources. Quantitative data from the self-developed questionnaire were collected early in 2021, at a public university in South Africa, from a large sample over several modules. Results indicate students are partially prepared for learning fully online, with significant effect on performance.

GERMAN GOVERNMENT APPROACHES TO RUSSIAN ACTIVISTS IN GERMANY AFTER 2022

The purpose of the study is to determine the nature of the actions of the German government in relation to politically active Russian citizens staying in Germany in the context of the deterioration of Russian-German relations in 2022 and to consider the dynamics of the transformation of the approach of the German authorities to interaction with certain groups of the Russian-speaking population. Based on the analysis of public speeches by German politicians, official government and party documents, it was concluded that Berlin is moving towards the institutionalization of the political activities of Russian activists and promoting the formation of horizontal ties between political movements. In this context, special attention is paid to the work of «near-party» political funds as structures formally independent of the parties, indirectly contributing to the implementation of their political programs – the key features of their cooperation with representatives of the Russian-speaking community are highlighted. The conclusion is made about the actualization of human rights issues in the framework of the interaction of the government with representatives of Russian civil society and the use of the latter as a resource for influencing political processes in Russia. The fact of the work of the German authorities with Russian supporters of the ideas of separatism and changes in the constitutional order of the Russian Federation living in Germany is also emphasized. The conclusions are of particular importance in the context of countering external interference in internal affairs and adapting Russia’s national security policy to new challenges and threats.

Improving Delivery of Positive Pressure Ventilation During Neonatal Resuscitation: A Quality Improvement Study

Background Positive pressure ventilation (PPV) is one of the most crucial steps of the Neonatal Resuscitation Program (NRP) algorithm. We observed multiple deviations from NRP algorithm during PPV delivery in our unit for which we planned a quality improvement (QI) initiative. The aim of this study was to improve PPV score (total score 14) from existing 20% (~3) to at least 60% (~8) during neonatal resuscitation in delivery room and maternity OT over a period of 48 weeks. Methods The study was conducted in 3 phases over a period of 48 weeks. The baseline and the sustenance phase were of 12 weeks and the intervention phase consisting of 4 PDSA cycles was of 24 weeks duration. Several change ideas were tested and implemented during these PDSA cycles including training sessions for effective PPV delivery, ensuring adequate number of personnel attending delivery and equipment check, specification of delivery team at the start of a shift, and involvement of obstetrics colleagues for better communication. The objective scoring of PPV (a total composite score of 14 over 7 domains) was taken as the process measure, while the proportion of deliveries with PPV score >60% (~8) and need for alternate airway were the outcome measures. We used statistical process control (SPC) Xbar mean chart and P charts for analyzing the data. Results The median score during the baseline phase was 20% (3/14) which improved to 71% (10/14) during the sustenance phase. The percentage of deliveries having a score of at least 60% (8/14) also improved significantly from the baseline to the sustenance phase; there was, however, no change in the need for alternate airway. Conclusion This QI study successfully improved the PPV delivery practices. Similar studies involving multiple centers and including other steps of NRP algorithm should be undertaken for the overall betterment of neonatal care and outcomes. What Is Known NRP is an evidence-based approach for neonatal resuscitation; however, evidence suggests that the quality and sequence of events during neonatal resuscitation significantly deviate from the standard guidelines. What This Study Adds QI is an excellent tool to improve the adherence to PPV delivery during newborn resuscitation. Along with training and teaching of the care giving staff, the study identified important gaps in PPV delivery which were solved using simple and comprehensive measures.

"Head of the Class": equity discourses related to department head appointments at one Canadian medical school.

