Nurses’ Experiences of Using the Liverpool Care Pathway Plan in Hospitalized Patients with Heart Failure in the End-of-Life Stage: A Qualitative Content Analysis

Background: The introduction of care pathway plans for end-of-life cares such as the Liverpool Care Pathway (LCP) reveals a unique possibility for inter professional collaboration. Knowledge of symptom relief and how to meet the patients’ needs at the last stage of the palliative phase are essential for the nurses’ approach and care actions, but the documentation of such implementations is still rare and sometimes criticized. Aim: To explore and describe nurses’ experiences of using the LCP plan with patients hospitalized with heart failure at the end-of-life stage. An explorative design was applied, using qualitative content analysis of 20 interviews with nurses practicing the LCP plan in two district hospitals in Norway. Results: The nurses found the LCP plan as quality assurance for treatment and care in patients with heart failure in the last hours and days of life. The use of the LCP plan implied: 1) individualized adjustment, 2) symptom relief and 3) a holistic approach. Conclusion: Nurses experienced that using the LCP plan as a comprehensive action plan contributed in the decision making process and improved inter professional communication. Using the LCP plan should be seen as a tool to practice individualized and holistic nursing to patients at the end-of-life and their families, as well as a purposeful relief of symptoms associated with heart failure.

我国省域公共卫生服务与经济耦合协调及提升路径

目的探究我国各省域公共卫生服务与经济协调发展的现状及其影响因素,为地区实现高效、均衡发展提供建议。方法运用熵权法、耦合协调度、模糊集定性比较分析等方法评价我国各省域公共卫生服务与经济发展协调关系,借助fsQCA 3.0软件探究二者协调关系的影响因素与驱动路径。结果2020年我国各省域公共卫生服务与经济发展耦合协调度属于良好协调等级以上的地区较少,大部分地区处于濒临失调状态。条件变量的必要性检验一致性均≤0.9,单一条件变量对地方公共卫生服务与经济协调发展驱动能力有限,存在多条件变量构成复杂驱动路径。组态分析共得出8种组态结果,共归纳为3种组态路径,其中组态1与组态2属于地方高经济水平主导型驱动路径,组态3、组态4、组态5和组态8属于公共卫生服务与地方经济融合型驱动路径,组态6与组态7属于公共卫生服务主导型驱动路径。结论我国公共卫生服务与经济发展协调性整体不高,每万人口公共卫生机构数、每万人口公共卫生技术人员数以及人均国内生产总值等是影响地方公共卫生服务与经济协调发展的核心因素,不同条件变量组合可促进地方公共卫生服务与经济协调发展。低协调地区可根据本地区实际情况,参考高协调路径,实现公共卫生服务与经济协调发展。

Innovative Business Model Canvas for Foreign Entrepreneurship in Food Service Industry

This study aims to utilize the business model canvas to explore foreign entrepreneurial strategies in Taiwan.The contribution of business model canvas is expected to assist entrepreneurs to build up more effective decisions and judgements as well as increase the probability of success.This study is divided into three major phases.First,the research framework and interview outline were established on the basis of relevant literatures review.Next,this paper used semi-structured interviews for six foreign entrepreneurs.Through the content analysis of interview results,a new 10 building blocks of business model canvas in the food service industry for foreign entrepreneurship was thereafter developed.The results of the analysis would enable foreign entrepreneurs who would like to establish business in Taiwan to review as potential strategies,as well as a further reference to attract foreigners who would like to start new business ventures in Taiwan.

Grey Qualitative Modeling and Control Method for Subjective Uncertain Systems

A new approach to model and control an unknown system using subjective uncertain rules is proposed. This method is established by combining the grey system theory and the qualitative simulation method. The proposed approach mainly contains three steps. In the first step, subjective uncertain rules are accumulated gradually during cognizing the system; the mapping relations between the system inputs and outputs are built and represented using the grey qualitative matrix in the second step; in the third step,the generalized whitening function is defined to realize the transformation between qualitative and quantitative information. Besides the theoretical results, two sets of simulations based on a water level control system are conducted comparatively to demonstrate the effectiveness of the proposed method. The water level expectation is set to be constant in the first set, while it changes in the second set. The simulation results show that the proposed method tracks the water level expectation well. By combining the proposed method with proportional-integral-derivative(PID) or fuzzy logic controller(FLC), it can be concluded that the system can reach the stable state more quickly and the overshoot can also be reduced compared to using PID or FLC alone.

Barriers and facilitators to mexican-american participation in clinical trials: physician and patient focus group perspectives

Racial/ethnic minority populations are under- represented in clinical trials and Hispanic participation rates are particularly low. This study assessed barriers and facilitators to clinical trials participation by Medicaid eligible Mexican- Americans and their serving physicians. Qualitative data from two focus groups conducted among Mexican-American Medicaid eligible patients and four physician focus groups were analyzed. Mexican-American patients have a basic understanding of clinical trials. While most are open to participating in clinical research, not speaking English, time, and transportation were identified as barriers. Physicians believe that desperation and financial need are the primary patient motivators for participation. Barriers to physician recruitment and referral include: lack of information about clinical trials, concern that study participation may not be in the patient’s best interest, and lack of staffing and time to conduct trials. Ample opportunities exist to engage providers and patients in future efforts to increase Mexican-American patient recruitment into clinical trials.