Equitable appointments of departmental leaders in medical schools have lagged behind other Equity, Diversity, and Inclusion (EDI) advancements. The purpose of this research was to 1) analyze how policy documents communicate changing ideas of EDI, employment equity, and departmental leadership; and 2) investigate department heads' (DH) perspectives on EDI policies and practices. We conducted a critical discourse analysis to examine underlying assumptions shaping EDI and departmental leadership in one Canadian medical school. We created and analyzed a textual archive of EDI documents (n = 17, 107 pages) and in-depth interviews with past (n = 6) and current (n = 12) DH (830 minutes; 177 pages). Documents framed EDI as: a legal requirement; an aspiration; and historical reparation. In interviews, participants framed EDI as: affirmative action; relationships; numerical representation; and relinquishing privilege. We noted inconsistent definitions of equity-deserving groups. Change is slowly happening, with emerging awareness of white privilege, allyship, co-conspiracy, and the minority tax. However, there is more urgent work to be done. This work requires an intersectional lens. Centering the voices, and taking cues from equity-deserving leaders and scholars will help ensure that EDI pathways, such as those used to cultivate department leaders, are more inclusive, effective, and aligned with intentions.

Is it time to abandon the theory of constituent power?

Abstract A group of scholars has shown that the theory of constituent power—which seeks to describe and justify the dismantling of the constitutional order and its replacement with a new constitution—is flawed. The analytical tools the theory deploys fail to explain how constitution-making processes unfold. Also, the theory has been subject to normative challenges that question its democratic nature. However, the theory remains a mainstream idea in many countries, and some academics have attempted to defend its democratic nature. I claim that those attempts have rendered the theory meaningless or failed to address all of its problems. I then raise two objections. First, the constituent power theory cannot be used to justify most—if any—constitution-making processes without an excessive idealization of the founding moment, but we are yet to understand the actual costs of that idealization. Second, redeemers of the theory need to decide whether constitution-making can operate under reasonably favorable electoral and democratic conditions or not. Ideal conditions are improbable when constitutional change is carried out in response to a crisis. In the unlikely case that these conditions can be met, using an idea of constitutional change as radical as the constituent power theory is not warranted from a normative perspective. I call this the dilemma of constituent power redemption.

Stakeholder views on the design of National Health Service perinatal mental health services: 360-degree survey.

At the start of a new community perinatal mental health service in Scotland we sought the opinions and aspirations of professional and lay stakeholders. A student elective project supported the creation of an anonymous 360-degree online survey of a variety of staff and people with lived experience of suffering from or managing perinatal mental health problems. The survey was designed and piloted with trainees and volunteer patients. A rich variety of opinions was gathered from the 60 responses, which came from a reasonably representative sample. Respondents provided specific answers to key questions and wrote free-text recommendations and concerns to inform service development. There is clear demand for the new expanded service, with strong support for provision of a mother and baby unit in the North of Scotland. The digital survey method could be adapted to generate future surveys to review satisfaction with service development and generate ideas for further change.

Safe to Sleep in Tennessee: A Statewide Quality Improvement Initiative.

Sleep-related deaths were the fourth leading cause of infant death in Tennessee between 2014 and 2018. In response, the Tennessee Initiative for Perinatal Quality Care developed a statewide quality improvement project, which focused on the demonstration and enforcement of a safe sleep environment in participating birthing hospitals to help families learn and practice the same at home. The project's aim was to improve the percent of infants audited for safe sleep practices (0-12 mo of age, cared for in participating newborn nurseries or neonatal intensive care units) that were compliant with the practices recommended by the 2016 American Academy of Pediatrics (AAP) Task Force on Sudden Infant Death Syndrome. Participating teams were required to develop and implement safe sleep policies in compliance with the AAP recommendations, provide safe sleep education to staff and families, and complete monthly safe sleep audits. A tool was provided to assess whether each audited infant was compliant with safe sleep recommendations and any reason(s) the infant was not compliant. Teams met virtually for monthly huddles and semiannual learning sessions to discuss the development and testing of change ideas. The project teams were able to improve the percent of infants audited that were compliant with safe sleep recommendations by 22% over the course of the project. Audits revealed the main reasons for noncompliance were additional objects in the crib (49%, 329/671), unsafe bedding (27%, 181/671), and head of bed elevation (24%, 164/671). This project demonstrates the positive impact that a statewide quality improvement initiative can have on identifying and addressing barriers, sharing resources and education, and monitoring local and statewide data, which led to increased compliance with safe sleep recommendations in the hospital. Safe sleep education and monitoring should be ongoing as new parents and staff always need to be educated on safe sleep principles. · In 2020, 25% of all infant deaths in Tennessee were due to an unsafe sleep environment.. · Sleep-related deaths in infants are frequently preventable.. · State quality improvement projects are effective in increasing safe sleep compliance.. · State perinatal quality collaboratives can partner with their State Department of Health, local hospitals, and providers, to increase awareness, educate parents, and model a safe sleep environment..

Poliziano Correcting Poliziano

Abstract The present article offers the first comprehensive examination of the handwritten corrections attested in copies of Angelo Poliziano’s most important scholarly work, the Miscellaneorum centuria prima (1489). Based on a collation of 32 copies, this study identifies the corrections made by Poliziano’s assistants in Antonio Miscomini’s Florentine printing house. The first part of the article furnishes an overview of the handwritten corrections and indicates their relevance to our knowledge of the work’s textual genesis. The contribution then moves to an in-depth discussion of some specific corrections that reflect, amongst other things, Poliziano’s changing ideas on Latin prosody in some of his Greek-to-Latin translations, as well as on his interpretation of classical texts.

Qur’anic Metaphors: Between the Historicity of Poetic Imagination and the Continuity of Context

Due to their contextual breadth and hermeneutic continuities, Qur’anic metaphors are held to be manifestations of Qur’anic iʿjāz that outshine the metaphors and imagery found in pre-Islamic poetry: they transcend temporal and spatial limits and are accessible to all languages and cultures. The historicity of metaphors and rhetorical images that characterise the Arabic poetic heritage is contextualised by their location within the temporal and spatial regions in which they were produced, the conceptual connections to which have been lost due to changing cultural beliefs, ideas, and contexts. In contrast, Qur’anic rhetoric has enduring continuity due to its observance of similarities in the construction of its metaphors, as well as the fact these are revealed within a religious, legislative text, whose contexts enjoy a rich continuity that encompasses meaning and connotations that accommodate the knowledge paradigms of different cultures.

Developing and delivering a hybrid Cardiac Rehabilitation Phase II exercise program during the COVID-19 pandemic: a quality improvement program

The COVID-19 pandemic resulted in the cessation of approximately 75% of cardiac rehabilitation (CR) programmes worldwide. In March 2020, CR phase II (CRP2) services were stopped in Qatar. Multiple studies...

Socio-economic Impacts of Water Project on the Community Livelihood in Peri-urban of Tanzania: Case study Gairo District – Morogoro Region

This study analyzed the socio-economic impacts of water projects on community livelihood in peri-urban Tanzania. It employed a cross-sectional research design, and a survey questionnaire was distributed to 353 households that were randomly selected by probability sampling procedures. Data were analysed using the logistic regression model. This study was guided by theory of Peri-Urban Turbulence (PUT) which is founded on the idea of changes in the balance and magnitude of natural and caused infrastructure and local and distant established arrangements during the transition, primarily in fast-growing urban areas of the Global South. The findings suggests the respondents’ year of schooling positively affect household access to water. Having one additional year of schooling may increase the chance to access to water facilities. Furthermore, the average household head’s monthly income was a significant explanatory variable at a one percent level of significance. Besides, non-farm activities were significantly associated to access to water. Nevertheless, the study identified the four major economic activities that the community engaged in as a result of water accessibility; male and female hair saloon salons, petty trading in village open auctions, vegetable gardening, and motorbike riding. Among of the four major economic activities performed, petty trading in the village open auction business is the most practiced. One can conclude that, the existence of water projects promotes socio- and economic development.