A Spider in a Broken Web:Nurses’Views on Discharge Planning for Older Patients after Hip Fracture Surgery Who Live in their Own Homes in Rural Areas

Introduction: The in-hospital rehabilitation of patients who have undergone surgery for hip fracture requires a team-based effort, in which nurses play an all-embracing role throughout the patients’ hospital stays. Although discharge planning has been widely studied, little is known about discharge planning from hospitals to homes in rural settings. Aim: To describe nurses’ views on discharge planning for older patients after hip fracture surgery who live in their own homes in rural areas. Methods: A qualitative method was used. Four focus group interviews were conducted with 18 nurses who work at an orthopaedic clinic. The interview texts were analysed with qualitative content analysis. Findings: Nurses expressed that patients needed support from healthcare personnel as well as relatives in order to prepare for life at home. They also expressed that patients were not supported in all aspects of discharge planning because they faced difficulties in having their voices heard. Nurses described that many of those aspects were beyond their own control, which had left them with little to non-ability to influence discharge planning. Findings additionally indicate that discharge planning seems not affected by occurring in rural settings. Conclusions: Although discharge planning is intended to meet the unique wishes and needs of each patient given the realities of existing resources, nurses’ responsibilities in discharge planning are unclear. This study shows an organisation in which healthcare personnel continue to make decisions for patients. Significance for nurses to perform a discharge planning that support patients’ participation seems to be a communication based on shared understanding.

The Impact of Chronic Pelvic Pain in Women

Chronic pelvic pain (CPP) is a prevalent condition with a significant impact on the personal, social, professional and marital life of women. It is a complex condition that may have no specific causal diagnosis or may be associated with multiple diagnoses, frequently involving treatment failure. The definition of health care strategies fundamentally depends on the way women live with this condition. Thus, the objective of the present study is to learn how women with CPP experience their diagnosis and the meaning they attribute to it. A qualitative study was conducted by interviewing a focus group of 11 women. The content of the interviews was recorded and fully transcribed, and the speeches were interpreted by Bardin’s content analysis. The topics most frequently dealt with in the interview were diagnosis, beginning of pain, worsening and improving factors, marital and interpersonal relationships, interference with daily activities, association with emotional aspects, and perspectives for the future. It could be perceived how much these women need to be better heard and how much the association between psychic and physical questions must be visualized by the professionals who provide care for them. The approach used by professionals from different areas, when properly structured, can minimize the problem of the division of a sick person into separate parts. Psychological care is very important, especially in relation to the discovery of more effective strategies for living with pain.

The Consumption of a ‘Self-development’ Product or Service: Take the Dance Club at Copenhagen Business School as an Example

This research takes the Dance Club at Copenhagen Business School as an example to attempt to explain consumption behaviors of a‘self-development’product,using qualitative methods.With 3 different qualitative methods,the researcher analyzes the consumption behavior in culture perspective,consumer rituals,identity and consumption/selves in transition.The dancing classes have many virtues to contribute to the identity construction of female college students and the research gives the a clear understanding of female college students’consumer behaviors in dancing classes.Upon understanding,marketers will have a clearer insight into the current market and trend.

Post-evaluation of a water pollution control plan： methodology and case study

China has developed more than 20 water pollution control plans for river basins （RBWPs） since 1996. However, the implementation has generally lagged. This paper proposes a three-step, post-evaluation methodology to analyze the implementation result of a RBWP and its influential factors. First, a multi-attribute evaluation method based on an index system is established to score the enforcement results of a RBWP. Indicators measure how well a RBWP has achieved its objectives, which include water quality compliance, pollution load control, project construction, financial inputs, and related management requirements. Second, an interpretive structural model is used to detect the significant factors that affect RBWP implementation. This model can effectively analyze the cause-effect chain and hierarchical relationship among variables. Five groups of factors were identified, namely, plan preparation, water resource endowment, policy, institution, and management. Both qualitative and quantitative methods are employed in the third step to evaluate the extent to which these factors have influenced the execution result of a RBWP, including pre-post contrast, scenario analysis, and correlation analysis. This research then post-evaluated the implementation of the Huai River Basin water pollution control plans （H-RBWPs） over a period of 10 years as a case study. Results showed that the implementation of the H-RBWPs was unsatisfactory during 2001–2005, although it improved during 2006–2010. The poor execution of these plans was partially caused by the underestimation of regional economic development in combination with ineffective industrial structure adjustment policies. Therefore, this case study demonstrates the feasibility and flexibility of the proposed post-evaluation methodology.

Exact Traveling Wave Solutions and Bifurcations in a Nonlinear Elastic Rod Equation

The exact parametric representations of the traveling wave solutions for a nonlinear elastic rod equation are considered. By using the method of planar dynamical systems, in different parameter regions, the phase portraits of the corresponding traveling wave system are given. Exact explicit kink wave solutions, periodic wave solutions and some unbounded wave solutions are obtained.