“Quality teaches you how to use water. It doesn’t provide a water pump”: a qualitative study of context and mechanisms of action in an Ethiopian quality improvement program

BackgroundQuality improvement collaboratives are a common approach to bridging the quality-of-care gap, but little is known about implementation in low-income settings. Implementers rarely consider mechanisms of change or the role of context, which may explain collaboratives’ varied impacts.MethodsTo understand mechanisms and contextual influences we conducted 55 in-depth interviews with staff from four health centres and two hospitals involved in quality improvement collaboratives in Ethiopia. We also generated control charts for selected indicators to explore any impacts of the collaboratives.ResultsThe cross facility learning sessions increased the prominence and focus on quality, allowed learning from experts and peers and were motivational through public recognition of success or a desire to emulate peers. Within facilities, new structures and processes were created. These were fragile and sometimes alienating to those outside the improvement team. The trusted and respected mentors were important for support, motivation and accountability. Where mentor visits were infrequent or mentors less skilled, team function was impacted. These mechanisms were more prominent, and quality improvement more functional, in facilities with strong leadership and pre-existing good teamwork; as staff had shared goals, an active approach to problems and were more willing and able to be flexible to implement change ideas. Quality improvement structures and processes were more likely to be internally driven and knowledge transferred to other staff in these facilities, which reduced the impact of staff turnover and increased buy-in. In facilities which lacked essential inputs, staff struggled to see how the collaborative could meaningfully improve quality and were less likely to have functioning quality improvement. The unexpected civil unrest in one region strongly disrupted the health system and the collaborative. These contextual issues were fluid, with multiple interactions and linkages.ConclusionsThe study confirms the need to carefully consider context in the implementation of quality improvement collaboratives. Facilities that implement quality improvement successfully may be those that already have characteristics that foster quality. Quality improvement may be alienating to those outside of the improvement team and implementers should not assume the organic spread or transfer of quality improvement knowledge.

Jack Quin. W. B. Yeats and the Language of Sculpture

W. B. Yeats and the Language of Sculpture considers the way sculptural aesthetics infiltrate Yeats’s poetry and critical writing. It seeks to move beyond what previous scholars have described as sculptural analogies in Yeats’s poems or qualities of sculpture that imbue the poetry: monumentality, solidity, and timelessness. By carefully tracing some significant overlaps between the work of sculptors and that of poets in the late nineteenth and early twentieth centuries, Jack Quin’s monograph draws on ‘competing ideas of sculpture as solid or fluid, durable or durational, abstract or figurative, autonomous or contingent’ (p. 6). In examining changing ideas of sculptural properties in poetry and art writing by Yeats, Pound, Eliot, and others, Quin makes clear the profound influences and interconnections of ‘inter-arts aesthetics’ at a time of revolutionary state formation in Ireland. The first and fifth chapters are the most cohesive and provide contextual bookends to Yeats’s poetic and political career. Pointing to sculptural references in art criticism and cultural writing from the 1890s onward, Quin seeks to expand earlier work that locates a ‘late sculptural turn’ in Yeats’s literary oeuvre. He convincingly argues that the art school training Yeats gained at the Dublin Metropolitan School of Art between May 1884 and July 1885, as well as a stint at the Royal Hibernian Academy, profoundly shaped the poet’s early ‘fascination with sculpture as a practice, a product, and resource for poetry’ (p. 19). Yeats tried out and first began writing about the allied goals of sculpture and poetry in conversations with his art school peers Oliver Sheppard and John Hughes, both of whom would go on to become celebrated Irish sculptors. The ‘language of sculpture’ appears in Yeats’s arguments for new national forms and symbols.

Contextual graffiti and collective action frames at the Chilean social outbreak in 2019

Abstract Protest graffiti as visual activism provides a democratic space for demonstrators to articulate their narratives. Nevertheless, the lack of leadership in the Chilean social outburst in 2019 becomes a challenge in outlining its impact. Thus, this article provides an empirical case of political graffiti and explains how graffiti had a constitutive role in the social movement and the immediate country’s political course after that. This paper proposes a transdisciplinary approach by combining the analysis of graffiti as contextual texts (Pennycook, 2007) with ‘collective action frames’ in studying political graffiti collected in a six-kilometre walk in Santiago, Chile. As a result, graffiti frameworks of injustice denounce the state and police violence; frameworks of agency tend to organise protesters’ ideas for change, such as a new constitution and the end of the current pension systems; and a strong sense of feminism conforms part of identity frames.

Time-variant destination lifecycle model and the coactive development process

ABSTRACT The central tenet of the tourism-area lifecycle (TALC) rests on the idea of change. This paper utilized latent-growth curve modelling (LGCM) to synthesize a time-variant lifecycle model that quantifies changes in TALC-based hotel development. We accommodated the model with cross-lagged analysis to draw causal inferences. Based on data collected from 197 economies from UNWTO, findings reveal that the onset and growth rate of hotel development are associated with growth trajectories of tourist arrivals and overnight stays, which are subsequently associated with the growth trajectory of travel expenditure. A reciprocal influence between hotel development and tourist arrivals is also evident, suggesting a coevolutionary process underpinning TALC. This study adds to the nascent concept of multiplicity tourism-area lifecycles to denote an intricate web of linkages among different lifecycle traits of a destination. It improvises the concept of coactive development and paves the way for destination coevolution to articulate evolutionary interactions between tourists and tourism operators through reciprocal changes.

Liturgical Renewal in Contemporary Orthodox Thought in Romania: A Preliminary Assessment

Abstract The Romanian Orthodox Patriarchate’s liturgical renewal movement has a spontaneous character, but without a well-defined agenda. This paper examines some of the reflections from renowned Romanian theologians about the liturgical renewal in the Orthodox Church and explores how they define the notion of liturgical reform, how they perceive the idea of change in worship, and what a liturgical renewal might look like. Moreover, it examines some concrete reforms that have already been put into practice, but without specific authorization from the Romanian Church hierarchy. The purpose of this approach is to find a starting point for an official synodal and academic debate on the possibility to implement a systematic liturgical reform at an institutional level.**

Transition in the ages at key reproductive events and its determinants in India: evidence from NFHS 1992-93 to 2019-21

IntroductionReproductive health events have changed fertility and family planning needs, depicting the changing life patterns of women and the population to which they belong. Understanding the pattern at which these events occur helps in understanding the fertility pattern, family formation and the idea about health essential needs for women. This paper attempts to see the variation in reproductive events (first cohabitation, first sex and first birth) over three decades and also to see potential contributing factors among the reproductive age group of women using secondary data from Data Source: All rounds of the National Family Health Survey (1992-93 to 2019–2021) have been utilized.Methods and ResultsCox Proportional Hazard Model illustrates that all regions have initiated their first birth later than women who belong to the east region similar pattern has been obtained for first cohabitation and first sex except for the central region. Multiple Classification Analysis (MCA) depicts the increasing pattern in the predicted mean age at first cohabitation, sex and birth for all demographic characteristics; the highest increment was found in SC women, Uneducated women and Muslim women. Kaplan Meier Curve demonstrates that women with no education, primary or secondary education are shifting towards higher educated women. Most importantly, the results of the multivariate decomposition analysis (MDA) revealed that education played the largest contribution among the compositional factors in the overall increase in mean ages at key reproductive events.ConclusionsThough reproductive health has long been essential in women’s lives, they are still very confined to specific domains. Over time the government has formulated several proper legislative measures relating to various domains of reproductive events. However, given that the large size and heterogeneity in social and cultural norms result in changing ideas and choices regarding the initiation of reproductive events, national policy formulation needs to be improved or amended.

Quran's Method of Changing Thoughts and Concepts Ibn-Abbas' Answer to the Kharijites' Thought Model


 
 
 
 ABSTRACT
 
 The Qur'anic approach to changing ideas and concepts wants a person to obtain self-conviction based on argument and evidence, in the context of a quiet and deep dialogue. For every question a person faces an answer that guides him to the straight path. The one who looks at the book of Allah finds this in many models and situations, between the Creator and the creature, and between the prophets and their people, but we dealt with a living model that we can benefit from in our contemporary reality, showing us how to respond to some extremist visions and concepts stemming from a superficial understanding of the Qur’anic text, through the responses of Ibn Abbas May Allah be pleased with them both on the thought of the Kharijites. The title was: (The Qur’anic Approach to Change Ideas and Concepts, Ibn Abbas’s Responses to the Thought of the Kharijites as a Model)