The fight against lymphatic filariasis:perceptions of community drug distributors during mass drug administration in coastal Kenya

Background:Lymphatic filariasis(LF)#a neglected tropical disease(NTD)and leading cause of global disability,is endemic in 32 countries in Africa with almost 350 million people requiring regular drug administration,and only 16 countries achieving target coverage.Community Drug Distributors(CDDs)are critical for the success of NTD programs,and the distribution of medicines during mass drug administration(MDA)in Africa;however they could also be a weak link.The primary aim of this study is to explore and describe perceptions of CDDs during MDA for LF in Mvita sub-county in Mombasa county and Kaloleni sub-county in Kilifi county,Kenya;and provide recommendations for the effective engagement of communities and CDDs in low-resource settings.Methods:In September 2018,we conducted six focus group discussions with community members in each sub-county,three with men aged 18-30,31-50,and 51 years and above and three with women stratified into the same age groups.In each sub-county,we also conducted semi-struaured interviews with nine community health extension workers(CHEWs),the national LF focal point,the county NTD focal points,and seven community leaders.Content analysis of the data was conducted,involving a process of reading,coding,and displaying data in order to develop a codebook.Results:We found that several barriers and facilitators impact the engagement between CDDs and community members during MDA.These barriers include poor communication and trust between CDDs and communities;community distrust of the federal government;low community knowledge and perceived risk of LF,poor timing of MDA,fragmented supervision of CDDs during MDA;and CDD bias when distributing medicines.We also found that CDD motivation was a critical factor in their ability to successfully meet MDA targets.It was acknowledged that directly observed treatment and adequate health education were often not executed by CDDs.The involvement of community leaders as informal supervisors of CDDs and community members improves MDA.Conclusions:In order to achieve global targets around the elimination of LF,CDDs and communities must be effectively engaged by improving planning and implementation of MDA.

Exact and Approximate Values of the Period for a “Truly Nonlinear” Oscillator: x + x + x^(1/3)= 0

We investigate the mathematical properties of a“truly nonlinear”oscillator differential equation.In particular,using phase-space methods,it is shown that all solutions are periodic and the fixed-point is a nonlinear center.We calculate both exact and approximate analytical expressions for the period,where the exact solution is given in terms of elliptic functions and the method of harmonic balance is used to calculate the approximate formula.

Investigating Equity-Minded Migrant Education Policies in Shanghai From Migrant Parents’ Perspectives

Purpose:This article aims to explore how suburban public schools in Shanghai of China have implemented the top-down equity-minded migrant policies of free compulsory education and equal access to public education.Design/Approach/Methods:This qualitative study focuses on public schools in the suburb of Shanghai,one of the top migrant-receiving metropolitan cities in China.Using personal network,referral,snowballing,and“guerrilla interviewing,”the researcher recruited 13 migrant parents that represent 11 cities of 9 provinces and collected interview data between early January and late June of 2015.Data sources include 10 face-to-face interviews,3 telephone interviews,6 follow-up interviews,and supplementary policy documents.Findings:It finds that local public schools have fully implemented free compulsory education,but have not supported equal access,revealing an inconsistent and arbitrary policy enactment pattern.Although all the interviewees have worked and lived in Shanghai for an average of 10 years,only those that afford a real property,receive exceptions,or have personal connections can have children enrolled in public schools.Further,parents’perceptions of the policy implementation vary across cases with most of them not demonstrating an awareness of education equality.Originality/Value:This study synthesizes stories shared by migrant parents and reports an interesting policy implementation pattern.It contributes to the field of migrant education study and confirms that top-down equity-minded reform is likely to encounter challenges.

Primary care clinicians’ strategies to overcome financial barriers to specialty health care for uninsured patients

Objective:This study describes strategies used by federally qualified health centers(FQHCs)to assist medically uninsured patients in obtaining specialty health care services.Methods:Qualitative methods were used to study strategies for obtaining specialty health care for uninsured patients.Data were gathered from 10 primary care clinicians at three FQHC clinics by means of 10 semistructured interviews,23 brief interviews,and 45 h of direct observations.We captured additional data by studying cases of referred uninsured patients.Results:The following six strategies were identified:(1)quid pro quo-a specialist accept-ing the clinic’s medically uninsured patients was rewarded with referrals of the clinic’s insured patients;(2)over referral-clinicians referred insured patients whose needs could have been met at the FQHC;(3)brief hospitalization-when a specialist could not be obtained,high-risk patients were briefly hospitalized;(4)case building-diagnostic tests were conducted at the FQHC to justify a referral;(5)direct communication-communication between clinicians and specialists was neces-sary when requesting a referral;(6)specialty clinics-in return for conducting a specialty clinic at the FQHC,the specialist received all referrals of insured patients.Conclusion:Uninsured FQHC patients encountered difficulties accessing specialty health care,and in response,clinicians developed a range of innovative strategies.